Hyperplasia of mammary glands, not inflammatory or tumorous, is a proliferative disease, which is included in TCM, in the category of Rupi (nodules of breast) and Ruzhongjiehe (nodules in breast). Some type of it will develop into cancer. Most of its subjects are women of 30-45, 5-15% and even 30% of whom will be3 ill with it.

Etiology and Pathogenesis

1. Anger impairs and depresses the liver. Qi stagnation is due to the depressed liver, and blood stasis is due to qi stagnation.

2. Stagnation of qi and blood tends to occur in the breast, for it is on the route of Stomach Channel of Bright-Yang with plenty of qi and blood.

3. Transverse flow of the liver qi or anxiety impairs the spleen, the impaired spleen fails to perform its function in transportation, and phlegm-dampness is thus produced.

Stagnation of the liver qi, blood stasis and accumulation of phlegm get together to form lumps, causing this disease.

Stagnation of the liver qi can result in this disease alone or lead to this disease by disturbing the Penetraring and controlling Channels.

Clinical Manifestations

The following three types are established according to different pathologic manifestations.

1.Syndrome of Mammary Pain

Usually intermittent dull. stabbing or vague pain as the main symptom which is induced of ten before menstruation, aggravated by anger and relived or wiped away when menstruation or happiness comes; the pain worsened by the clothes worn orbed-clothes used and sometimes referring to the armpit, shoulder or upper limbs; examination through which no evident masses are found but hypertrophic mammary tissue or granular nodules with mild tenderness may be palpable; often-seen emotional depression and irritability.

2.Hyperplasia of Lobules of Mammary Glands

Onset usually in both the mammae but occasionally limited in one; pain of mammary glands with masses as the main symptom which is severe usually before menstruation, aggravated often by anger and relieved or stopped after menstruation with the masses remarkably reduced in size; the pain manifested in the same way as syndrome of mammary pain; the masses in different sizes and shapes, tough, indistinctly-bordered and not cementing with the muscular layers; discharge from nipple in a small number of cases; hypomenorrhea in most cases, and sexual hypoesthesia. in part of cases.

3. Cystic Hyperplasia of Breast

Masses of mammary glands as the main symptom which is accompanied by mild mammary pain and manifested as one or more differently-sized round tough movable indistinctly-bordered and not obviously painful cysts, general distending pain in the breast, the masses more painful before menstruation but softened and shriveled with the pain reduced after menstruation comes, brown or bloody fluid discharged out of the nipple in some cases, and symptoms due to emotional disorders, Because this disease may develop into cancer, examination with pathological section should be made to identify the diagnosis if cancer is suspected.

Differential Diagnosis

1. Adenoscarcoma of Breast

Usually seen in women of 20-25; one or more masses in the breast which are round or egg-shaped, distinctly-bordered, sooth, though, movable and developing slowly; and no general symptoms.

2. Mammary Cancer

Usually seen in women of 40-60 just before or after climacteric; masses in the breast which are as hard as stone, rough, movable in the early stage and fixed in the advanced stage; skin dimpling, retreated nipple, enlarged and hard axillary lymph nodes which become cauliflower-like or rock-like ulcers after festering, and bloody fluid wit awful smell discharged from the ulcers. In the early stage pathological section is needed to make the diagnosis.

Type and Treatment

Good effects will be obtained if TCM is relied on in treating this disease. Remarkable effects without side ones come from correct differentiation, and proper administration, and long taking, of Chinese drugs.

1. Internal Treatment

(1) Syndrome due to depression of the liver qi, blood stasis and accumulation of phlegm.

Main Symptoms: Evident tough masses enlarged or reduced with the change of emotion, irritability, choking sensation in the chest, distending or stabbing pain in the breast, white tongue coating, and taut slippery pulse.

Therapeutic Method: Soothing the liver, promoting the flow of the liver-Qi, activating blood circulation to remove blood stasis, resolving phlegm and dispersing masses.

Prescription: Rukuaixiao Tang (Decoction for Resolving Masses in the Breast).

Ingredients:

Gualou  Fructus Trichosanthis

Xiakucao Spica Prunellae

Shengmuli Concha Ostreae

Kunbu Thallus Laminariae seu Echloniae

Haizao Sargassum

Danshen Radix Salviae Miltiorrhizae

Chaihu Radix Bupleuri

Tiandong Radix Asparagi

Sanleng Rhizoma Spargnii

Ezhu Rhizoma Curcuae

Juye Folium Citri Reticulatae

Juhe Semen Citri Reticulatae

Banxia Rhizoma Pinelliae

Administration: Decocted in water twice for the decoction, which is taken warm in the morning and evening, 1 dose daily. 1 course of treatment consists of 12 days.

Modification: In case of irritability and fullness in the chest, the herbs added are.

Shanzhizi Fructus Gardeniae

Qingpi Pericarpium Citri Reticulatae Viride

Xiangfu Rhizoma Cyperi

In case of harder masses, the herb added is

Shanjiazhu Squama Manitis Preparata

In case of severe pain, the herb added is

Yanhusuo Rhizoma Corydalis

(2) Syndrome due to disorder of Penetrating and Controlling Channels resulting from stagnation f the liver Qi.

Main Symptoms: Softer mass with indistinct border, soreness of the waist, irregular menstruation, scanty and pale menstruation, distending pain of the breast before menstruation, pale red tongue with white coating, and taut thready or deep thready pulse.

Therapeutic Method: Soothing the liver and promoting the flow of the liver qi, regulating Penetrating and Controlling Channels, resolving phlegm and masses.

Prescription: Modified Rukuaixiao Tang.

Ingredients:

Gualou Fructus Trichosanthis

Xiakucao Spica Prunellae

Shengmuli Concha Ostreae

Kunbu Thallus Laminariae seu Echloniae

Haizao Sargassum

Yinyanghuo Herba Epimedii

Shudi Radix Rehmanniae Preparata

Xuduan Radix Dipsaci

Danshen Radix Salviae Miltiorrhizae

Xianmao Rhizoma Curculiginis

Lujiaoshuang Cornu Cervi Degelatinatum

Chaihu Radix Bupleuri

Tiandong Radix Asparagi

Juye Folium Citri Reticulatae

Banxia Rhizoma Pinelliae

Administration: Decocted in water twice for the decoction, which is taken warm in the morning and evening 1 dose daily.

2. External Treatment

For a few localized masses, Yanghe Jiening Gao or Huiyang Yulong Gao is applied externally. The following is the introduction to Huiyang Yulong Gao.

Ingredients:

Caowu Radix Aconiti Kusnezoffii

Ganjiang Rhizoma Zingiberis

Chishao Radix Paeoniae Rubra

Baizhi Radix Angelicae Dahuricae

Nanxing Rhizoma Arisaematis

Rougui Cotex Cinnamomi

Administration: Ground into fine powder and made into a paste, which is applied externally.

Prevention

1. Live a joyful life and treat irregular menstruation.

2. Try to live a natural life such as marrying not too late, giving birth after marriage, doing breast feeding after giving birth and living a normal sexual life.

3. Take measure for birth control and avoid artificial abortion. The breast is distended during pregnancy. Sudden pause of pregnancy will make mammary glands fail to be supported by hormone. However, this sudden restoration of mammary glands is often incomplete, and masses and pain in mammary glands are easy to lead to.

4. In case of prolonged hard tough masses in the breast, biopsy with pathological section is needed to make sure whether cancer has been developed or not.