Gynecomastia and Male Breast Cancer
Not only women's breasts develop; in some men the breast tissue also enlarges. But male breast enlargement is not a normal physiological phenomenon—it is a disease, called gynecomastia or male breast hypertrophy.
Gynecomastia is classified as primary or secondary. Primary gynecomastia is mostly due to physiological hormonal changes, i.e., imbalance of sex hormones (androgens/estrogens) in the body. Secondary gynecomastia arises from other stimulating factors—certain diseases, drugs or narcotics—that cause sex-hormone imbalance, eventually developing into gynecomastia.
Most gynecomastia is benign. It usually presents in middle-aged and older men as a flat, round mass or swelling beneath the areola, clinically as unilateral or bilateral palpable breast tissue, disc-shaped nodules or diffuse enlargement. Sometimes the nipple and areola also enlarge; a few patients even show lactation. The affected area may be dull, uncomfortable or tender. A small number of cases progress to male breast cancer, though male breast cancer is relatively rare.
Gynecomastia and male breast cancer are already recorded in ancient TCM texts. Gynecomastia generally falls under "ru jie" or "ru li"; male breast cancer is "nan zi ru yan." In addition, the rotting and dropping away of the breast in late-stage breast cancer had a specific ancient disease name, "ru tuo" or "tuo nang," which occurred in both men and women. The renowned external medicine specialist Ma Peizhi recorded it.
The Ming-dynasty external medicine master Chen Shigong wrote in his Waike Zheng Zong (Orthodox External Medicine) about male breast boils: "Male breast boils differ slightly from women's: in women they injure the liver and stomach; in men, the liver and kidneys. When raging anger and excessive bedroom activity cause liver deficiency and blood dryness, kidney deficiency and fineness of essence, the blood vessels cannot ascend and the liver sinews lose nourishment, resulting in binding swelling and pain. Treat with Ba Zhen Tang plus Shan Zhi (Gardeniae Fructus) and Mu Dan Pi (Moutan Cortex). For dry mouth and thirst, use modified Ba Wei Wan. For those with constitutionally deficient kidney qi, use Shen Qi Wan. For those that have ulcerated and discharged pus, use Shi Quan Da Bu Tang."
Here Chen Shigong not only explains the cause of gynecomastia but also proposes treatment strategies. From a modern medical perspective, what TCM calls "raging anger and excessive bedroom activity" is in fact the result of sex-hormone imbalance. Chen divided this condition into several patterns, each treated with a corresponding prescription. The most common is Ba Zhen Tang plus the heat-clearing, fire-draining Zhi Zi and Mu Dan Pi, tonifying qi and blood while clearing heat and draining fire.
Whether Chen Shigong's breast-boil patients actually improved, we cannot know. The contemporary veteran TCM physician Zhu Yongxian has treated some cases of gynecomastia and published case records of four patients. From those records, his main strategy is to soothe the liver and move qi, nourish and tonify the liver and kidney, and soften hard masses. He commonly uses modified Xiao Yao San, with herbs such as Chai Hu, Bai Shao, Zhi Xiang Fu, Yu Jin, Dan Shen, Lu Jiao Shuang (deer antler cream), He Shou Wu (Polygoni Multiflori Radix), Yin Yang Huo (Epimedii Herba), Bei Mu, Sheng Mu Li, Dang Gui and Ba Yue Zha (Akebiae Fructus). This is basically consistent with the approach we use for female and male breast cancer.
Some adolescents today also have gynecomastia, possibly related to the current diet and food safety. People today eat too much meat, and meat is high in estrogen, which can cause breast development in some teenagers. The treatment principles for adolescent gynecomastia are the same as for middle-aged and elderly men; both can follow Dr. Zhu Yongxian's approach.
Although male breast cancer is very rare, I have seen two cases. TCM alone has a very low success rate against male breast cancer. Breast cancer was called ru yan in antiquity. The Ming external medicine master Chen Shigong said: "Of those who contract this [ru yan], a hundred in a hundred die. If recognized early, one may try Qing Gan Jie Yu Tang or Yi Qi Yang Rong Tang; if the patient adds mental quiet, freedom from worry, and takes the medicine with regimen care, a few years may be eked out." This shows Chen already understood that breast cancer has a poor prognosis and treatment can only prolong life, not cure.
Chen Shigong's case records include a male breast cancer patient in his fifties: widowed, with a worthless son, so that melancholy injured his liver, and left-sided breast cancer developed. Chen treated him for only about a month before the patient died. This case faithfully records the course and outcome of a great external-medicine master treating male breast cancer. Chen was the representative of the Orthodox school, one of the three great schools of TCM external medicine. It is clear that ancient TCM treatment of male breast cancer was not effective.
Male breast cancer requires integrated Chinese and Western medicine. Patients found early can be cured by surgery. Mid- and late-stage patients, with timed surgery, radiotherapy, chemotherapy, endocrine therapy plus Chinese medicine, can also achieve good results.