Pattern Differentiation and Treatment of Breast Hyperplasia in TCM

Breast hyperplasia refers to benign hyperplasia of the interstitium of the female breast and is one of the common gynecological diseases. It occurs most often between the ages of 25 and 40, though it is also seen after menopause. Its cause is mostly related to ovarian dysfunction. The main presentation is multiple nodules of varying size in one or both breasts; the nodules feel firm and thick, or cystic, with borders clear or unclear, and good mobility. They often enlarge before menstruation and shrink afterward. Patients report breast distending pain, especially during menstruation, which subsides or lessens after menstruation.

Simple breast hyperplasia is seen most often in young and middle-aged women, usually around age 30. Cystic hyperplasia occurs most often around age 40, though it occasionally appears in young women and is also seen occasionally in men over middle age. Cystic breast hyperplasia can be extremely similar to breast fibroadenoma, intraductal papilloma, and breast cancer, and cystic hyperplasia is prone to malignant transformation. Cystic breast hyperplasia therefore requires regular follow-up, and when necessary a pathological examination should be performed to establish the diagnosis, so as to avoid misdiagnosis, missed diagnosis, and delay of the best treatment window.

Women with a family history of gynecological tumors should, when breast hyperplasia appears, arrange regular follow-up and periodically check breast-cancer-related tumor markers such as CA125 and CA153. Obese women who develop breast hyperplasia should take it seriously, as they are at risk of progression to breast cancer. In many parts of China, early breast-cancer screening programs have now begun; women over 30 with a history of breast hyperplasia should include such screening in their routine physical examinations.

TCM has certain advantages in diagnosing and treating breast hyperplasia, which TCM classifies as an external medicine (waike) disease. TCM generally holds that breast hyperplasia is related to the patient's emotions and family environment. Women who are irritable and prone to anger, or prone to depression, and who have tense family relationships, commonly develop this condition.

Breast palpation can detect the nodules. If, during inquiry, the patient reports that the size fluctuations and pain of the nodules are related to menstruation, the diagnosis of breast hyperplasia can generally be made. Breast hyperplasia is often accompanied by menstrual irregularity or dysmenorrhea. Some patients have a bitter taste in the mouth and dry throat, chest oppression with abundant phlegm, or a sensation of a foreign body in the throat; the pulse is often wiry (xian) or wiry-slippery (xian-hua). Such patients usually belong to the liver-qi stagnation pattern and are treated with Xiaoyao Wan combined with Erchen Tang and Xiaojin Wan.

Some patients present with the typical symptoms of aversion to cold with cold limbs, clear and long urination, stools either formed or unformed, low libido, long-standing coldness in the upper back, and a deep, slow or deep, moderate pulse. Such patients are mostly yang-deficient; their breast hyperplasia falls under TCM's yin ju (yin abscess), and is treated mainly with Yanghe Tang and Xihuang Wan.

Breast hyperplasia in menopausal women often manifests as liver qi transforming into fire. Such patients are often thin, with afternoon tidal fever and night sweats, low spirits, vexation and insomnia, frequent dreaming and dizziness, irritability, bitter mouth and dry throat, irregular menstrual cycles, and distending pain in the breast lumps with a burning sensation; the tongue is red at the edges with little coating or a thin yellow coating, and the pulse is fine, wiry, and rapid. Modified Danzhi Xiaoyao San is appropriate.

Breast hyperplasia due to heat-toxin often follows a history of acute mastitis. Such patients present mainly with throbbing breast pain that is unbearable; the pain is so severe that even a light touch is intolerable. These patients should be treated with heat-clearing, toxin-resolving formulas such as Wuwei Xiaodu Yin or Xianfang Huoming Yin. The author commonly treats such breast hyperplasia with Pugongying (Taraxaci Herba) and Rendongteng (Lonicerae Caulis) each one liang, with good effect, though the course is long—often requiring months or even more than half a year. Decocting the herbs with equal parts yellow rice wine and water can speed the effect.

Gynecological diseases are often related to emotion, which is why the Chinese patent medicines Xiaoyao Wan and Jiawei Xiaoyao Wan are commonly used in breast hyperplasia. Some patients who fail to respond to common breast-hyperplasia patent medicines such as Rupixiao or Xiaoru Sanjie Pian obtain clear improvement after adding Xiaoyao Wan or Jiawei Xiaoyao Wan.