Xiaolou Loubei San: A Common Formula for Mammary Nodules and Early Breast Cancer

Xiaolou Loubei San is an empirical formula of modern TCM external medicine, from the textbook Chinese External Medicine. Its composition and dosages are: Chaihu 10 g, Danggui 10 g, Baishao 10 g, Fuling 10 g, Zhebeimu 10 g, Fabanxia 10 g, Dannanxing (Bile Arisaema) 10 g, Sheng Muli 30 g, Baizhu 12 g, Gualou 15 g, Shancigu 15 g.

This formula soothes the liver and fortifies the spleen, and resolves phlegm and dissipates nodules. It is commonly used for rupi (mammary hyperplasia) and early-stage breast cancer presenting with lumps in the breast that are painful and swollen, of soft or firm texture, ill-defined borders, and movable. The lump and pain also vary with the patient's mood: when depressed or unhappy, the lump enlarges and the pain intensifies; when the mood is relaxed, the lump shrinks and the pain eases.

It is now used mainly for diseases such as mammary lobular hyperplasia, breast fibroids, menstrual disorders, and early breast cancer of the liver-qi stagnation with phlegm congelation type.

This formula uses Chaihu to soothe the liver, Baishao to soften the liver and stop pain, Danggui to nourish blood, Fuling to calm the spirit and fortify the spleen, and Baizhu to fortify the spleen and drain dampness; the rest—Beimu, Fabanxia, Dannanxing, Sheng Muli, Gualou, and Shancigu—are all phlegm-resolving, nodule-dissolving herbs. So the formula focuses on soothing the liver, fortifying the spleen, and softening hardness and dissipating nodules.

If the lump size and pain are closely tied to menstruation and the pattern is a thoroughfare/conception-vessel disharmony, add Lujiaoshuang (deer-antler residue) and Xianlingpi (Epimedii Herba) to warm yang and disperse cold, and reduce swelling and dissipate nodules. If the patient has blood stasis and qi stagnation with unbearable breast-lump pain, add Ruxiang (Olibanum), Moyao, Chuanlianzi, and Yanhusuo to activate blood and resolve stasis, and move qi and stop pain. If yin-blood is deficient with marked postmenstrual soreness and pain, have the patient, while taking this formula, additionally take Erzhi Wan. If hypochondriac distending pain is severe, add Xiangfu (Cyperi Rhizoma) and Bohe (Menthae Folium) to soothe the liver and stop pain. If heat-toxin is exuberant, add Pugongying, Xiakucao, Banzhilian (Scutellariae Barbatae Herba), and Baihua Sheshucao to clear heat and resolve toxin.

One may also, while taking this formula, internally take patent medicines with swelling-reducing, nodule-dissolving effects such as Xihuang Wan and Xiaojin Wan. But this formula's force is fairly strong and should not be taken for long; patients with yin deficiency or dual qi-blood deficiency should use it cautiously. If long-term medication is needed, after taking the decoction for a while, have the patient convert the formula into pills to reduce side effects.