The Chinese Medicine Perspective on Fibrocystic Breasts

Fibrocystic breast disease refers to the cobblestone lumps which can be present in the breast and which change in size, shape, and discomfort usually in relation to the menstrual cycle.  Fibrocystic breasts are considered in Western medicine to be so common that it is a variation of normal, and because there is no disease progression recognized as such, it is more and more frequently referred to by doctors as fibrocystic breast condition, mammary dysplasia, or benign breast disease. (5)  In Chinese Medicine, however, fibrocystic lumps are considered to be stagnation of qi, phlegm, heat, damp, or a combination of those four.  It is also unclear in either western or Chinese Medicine whether or not fibrocystic breasts are simply the first phase in a progression toward malignancy.  I think it is important to take into account the phenomenon of fibrocystic breasts from the perspective of Chinese Medicine contrasting the theories of renowned acupuncturists Jeffrey Yuen, Giovanni Maciocia, Honora Wolfe, and Bob Flaws. 

While three of the four of the above experts in the field of Chinese Medicine assert that it is a progression of phlegm stasis, each of the acupuncturists has different views of the etiology, progression, and treatment.

Let us begin with Maciocia, and his thorough exploration of breast lumps.  Maciocia calls fibrocystic breast lumps the most common benign condition of the breast.  In Chinese Medicine he differentiates them as “phlegm with qi stagnation.” Interestingly he states that the condition affects the left breast more often than the right and affects women in the northern hemisphere more from December to May when the ovaries are more active and is most often found in women over thirty.  He claims that from a western perspective the etiology lies in the fact that the breasts are preparing for milk production during the first part of the cycle too enthusiastically and not draining effectively enough in the latter part of the cycle.  This process can cause swelling and result in cysts. (1)  

In Chinese Medicine, these lumps are referred to as  Ru Pi, or benign lumps and are caused by qi and phlegm stagnating.  Emotional problems are the primary etiology in the case of Ru Pi according to Maciocia.  “worry, pensiveness, sadness, bitter weeping, anger, frustration, resentment, hatred, and other negative emotions can cause stagnation of qi”  this will eventually lead to blood stagnation which forms masses.  Another result of these emotions is stagnant qi over a long time may “implode” to cause fire and toxic heat.  Maciocia points out that the liver is not the only organ affected by qi stagnation.  The heart and especially the lungs are affected because of grief depleting qi and causing stagnation.  This can be emphasized by the fact that these two channels travel through the chest. (1) 

But easily the two most important channels in breast lumps are the liver and stomach channels as they travel directly to the breast and have a direct correlation with the function of the breast and formation of breast lumps.  However he differentiates Ru Pi as being caused primarily by liver qi stagnation and phlegm.  Also, says Maciocia, qi stagnation may be secondary to deficient liver and kidneys affecting the Ren Mai and Du Mai.  In summary, Maciocia therefore implicates stagnation of qi, stasis of blood, phlegm, toxic heat, and liver and kidney deficiency as the primary etiologies.  Differentiation, as in every disharmony in Chinese Medicine is the most important factor in treating fibrocystic breast lumps, or Ru Pi. (1)

Jeffrey Yuen, in contrast, talks much less about stagnation, but more on the hormonal aspect of breast cysts.  Based on his three part series on gynecology, he describes fibrocystic breasts as the result of a few bodily processes.  Firstly overactive ovaries, from a hormonal point of view, cause over-activity in the breasts.  This can translate into fibrocystic, benign breast lumps.   Yuen claims that “if you regulate ovarian function, the cyst[ic breasts] will disappear.”   In a very basic sense, he says, any disorder where there are cysts, tumors, or masses of any kind, there is a dysfunction in the anterior lobe of the pituitary, which controls the Governing Vessel, spine, yang, metabolism, and sympathetic nervous function.  This disorder, in turn, means that “jing is going to the wrong places.”  In other words, fibrocystic breasts are deposits of jing where they are not supposed to be.  (2)

From another perspective, cystic breasts, Yuen says, are an issue of ascendant liver yang.  This is hyperparathyroid function with the host of liver yang ascendant symptoms:  red eyes, irritability, headaches, premenstrual changes.  This is similar to Maciocia’s idea of stagnation of pathology of the liver channel, though Yuen has a different spin. (2)

From yet another angle, Yuen implicates a Dai Mai disharmony in fibrocystic breast changes.  When the Dai Mai constricts, as it can, the large intestine is constricted as well, and with St 25 relationship with the Dai Mai and the breast, the large intestine mu point can’t communicate with the lungs, the breasts get very distended and cystic breasts can develop.  The Dai Mai, of course, is an absorber, if flushes all of the toxins and if it is constricting then there is an accumulation of toxins in the stomach channel thereby affecting the breast.

The Chong Mai can also be a player in fibrocystic breast disease according to Yuen.  The second pathway of the Chong Mai goes into the intercostals spaces, into the ribs and most especially into the breast.  When there is stagnation of blood, qi, or phlegm in the Chong Mai, these lumps can develop. (2) 

So these descriptions of etiology from Jeffrey Yuen suggest many routes to the same destination.  But ultimately the culprit is stagnation of some sort in each case.  And treatment, obviously, depends on the imbalance.  In the case of Dai Mai constriction, open the Dai Mai.  In the case of Chong Mai, treat the Chong.  In the case of ovarian overactivity, treat the Du.  (2)

Honora Wolfe has another perspective on fibrocystic breasts.  She is a firm believer in the idea that fibrocystic breasts are only a progression toward malignancy.  In her book The Breast Connection, she writes “It is one thing to have some PMS symptoms with tender or swollen breasts each month for a few days.  It is quite another to have carcinoma of the breast.  The process of getting from one to the other is complex, but according to Chinese Medicine, there is a very logical progression from distention to neoplasm.”  (4) Wolfe and Flaws purports that fibrocystic breasts are simply the result of stagnation, be it stagnant blood, food, dampness, phlegm, fire, or qi.  Primarily liver qi stagnation is the culprit. Although any of these stagnations, in any combination in the liver or stomach channels, can cause fibrocystic breasts which almost inevitably, she suggests, without treatment, becomes cancerous.  Wolfe does emphasize that with proper treatment, breast lumps are reversible at any stage, but the stagnation must be cleared from the body.  Wolfe supports the usage of Yue Jue Wan, a formula designed to promote movement of qi and relieve constraint.  Made up of xiang fu, chuan xiong, cang zhu, zhi zi, and shen qi it addresses all the primary forms of stagnation. (3)

Wolfe focuses on four treatment principles for women to arrest development and even reverse breast lumps.  First and foremost she recommends daily relaxation such as meditation, yoga, biofeedback, or just a simple audio guided relaxation for women to reverse liver qi stagnation.  She is specific that it must be done twice per day at least ten minutes each session for at least 100 days to see the effects.  The second in her protocol is exercise of an aerobic nature which she says must performed at least every other day.  The third protocol is making dietary adjustments including cutting out all caffeine, alcohol, meat, greasy, fatty, or oily foods, spicy foods, and smoking.  And lastly she advocates for professional therapies such as acupuncture, of course! (4)

Each of these respected acupuncturists has a slightly different perspective on fibrocystic breast condition, and each their own assertions and treatment strategies.  Fibrocystic breast condition is easily resolved in Chinese Medicine as well, though not well-addressed at all in Western Medicine.  The usual treatment for the condition in Western medicine is either aspiration of the lumps or dietary recommendations.  Some recommend vitamin E and avoidance of caffeine.  These can make a difference.  Most recently it seems to be a throwing up of hands and calling it “normal”. 

References:

1.  Maciocia, Giovanni. Obstetrics and Gynecology in Chinese Medicine. 1998.  Toronto: Elsevier.

2.  Yuen, Jeffrey C. Gynecology: Transcribed by Brandon Horn from a 3 part series beginning August 1992.

3.  Wolfe, Honora Lee and Flaws, Bob.  Better Breast Health Naturally.  1998.  Boulder.  Blue Poppy Press.

4.  Honora Lee Wolfe:  The Breast Connection:  A Laywoman’s Guide to the Treatment of Breast Disease by Chinese Medicine. 1989.  Blue Poppy Press. 

5.  http://health.google.com

Chinese Medicine for my Littlest Patients

Eleanor McLamb, Lutea's littlest fan.

If you are a parent you have probably known the worry, the anxiety, and the absurd exhaustion from sleepless nights up with a sick child.  You have probably made hard decisions about what doctor to see, what medicine to take, and what alternatives to try.  As a mother I've struggled with difficult healthcare decisions for my daughter even as I was studying Chinese Medicine from some of the greatest pediatric acupuncturists in the country.  The question shouldn't be: should I use conventional or natural medicine, but to know when each is appropriate.

When my daughter was three-years-old she became suddenly ill with a fever of 104 and began to have trouble breathing until she began turning purplish-red gasping for breath.  I was not yet a practitioner so I bundled her quickly into the car and rushed her to our acupuncturist, Rachel.  Once in the treatment room, Rachel put in four needles and applied suction cups to her little back and within moments she was breathing normally.  We administered an herbal tincture and by the time we got home her fever was down and she was fast asleep.  I become overwhelmed with gratitude when I think of this incident and saddened thinking of the parents who don't know of this option that might have rushed their child to the emergency room to receive steroids, fever reducers, inhalers, and likely charged far more than the $30 that I paid for the amazing and compassionate service we received that night.  The most gratifying thing for me as an acupuncturist now, is being on the other end and helping children just as my daughter has been helped. 

Of course, not all acupuncture treatment for children is so dramatic.  But in my experience gained from treating many children, they respond even better and more quickly to acupuncture than adults.  This, for me, is the best argument that acupuncture is not placebo.   I see real results everyday with absolutely no side effects.  I talk to parents who are worried that their child would not accept an acupuncture treatment.  To that I respond that the needles I use for children are hair-thin, and if the child is apprehensive I can work just on the child's back so they aren't worried by seeing the needle.  Essential oils are also quite effective for children and I use a wide array with great results.  Cupping, massage and acupressure, gua sha (gentle scraping with a porcelain edge), and even a tuning fork are some of the other methods I use for children.  I also teach parents many of these techniques to do at home. Some of the more common childhood ailments that I have successfully treated include:

• Nausea and vomiting.  This can be relieved in moments with a few points.  Though care must be taken.  If there is food poisoning or some other toxin, vomiting is an appropriate response.  But if the nausea or vomiting is ongoing or related to a stomach bug or other virus it can be easily remedied with acupuncture and herbs.
• Upper Respiratory Infection (URI, common cold)  this can be helped easily with acupuncture best at the beginning signs of illness
• Asthma.  As mentioned above, cupping and a few empirical points can stop an acute attack in its tracks, and regular acupuncture can prevent attacks.  I have seen the seemingly miraculous effect this has for children and the relief it brings to parents as well.
• Ear Infections.  Ear pain can be eased immediately with acupuncture and recurrent use of antibiotics for repeated infections can be lessened and even stopped.  Some medical literature coming out now even reports that antibiotic use can create a cycle of ear infections.  
• Night Terrors and other sleep disturbances.  I so frequently hear parents frustrated that their children just won't go to sleep, won't stay asleep, and sometimes wake up screaming from night terrors.  Acupuncture is very effective at leveling out sleep in children and adults.  
• Chronic Cough.  Walk into any elementary school classroom this time of year and you will often hear a chorus of coughing.  Often this is worse at night.  Chinese Medicine can work almost immediately for this malady.  Try rubbing a little Eucalyptus Radiata or German Chamomile essential oil on the bottoms of the feet of a coughing child.  In mild cases this usually works quickly.
• Diarrhea, constipation, and "tummy ache".  Herbal remedies work quite well and quickly for this.  Often I can do two points on a child and there is change within an hour.  Hand and foot massage can also work wonders in chronic cases.  This is something the parent can learn quickly and use at home on a daily basis.

These are just the most common. Chinese Medicine can help colic, thrush, teething, strep throat, bed-wetting, allergies, eczema, hives, nosebleeds, and many others.  My daughter has become used to asking for "a treatment" whenever she doesn't feel well.  She just knows that it makes her feel better.  She has also never had a round of antibiotics and never taken a fever reducer.  She also knows that we limit our sugar intake, our dairy intake, and eat fermented foods everyday to stay healthy.  (I will talk more about dietary therapy in a future post.)  

For the record, I greatly value Western medicine.  It has many redeeming qualities.  If I sustain a serious wound, don't take me to an acupuncturist.  I prefer the ER.  If I have a life-threatening infection I will probably take antibiotics.  But all too often, the medications prescribed by MDs for mild conditions are overkill for children.  I liken it to killing a fly with a hammer.  Our children are sacred and beloved to us and we as parents deserve to know our options.  Chinese Medicine isn't the only option, but it is an ancient system of medicine that has many options within it.  It is what my family and many others use as primary health care with great results.  It isn't expensive, it is completely safe, and it doesn't have side effects.  As my friend Todd asks, "When did natural become the alternative?"