Mammary welling-abscess

A welling-abscess (yōng) on the female breast. It is most common after childbirthbut may occur in the later stages of pregnancy. It is characterized by a redness and swelling in the breast, which if left untreated can suppurate and burst. Severe cases are called effusion of the breast. At least since the Song, the breath of the infant has been understood as cause of mammary welling-abscesses, and in The Golden Mirror of Medicine (医宗金鑑 yī zōng jīn jiàn) the distinction is made between external blowing (mammary welling-abscess developing after childbirth) and internal blowing (developing before childbirth).

Biomedical correspondence: acute mastitis. Several causes exist:

• worry or anger affecting the normal free coursing of liver qì;
• accumulated stomach heat from excessive consumption of rich foods, causing stagnation in the yáng brightness (yáng míng) channel and disharmony of provisioning qì;
• accumulation and stagnation of milk in the breast;
• contraction of heat toxin through a damaged nipple;
• contraction of wind evil in postpartum blood vacuity.

Medicinal therapy: In the initial stage, treat by soothing the liver and clearing the stomach and by promoting lactation and dispersing binds; use formulas such as Trichosanthes and Arctium Decoction (瓜蒌牛蒡汤 guā lóu niú bàng tāng) plus dandelion (Taraxaci Herba, 蒲公英 pú gōng yīng), Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī), rhaponticum (Rhapontici Radix, 漏芦 lòu lú), and red peony (Paeoniae Radix Rubra, 赤芍药 chì sháo yào). For pronounced liver depression, use the same formula minus scutellaria (Scutellariae Radix, 黄芩 huáng qín), gardenia (Gardeniae Fructus, 山栀子 shān zhī zǐ), and lonicera (Lonicerae Flos, 金银花 jīn yín huā), plus perilla stem (Perillae Caulis, 紫苏梗 zǐ sū gěng), and liquidambar fruit (Liquidambaris Fructus, 路路通 lù lù tōng), to course the liver and resolve depression. For pronounced heat toxin, use Immortal Formula Life-Giving Beverage (仙方活命饮 xiān fāng huó mìng yǐn) plus dandelion (Taraxaci Herba, 蒲公英 pú gōng yīng) to clear heat and resolve toxin. Apply Golden Yellow Powder (金黄散 jīn huáng sǎn) or crushed dandelion (Taraxaci Herba, 蒲公英 pú gōng yīng) topically.

Acumoxatherapy: Base treatment on yáng brightness (yáng míng) and reverting yīn (jué yīn). Select ST-16 (Breast Window, 膺窗 yīng chuāng), GB-21 (Shoulder Well, 肩井 jiān jǐng), PC-6 (Inner Pass, 内关 nèi guān), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), LI-11 (Pool at the Bend, 曲池 qū chí), LI-7 (Warm Dwelling, 温溜 wēn liū), and LR-2 (Moving Between, 行间 xíng jiān); needle with drainage. Mammary welling-abscess responds to acupuncture best before suppuration. The above formula is therefore mostly used for presuppurative conditions. In addition, the swelling and surrounding area can be tapped with a cutaneous needle to reduce momentum. Medicinal therapy is more effective for the suppurative stage.

Point selection according to signs: For pronounced liver depression, LR-14 (Cycle Gate, 期门 qī mén) and GB-41 (Foot Overlooking Tears, 足临泣 zú lín qì). For pronounced heat toxin, add ST-44 (Inner Court, 内庭 nèi tíng) ST-18 (Breast Root, 乳根 rǔ gēn), and ST-34 (Beam Hill, 梁丘 liáng qiū). For inhibited milk flow, add CV-17 (Chest Center, 膻中 shān zhōng), and SI-1 (Lesser Marsh, 少泽 shào zé). For aversion to cold with heat effusion, add LI-4 (Union Valley, 合谷 hé gǔ), and GB-20 (Wind Pool, 风池 fēng chí). See welling-abscess.