OBSERVATION OF WOMEN’S BREASTS

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Chapter 12

imageOBSERVATION OF WOMEN’S BREASTS

CHANNELS INFLUENCING THE BREASTS

The channels coursing through the breasts are illustrated in Figure 12.1.

As we can see, the main channels influencing the breast are the Liver, Stomach and Penetrating Vessel: in addition, the Muscle channels of the Heart, Pericardium and Gall-Bladder also flow through the breast. In the internal anatomy of the breast, the various structures are influenced by the following channels or tissues:

Box 12.1 summarizes the channels influencing the breasts.

BOX 12.1   CHANNELS INFLUENCING THE BREASTS

BREAST SIZE

BREAST LUMPS

Interrogation, Chapter 46; Palpation, Chapter 51; Symptoms and Signs, Chapter 88

There are four broad categories of breast lumps in Western medicine: cysts, fibroadenomas, breast nodularity or carcinoma of the breast.

Cysts Also called fibrocystic disease, these constitute the most common benign condition of the breast. They are usually bilateral and they feel soft and moveable on palpation. From the Chinese point of view, they are usually due to Phlegm. Cysts are most common between the ages of 30 and 50.

Fibroadenoma This is the next most common benign breast disease, and occurs most often in young women. The adenoma is usually a single, unilateral lump and, on palpation, it feels harder than a cyst. From the Chinese point of view, it is due either to Blood stasis or to a combination of Blood stasis and Phlegm. Fibroadenomas are most common between the ages of 20 and 30.

Breast nodularity and tenderness These occur in the breast before menstruation and usually decrease after the period. From the Chinese point of view, breast nodularity is due to a combination of Liver-Qi stagnation and Phlegm. It is most common between the ages of 30 and 50.

Carcinoma of the breast This usually presents with a single, painless, unilateral, immoveable, hard lump with indistinct margins. Its incidence is highest after the age of 50. It is nearly always due to a combination of Phlegm and Blood stasis occurring against a background of disharmony of the Penetrating and Directing Vessels. In carcinoma of the breast, there may be Toxic Heat in addition to Phlegm and Blood stasis. Phlegm is usually manifested by a Swollen tongue with sticky coating, and Blood stasis by a Purple colour on the breast areas of the tongue (Fig. 12.2) and Toxic Heat by a Red tongue with a thick, dry, dark-yellow coating and red points.

The three most common patterns leading to the formation of breast lumps (benign or malignant) are Qi stagnation, Blood stasis and Phlegm, but the first of these, Qi stagnation, usually accompanies the second and third as well. In Chinese medicine the Qi stagnation that leads to the formation of breast lumps is usually considered to be the result of emotional stress; this may be Liver-Qi stagnation, caused by such emotions as anger, resentment or repressed frustration, or Lung-Qi stagnation caused by sadness, worry or grief. Both conditions affect the breast and may lead to the formation of lumps.

Remember: Qi stagnation affecting the breast may derive not only from the Liver but also from the Lungs.

Case history 12.1 illustrates a pattern underlying a breast lump.

Case history 12.1

A 39-year-old woman had been suffering from a lump in the left breast (upper-left quadrant) for 5 years: the size of the lump had varied in relation to her menstrual cycle, increasing slightly before the period and decreasing afterwards. The lump was sometimes also painful. A biopsy, mammogram and MRI scan had confirmed the absence of any malignancy. The lump was neither a fibroadenoma nor a cyst and had been described simply as ‘breast tenderness and nodularity’. On palpation, the lump was firm but not too hard, elongated and mobile. There was no lymph node involvement in the axilla.

Her periods were regular, not painful, not too heavy or scanty; she did suffer from premenstrual distension of the breasts and abdomen. She had no other symptoms, apart from a tendency to loose stools.

On observation, her complexion was dull and sallow and her eyes were slightly ‘staring’; there was also a horizontal red vein starting from the outer corner of the left eye and reaching the edge of the pupil (Fig. 12.3; see also Plate 12.1 on p. P8). In addition, the white under the pupil was visible (this is not normally visible).

Her tongue was Red on the sides and tip, had a yellow coating and teeth marks in the left breast area (Fig. 12.4). Her pulse was Slippery on the whole, the left side was Slippery and Wiry, especially so on the Liver position, while the left-Front position was relativelyOverflowing; the pulse was also slightly Rapid (84).

Diagnosis: In breast lumps, the most common pathogenic factors are Liver-Qi stagnation, Liver-Blood stasis and Phlegm appearing in varying combinations. In this case, there are signs of all three patterns. There is Liver-Qi stagnation because of the premenstrual distension, the varying size of the lump in relation to the menstrual cycle and the Wiry pulse. There is Liver-Blood stasis because the lump is firm and slightly painful and the pulse is Wiry. There is Phlegm because the pulse is Slippery. Liver-Qi stagnation and Liver-Blood stasis are the predominant patterns compared with Phlegm. The chronic Liver-Qi stagnation has given rise to Liver-Heat and Heart-Heat, as evidenced by the Red sides and tip on the tongue: this is also confirmed by the rapidity of the pulse and the Overflowing quality on the Heart pulse.

The teeth marks in the left breast area on the tongue indicate that the breast pathology occurs against a background of Spleen-Qi deficiency, which is also confirmed by the tendency to loose stools. The slightly staring look of the eyes indicates that the Mind and Spirit are disturbed from emotional problems which, on interrogation, she confirmed having. The showing of the white under the pupil is generally a poor prognostic sign. The red vein in the left eye was in the Heart and Lung area and in the lower part of the sclera corresponding to the chest.1

Box 12.2 summarizes the factors underlying breast lumps.

BOX 12.2   FACTORS IN BREAST LUMPS

NIPPLE ABNORMALITIES

Bloody discharge from the nipple

Symptoms and Signs, Chapter 88

As in all forms of bleeding, the two main causes are either Blood-Heat or Qi not holding Blood. In cases of a bloody discharge from the nipple, Toxic Heat is a common cause, especially in acute conditions. In chronic conditions, stagnant Liver-Qi turning into Heat may also cause an intermittent bloody nipple discharge. As for Deficiency conditions, a deficiency of the Liver and Kidneys and of the Penetrating Vessel may cause an intermittent bloody nipple discharge with pale blood.

Box 12.3 summarizes patterns underlying nipple discharges.

BOX 12.3   NIPPLE DISCHARGES

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