Mastitis, Breast Abscess

General

Clinical Manifestations	Acute infection of the breast (abscess)  often seen in first-time mothers during the third or fourth week of postpartum breast feeding Symptoms are usually unilateral and characterized by chills and fever and tachycardia The breast is red hot The main complaint is pain About 10% of women with mastitis develop a breast abscess when the source of infection is the mouth and pharynx in the newborn Distended, painful, swollen breast with lumps If caught early, it can be massaged out and treated with warm moist herbal washes and compresses. If left untreated or unnoticed it may manifest with flu like symptoms (toxic Heat).  As it grows and fills with pus it can get very painful and lead to an abscess which can get red and hot.  Internal blockages are deeper and generally can’t be seen on the surface. They grow slower, are harder to detect and are tougher to move or break-up.  The major cause is the milk stagnates (from irregular feeding, not enough stimulation, etc.) during breast feeding resulting in blocked duct(s) and creating infection. There are two types: 1. Late pregnancy 2. Postpartum
Treatment Principle
Herb Formulas	Tuo Li Xiao Du Yin Mastitis #4 For early-stage acute mastitis: mix equal portions of powdered Bul. Bolbostemmae Tu Bei Mu and Angelicae Dahuricae Bai Zhi and take 9g per day. If the patient is strong, take 15g per day. Topical: Jin Huang San Qing Fu Yao Xiang Fu Bing Mastitis #3 Cong Yun Fa (Scallion Ironing Method): Apply mashed Cong Bai to the affected area. Place a piece of smoldering charcoal on this and cover with a jar. Leave in place until the patient begins to perspire profusely. The swelling should be alleviated when the jar is withdrawn.
Points	PC-6, REN-17, SI-1, SJ-10 GB-21, HT-1, KI-22, PC-2, PC-7, REN-17, SI-1, SP-18, ST-16, ST-18, ST-36, UB-18, UB-40, UB-43, UB-44 LI-4, LI-11, REN-17 LI-4, LI-11, REN-17, UB-16 GB-43, LI-8, LU-10, ST-36, SI-1, UB-40 KI-27, PC-7, REN-17, SI-1, UB-40 GB-21, SI-1, SI-11 REN-17, SI-1, SI-11, ST-16 Moxa - 14 cones on LI-4, LI-15, 7-14 cones on LI-7, needle ST-36, ST-38, ST-39 Abscess: GB-41, GB-43, KI-23, LI-8, SP-18, ST-16, ST-18, ST-36, ST-39 Ear: 1. Mammary Gland, Endocrine, Adrenal Gland, Thorax 2. Mammary Gland, Shenmen, Occiput, Adrenal, Subcortex Due to breast feeding: GB-21, LIV-3, PC-3, ST-16, ST-18, ST-37 Early-Stage: Make a paste of Bul. Allii Xie Bai with moxa Late-Stage: Cupping

Internal (Late Pregnancy)

Clinical Manifestations	Starts with feeling a deep hard lump or lumps The skin gets red hot and painful Fever Flu -like symptoms may appear This takes longer to manifest (1 month)
Treatment Principle	Soothe the Liver Clear Stomach Heat Calm the fetus
Herb Formulas	Xiao Yao San  modified
Points	DU-14, GB-41, LI-4, LI-11, LIV-14, PC-6, REN-17, SI-1, SI-11, SJ-6, SP-21, ST-15, ST-18, ST-44, UB-15, UB-17, UB-18 + general points

Wind-Cold

Clinical Manifestations	Starts with feeling a deep hard lump or lumps Chills and fever Anhidrosis Stiff and rigid neck, shoulders and upper back Intolerance of Wind Dislike of Cold Inflammation Diarrhea Muscle spasms Mucosal swelling Nasal congestion Sensitivity to dust Headache Wind-Cold Bi (few joints affected, inflammation intense but short lived, changes over days or weeks) T: Normal C: Thin and white P: Floating and tight.
Treatment Principle	Release Wind-Cold in the exterior and muscle layer Generates Fluids
Herb Formulas	Ge Gen Tang Ge Gen Jia Ban Xia Tang Ma Huang Tang
Points	General points

Shao Yang Jing

Clinical Manifestations	Alternating chills and fever Restlessness Irritability Anorexia Sometimes fatigue Fullness in the chest Dizziness Irritability Nausea Occasional vomiting Headaches (side of head) Hypochondriac pain, distention or tenderness A bitter taste in the mouth Rib pain Achiness Ear infection Hearing difficulty Red eyes Stiff shoulders Throat pain Hip pain T: Normal with bumps or dots on side C: Thin white P: Wiry
Treatment Principle	Harmonize the Liver and Gall Bladder
Herb Formulas	Xiao Chai Hu Tang modified Chinese Patent Medicines: Xiao Chai Hu Wan
Points	GB-34, GB-39, GB-41, SJ-5, UB-19, UB-21, UB-22 With Spleen Qi Deficiency: + LIV-13, ST-36 GB-41, SJ-5 GB-39, GB-41, SJ-5, UB-19 To harmonize the Liver and Gall Bladder: GB-34, LIV-3, LIV-14, SJ-5 To stop nausea and vomiting: PC-6, SP-4, ST-36 To treat headache: GB-1, GB-8, GB-14, Taiyang To treat constipation: SJ-6, ST-25 To treat fever: DU-13, DU-14 To support the San Jiao and Regulate Yin: PC-5, PC-6 To support Yin: KI-7 To support the Ying: SP-10 Head: GB-8, SJ-20, Yintang Eyes: GB-14, GB-20, ST-1, UB-1, UB-2 Ear: GB-2, SJ-5, SJ-17, SJ-21 Hypochondriac area: GB-34, GB-40 Ear: Shenmen, Gall Bladder, Point 0 Ear: Liver, Sanjiao, Spleen, Stomach, Shenmen, Sympathetic

Wind-Heat

Clinical Manifestations	Inflammation of throat and/or tongue Fever and chills with more fever than chills Perspiration Cough with sticky yellow sputum Aversion to Wind and Heat Yellow nasal discharge Thirst with desire for cold drinks Red bumps around mouth and lips (herpes simplex) Headache Nasal obstruction Sore, swollen throat Dyspnea Chest pain Dry mouth Rapid breathing Maybe constipation Maybe scanty urine T: Red tip C: Thin and yellow P: Floating and rapid
Treatment Principle	Disperse Wind Clear Heat Clear the Lungs
Herb Formulas	Niu Bang Jie Ji Tang
Points	Bleed UB-40, needle Dingchuan, DU-14, DU-16, DU-23, DU-24, GB-20, LI-4, LI-11, LU-5, LU-7, LU-10, REN-22, SJ-5, ST-8, ST-40, Taiyang, UB-12, UB-13 For a mild case with cough, fever is not high, slight thirst: Bleed UB-40, needle DU-14, GB-20, LI-4, LI-11, LU-7, REN-22, SJ-5, UB-12, UB-13 For fear of Cold at the beginning stage: Bitong, DU-16, GB-20, KI-7, LI-4, LI-20, LU-7, SJ-5, UB-12, UB-13, Yintang

Wind-Damp Invasion

Clinical Manifestations	Postpartum breast swelling and pain Difficulty breast feeding Cracked nipple
Treatment Principle	Dispel Wind Transform Dampness
Herb Formulas	Shi Wei Bai Du San With Internal Dampness: Ma Huang Jia Zhu Tang
Points	To Expel Wind Cold: DU-16, GB-20, UB-12, LI-4, SJ-5 (Sedating technique) To Disperse the Lungs: UB-13, LU-7, REN-17 To Expel water: SP-6, SP-9, Moxa REN-4, REN-6, DU-4 To Resolve Phlegm:  ST-40 + General points

External Wind-Toxin Invasion

Clinical Manifestations	Postpartum breast swelling and pain Difficulty breast feeding Cracked nipple Localized burning Heat Maybe redness Palpable nodular lumps which are worse with pressure Aversion to Cold Fever Anhidrosis Headache Muscular soreness and pain Whole body joint pain Chest oppression T: Normal C: Thin and yellow or Thin and white P: Floating and rapid or Floating and tight
Treatment Principle	Dispel the Exterior Detoxify Dredge the Liver Clear the Stomach
Herb Formulas	Jing Fang Niu Bang Tang modified Jing Fang Niu Bang Tang + Lian Qiao Jin Bei Jian Xian Fang Huo Ming Yin modified For swelling and pain without chills and fever: Shen Xiao Gua Luo San modified With Qi and Blood Deficiency: Xing Xiao Wan External: Chan Su Ding Compress + vinegar Cong Yun Fa Compress (Apply mashed green onions with roots on the affected area of the breast and cover with a jar in which there is a smoldering piece of charcoal. Leave in place until the patient begins to perspire profusely, then withdraw.)
Points	GB-20, LI-4, SI-1, ST-18, ST-34 + general points

Liver Qi Stagnation With Stomach Heat (Postpartum - Early-Stage)

Clinical Manifestations	The milk secretion is not smooth Emotional stress Starts with a hard lump Breast engorgement Redness, swelling,distention and mass formation in the breast Heat and pain of the breast Aversion to Cold Fever Maybe chills and fever Headache Chest oppression Nausea Irritability Thirst T: Normal or Red edges C: Yellow or Slimy yellow P: Wiry and rapid or Floating and rapid
Treatment Principle	Soothe the Liver Clear Stomach Heat Promote lactation Dissolve hardness
Herb Formulas	Gua Lou Niu Bang Zi Tang modified Xiao Yao San  modified Xiao Chai Hu Tang Chai Hu Shu Gan Tang Chai Pu He Ji For breast masses failing to disperse after treatment with slight breast pain, no fever, a wiry and slow pulse and a white tongue coat: Si Ni San modified External: Jin Huang San (Gao) Mang Xiao(50%solution)
Points	GB-21, LIV-14, PC-6, REN-17, ST-18, ST-34, ST-36 LIV-2, LIV-3, LIV-4, LIV-5, LIV-13, LIV-14, SP-6, UB-18 LIV-3, LIV-14, ST-18 GB-21, GB-41, LIV-3, REN-17, ST-18 For chills and fever: + LI-4, SJ-5 For breast pain: + ST-16 GB-21, LI-11, PC-6, ST-36, UB-40 GB-41, LIV-3, REN-17, SI-1, ST-18, ST-36 Ear: 1. Chest, Adrenal, Shenmen, Subcortex 2. Mammary Gland, Shenmen, Occiput, Adrenal, Subcortex For breast ulcer: GB-41, GB-42, KI-21, KI-26, LI-8, LIV-2, PC-7 For breast abscess: GB-21, KI-21, LI-8, LIV-2, LU-10, SP-12, ST-16 External treatment: 1. Massage (from base to nipple) 2. Moist Heat herbal compresses (Pu Gong Ying) 3. Moxibustion

Liver Qi Stagnation Attacks The Spleen And Stomach

Clinical Manifestations	The milk secretion is not smooth Emotional stress Starts with a hard lump Breast engorgement Epigastric pain (worse when emotionally upset) Abdominal distention and pain Belching with acid regurgitation Nausea / vomiting Gas Borborygmus Diarrhea Anorexia Epigastric distention Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white or White and greasy P: Wiry or Slippery and wiry
Treatment Principle	Soothe the Liver Harmonize the Spleen and Stomach Promote lactation Dissolve hardness
Herb Formulas	Xiao Chai Hu Tang modified
Points	LIV-14, PC-6, ST-34, UB-18 GB-21, LIV-14, PC-6, REN-17, ST-18, ST-34, ST-36 LIV-2, LIV-3, LIV-4, LIV-5, LIV-13, LIV-14, SP-6, UB-18 LIV-3, LIV-14, ST-18 GB-21, GB-41, LIV-3, REN-17, ST-18 For chills and fever: + LI-4, SJ-5 For breast pain: + ST-16 GB-21, LI-11, PC-6, ST-36, UB-40 GB-41, LIV-3, REN-17, SI-1, ST-18, ST-36 LIV-3, LIV-13, LIV-14, PC-6, REN-12, SP-6, ST-25, ST-36, ST-37 Ear: 1. Chest, Adrenal, Shenmen, Subcortex 2. Mammary Gland, Shenmen, Occiput, Adrenal, Subcortex For breast ulcer: GB-41, GB-42, KI-21, KI-26, LI-8, LIV-2, PC-7 For breast abscess: GB-21, KI-21, LI-8, LIV-2, LU-10, SP-12, ST-16 External treatment: 1. Massage (from base to nipple) 2. Moist Heat herbal compresses (Pu Gong Ying) 3. Moxibustion

Liver And Gall Bladder Damp-Heat

Clinical Manifestations	Yang jaundice (sclera and skin bright yellow) Pain and fullness in ribs on both sides Maybe pain in the right hypochondrium Bitter taste in mouth Nausea Vomiting sour and bitter fluids Anorexia Maybe alternating chills and fever Concentrated, dark urine Abdominal distention Women: Yellow vaginal discharge with foul smell Pruritis vulvae Men: Pain, swelling and burning sensations of testicles T: Pink C: Yellow and greasy or sticky P: Wiry and rapid or Slippery and rapid
Treatment Principle	Clear Dampness Purge Heat from Liver and Gall Bladder
Herb Formulas	Long Dan Xie Gan Tang
Points	Dannangxue, DU-9, GB-24, GB-34, LIV-14, SI-4, SP-9, UB-18, UB-19, UB-48

Disharmony Between The Liver And Spleen

Clinical Manifestations	Abdominal pain Irritability Slight chills Spasms of the calf muscles Convulsions Cramps in the hands Weak legs Hypertonicity of the extremities characterized by difficult flexion and extension Wheezing Coughing Vomiting Diarrhea Sciatic pain Severe and painful muscle spasms in the Stomach, bronchi, Gallbladder and uterus. Intestines Shoulder pain Pain in the head, body or limbs due to arterial spasms characterized by a severe pulling pain T: Normal or Reddish C: None or Yellowish P: Wiry and rapid or Thready and rapid
Treatment Principle	Soften the Liver Nourish the Blood Nourish Yin Moderate painful spasms Relieve pain Harmonize the Middle Jiao Replenish Body Fluids
Herb Formulas	Shao Yao Gan Cao Tang
Points	General points

In?Ternal Heat

Clinical Manifestations	Headache Brain ringing Swelling with no change in skin color Fever Irritability Abdominal fullness Vomiting Dry heaves Thirst Constipation Reduced urination Reddish urination T: Reddish C: Turbid and yellow P: Deep and excess
Treatment Principle	Clear Heat Resolve toxicity Invigorate the Blood Reduce swelling Reduce constipation Alleviate pain
Herb Formulas	Nei Shu Huang Lian Tang
Points

Blood Heat

Clinical Manifestations	Initial stage Chronic, stubborn skin lesions Sores Enlarged lymph nodes Nodules Malignant abscesses and sores Syphilitic sores Red itching skin Hardness T: Pale with red spots P: Rapid and pecking
Treatment Principle	Clears Heat Cool the Blood Dissipates swellings Dispels noxious sores Disperses nodules and hardness
Herb Formulas	Zi Gen Mu Li Tang
Points

Breast Milk Accumulation

Clinical Manifestations	Postpartum swollen lumps in the breast The lumps begin soft and gradually harden Stagnant breast milk Local distention and pain Chest oppression Vexation Agitation T: Normal C: Slimy P: Deep and wiry
Treatment Principle	Move Qi Open the breasts Scatter nodulation
Herb Formulas	Xia Ru Yong Quan San Mastitis #1 Mastitis #2 For localized redness, swelling, aching and pain with fever, thirst, reddish urination and dry stools: Ru Yong Yan Fang Jia Jian
Points	LIV-3, REN-17, ST-36, UB-21 PC-6, REN-17, SI-1, SJ-10 GB-21, HT-1, KI-22, PC-2, PC-7, REN-17, SI-1, SP-18, ST-16, ST-18, ST-36, UB-18, UB-40, UB-43, UB-44 LI-4, LI-11, REN-17 LI-4, LI-11, REN-17, UB-16 GB-43, LI-8, LU-10, ST-36, SI-1, UB-40 KI-27, PC-7, REN-17, SI-1, UB-40 GB-21, SI-1, SI-11 REN-17, SI-1, SI-11, ST-16 Moxa - 14 cones on LI-4, LI-15, 7-14 cones on LI-7, needle ST-36, ST-38, ST-39 Abscess: GB-41, GB-43, KI-23, LI-8, SP-18, ST-16, ST-18, ST-36, ST-39 Ear: 1. Mammary Gland, Endocrine, Adrenal Gland, Thorax 2. Mammary Gland, Shenmen, Occiput, Adrenal, Subcortex Due to breast feeding: GB-21, LIV-3, PC-3, ST-16, ST-18, ST-37 Early-Stage: Make a paste of Bul. Allii Xie Bai with moxa Late-Stage: Cupping

Phlegm-Damp Retention With Kidney Yang Deficiency

Clinical Manifestations	Suppurative toxic swellings Coughing and wheezing with copious, dilute, white, frothy or lumpy sputum Chest and epigastric congestion Cold legs Pain and full feeling in the chest Dizziness Vertigo Palpitations Dyspnea - worse lying down Sometimes asthma Throat rattle Nausea Vomiting Shortness of breath with labored inhalation and smooth exhalation Acute attack of panting with a high pitched wheezing sound and rapid exhalation Leg Qi Acute cramping Muscle wasting Diarrhea in response to cold or hot weather Maybe anorexia Insensitivity in the lower abdomen Headache Facial edema Palpitations Lumbar pain Weakness in the body and feet Numbness, weakness and aching of the feet and legs Edema of the extremities Fever Dysuria Weakness below the umbilicus Fatigue with a desire to curl up Epigastric distention Disorientation Disordered speech Tinnitus T: Pale C: Thick, white and greasy or sticky P: Slippery or Soft
Treatment Principle	Disperse and Descend Lung Qi Warms and transforms Phlegm-Cold
Herb Formulas	Su Zi Jiang Qi Tang Qian Jin Nei Tuo San With Internal Cold Stagnation: Yang He Tang
Points	General points

Toxic Heat (Postpartum-Late-Stage)

Clinical Manifestations	Hard, red lump, with Heat on skin May feel pulse on the lump The lump may also have a soft center (pus) When pressed, there is a wavelike sensation High-fever T: Red C: Slimy and yellow P: Wiry, slippery and rapid
Treatment Principle	Clear Heat Eliminate toxins Reduce swelling Soften hardness Activate Blood circulation Stop pain
Herb Formulas	Xian Fang Huo Ming Yin Wu Wei Xiao Du Yin Qing Chuan Yin Jia Jian Zhen Ren Huo Ming Yin Pai Nong San Da Huang Mu Dan Tang With underlying Qi and Blood Deficiency: Tou Nong San
Points	GB-21, LIV-14, PC-6 + General points Cupping: Place appropriate size glass fire cups over lesion and suction to draw out pus External: Lance, drain the pus and apply  Jin Huang Gao

Phlegm-Fire

Clinical Manifestations	Severe sore and swollen throat High fever with convulsions in infants Difficulty swallowing Carbuncles Acute localized infection Lymphangitis Furuncles Abscesses Boils T: Red C: Greasy and yellow P: Rapid
Treatment Principle	Clear the Lungs Resolve Phlegm-Fire Clear Heat
Herb Formulas	Liu Shen Wan
Points

Heat Excess In The Exterior And Interior (Acute)

Clinical Manifestations	Dizziness Red, sore eyes Difficulty swallowing Nasal congestion Thick, sticky nasal discharge and saliva Bitter taste in the mouth Dry mouth Focal distention in the chest and diaphragm Stifling sensation in the chest and diaphragm Manic behavior Carbuncles Heat rash Headache Sore throat Skin ruptures or ulcers Tense abdomen Shoulder stiffness Numb extremities Fatigue Constipation Dysuria with reddish urine Dark, rough urination Obesity Heaviness in the head T: Red C: White or yellow, greasy P: Flooding and rapid or Wiry and slippery or Floating, smooth and rapid
Treatment Principle	Disperse Wind Release the Exterior Drain Heat Unblock the bowels
Herb Formulas	Fang Feng Tong Sheng San
Points	PC-6, ST-25, ST-40, REN-4, SP-6, LU-7

Qi And Blood Deficiency -Pre-Rupture Stage

Clinical Manifestations	Pallor Fatigue Somnolence Less severe pain in the breast The swelling is rock hard Difficulty erupting T: Pale C: Thin white P: Thready and weak
Treatment Principle	Tonify Qi and Blood
Herb Formulas	For swelling like a rock which cannot erupt and mild tenderness: Tuo Li Xiao Du Yin For clear discharge of abundant pus which is reluctant to heal: Yi Qi Yang Rong Tang Tuo Li Xiao Du Yin modified
Points	SP-3, SP-6, SP-18, ST-18, ST-36, UB-20 + general points

Rupture Stage: Discharge Of Pus

Clinical Manifestations	Discharge of pus from the breast Gradual return of normal body temperature Relief from severe aversion to Cold Relief from fever Disappearance of swelling and pain Gradual healing of the superficial lesions May still be redness of the breast with pain If there are lesions, there may be a thick, yellowish exudate with itch around the affected (this is a sign of healing) If there are multiple lesions with heartburn, nausea and vomiting, recovery may be difficult If there are ulcerous lesions surrounded by dark flesh with pain radiating to the Heart and a thin, weak constitution, the condition may be critical T: Pink C: Thin and yellow P: Rapid or Weak
Treatment Principle	Regulate Qi and Blood Clear remaining evils For alternating swelling and softness, local brightness of the skin and hot sensations over the area with thick, yellow pus, surgery is indicated.
Herb Formulas	Si Miao Tang For milk escaping through the lesion after the rupture of a carbuncle:  Tuo Li Xiao Du Yin Alternative to surgery: Tuo Li Xiao Du Yin modified Shen Xiao Gua Lou San modified External treatment: Insert into lesions: Ba Er Dan Jiu Yi Dan Shen Xian Tai Yi Gao After pus has drained apply: Sheng Ji San
Points	LI-10, SP-6, ST-36, ST-37, ST-39 + general points When discharge has stopped: + REN-4, REN-6, ST-30

Rupture Stage: Discharge Of Pus: Wind-Heat

Clinical Manifestations	Suppuration Delicate constitution Polyps Pain Fever Headache Muscle spasms Inflammation Swelling Congestion
Treatment Principle	Induce sweat Release the Exterior Dispel Wind Resolve Phlegm Detoxify Clear Heat
Herb Formulas	Bai Nung Tang Jing Fang Bai Du San Chinese Patent Medicines: Qian Jin Nei Tuo San
Points	General points

Qi And Blood Deficiency - Post-Rupture Stage

Clinical Manifestations	Pus filled water which is clear and dilute The opening of the sore is slow to close or endures for days without healing Lassitude Lack of strength Shortness of breath Doesn't want to speak Insomnia Profuse dreams A lusterless complexion T: Pale C: Thin white P: Thready and weak
Treatment Principle	Tonify Qi and Blood
Herb Formulas	Ren Shen Yang Rong Tang Tuo Li Xiao Du Yin modified
Points	SP-3, SP-6, SP-18, ST-18, ST-36, UB-20 + general points Moxa ST-36, SP-6