The death of Linda McCartney in April 1998 from breast cancer, and the number of stories on television regarding the use of tamoxifen and other estrogen suppressors to prevent this disease, have made the subject of breast cancer a frequent news item. How may women reading this article have ever had a complaint about breast health? How many people reading this article know at least one woman who has (or has had) breast cancer? How many of you know someone who has died of this disease or its complications? By the time we are in our forties, most women would have said yes in response to many, if not all, of these questions.
Breast diseases and complaints are extremely common among Western women. Fifty percent of the women in this country will have some medical complaint concerning their breasts at some point in their life. One out of every eight or nine women in the U.S. will get breast cancer. Forty-six thousand women die from breast cancer each year, and these numbers are growing. We see lots of these women in our clinics. The good news is that we can often help them both with acupuncture and herbal medicine.
Before discussing treatment strategies, I would like to say something about breast diseases in general according to Chinese medicine. In Chinese medicine, all breast diseases share the same basic disease mechanisms. Breast diseases may not necessarily share the same outcome or degree of virulence. Therefore, I am not saying that all breast disease will lead to breast cancer.
In terms of prevention, it is my belief that breast diseases can be treated and prevented by Chinese medicine. For women who have or get breast cancer, the most successful treatments I have seen combine standard Western medical approaches or other high-tech alternatives with acupuncture and herbal Chinese medicine.
Chinese Medicine and Breast Disease
Chinese medicine has a rational explanation of why and how breast diseases happen and a variety of approaches for treatment and prevention. Let's take a look at the TCM diagnoses of various breast diseases and their disease mechanisms.
Liver Depression, Qi Stagnation
This pattern forms the basis of all patterns that relate to breast disease. As a pure pattern appearing by itself, it is usually seen only in younger women. The most common symptoms include emotional lability or irritability; breast distention and tenderness; frequent sighing; abdominal distention; menstrual irregulatiry; and a bowstring pulse.
Disease mechanisms: Unrelieved stress or frustration leads to the lack of smooth and free flow of liver qi, which is experienced as depression or irritability. If the qi flow is trapped in the chest or hypochondral area, this can affect the breasts, flanks, chest or upper back. Sighing is an attempt to release pent up qi. The flow of liver qi also controls the liver's storage of blood and hence the regularity of the menses. If liver qi flow loses its harmony, menstrual flow can become irregular or painful.
The bowstring pulse is a main indication of this pattern and shows that the sinews and tissues are clamped down, constricting the vessels that carry the blood. Abdominal distention before the menses indicates that the qi in the abdomen is pent up and not flowing smoothly.
Liver-Stomach Depressive Heat
Symptoms and disease mechanisms: The liver and stomach are in close proximity to each other, as are their respective channels. If liver depression persists for a length of time and transforms to heat, it may spill over to invade the stomach. This may cause loss of harmony to the stomach qi and overheating of the stomach. If the qi of these two viscera counterflow upward into their channels, both of which transverse the breasts, these tissues will experience pain, inflammation and distention.
Heat in the foot yang ming channel may also manifest as red pimples on the chin or around the mouth, and increased appetite. A bitter taste in the mouth and a rapid pulse also suggest pathological heat. Easy crying is due to the heat disturbing the function of the lungs.
Liver Depression with Spleen Vacuity
Symptoms and disease mechanisms: If the liver becomes depressed for any length of time, it often counterflows horizontally to disturb the normal functions of the spleen. In addition, when the stomach becomes hot and replete, the spleen often becomes empty and weak. Thus, we see fatigue, loose stools, nausea, abdominal distention after meals, cold hands and feet, edema and a fat tongue.
The last two symptoms suggest that the spleen has lost control over body fluids. The fine pulse suggests that the spleen vacuity has led to blood vacuity. It is very common to see a combination of these first three patterns in women aged 35-50.
Liver Depression with Liver Blood-Kidney Yin Vacuity
Symptoms and disease mechanisms: Here, we se a combination of symptoms of both the kidneys and liver. Liver depression qi stagnation is often exacerbated by liver blood vacuity, since qi and blood are a yin/yang pair. Liver qi controls the storage of blood; the liver blood nourishes and emolliates the liver qi. Therefore, liver blood vacuity can worsen liver depression symptoms.
Since the liver and kidneys share a common source, and since blood is a part of the yin, when liver blood vacuity occurs, there is often concomitant kidney yin vacuity. When yin is weak, it cannot control yang, which then flushes upward and outward, leading to symptoms such as night sweats, vexation and agitation, dream-disturbed sleep, tinnitus and dizziness. The characteristic pale tongue fur and fine pulse is due to blood vacuity. The pulse may also be rapid because yin cannot control yang. Bowstring pulse is due to liver depression. This pattern is usually seen with spleen vacuity, and even kidney yang vacuity as well.
Liver Depression with Liver Blood and Kidney Yang Vacuity
Symptoms and diseases mechanisms: Loss of warmth of the body, strength of the body and sex drive are all related to kidney yang vacuity. The other symptoms of this pattern are of the typical liver depression qi stagnation configuration.
Blood Stasis
Symptoms and disease mechanisms: Long-term qi stagnation can lead to blood stasis, as can chronic blood vacuity. Thus, there may be symptoms of qi stagnation (as well as others) due to blood stasis such as brown skin patches, a dark or spotted tongue body, and palpable lumps underneath the skin. These lumps may be malignant or benign.
Phlegm Nodulation
Symptoms and disease mechanisms: When spleen vacuity leads to lack of control over body fluids and liver depression qi stagnation leads to the loss of harmony and smooth flow of qi, dampness may congeal to form hard, movable lumps. It is possible to have both blood stasis and phlegm nodulation combine in the formation of lumps.
Heat Toxins
Symptoms and disease mechanisms: This pattern usually arises only with long-standing liver depression and depressive heat, spleen qi vacuity and stomach depressive heat. Thus, symptoms of any of these patterns may be present, as well as redness, swelling and open, purulent sores, which are signs of unresolved toxic heat. This scenario has become quite complex and difficult to resolve. Many cases of cancer include this pattern, among others.
In part II of this series, we will review breast diseases and aging, acupuncture treatment suggestions, and tips to help prevent breast disease.
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