Name: Luo.

Sex: Female.

Age: 23 years.

0ccupation: A worker.

Chief Complaint: Swelling-pain of left breast for 3 days.

History of Present Illness: Forty three days ago, the patient had a normal parturition. Since then she had kept suckling her baby by herself all along. Her milk was enough for the baby. 3 days ago, there appeared a swelling lump in the median part of the left breast, accompanied with partial distending pain. Then she herself had fomentation on the affected region, but the distending-pain couldn' t be relieved, furthermore, the pain got more and more severe, and the swelling lump in the left breast slowly enlarged in size, it became from primarily pigeon egg-like to currently palm like. The skin of the affected region got redder and hotter than normal, accompanied with severe distending pain. When the skin of the affected region rubbed on her underclothes, it offered her a severe burning pain, which caused she couldn't sit or stand at ease and prevented her from suckling her baby as normal. Then she came to our hospital for treatment on May 2,2000. After the illness came on, she got poor appetite, while her urination and defecation were all normal all along. Her sleeping got bad because of the severe pain. There was not other complaint.

Physical Examination: The temperature was 37.2¡æ. The patient was conscious with an acute painful complexion. The pulse was thready and taut, the tongue was dark red with a thick layer of white fur. The 2nd quarter of the left breast got severely swelling, the skin of the affected region was redder and hotter than normal. If touched upon, there was sharp tenderness. A lump was palpated in the 2nd quarter of the left breast, which was hard in texture and palm-like in size, it couldn't be moved easily. The right breast was normal. The lungs, heart and abdomen were all normal too. There was not other abnormal sign.

Diagnosis: Acute Mastadenitis.

Differentiation: This disease, in TCM, is called "RuYong" (acute mastitis). It was caused by the hyperfunctional liver-qi after the parturition, which encouraged the qi and blood to flow upward to the breasts along liver-channel in order to produce more milk for suckling the baby. If the production of milk is equal to the drain of milk, the function and shape of the breasts could be kept normal all along. However if liver-qi was hyperfunctional too much, the qi and blood were too encouraged. Then there were excessive qi and blood flowing upward into the breasts and promoted excessive production of milk, which was more than the drain of milk in amount. When the superfluous milk could not be drain off timely, it accumulated together and formed the lump in the affected breast and the patient got the severe distending pain. As for why the skin of the affected region was redder and hotter than normal, it was directly caused by the accumulated heat evil in the breast ,not by the exogenous wind heat.

Therapeutic Principle: Soothing liver to relieve depression, activating blood to eliminate stagnation, activating qi and softening mass, invigorating spleen-qi in order to transform the superfluous milk into blood.

Recipe:

XiangFu,Nutgrass Flatsedge Rhizome 9g

YuanHu,Corydalis Tuber 8g

ShengShanZha,Raw Hawthorn Fruit 15g

GuaLouPi,Trichosanthes Fruit 30g

ChiShao,Red Peony Root 18g

DangGui,Chinese Angelica Root 10g

ShengHuangQi,Raw Milkvetch Root 20g

YiYiRen,Coix Seed 18g

DanShen,Red Sage Root 25g

TaoRen,Peach Seed 10g

ChuanShanJia,Pangolin Scale 5g (to be decocted earlier)

BaiJieZi,White Mustard Seed 9g

HongHua, Safflower 9g

ZhiKe,Fruit of Citron 12g

MuTong,Manshurian Aristolochia Stem 12g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Hot and greasy food was forbidden during the treatment. In addition, in order to soften the hardness and resolve the swelling quickly, some external drugs should be applied onto the affected region at the same time.

Recipe :

MangXiao, Mirabilite 50g

LuJiaoShuang,Deglued Antler Powder 30g

LuJiaoPian, Antler 15g

All the above drugs were to be ground into powder and mixed with some. honey to make herb plaster, applying some herb plaster onto the affected part of the left breast, covering the plaster with a layer of plastic film, putting a hot towel onto the plastic film to have fomentation. She should do it more than 40 minutes each time, twice a day. All the used external drugs could promote partial blood flowing and soften, resolve the hardness.

Effect Observation: After 1 day's treatment, the distending pain disappeared immediately, the hardness began being soft and decreasing. After 2 days' treatment, the lump in the breast disappeared at all, she could suckle her baby without any uncomfortable sensation. After 3 days' treatment, the patient got well completely. Her sleeping became smooth and steady, and she got good appetite too. After 1 month's follow-up, the illness didn't recur. Then it's ending.