Editor's note: Part I of "An Acupuncture Approach to Improved Breast Health" appeared in the July issue.
Breast Disease and Aging
According to Western medicine, breast disease becomes more common and potentially more serious with aging.We know that the incidence of breast cancer definitely increases as women age. Chinese medicine has a logical rationale for this statistical fact.
Zhu Dan-xi, one of the four great masters of Chinese medicine living during the Jin-Yuan dynasties, said that early stage breast disease or breast disease in young women can usually be ascribed to the liver, whereas in older women, or in long-standing or more serious cases, breast disease usually relates to the chong mai.1
What does Zhu mean by chong mai? As an extraordinary vessel, the chong is responsible for connecting the kidneys and uterus to the heart, chest and upper body. The chong also carries blood from the heart down to the uterus and yin essence up from the kidney to nourish the heart spirit. Conceptually, the chong can be seen as the relationship between these viscera and bowels in all three burners.
Clinically, what Zhu means is that breast disease in older women, or in more serious or long-standing cases, often involves a more complex configuration of interpromoting pattern and related symptoms which may include the liver, spleen, stomach, kidneys, and often the heart. It is of key importance that these symptoms will worsen as the spleen weakens with age. A depressed liver will also exacerbate the weakening of the spleen if it is already tending to vacuity. A weakened spleen cannot produce adequate amounts of qi to either transform or move the blood, leading to both blood vacuity and possibly blood stasis. Neither can a weakened spleen transform and control body fluids properly, increasing the likelihood of damp congelation and eventually phlegm nodulation. Thus, an overheated, depressed liver, combined with spleen vacuity leading to blood vacuity, blood stasis and phlegm nodulation, increases the likelihood and severity of breast (and other) diseases. This is a pattern configuration more likely to be seen in older women.
Furthermore, if the liver becomes depressed, the spleen will become vacuous and possibly damp, but the stomach will become hot. Heat rises in the body, or in any enclosed space, and stomach heat specifically will counterflow into the foot yang ming channel that traverses the breast tissue. Heat also damages yin if it is long-standing. In this case, a scenario occurs which may encompass several of the patterns listed above and which is not uncommon in middle-aged and older women.
Acupuncture Treatment Suggestions
In acupuncture therapy, the chong is used to treat the viscera and bowels in relationship to each other, including the uterus, kidney, heart, spleen, stomach and liver. One way the chong mai is commonly used is to harmonize the liver and spleen or liver and stomach. Since the spleen is the pivotal viscera in this theory of breast disease vis---vis aging, it is important to be sure that the spleen is included in any treatment given. Gong sun (SP4) is not only the hui meeting point of the chong mai, it is also the luo network point of the spleen. Tai chong (Liv3) is known to not only harmonize wood and earth, but its name also suggests that it is a powerful point for affecting the chong mai or, seen another way, affecting the relationship between the liver, spleen, stomach and heart. We also know that the foot jue yin channel has an internal branch which homes to the nipples, and that tai chong, as a yuan source point, is one of the most powerful points on this channel.
The chong mai is a yin channel. As such, it has no affinity to pathological replete yang qi. Therefore, if depressive heat from the liver or stomach enters the chong mai, it may well be passed into the connecting du mai or governing vessel. The du is the sea of all yang. Pathological heat will flush up the du mai and spread into the tai yang channels of the neck and upper back. This helps explain why shao ze (SI1) is an empirical point for a number of breast diseases, and why tian zong (SI11) is reliably sore or tender in women with breast disease.
In a typical TCM style acupuncture treatment, one might choose tai chong (Liv3), liang qiu (ST34), ru gen (ST18) and nei guan (Per6). While these points are all right, based on the above discussion, I would choose additional points from among the following for root and branch treatments.
- Palpate da du (Sp2) and tai bai (Sp3) to check for tenderness. If either point is tender, it can either be needled very shallowly (using a 40 gauge, #1 or gold needle) as a root treatment, or treat with 3-5 tiny threads of super pure gold moxa.
- Alternatively, you might palpate gong sun (Sp4). If this point is tender, again needle it shallowly. If you have also needled nei guan (Per6), you may wish to attach IP cords. In that case, I would use gong sun as the ruling point and black clip, but that decision must be made in the moment. You may also conduct an IP cord treatment using tai chong (Liv3) to replace gong sun.
- For branch treatment, one might palpate the back shu points between Bl17 and Bl23. Needle the sore ones briefly. Definitely palpate the tian zong (SI11) area and needle the sorest point.
- Also palpate dan zhong (CV17), ru gen (St18), shi dou (Sp17) and da bao (Sp22). It is likely that at least one or two of these points will be tender. The two spleen channel points will respond to treatment with thread moxa, but I would needle the other two points, pointing the needles downward to reverse any counterflow qi and heat.
In patients with chronic fibrocystic breast disease or breast distention and pain, I would suggest doing some version of this treatment once per week between the onset of the period and ovulation, and more frequently between ovulation and the onset of the period when the breasts are often more tender. During this time, the woman should also be counseled about her diet and any lifestyle choices that may either ameliorate or exacerbate her health problems.
None of us is perfect. Although most of us really do know what we should and should not do, few of us are able to maintain a perfect lifestyle with no lapses. In that case, you may need to repeat a course of treatment two or three times a year to help a woman keep her symptoms at an acceptable minimal level. A woman can do many other things on her own to help herself between treatments, or better yet, to keep from needing treatment at all.
Preventing Breast Disease
Another quote from Zhu Dan-xi relates more to how women can prevent breast disease. Zhu states: "By eating too much think, heavy foods or by bearing grudges, the portals (of the breast) will become blocked. As a cumulative effect of worry (which damages the spleen and liver by knotting or binding of the qi), a dormant node may develop, hard like a turtle shell (but) with no pain or itching. It takes more than 10 years to become a sunken sore · called suckling breast rock because it forms a depression like a rock cave. It is incurable. If, at the initial stage of its generation, (one) eliminates the root of the disease by keeping the heart tranquil and the spirit calm and administers certain treatment, there is the possibility of treatment ·"2
In other words, Zhu is saying that emotional health is the root of breast diseases. With proper diet and keeping the spirit calm, serious breast disease is treatable or, better yet, preventable.
While we all know what to eat to support health and what other healthy lifestyle choices are, it never hurts to go over them again.
Diet. Many women know about the studies showing the relationship of fat intake to breast cancer; caffeine and fibrocystic breast disease; alcohol and breast cancer; and cruciferous vegetables and beta carotene. We also know that we should eat lots of leafy greens and organic foods to limit chemical xenoestrogens, etc. Chinese medicine gives us another piece of information: maintaining the health of our spleen and stomach is one of the most important things we can do to prevent breast disease or, indeed, any kind of disease, because the spleen is central to the production of qi and blood, proper movement and transformation of fluids, and as a counterbalance to liver pathology.
What does Chinese medicine suggest in terms of a diet that supports the health of the spleen? Between 40-50% fresh, lightly-cooked vegetables; 30-40% well-cooked grains of all types; not too many bread (flour) products; 10% well-cooked meats; and 10-15% everything else (dairy, fruits, nuts, sweets, oils, etc.).
Exercise. Exercise controls stress by letting off steam, just like releasing the valve on a pressure cooker. It stimulates the lungs, which helps keep the liver in check and encourages the smooth and harmonious flow of qi. Exercise also helps prevent blood stasis by keeping qi and blood flowing smoothly.
Relaxation therapy. The other way to get rid of the pressure in a pressure cooker is by turning off the heat. This is analogous to relaxation therapy in our lives. Instead of blowing off steam through exercise, we can turn off the heat.
Self massage. Breast massage has been suggested in a number of publications in China. It involves 100 gentle circles in each direction over the breasts once per day. I would recommend this for any woman with higher risk factors for breast cancer and for any woman willing to take the time. This is obviously meant to keep the qi and blood circulating freely throughout the breast channels and vessels and prevent stagnation and stasis.
Herbal medicine. I am not trained in the use of internally administered Chinese medicinals. However, it is well known in the Chinese medical literature that dandelion (herba taraxaci mongolici cum radice/pu gong ying) has a special tropism for the breasts. One may use it either fresh or dried; it can also be used in congee, stir-fried greens, tea or wine. It clears heat, nourishes yin, resolves fire toxins, rectifies the qi, and scatters nodulation. There are several recipes for using dandelion as a simple home remedy, and this medicinal appears in many standard Chinese formulas used for treating breast disease.
- Dan-xi Z. Extra Treatises Based on Investigation and Inquiry. Boulder, CO: Blue Poppy Press, translated by Yang Shou-zhong and Duan Wu-jin.
- Ibid, p. 64.
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