A subcutaneous node in the breast refers to the symptom of having lumps of varying sizes in the breast, resembling a kernel, which are movable when pushed.

This condition is referred to as "奶癧" in the "Complete Book of Sore and Wound Doctor," "breast nodule (fibroadenoma of breast)" in "Waike Qixuan," and was first termed "乳中 subcutaneous node" in "Yizong Jinjian."

Some classify "thelorrhagia" and "carcinoma of breast" under the category of subcutaneous nodes in the breast, but from clinical practice, they should be distinguished. However, if a subcutaneous node in the breast does not heal, it can transform over time into "carcinoma of breast." As for "acute mastitis" and "breast gangrene," in the initial stage [first stage], there is a hard lump in the breast with local redness, swelling, heat, and pain, accompanied by fever and chills. These should be considered separately.

bubble_chart Pattern Analysis

1. Liver Qi Depression︰Mostly solitary, palpable like a plum or plum kernel, with clear edges, firm and tough texture, smooth surface, and movable upon pushing, accompanied by irritability, chest and hypochondriac distending pain, thin tongue coating, and wiry pulse. Often caused by emotional distress, liver failing to regulate free flow of qi, leading to qi stagnation, resulting in unilateral subcutaneous nodules in the breast, locally painless, movable upon pushing, relatively firm and tough, often fluctuating with emotional changes. The liver is a firm-characterized zang organ, its vessels distribute to both hypochondria, qi depression failing to disperse, hence dysphoria and irritability, chest and hypochondriac distension. Treatment should focus on soothing the liver and relieving depression, with the formula selection Peripatetic Powder plus Prunella and raw oyster shell, etc.
2. Qi Stagnation and Blood Stasis︰Subcutaneous nodules in the breast are often bilateral, varying in size, and present as nodular masses with fixed stabbing pain. They are slightly firm, and their symptoms fluctuate with the onset of menstruation. The tongue texture is dark with a white coating, and the pulse is wiry and thin. This condition is mostly due to prolonged liver depression and qi stagnation, which leads to blood stasis. The obstruction of qi and blood stasis results in firm subcutaneous nodules in the breast with fixed stabbing pain, often appearing bilaterally. This differs from liver qi depression, which manifests as unilateral, firm, and painless subcutaneous nodules in the breast. Qi stagnation and blood stasis, along with liver blood deficiency and disharmony of the Chong and Ren meridians, cause the breast nodules (fibroadenoma of the breast) to enlarge during menstruation and shrink slightly afterward as qi and blood gradually recover. The tongue texture is dark with a thin coating, and the pulse is wiry and thin. Treatment should focus on soothing the liver and regulating qi, invigorating blood, and resolving stasis. The recommended formulas are Blood House Stasis-Expelling Decoction or Minor Golden Pill with modifications.
3. Phlegm and Qi Stagnation︰It often occurs in the upper inner part of the breast, with a nucleus resembling a plum or apricot. Initially, it is hard but not firm and can be moved when pushed. Over time, the nucleus enlarges and becomes painful, with the skin turning red and feverish, eventually ulcerating and discharging pus resembling rotten cotton. Accompanying symptoms include afternoon tidal fever, vexing heat in the chest, palms, and soles, flushed cheeks, night sweats, soreness and weakness of the waist and knees, a red tongue with greasy coating, and a thin, rapid pulse. This condition is mostly caused by dietary irregularities, which damage the spleen and stomach, impairing their transformative and transporting functions, leading to the accumulation of dampness into phlegm. Phlegm congeals and causes qi stagnation, obstructing the liver collaterals, resulting in subcutaneous nodules in the breast. Over time, qi depression transforms into fire, leading to liver-kidney yin deficiency and yin deficiency with effulgent fire, which scorches the collaterals, causing ulceration and pus discharge. Additional symptoms include afternoon tidal fever, vexing heat in the chest, palms, and soles, night sweats, and waist soreness. In the initial stage [first stage], treatment should focus on regulating qi and resolving phlegm, dispersing nodules, and reducing swelling. The recommended formula is the {|###|}Four Seas Soothe Depression Pill{|###|} combined with the Two Old Ingredients Decoction with modifications. If the condition is due to liver-kidney yin deficiency and yin deficiency with effulgent fire, which consumes body fluids and generates phlegm turbidity, obstructing the collaterals and forming subcutaneous nodules in the breast, the treatment should nourish yin, benefit the kidneys, clear the liver, and drain fire. The recommended formula is the Liver-Clearing and Depression-Resolving Decoction.