Nipple fissure, also known as nipple rhagade, refers to the occurrence of cracks or erosions on the nipple and areola. It is commonly seen in lactating mothers.

In the literature, this condition is referred to as recurrent headache of the breast, as mentioned in Yangke Xinde Ji: "Recurrent headache of the breast refers to dryness and cracking of the nipple, pain as sharp as a knife cut, bleeding upon wiping, discharge of sticky fluid, or formation of yellow crusts."

bubble_chart Pattern Analysis

1. Liver Depression Transforming into Fire︰The skin on the nipple surface peels off, with cracks of varying sizes, and in severe cases, deep circular fissures may occur along the base of the nipple (the neck of the nipple). During suckling, the pain is as sharp as a knife cut. The nipple and areola may become moist and eroded, with oozing fluid and unbearable itching. The tongue coating is white or yellow and greasy, and the pulse is wiry-slippery or rapid. $liver depression transforming into fire leading to cracked nipples and yin deficiency with blood-heat causing cracked nipples! Both syndromes share common predisposing factors. For example: the nipple skin of lactating women is delicate, or the nipple is flat, retracted, or small, or there is insufficient milk secretion, making it unable to withstand the infant's suckling. However, their mechanism of disease differs. The Yangke Xinde Ji states: "cracked nipple, where the nipple is dry and cracked... This is caused by sudden anger or depression, leading to the discharge of liver channel fire pathogen." The nipple belongs to the liver, and the breast belongs to the stomach, so breast diseases should be attributed to the liver. Sudden anger damages the liver, causing liver qi stagnation, which accumulates and transforms into fire. Qi stagnation leads to dampness, resulting in the coexistence of fire and dampness. Its characteristic is moist, eroded, cracked, and itchy nipples. Clinically, it is often seen in women with obesity and excessive dampness. Treatment should focus on {|104|}clearing the liver and draining fire{|105|}, using the {|106|}Gentian Liver-Draining Decoction{|107|}, with external application of Coptis Rhizome ointment.
2. Yin Deficiency with Blood Heat︰The nipple is cracked, dry, and painful, with bleeding upon wiping or the formation of dry scabs, accompanied by irritability, night sweats, thirst, a red tongue texture, and a thin, rapid pulse. $Liver depression transforming into fire leading to nipple fissures and yin deficiency with blood-heat causing nipple fissures! Both conditions share common predisposing factors. For example: the nipple skin of lactating women is delicate, or the nipple may be flat, retracted, or small, or there may be insufficient milk secretion, making it unable to withstand the infant's sucking. However, their mechanisms of disease differ. The liver is yin in property and yang in function. This condition arises from constitutional yin deficiency, compounded by blood loss during childbirth and breastfeeding, leading to blood deficiency generating wind. Its characteristic features are dryness, cracking, and pain, with bleeding upon wiping. Treatment should focus on enriching yin and clearing heat, using the Angelica Six Yellows Decoction with modifications.