Department of Acupuncture, Chenzhou Hospital of Traditional Chinese Medicine, Hunan 423000, China

CLINICAL STUDY

Clinical Observation on Combination of Acupuncture and Medication in Treating Breast Hyperplasia

Zhou Li

Department of Acupuncture, Chenzhou Hospital of Traditional Chinese Medicine, Hunan 423000, China

Author:Zhou Li, master student, associate chief physician.

E-mail: zl102727@163.com

Objective: To observe the clinical efficacy of acupuncture combined with medication in treating breast hyperplasia.

Methods: One hundred patients with breast hyperplasia who met the inclusion criteria were randomly divided into an acupuncture combined with traditional Chinese medicine (A&TCM) group and a traditional Chinese medicine (TCM) group, 50 cases in each group. The A&TCM group received acupuncture combined with oral TCM; the TCM group only received oral TCM. After two courses of treatment, the efficacy was observed.

Results: During the two treatment courses, the recovery rates had been increasing in both groups. The recovery rate of the A&TCM group was 40.0% and the total effective rate was 98.0%. While the recovery rate of the TCM group was 18.0% and the total effective rate was 80.0%. According to statistical analysis, the differences of recovery rate and total effective rate between the two groups were statistically significant (P＜0.01).

Conclusion: Combination of acupuncture and TCM is more effective than simple oral TCM.

Acupuncture Therapy; Acupuncture Medication Combined; Fibrocystic Breast Disease

Breast hyperplasia is one of the most common female breast diseases, and its main manifestations are breast tenderness and lump. In recent years, because of people’s gradual awareness about breast hyperplasia, most of the patients may visit a doctor timely when they find breast discomfort. I used acupuncture combined with traditional Chinese medicine (TCM) to treat breast hyperplasia, and compared it with oral TCM, and the reports are summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria[1-2]

The diagnostic criteria were referring to theTraditional Chinese Medicine Criteria of Diagnosis, Differentiation and Evaluation of Breast Hyperplasiapassed by the 8th conference in 2002 by the Specialty Committee of Bread Disease, Chinese Society of Surgery. Firstly, there are distending, stabbing and dull breast pain of different degrees, which may radiate to the arms, shoulder and back, and also may be correlated with menstruation and mood swings. The pain may be consecutive for 3 months or may be intermittent for 3-6 months without any relief; secondly, there is single ormultiple lumps in unilateral or bilateral breasts which vary in size and shape, and may disperse in the entire breast, and have unclear boundaries, but they are not attached to the skin and deeper tissue and usually movable; there may be tenderness and size changes depending on mood and menstrual cycles, some patients may even have nipple discharge or itching.

1.2 Inclusion criteria

Those who met the diagnostic criteria; age between 20 and 50 years old; diagnosis confirmed by X-ray mammography, ultrasound, fiberoptic duct endoscopy, fine needle aspiration cytology or histology tests; having signed informed consent forms.

1.3 Exclusion criteria

Patients with early breast development before menarche, gynecomastia or breast benign and malignant tumors.

1.4 General data

Inpatients or outpatients in our hospital between May 2008 and May 2011 were enrolled. According to the visiting sequence, they were randomly divided into an acupuncture combined with TCM (A&TCM) group and a TCM group, following the random number table, 50 cases in each group. The cases of the A&TCM group aged from 23 to 50 years old, with average of (31±5) years old; the shortest disease duration was 4 months, and the longest was 10 years, with the average of (24.15±10.87) months. As to the TCM group, aged from 25 to 49 years old, with the average of (32±6) years old; the shortest duration was 4 months, the longest was 9 years, with the average of (28.61±19.32) months. There were no statistically significant differences between the two groups in age and duration (P＞0.05), therefore they were comparable.

2 Therapeutic Methods

2.1 A&TCM group

2.1.1 Acupuncture therapy

Major acupoints: Renying (ST 9), Wuyi (ST 15), Danzhong (CV 17), Hegu (LI 4), Jianjing (GB 21), Tianzong (SI 11), Ganshu (BL 18), Shenshu (BL 23).

Adjunct acupoints: Taichong (LR 3) was added for liver qi stagnation; Pishu (BL 20) and Fenglong (ST 40) were added for phlegm stagnation; Taixi (KI 3) and Sanyinjiao (SP 6) were added for disharmony between the Thoroughfare Vessel and the Conception Vessel[3].

Operation: After routine disinfection in point skin area, punctured the above-mentioned points with disposable sterile acupuncture needles of 0.30 mm in diameter and 40 mm in length. After the arrival of qi, reducing manipulation was used for Danzhong (CV 17), Taichong (LR 3) and Fenglong (ST 40), and reinforcing manipulation for Pishu (BL 20) and Taixi (KI 3), even reinforcing-reducing manipulation for other points. And the needling sensations in Renying (ST 9), Wuyi (ST 15) and Zusanli (ST 36) were required to radiate to the breast. Retained the needles for 20-30 min. Meanwhile, lifted, thrust, twisted and twirled the needles 2-3 times to strengthen the sensation. Treat the patient once per day, and 10 times made up a course of treatment, and there was a 3-day rest between two treatment courses.

In addition, stop the treatment during menstruation and observed the efficacy after two courses of treatment.

2.1.2 Oral TCM

Ingredients:Chai Hu(Radix Bupleuri) 10 g,Dang Gui(Radix Angelicae Sinensis) 10 g,Bai Shao(Radix Paeoniae Alba) 10 g,Fu Ling(Poria Cocos) 10 g,Bai Zhu(Rhizoma Atractylodis Macrocephalae) 10 g,Gua Lou(Fructus Trichosanthis) 15 g,Bei Mu(Bulbus Fritillariae Thunbergii) 10 g,Ban Xia(Rhizoma Pinelliae) 15 g,Shan Ci Gu(Bulbus Iphigeniae Indicae) 10 g,Xiang Fu(Rhizoma Cyperi) 10 g,Chuan Lian Zi(Fructus Toosendan) 10 g,Dan Shen(Radix Salviae Miltiorrhizae) 30 g.

Dosage and administration: Decoct one package in water for oral admnistration, twice a day, morning and night, 15-day treatment per month as a treatment course, 2 courses in total. Stop the treatment during menstruation.

2.2 TCM group

The patients in the TCM group were only treated with TCM which was the same as that of the A&TCM group.

3 Therapeutic Efficacy Evaluation

3.1 Observation indexes

The symptoms were observed before and after the treatment, including breast pain, breast lump, menstruation and the adverse reactions after treatment. In addition, the patients had breast ultrasound examination before and after treatment.

3.2 Therapeutic efficacy criteria[2]

Therapeutic efficacy criteria were referring to theTraditional Chinese Medicine Criteria of Diagnosis, Differentiation and Evaluation of Breast Hyperplasia.

Recovery: Breast lumps and pain disappeared; there was no recurrence during 3 months after treatment.

Marked effect: The maximum diameter of breast lumps narrowed by more than 1/2, and breast pain disappeared.

Improved: The maximum diameter of breast lumps reduced by less than 1/2, and breast pain relieved; or the maximum diameter of breast lumps reduced by more than 1/2, but breast pain relief was not obvious.

Invalid: Breast lump showed no change or even became harder and bigger, or only the breast pain relieved.

3.3 statistical methods

The SPSS 18.0 software package was used for statistical analysis, and Chi-square test was used for the rate comparison.

3.4 Therapeutic results

Clinical efficacy of both groups were evaluated respectively before treatment and after 0.5, 1, 2 courses of treatment. The results indicated that the recovery rates of both groups had been increasing during the two treatment courses, the longer the treatment, the higher the recovery rate. Both of the recovery rate and the total effective rate of the A&TCM group were higher than those of the TCM group, and there were significant differences between the two groups (bothP＜0.01).

Table 1. Two groups comparison of clinical therapeutic efficacy (case)

3.5 Adverse reactions

After treatment, there was no obvious adverse reaction in the A&TCM group, while there were 10 cases of epigastric pain in the TCM group.

4 Discussion

Breast hyperplasia is more common in middle-aged women, which is called ‘Ru Pi’ in TCM. In traditional Chinese medical theory, its pathogenesis is liver qi stagnation, disharmony between the Thoroughfare Vessel and the Conception Vessel, Phlegm stagnation and blood stasis, as well as meridian blockage, resulting in lumps and pain in breast. Therefore, the key of the treatment should be dredging, regulating, dispersing and purging[4-6]. This disease mainly involves the breast, but also has close relationship with the liver, spleen and kidney. The blood is the essence in women, and the liver stores blood and governs dispersion, and it prefers free activity and dispersion, and qi is the commander of blood, thus normal movement of qi ensures normal circulation of blood while stagnation of qi leads to stasis of blood. If liver qi is normal and emotion is relaxed, qi and blood will flow smoothly; if liver cannot disperse and liver qi stagnates, qi will stagnate and result in blood stasis. Over time, liver-qi stagnation transforms into fire or sudden violent anger damages the liver, the liver yin will be damaged, causing liver qi invading the spleen and dysfunction of spleen in transportation, which finally leads to phlegm and damp. And blood stasis and phlegm can knot together in the breast and form lumps, resulting in breast hyperplasia. Due to the complexity of the pathogenesis of breast hyperplasia, its clinical manifestations and accompanied symptoms are diverse, and most of the patients often present with many other symptoms including distending or stabbing breast pain before or after menstruation, irregular menstruation, constipation, facial pigmentation, black rim of the eyes, and a purple and dark tongue with white or yellow greasy tongue coating.

Liver qi stagnation is the main pathogenesis of this disease, thus puncturing Danzhong (CV 17) and Ganshu (BL 18) can disperse liver qi and remove lumps. Because the Stomach Meridian of Foot Yangming goes through the breasts, puncturing Renying (ST 9), Wuyi (ST 15) and Zusanli (ST 36) can disperse qi of Yangming Meridian as well as the qi and blood in the chest so that to make qi flow smoothly, regulate qi and blood into harmony, and dredge phlegm and dampness to kill the pain. Ask patients orally take TCM to tonify the spleen and harmonize Ying-nutrient. Add acupoints and herbs based on syndrome differentiation to strengthen the effect of dispersing liver qi, nourishing spleen and expelling phlegm, and regulating the Thoroughfare Vessel and the Conception Vessel. The combination of acupuncture and TCM not only can expel the obstruction of meridians in breast, but also can disperse the liver and tonify the spleen and kidney, treat both symptoms and root causes, the breast lumps and pain can be cured. It is thought in modern medicine that this disease is related to endocrine dysfunction. Modern studies have shown that puncturing Renying (ST 9), Zusanli (ST 36), Ganshu (BL 18), Danzhong (CV 17) and Shenshu (BL 23) canregulate women’s endocrine system[7-9]; meanwhile, puncturing Ganshu (BL 18) and Shenshu (BL 23) also has beneficial adjustment effect on hypothalamicpituitary-ovarian axis[10-11]. Beneficial stimulation to the points and the continuing effect of the herbs can remove aging and proliferating cells and regulate women's endocrine function, so the lumps of patients with breast hyperplasia can disappear or shrink.

This clinical observation suggests that the combination of acupuncture and TCM is more effective for breast hyperplasia than simple oral TCM, and it has no side effects, therefore it is worthy of clinical application. However, syndrome differentiation and treatment should be paid much attention, for there will be better clinical effect if adding points and herbs based on syndrome differentiation.

Conflict of Interest

There is no potential conflict of interest in this article.

Acknowledgments

This work was supported by Chenzhou Hospital of Traditional Chinese Medicine.

Statement of Informed Consents

All of the patients signed the informed consent.

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Translator:Deng Ying

R246.2

: A

Date:October 20, 2013