Prescription
Main formulas
Gui zhi tang and zheng qi tian xiang san
Alternative formula
Jing fang bai du san
Modifications
Patent remedy
Main points
Explanations
Alternative points
Modifications
Stagnation of Liver-Qi
Symptoms and signs
Principle of treatment
Prescription
Main formula
Xiao yao san
Alternative formulas
Chai hu shu gan san
Jia wei xiao yao san
Modifications
Patent remedies
Main points
Explanations
Alternative points
Modifications
Diagnosis
Principle of treatment
Herbal treatment
Xiao yao san
Explanations
Acupuncture treatment
Explanations
Accumulation of Damp-Phlegm in the collaterals
Symptoms and signs
Principle of treatment
Prescription
Main formula
Xiao luo wan
Alternative formula
Dao tan tang
Modifications
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Breast pain
Cinnamon Twig Decoction and Correct Qi Heaven Fragrant Powder. The first formula is specifically used to dispel Wind-Cold and relieve the External symptoms. It doesn’t have a specific function for relieving the breast pain. When there is invasion of External Wind-Cold to the body, it could cause stagnation of Qi resulting in different pain. Therefore a formula has to be applied to promote the Qi circulation and relieve the pain at the same time.
The second formula is particularly used to promote the Qi circulation and to relieve pain, such as breast pain and abdominal pain. Since this kind of Qi stagnation is not caused by disorder of the Liver, so Xiao Yao San is not indicated in this case.
Schizonepeta and Ledebouriella Tablet to Overcome Pathogenic Toxin. This formula can also dispel the External Wind and eliminate the Cold, and its special function is to relieve the general body pain or joint pain. When it is used to treat breast pain, ZHENG QI TIAN XIANG SAN Correct Qi Heaven Fragrant Powder could be applied at the same time.
1. If there is severe breast pain, add Yan Hu Suo Rhizoma Corydalis 10g to invigorate the Qi and Blood circulation and stop the pain
2. If there is severe cramp in the breast, increase the dosage of Bai Shao Radix Paeoniae Alba to 15g and add Zhi Gan Cao Radix Glycyrrhizae Praeparata 6g to moderate the speed of Qi circulation and harmonise the collateral so as to stop the pain
3. If there is a severe aversion to cold, add Zhi Fu Zi Radix Aconiti Praeparata 10g to expel Cold and warm the channels
4. If there is lower abdominal pain, add Xiao Hui Xiang Fructus Foeniculi 5g and Rou Gui Cortex Cinnamomi 5g to warm the Lower Burner and Kidney and disperse Cold.
Jing Fang Bai Du Pian Schizonepeta and Ledebouriella Tablet to Overcome Pathogenic Toxin.
LI-4 Hegu, TE-5 Waiguan, BL-12 Fengmen, LU-7 Lieque, PC-6 Neiguan and CV-17 Tanzhong. Reducing method is used on these points. Moxibustion is employed on the first four points.
• Invasion of External Cold causing breast pain usually has an acute onset. LI-4, TE-5 and LU-7 are used here to promote sweating in order to dispel the External Cold
• BL-12 dispels Wind and relieves External symptoms
• CV-17 and PC-6 regulate the Qi circulation in the chest and breast, and harmonise the collateral and channels in order to eliminate blockage in the breast
• Moxibustion dispels Cold and warms the channels.
ST-15 Wuyi, ST-16 Yingchuang, ST-18 Rugen, ST-36 Zusanli, ST-40 Fenglong, SP-17 Shidou, SP-18 Tianxi, SP-19 Xiongxiang, SP-20 Zhourong, KI-23 Shenfeng, KI-24 Lingxu and KI-25 Shencang, etc.
1. If there is severe breast pain, add PC-4, the Accumulation point of the pericardium channel, and ST-40, the Connecting point of the Stomach channel, to harmonise the collateral and sedate the pain
2. If there is generalised body pain, add BL-63 and BL-64, the Accumulation point and the Source point of the Bladder channel respectively, to eliminate the pathogenic factors at the Greater Yang level of the body and relieve the pain
3. If there is distension of the breast, add LR-14, the Front Collecting point of the Liver, to promote the Qi circulation and relieve the distension
4. If there is nausea and vomiting, add CV-12, the Front Collecting point of the Stomach, to harmonise the Stomach and cause the Stomach-Qi to descend.
Distension and pain in the breast, with aggravation before menstruation and alleviation after menstruation, pain related to the emotional situation, possible formation of soft nodules in the breast, accompanied by irritability, hypochondriac pain and distension, depression, a feeling of oppression across the chest, insomnia, a normal-coloured tongue with a white coating, and a wiry and tight pulse.
Smooth the Liver and circulate the Qi, relieve stagnation and sedate the pain.
Free and Relaxed Powder. This formula can harmonise the Liver and smooth the emotions, indicated in stagnation of Liver-Qi. When there is breast pain, which is related with emotional instability, this is a very good formula. Some other herbs should be added to strengthen the therapeutic result, such as Chuan Xiong Rhizoma Ligustici Chuanxiong 10g, Dai Dai Hua Flos Citri Aurantii 5g, Zhi Qiao Fructus Aurantii 10g and Xiang Fu Rhizoma Cyperi 10g.
Bupleurum Soothing the Liver Powder. This formula strongly promotes the Qi circulation and relieves the breast pain; however, its function to smooth the Liver is not as strong as the one above.
Augmented Rambling Powder. This formula is based upon XIAO YAO SAN Free and Relaxed Powder by adding Mu Dan Pi Cortex Moutan Radici and Zhi Zi Fructus Gardeniae, indicated in stagnation of Liver-Qi with formation of Heat or Fire in the Liver.
When there is stagnation of Liver-Qi for a long time, there is usually gradual formation of Heat or Fire in the Liver, causing Irritability, nervousness and headache, etc. In these circumstances, this formula could be applied. Xiao Ku Cao Spica Prunellae 10g, Chi Shao Yao Radix Paeoniae Rubrae 10g and Huang Qin Radix Scutellariae 10g could be added to clear the Heat, reduce the Fire in the Liver and calm the Liver.
When there is formation of Liver-Qi stagnation for a long time, there will be a possible gradual stagnation of Blood in the Liver, channels and collaterals. This formula is based upon XIAO YAO SAN Free and Relaxed Powder by adding Yuan Zhi Radix Polygalae Tenuifoliae, Tao Ren Semen Pruni Persicae, Su Mu Lignum Sappan and Hong Hua Flos Carthami Tinctorii. Therefore, it is much more effective at promoting the Qi and Blood circulation than XIAO YAO SAN.
1. If there is severe breast pain, or severe distension of the breast, add Chuan Lian Zi Fructus Meliae Toosendan 10g and Qing Pi Pericarpium Citri Reticulatae Viride 10g to break up Qi stagnation in the Liver and stop the pain
2. If there is an occasional stabbing pain in the breast, add Yan Hu Suo Rhizoma Corydalis 10g to promote the Blood circulation and relieve the pain
3. If there are nodules in the breast, add Yu Jin Radix Curcumae 10g and Gua Lou Fructus Trichosanthis 10g to promote the Qi circulation, soften the hard lumps and relieve the pain
4. If there are red spots on the breast or nipples, add Long Dan Cao Radix Gentianae 5g to clear the Heat in, remove the Toxin and eliminate the red spots
5. If there is irritability and headache, add Sheng Di Huang Radix Rehmanniae 12g to clear the Heat in the Liver, calm the Shen and relieve the headache.
6. If there is a bitter taste in the mouth, add Jin Qian Cao Herba Desmodii Styracifolii 10g to clear the Heat in the Liver and Gallbladder and remove the bitter taste
7. If there is breast pain radiating to the arm, add Tan Xiang Lignum Santali 3g and Dan Shen Radix Salviae 10g to promote the Blood circulation in the Heart and relieve the pain
8. If there is insomnia and restlessness, add Duan Long Gu Os Draconis 15g and Huang Lian Rhizoma Coptidis 5g to clear the Heat in the Heart, calm the Shen and improve the sleep
9. If there is nausea and a poor appetite, add Sha Ren Radix Aenophorae 5g to harmonise the Stomach and improve the appetite
10. If there is irregular menstruation or dysmenorrhoea, add Shu Di Radix Rehmanniae Praeparata 10g and Yi Mu Cao Herba Leonuri 10g to regulate the menstruation and relieve the dysmenorrhoea
11. If there is constipation, add Da Huang Radix en Rhizoma Rhei 10g to promote the defecation and relieve the constipation.
Shu Gan Wan Soothe Liver Pill
Xiao Yao Wan Free and Relaxed Pill.
LR-3 Taichong, LR-5 Ligou, LR-14 Qimen, LI-4 Hegu, PC-6 Neiguan, CV-17 Tanzhong and BL-18 Ganshu. Reducing method is used on these points.
▪ The Liver channel belongs to the Liver and connects to the Gallbladder, penetrating the diaphragm and covering the hypochondriac regions and the chest. Stagnation of the Liver-Qi would cause breast pain, so the key treatment should be to smooth the Liver and circulate the Qi.
▪ LR-3, the Source point of the Liver channel, LR-14, the Front Collecting point of the Liver, and BL-18, the Back Transporting point of the Liver, are used to smooth the Liver and promote the Qi circulation.
▪ LR-5, the Connecting point of the Liver channel, harmonises the collateral and sedates pain in the breast.
▪ PC-6 and CV-17 promote the Qi circulation in the chest and sedate the breast pain.
▪ LI-4 is used to promote the Qi circulation and relieve pain.
LR-8 Ququan, GB-20 Fengchi, GB-40 Qiuxu, HT-3 Shaohai, ST-15 Wuyi, ST-18 Rugen, ST-40 Fenglong, SP-6 Sanyinjiao, SP-18 Tianxi, SP-20 Zhourong, KI-23 Shenfeng and KI-25 Shencang, etc.
1. If there is a feeling of fullness and oppres- sion across the chest, add LU-7 and KI-6 to clear the blockage in the chest and sedate the chest pain
2. If there is severe breast pain, or severe distension, add LR-6, the Accumulation point of the Liver channel, to break up the Qi stagnation of the Liver and stop the pain
3. If there is an occasional stabbing pain in the breast, add BL-17, the Gathering point for the Blood, to promote the Blood circulation and relieve the pain
4. If there are nodules in the breast, add ST-40, the Connecting point of the Stomach channel, to promote the Qi circulation, soften the hard lumps and relieve the pain
5. If there are red spots on the breast, add ST-44 and LR-2, the Spring points of the Stomach channel and Liver channel respectively, to clear the Heat in the Blood, remove the Toxin and eliminate the red spots
6. If there is irritability, add GV-20 to clear the Heat in the Liver, calm the Shen and relieve the irritability
7. If there is a headache, add GV-20 to suppress the Liver-Yang and relieve the headache
8. If there is a bitter taste in the mouth, add GB-40 and GB-43, the Source point and the Spring point of the Gallbladder channel respectively, to clear the Heat in the Liver and Gallbladder and remove the bitter taste
9. If there is chest pain radiating to the arm, add HT-3 and HT-6, the Sea point and the Accumulation point of the Heart channel respectively, to promote the Blood circulation in the Heart and relieve the pain
10. If there is insomnia and restlessness, add HT-8, the Spring point of the Heart channel, to clear the Heat in the Heart, calm the Shen and improve the sleep
11. If there is nausea and a poor appetite, add CV-12, the Front Collecting point of the Stomach, to harmonise the Stomach and improve the appetite
12. If there is irregular menstruation or dysmenorrhoea, add KI-3 and CV-6 to regulate the menstruation and relieve the dysmenorrhoea
13. If there is constipation, add ST-25, the Front Collecting point of the Large Intestine, to promote the defecation and relieve the constipation.
A 35-year-old woman had complained of breast pain for 6 months. In the previous year, her relationship with her husband had been difficult and they often had quarrels. She became depressed and was given medication. Then she developed breast pain, which was worse before menstruation and also in stressful situations. Her gynaecologist and her doctor told her the breast pain was caused by the stress and asked her to continue her anti-depressive medications. Besides breast pain, she had been suffering from other symptoms such as chest pain with a sense of pressure over the chest, insomnia, headaches in the occipital region and sometimes eye pain, irritability, nervousness, tiredness and irregular menstruation for 1 year. Her tongue had a thin and slight yellow coating, a red tip and edges and a slight purple colour at the edges, and a deep, thready, wiry and slightly rapid pulse.
Breast pain due to stagnation of the Liver-Qi with generation of Liver-Fire.
Smooth the Liver, promote the Liver-Qi circulation, harmonise the collateral, reduce the Liver-Fire and relieve the pain.
Free and Relaxed Powder
Chai Hu Radix Bupleuri 6g
Dang Gui Radix Angelicae Sinensis 10g
Bai Shao Radix Paeoniae Alba 12g
Yan Hu Suo Rhizoma Corydalis 10g
Sheng Di Huang Radix Rehmanniae Recens 12g
Xia Ku Cao Spica Prunella 10g
Huang Qin Radix Scutellariae 12g
Ju Hua Flos Chrysanthemi 5g
Xiang Fu Rhizoma Cyperi 10g
Gan Cao Radix Glycyrrhizae 5g.
▪ Chai Hu and Bai Shao smooth the Liver, promote the Liver-Qi circulation and relieve the breast pain
▪ Xiang Fu helps Chai Hu to promote the Liver-Qi circulation and relieve the breast pain
▪ Yan Hu Suo promotes the Qi and Blood circulation and relieves the breast pain
▪ Sheng Di Huang, Huang Qin, Ju Hua and Xiao Ku Cao clear Heat in the Liver, reduce Liver-Fire, sedate the headache and relieve nervousness
▪ Dang Gui nourishes the Liver-Blood and smoothes the Liver
▪ Gan Cao, in combination with Bai Shao, harmonises the Liver and relieves the breast pain.
LR-2, LR-3, LR-5, LR-14, LI-4, PC-6, CV-17, HT-8 and GB-20. Reducing method was used on these points. Treatment was given once every other day.
▪ LR-3, the Source point of the Liver, and LR-14, the Front Collecting point of the Liver, are used to smooth the Liver, promote the Qi circulation and relieve breast pain
▪ LR-2, the Spring point, is used to reduce Liver-Fire and calm the Liver
▪ LR-5, the Connecting point, harmonises the collateral and sedates pain in the breast
▪ PC-6 and CV-17 promote the Qi circulation in the chest and sedate the breast pain
▪ LI-4 promotes Qi circulation, clears Heat in the Liver and relieves the pain
▪ HT-8, the Spring point, clears Heat in the Heart, calms the Mind and improves the sleep.
After treatment for 3 weeks, she was much calmer, her breast pain had begun to diminish, and her sleep pattern and irritability had also improved. Treatment frequency was reduced to once every 3 days, and after another 3 weeks her breast pain had disappeared. She continued with the herbal treatment for another 6 months, during which the other symptoms also resolved.
Gradual onset of breast pain with feelings of fullness, distension and heaviness, and the formation of soft nodules in the breast, accompanied by tiredness, nausea, phlegm in the throat, coughing with expectoration of white phlegm, a feeling of fullness in the stomach region, a poor appetite, loose stools, obesity, somnolence, a white and greasy tongue coating and a slippery pulse.
Resolve the Damp, eliminate the Phlegm, circulate the collateral and sedate the pain.
Reduce Scrofula Pill. This formula eliminates Damp-Phlegm in the collateral, subsides the nodulations and relieves the breast pain. Hou Po Cortex Magnoliae Officinalis 10g, Gua Lou Fructus Tricosanthis 10g, Gui Zhi Ramulus Cinnamomi 5g, Chuan Xiong Rhizoma Ligustici Chuanxiong 5g, could be added to relieve the pain.
Guide Out Phlegm Decoction. This formula has a stronger function than the one above to eliminate Damp-Phlegm in the body; however, its ability to eliminate Damp-Phlegm and harmonise the collaterals is not so strong, therefore some other herbs should be added to the prescription, such as Hou Po Cortex Magnoliae Officinalis 10g, Gua Lou Fructus Tricosanthis 10g, Gui Zhi Ramulus Cinnamomi 5g, Chuan Xiong Rhizoma Ligustici Chuanxiong 5g, Dai Dai Hua Flos Citri Aurantii 5g and Zhi Qiao Fructus Aurantii 5g, to increase the therapeutic result.
1. If there is distension of the breast, add Xiang Fu Rhizoma Cyperi 10g to promote the Qi circulation in the chest and relieve the distension
2. If there are nodules in the breast, add Yu Jin Radix Curcumae 10g and Zhe Bei Mu Bulbus Fritillariae Thunbergii 10g to eliminate Damp-Phlegm in the breast and soften the nodules
3. If there is an occasional stabbing pain in the breast, add Yan Hu Suo Rhizoma Corydalis 10g to promote the Blood circulation and relieve the pain
4. If there is a burning feeling in the breast, add Xia Ku Cao Spica Prunella 10g and Huang Qin Radix Scutellariae 12g to clear the Heat in the breast and remove the Toxin
5. If there is a yellow and greasy tongue coating and a slippery and rapid pulse due to the accumulation of Damp-Heat, remove Tian Nan Xing from the prescription and add Huang Lian Rhizoma Coptidis 5g, Cang Zhu Rhizoma Atractylodis 10g and Zhu Ru Caulis Bambusae in Taeniam 10g to clear the Heat and resolve the Damp
6. If there is depression, irritability and headache, add Gou Teng Ramulus Uncariae cum Uncis 10g to calm the Liver and relieve the headache
7. If there is a bitter taste in the mouth, add Zhi Zi Fructus Gardeniae 9g to clear Heat in the Liver and Gallbladder and remove the bitter taste
8. If there is diarrhoea or loose stools, add Bai Zhu Rhizoma Atractylodis Macrocephalae 10g and Ge Gen Radix Puerariae 10g to activate the Spleen, eliminate the Damp and relieve the diarrhoea
9. If there is nausea and a poor appetite, add Sha Ren Radix Aenophorae 5g to harmonise the Stomach and improve the appetite
