abstracted & translated by
Bob Flaws, L.Ac.

On page 37 of issue 6, 2009 of Gan Su Zhong Yi (Gansu Chinese Medicine), Zhang Bao-hong published an article titled, "The Treatment of 92 Cases of Fibrocystic Breast Disease with Modified Xiao Yao San." A summary of this article is presented below.

Cohort description:

All the women in this single-wing cohort study were 21-48 years of age. In 47 cases, the course of disease was less than one year, in 33 cases, it was 1-2 years, and in 12 cases, it was more than two years. All these women were married. Sixteen cases experienced single-sided disease, while the other 76 cases experienced bilateral disease.

Treatment method:

All participants in this study were orally administered the following modified version of Xiao Yao San (Rambling Powder):

Chai Hu (Radix Bupleuri), 12g
Bai Shao (Radix Alba Paeoniae), 15g
Bai Zhu (Rhizoma Atractylodis Macrocephalae), 15g
Dang Gui (Radix Angelicae Sinensis), 15g
Fu Ling (Poria), 15g
Gan Cao (Radix Glycyrrhizae), 10g
Xiang Fu (Rhizoma Cyperi), 15g
Yu Jin (Tuber Curcumae), 15g
Xia Ku Cao (Spica Prunellae), 20g
Ban Xia (Rhizoma Pinelliae), 15g
Zhe Bei Mu (Bulbus Frtillariae Thunbergii), 15g
Shan Ci Gu (Pseudobulbus Cremastrae/Pleionis), 20g
Gua Lou (Fructus Trichosanthis), 20g
Li Zhi He (Semen Litchi), 15g

Modifications:

If aching and pain were marked, 15 grams of Yan Hu Suo (Rhizoma Corydalis) and 12 grams of Jin Yin Hua (Flos Lonicerae) were added.

If lumps were relatively large and hard to disperse, 15 grams each of blast-fried Chuan Shan Jia (Squama Manitis) and Dan Shen (Radix Salviae Miltiorrhizae) were added.

If qi vacuity was marked, 20 grams each of Dang Shen (Radix Codonopsis) and Huang Qi (Radix Astragali) were added.
One packet of these medicinals was decocted in water per day and the resulting medicinal liquid was administered in two divided doses. One month equaled one course of treatment, and 1-3 courses were given before analyzing outcomes.

Study outcomes:

Outcomes criteria were based on Zhong Yi Bing Zheng Zhen Duan Liao Xiao Biao Zhun (Criteria for Chinese Medical Disease & Pattern Diagnosis and Treatment Efficacy). Cure was defined as complete disappearance of breast lumps and pain. Improvement was defined as a marked shrinkage in breast lumps and decrease or disappearance of pain. No effect was defined as no change in either the breast lumps or the pain. Based on these criteria, 41 cases (44.6%) were judged cured, 45 cases (48.9%) improved, and only six cases (6.5%) got no effect. Therefore, the total effectiveness rate was published as 93.5%.

Discussion:

According to Dr. Zhang, FBD is due to unfulfilled desires or other psycho-emotional stress resulting in liver qi depression and binding. Hence, the qi mechanism is blocked and stagnant. In addition, thinking and worry damages the spleen resulting in the spleen's loss of fortification and movement. Thus phlegm turbidity is engendered internally. Liver depression and phlegm congelation, qi and blood stasis and stagnation block the network vessels of the breasts and this is what Dr. Zhang believes causes the occurrence of this condition. It is also possible for loss of regulation of the chong and ren to lead above to breast phlegm turbidity congealing and binding and hence the occurrence of this disease. Nevertheless, Dr. Zhang says that the main disease mechanism of this condition is loss of regulation of the mind with liver qi depression and binding and qi and blood not flowing easily or smoothly. Therefore, she believes that treatment principles for dealing with FBD should be to course the liver and rectify the qi, move the qi and resolve depression, soften the hard and scatter binding.

Within the above formula, Chai Hu, Xiang Fu, and Zhi Ke (Fructus Aurantii, sic)course the liver and rectify the qi to smooth the liver's depression and binding. Dan Shen, Yu Jin, and Yan Hu Suo quicken the blood and move the qi. Shan Ci Gu, Li Zhi He, Gua Lou, blast-fried Chuan Shan Jia, and Zhe Bei Mu soften the hard and scatter binding, free the flow of the channels and quicken the network vessels. If liver depression transforms heat, one commonly sees yin vacuity and liver fire effulgence. Therefore, Dr. Zhang uses Bai Shao, Sheng Di Huang (uncooked Radix Rehmanniae, sic), and Xia Ku Cao to nourish liver yin, clear liver heat, and relax liver urgency. If liver depression is severe, one can also have wood assailing spleen earth with the spleen and stomach's loss of duty. Therefore, she uses Bai Zhu, Ban Xia, Fu Ling, and Gan Cao to fortify the spleen and boost the stomach, dry dampness and transform phlegm. If one then further modifies this formula to fit the patient's patterns, the medicinals and the patterns mutually correspond and so this protocol achieves very satisfactory therapeutic effects. At the same time, the patient should be counseled to reduce her emotional tension and to decrease her consumption of stimulating foods. This will increase the therapeutic effects.

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