Clinical Characteristics Of Plasma Cell Mastitis And Analysis Of Traditional Chinese Medicine

Background:Plasma Cell Mastitis (plasma-cell mastitis PCM) is a kind of non-infectious inflammation, its incidence has been increasing in recent years, the cause of this disease is not clear. PCM diagnosis is mainly relying on clinical features, pathological analysis, but because of its complicated clinical symptoms, there is still a high rate of misdiagnosis. PCM treatment at present is mainly based on surgery, but the breast of patients would be damaged greatly after surgeries. With the improvement of the level of awareness of this disease, more medical workers and patients began to pay attention to the early diagnosis of the disease and more appropriate treatments. The number of patients in our hospital for diagnosis and treatment of this disease is large, but we haven’t reviewed the relevant literature and done the retrospective study. This research review relevant articles, consult experts, sort clinical data, then analysize the general information, disease characteristics, symptoms, examination and etc. This study analysize the TCM treatments of PCM in 111 pieces of Chinese medicine articles, which collected from CNKI、Wanfang Data from January 1996 to 2016 January.Objective:This study focuses on the researches and conclusions of the cases of PCM in Dong fang Hospital of Beijing University of Chinese medicine. I discussed the general information, risk factors, clinical characteristics, diagnosis and treatment, etc. I also discussed retrieval treatments of plasma cell mastitis of TCM literature and the type of syndrome and prescription rules to guide future clinical diagnosis and treatments.Methods:I collected 208 female and 5 male PCM hospitalized cases during September 2004 June 2015 period in Beijing University of Chinese Medicine Dong fang Hospital, then I sorted and analysied those datas. I searched 111 articles about PCM TCM treatment from CNKI and Wanfang Data that published during January 1996 to 2016 January. I then used Excel2010 to do preliminary data collation, data classification and data reconciliation, the data was checked after the original data had been preserved. After importing data into SPSS 19.0,I made chart drawing works and data statistical processing.Result:1. There are 208 female and 5 male cases of plasma cell mastitis, and men accounts for 2.35%.2. In female cases,13-64 years old were observed in this disease, the average age is 33.18. And the peak is at the age of 26-39.3. In female cases, married accounts for 83.65%, unmarried accounts for 16.35%. No pregnancy accounts for 30.77%, pregnant nulliparous accounts for 8.17%, the property side non-lactation accounts for 17.79%, normal lactation accounts for 43.27%. The average breast feeding time is 8.62 months. The time from last production to onset of the disease is 7 years on average. There is one case in lactation.4. Female cases with allergies history accounts for 20.19%, cases with breast surgery history for 4.81%, cases with hypertension accounts for 4.81%, cases with ovary and uterus disease accounts for 4.81%, cases with antipsychotic drug history accounts for 4.33%, cases with pituitary micro adenoma/hyperprolactinemia history accounts for 3.37%, cases with fatty liver accounts for 3.37%, cases with rheumatism accounts for 2.88%.5. In female cases, the average number of body mass index was 24.19 kg/m2, the median was 23.44 kg/m2. Patients whose BMI are more than 24 kg/m2 accounts for 39.26%.6. In female cases, unilateral incidence accounts for 80.29%, bilateral incidence accounts for 19.71%. The left side accounts for 55.29%, the right accounts for 44.71%. Areola accounts for 78.37%, inner upper quadrant accounts for 50.48%.7. In female cases, cases with the nipple retraction in injured breast accounts for 70.66%, cases with nipple retraction in uninjured breast accounts for 29.34%. Through the chi-square test(P=0.045<0.05), the nipple retraction in the injured and uninjured breast have significant difference. Cases with the nipple discharge in injured breast accounts for 43.71% and cases with the nipple discharge in uninjured breast accounts for 11.98%. Through the chi-square test(P=0.000<0.05), the nipple discharge in the injured and uninjured breast have significant difference.8. In female cases,80.29% of patients had palpable masses,28.37% of patients had wave motion,47.12% of patients had redness on the skin,51.92% cases had pressing pain.9. In female cases, patients have higher value on serum prolactin accounts for 24.07%. Patients have high cholesterol accounts for 12.05%. Patients have serum triglyceride accounts for 30.12%.10. Female patients accepted focus resection+galatophore resection+nipple forming at the first stage operation account for 48.08%. Patients that accept debridement, the traditional Chinese medicine dressing treatment, and focus resection+galatophore resection+nipple forming by stages account for 51.92%. All cases were treated with traditional Chinese medicine.11. In female cases,92.86% of the cases were found to have large duct dilatation during the operation,76% of the cases had abnormal secretions.12. Thete 31 female cases who had not received any treatment before admission, and had tumors during the time of admission. The analysis of the characteristic of this group of patients with tumors, such as size, age, BMI value, PRL value, the extent of the affected side of the nipple and the side of the discharge of the correlation did not prove that there is a correlation among them.13. There are 14 TCM Syndrome Types in Chinese medical treatment, among which, "the heat in the liver"," Residual toxin"," Phlegm and blood stasis"," Qi and blood weak" are common. The location elements includes liver, kidney, spleen, stomach and etc. TCM Syndrome Types about liver accounts for 39.29%.14. At present the clinical medication maily uses Yang He soup and soup with Trichosanthes burdock soup.15. The top 20 Chinese medicines in turn are Pu dandelion, bupleurum root, Chinese angelica root, licorice, Chinese honeylocust spine, danshen root, red peony root, honeysuckle, white snake tongue grass, astragalus root, Trichosanthes kirilowii Maxim, baikal skullcap root, haw, pangolin, tuckahoe, Cornu Cervi degelatinatum, forsythia, white Atractylodes rhizome, tangerine peel and Radix Curcumae.16. The clinical medication focuses on antipyretic, tonic, blood stasis. Antipyretic aims at detoxify and heat clearing mainly. Tonic drugs target on qi and blood adjustment.17. The drugs usually are attributed to the liver, lung and stomach meridian.Conclusion:1. PCM sees more in female, and less in male. All ages of females were found to have this disease. But the peak is at the age of 26-39.2. The incidence of PCM is related to the abnormal nipple, high PRL value and obesity.3. Unilateral disease PCM is more common, and the left-side-disease is more common. Lesions located in or near the areola area.4. The ill breasts had different levels of nipple attraction, breast duct dilatation and nipple discharge.5. In different periods, the disease can be showed as nipple discharge, tumors near the areola, abscess, fistula, accompanied by local skin redness, tenderness and axillary lymph node enlargement, among which small lumps are the most common one.6. The lesion of this disease has huge individual differences, and there is no significant correlation between age, BML, PRL level, nipple attraction and nipple discharge.7. PCM treatment mainly uses the debridement, the traditional Chinese medicine dressing treatment, focus resection+galatophore resection+nipple forming, the Chinese medicine oral administration, and we always combined use these four ways..8.The pathological factors of PCM are mainly heat, phlegm and the elements includes liver, kidney, spleen, stomach and etc. So treatments should pay more attention to soothing liver, clearing heat, resolving phlegm and so on.9. The treatments of Yin Syndrome of PCM should base on Yang He soup, and the treatments of Yang Syndrome of PCM should base on Trichosanthes burdock soup.10. PCM should be treated with antipyretics, tonic and blood circulation drugs.11. PCM clinical medication focus on the liver, stomach and lung meridian.