Ancient Chinese Medicine and Breast Lumps
Ancient Chinese medicine did not have a concept of cancer or malignancy and could not differentiate lumps according to benign and malignant. However, the doctors were well aware of the seriousness and poor prognosis of certain types of lumps, and Ru Yan indicated a lump which was difficult to treat and often led to death, while Ru Pi corresponds to a benign lump such as those found in fibroadenoma or cysts.
The Concise Dictionary of Chinese Medicine defines Ru Pi as: "a lump (or lumps) in the breast which is like a plum seed or an egg or nodules which feel hard and are painless and mobile. The breast does not feel hot or cold to the touch, the skin color is unchanged and the size of the lump varies according to the mood of the woman." The description of such lumps appeared in the Classic of the Central Treasure of the Han dynasty (206 BC–AD 220). Ru Yan, on the other hand, judging from its descriptions, resembles more closely breast cancer or other types of breast diseases: the hardness of the lump, its lack of mobility on palpation, its progressive increase in size and the nipple inversion all seem to point, although not exclusively, to breast cancer more than to benign tumors.
Clinical Manifestations and Treatment Principles
According to Chen Bai Ming in the Beneficial Formulae of the Great Compendium of Gynecology (Fu Ren Da Quan Liang Fang, 1273), there is a differentiation between breast carbuncle (yong) and lump (yan). Breast carbuncle is characterized by redness, swelling, and heat, while the latter is characterized by its development process: in the beginning, there is a small accumulation like a turtle egg that is not red or painful. After several months, it becomes bigger and the lump breaks up like a ripe pomegranate. This is due to Liver and Spleen being affected by anger, Qi and Blood being exhausted, and it is called Ru Yan.
Prognosis and Prevention
Zhu Dan Xi (Yuan dynasty, 1281–1358) discussed the treatment of breast lumps in detail. He said: "Worry, anger and depression cause accumulation, Spleen-Qi is weakened, Liver-Qi free flow fails, there is a hidden nodule formed like an egg without pain or itching; after several years it forms an ulcer (chuang) and it is called Ru Yan. It looks like an ulcer on the surface and is like a stone in a cavity, it cannot be treated."
During the Ming dynasty, a doctor gave an accurate account of the development of breast lumps. He said: "In the beginning it is like a bean, then like an egg, without pain or itching. The longer it persists, the more the skin becomes yellow and pale. Later it grows bigger like a chicken egg. The skin becomes purple and hard, it is difficult to move on palpation, it is called Ru Yan. It is a very serious illness."
These ancient Chinese descriptions of breast lumps are in accordance with modern Western medicine. The benign Ru Pi corresponds to fibroadenoma or cysts, while the malignant Ru Yan corresponds to breast cancer or other types of breast diseases. The descriptions of the progression of the disease, its spread to the internal organs and its poor prognosis are also in line with modern medical understanding of breast cancer.
Prevention of breast cancer and early detection of breast lumps are crucial for improving prognosis and treatment outcomes. Regular self-examination of the breasts and clinical breast exams by a healthcare provider can help identify lumps or changes in the breasts early on and allow for timely treatment.