Investigation on the Historical Origins of Traditional Chinese Medicine Diagnosis and Treatment of “Ruyong (Breast Abscess)”

Abstract

“Ruyong (breast abscess)” has a high incidence rate. Traditional Chinese medicine (TCM) diagnosis and treatment of this condition demonstrate significant advantages, including diverse therapeutic methods, outstanding efficacy, and high safety. Based on TCM theory and combining relevant ancient texts and modern research, this paper systematically summarizes the different understandings of “Ruyong (breast abscess)” by physicians throughout history in terms of disease names, etiology, pathogenesis, and treatment. The ancient names for Ruyong (breast abscess) were varied, also referred to as “Duru (stagnation in breast)” or “Naichuang (breast sore )”. Its symptoms are diverse, with the main clinical manifestations being localized redness, swelling, heat, pain, and poor milk discharge in the affected breast. The etiology is primarily attributed to “milk stasis” “liver qi stagnation and stomach heat” and “exposure to external pathogens”. Additionally, this paper summarizes the treatment experiences from ancient and modern medical texts and highlights the complementary effects of internal and external therapies. This study provides a reference for modern clinical understanding and treatment of “Ruyong (breast abscess)” in the hope of further improvement of clinical efficacy.

 

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Keywords

Ruyong - breast abscess - Duru (stagnation in breast) - Naichuang (breast sore) - historical origins - disease name - etiology and pathogenesis - treatment methods

Introduction

Ruyong (breast abscess) is a clinically common infectious disease of the breast, primarily manifested as localized redness, swelling, heat, pain, and poor milk discharge in the affected breast, accompanied by systemic symptoms such as chills and fever, fatigue, and general malaise. The discharged pus is typically thick after rupture. This condition occurs most frequently during lactation and, in Western medicine, it is referred to as acute mastitis or acute suppurative mastitis, with a high incidence rate. Cases occurring during lactation are called “external blowing Ruyong (breast abscess),” mostly seen in lactating women within 1 month postpartum, particularly in primiparas,[1] accounting for over 90% of all Ruyong (breast abscess) cases. Cases occurring during pregnancy are termed “internal blowing Ruyong (breast abscess)”. while those occurring outside of both lactation and pregnancy are called “non-lactational Ruyong (breast abscess)”. which is relatively rare in clinical practice.

Overall, Ruyong (breast abscess) has an acute onset and progresses rapidly. If not diagnosed and treated promptly or managed improperly, it may lead to complications such as Chuannang (spreading abscess), mammary Rulou (fistula), or even septicemia. As one of the key conditions effectively treated by traditional Chinese medicine (TCM), this paper investigates the historical origins of Ruyong (breast abscess) and summarizes the different understandings of ancient and modern physicians regarding “Ruyong (breast abscess)”, which aims to provide valuable insights for modern clinical research and therapeutic approaches.

 

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Tracing the Origins of the Disease Name “Ruyong (Breast Abscess)”

Ruyong (breast abscess) has been historically referred to by various names, including “Duru (stagnation in breast)” “Naichuang (breast sore)” “Chuiru (blowing breast)” “Rudu (breast toxins)” “Waichui (external blowing)” “Neichui (internal blowing)” and “Xifeng Henai (exposure to wind and blowing breast)”. The Examination and Standardization of Traditional Chinese Medical Terminology defines it as: “An acute suppurative disease characterized by breast lumps, swelling and pain, and discharge of thick pus after rupture.”[2] The term “Ruyong (breast abscess)” as a TCM disease concept can be traced back to The Explanations of Names (Shi Ming) compiled during the Eastern Han Dynasty, which records: “Ruyong (breast abscess) is called ‘Du’. Du means stagnation. When qi accumulates and stagnates, it leads to swelling and ulceration.” This suggests that “Ruyong (breast abscess)” and “Du” were considered the same condition, with “qi stagnation and obstruction” as its pathogenesis and “swelling and ulceration” as its symptoms. Earlier, the Han dynasty bamboo slips, The Book of Pulses (Mai Shu), briefly mentioned that “Ruyong (breast abscess)” causes intoxication, but only indicated the disease location and type, leaving its full meaning unclear.

Among surviving medical texts, the name “Ruyong (breast abscess)” was first recorded in Mi Huangfu's A-B Classic of Acupuncture and Moxibustion (Zhenjiu Jiayi Jing) of the Jin Dynasty: “For Ruyong (breast abscess) with heat, Zusanli (ST-36) is the primary acupoint.” It further describes symptoms such as “chills, fever, and unbearable pain,” confirming fever and pain as key clinical manifestations. However, Mi Huangfu did not elaborate on its etiology or pathogenesis. In contrast, Jin Dynasty physician, Hong Ge, in his Handbook of Prescriptions for Emergencies (Zhouhou Beiji Fang), was the first to discuss the cause of Ruyong (breast abscess): “When breast milk fails to be discharged and accumulates internally, it is called ‘Duru (stagnation in breast)’, which rapidly progresses into an abscess”. This passage explicitly links “Duru (stagnation in breast)” to the lactation period, attributing the condition to milk stasis. The use of “rapidly” highlights its acute onset. Hong Ge's description appears to standardize “Duru (stagnation in breast)” as the proper term for lactational Ruyong (breast abscess), influencing later medical texts to adopt “Duru (stagnation in breast)” specifically for cases occurring during breastfeeding.

Subsequent physicians further developed and refined the understanding of the term “Ruyong (breast abscess)” based on these foundations. Yuanfang Chao of the Sui Dynasty first proposed in the Treatise on the Origins and Symptoms of Diseases (Zhubing Yuanhou Lun) the concept of “developing Ruyong (breast abscess) during pregnancy…,” referring to internal blowing breast abscess (Neichui Ruyong). Ziming Chen of the Song Dynasty, in the Complete Effective Prescriptions for Women's Diseases (Furen Daquan Liangfang), further classified the condition into “Chuinai (blowing breast)” “Duru (stagnation in breast)” and “Ruyong (breast abscess)” according to its different manifestations at various stages. Formulas from Benevolent Sages Compiled during the Taiping Era (Taiping Shenghui Fang)·Treatments for Women's Ruyong (Breast Abscess) followed Hong Ge's understanding, stating “when women's milk fails to flow and accumulates internally forming swelling, it is called Rudu (breast toxin).” Complete Effective Prescriptions for Women's Diseases (Furen Daquan Liangfang) provided more detailed classification, proposing that “Chuinai (blowing breast), Duru (stagnation in breast), and Ruyong (breast abscess) are essentially the same condition, differing only in severity—mild cases being Chuinai (blowing breast) or Duru (stagnation in breast), while severe cases become Ruyong (breast abscess).” Tingxian Gong of the Ming Dynasty, in Longevity and Life Preservation (Shoushi Baoyuan), further subdivided acute mastitis into “Neichui (internal blowing)” and “Waichui (external blowing)” based on time of onset, considering the former as Ruyong (breast abscess) during pregnancy and the latter during lactation.

Thus, it can be seen that terms like Duru (stagnation in breast), Naichuang (breast sore), Rudu (breast toxins), Chuinai (blowing breast), Waichui (external blowing), Neichui (internal blowing), though differing in name, all refer to Ruyong (breast abscess), with variations mainly in disease progression and severity.

 

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Etiology and Pathogenesis

TCM's understanding of the etiology and pathogenesis of “Ruyong (breast abscess)” has continuously deepened with medical development. Ancient and modern physicians have offered different interpretations of its etiology and pathogenesis, but most revolve around “milk stasis” “liver qi stagnation and stomach heat” and “exposure to external pathogens”. In modern times, some scholars have explored the pathogenesis from the perspectives of the external environment and microorganisms. For example, Lin and Liu[3] believe that an imbalance in the breast milk microenvironment and microbial flora constitutes an important mechanism in the development of Ruyong (breast abscess). Other scholars have explained the etiology and pathogenesis from the perspective of internal organs and meridians, such as Xu et al.[4] who maintained that the onset of “Ruyong (breast abscess)” is mainly related to functional abnormalities of the stomach meridian of foot-Yangming and the liver meridian of foot-Jueyin. These can be specifically summarized in the following aspects.

Milk Stasis Leading to Heat Transformation

Milk stasis is the most common cause of Ruyong (breast abscess). Improper breastfeeding techniques, cracked and painful nipples causing feeding aversion, or congenital nipple inversion can all obstruct the milk ducts, preventing the discharge of fresh milk. Alternatively, an imbalance between milk production and consumption, where a nursing mother's abundant qi and blood lead to excessive milk accumulation, may result in retained turbid milk when feeding is insufficient. For first-time mothers, underdeveloped milk ducts and tense mammary vessels with inadequate qi and blood circulation can cause sluggish milk flow. Improper weaning methods, such as abrupt cessation of breastfeeding or incomplete drainage of residual milk, may lead to the accumulation of spoiled milk. Chronic milk stasis combined with phlegm–blood stasis, when prolonged, transforms into heat, and intense pathogenic heat can all result in milk stagnation, retention of spoiled milk, heat transformation, and pus formation.[5]

Hong Ge of the Jin Dynasty recorded in the Handbook of Prescriptions for Emergencies (Zhouhou Beiji Fang): “When milk cannot be discharged and accumulates internally, it is called ‘Duru (stagnation in breast)’, which quickly develops into an abscess,” which first proposed milk stasis as the cause of Ruyong (breast abscess). Yuanfang Chao of the Sui Dynasty wrote in Treatise on the Origins and Symptoms of Diseases (Zhubing Yuanhou Lun): “This occurs when a newborn cannot suckle effectively after delivery, or when feeding fails to drain the milk…causing tugging pain that makes the breast too tender to touch,” similarly attributing “Ruyong (breast abscess)” to milk stasis.

From the Tang and Song dynasties onward, discussions about milk stasis-induced Ruyong (breast abscess) largely aligned with earlier views and consistently recognized milk stasis as a key causative factor. For instance, Yin Zan of the Tang Dynasty noted in Tested Treasures in Obstetrics (Jingxiao Chanbao): “If postpartum women do not breastfeed, accumulated milk may also form abscesses.” Ziming Chen of the Song Dynasty stated in the Complete Effective Prescriptions for Women's Diseases (Furen Daquan Liangfang): “For ‘Duru (stagnation in breast)’…at the first signs, manually express the milk or have someone assist in sucking it out. Otherwise, sores with pus may form, and with intense heat, abscesses will inevitably develop.”

Modern scholars, He et al.[6] share similar views with ancient physicians, and believe that any factor causing milk stasis may trigger Ruyong (breast abscess), such as incorrect breastfeeding postures, excessively long intervals between feedings, or breast trauma. Zhang et al.,[7] while summarizing the therapeutic thought of the “Fang's Surgery” of the Yanjing school for lactational breast diseases, explicitly linked the etiology of bloody nipple discharge during lactation to primiparous women's lack of breastfeeding knowledge, which contributes to feeding aversion and milk stasis. First-time mothers, lacking breastfeeding experience while producing colostrum and subsequent milk, are prone to milk stasis if drainage is delayed. Combined with infant crying and the mother's eagerness to feed, inappropriate milk expression methods, such as improper massage, forceful squeezing, or excessive heat application, may cause ductal congestion, edema, and epithelial damage, ultimately leading to retention of spoiled milk, heat transformation, pus formation, and disease onset.[8] [9]

 

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Liver – Stomach Disharmony with Qi Stagnation and Heat Accumulation

Ruyong (breast abscess) is located in the chest and breasts. The nipples are associated with the liver, while the breast pertains to the stomach. In meridian differentiation, the liver and stomach meridians are primarily considered. Milk originates from the spleen and stomach, produced through the transformation of nutrients by these organs, thus, the spleen is also implicated. Therefore, the onset of Ruyong (breast abscess) is often attributed to liver–stomach dysfunction. Dietary irregularities can lead to internal blazing of stomach fire, which ascends along the meridians and scorches the breast collaterals. The pathological progression begins with qi stagnation and heat accumulation, manifesting as milk stasis, distension, and pain. As the condition progresses to the blood level, heat toxins fester, ultimately leading to tissue necrosis and pus formation. In summary, liver qi stagnation marks the onset of Ruyong (breast abscess), exuberant stomach fire drives its progression, and pus formation leading to abscess is the final outcome.

The Spiritual Pivot (Ling Shu)·Meridians states: “The stomach meridian of foot-Yangming…is responsible for blood-related disorders…it courses through the chest and breasts…causing pain on the dorsum of the foot.” This is the earliest documented description of stomach meridian pathology leading to breast pain. Ziming Chen of the Song Dynasty, in the Complete Effective Prescriptions for Women's Diseases (Furen Daquan Liangfang), noted: “Among the thirty-six diseases of women, all arise from exhaustion of the thoroughfare and conception vessels.” He proposed that qi and blood from the thoroughfare vessel transform into milk, which is then transported to the breast via the stomach meridian of foot-Yangming. Obstruction in the stomach meridian or the thoroughfare vessel's qi and blood flow often results in milk stasis. Congzheng Zhang of the Jin Dynasty, in the Confucians' Duties to Their Parents (Rumen Shiqin), documented cases of postpartum women developing liver qi stagnation and blocked milk ducts due to emotional depression.

Modern scholars, such as Jiang,[10] Qiao,[11] Yao,[12] and Wang and Pu,[13] have explored the mechanisms of liver qi stagnation and stomach heat in the pathogenesis of Ruyong (breast abscess) through clinical observations, network pharmacology, and clinical diagnostic approaches. Thus, whether from the meridian perspective emphasizing the roles of the liver meridian of foot-Jueyin and stomach meridian of foot-Yangming in abscess formation, or from the visceral qi–blood perspective discussing postpartum qi–blood imbalance, emotional distress impairing the liver, and dietary irregularities harming the stomach, leading to obstructed liver meridian qi and blocked milk ducts, thereby causing Ruyong (breast abscess). From modern scientific research, the etiology and pathogenesis of Ruyong (breast abscess) invariably revolve around liver qi stagnation and stomach heat.

 

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Exposure to External Pathogens and Accumulation of Heat Toxins

Lactating women are prone to qi and blood deficiency, making exposure to external pathogens another important cause of Ruyong (breast abscess). As Yuanfang Chao of the Sui Dynasty stated in the Treatise on the Origins and Symptoms of Diseases (Zhubing Yuanhou Lun): “Postpartum deficiency makes one susceptible to wind pathogens.” If the breasts are exposed during nursing, wind pathogens can directly invade the liver and stomach meridians. Combined with cracked nipples—like an unguarded gate—external pathogens may infiltrate through the fissures. Alternatively, when an infant sleeps while nursing, the stomach meridian's orifice may be scorched by foul heat from the mouth and nose. These three conditions can all lead to pathogenic heat contending with liver–stomach stagnant fire. Initially, the pathogenic toxins obstruct qi and blood in the milk ducts and cause milk to coagulate into lumps. Subsequently, heat toxins steam and corrode flesh, eventually leading to localized breast redness, swelling, and suppuration. This demonstrates the pathological progression under the combined action of external six excesses and internal emotional/dietary factors: “pathogen invasion and latent onset—heat accumulation in milk ducts—flesh corrosion and pus formation.”

Ziming Chen of the Song Dynasty recorded in the Complete Effective Prescriptions for Women's Diseases (Furen Daquan Liangfang): “Postpartum Chuinai (blowing breast) occurs when the infant suddenly falls asleep while nursing, causing blocked exhalation and untimely milk discharge that accumulates internally, forming hard swelling.” Dezhi Qi of the Yuan Dynasty noted in the Quintessence of External Medicine (Waike Jingyi): “External pathogens invading the breast initially manifest as Chuinai (blowing breast),” identifying pathogenic invasion as one cause of external blowing Ruyong (breast abscess). Zhaozhang Feng of the Qing Dynasty wrote in the Feng's Essential Compendium of Surgical Secrets (Waike Fengshi Jinnang Milu Jingyi): “When the nursing infant has phlegm stagnation and heat breath, sleeping while nursing allows the heat qi to blow inward, forming nodules,” describing how newborns' phlegm and heat toxins can invade milk ducts through the nipple, obstruct the ducts, and cause abscess. Ming Dynasty's Ji Xue in Elaboration on External Medicine (Waike Fahui) and Qing Dynasty's Bingjun Gao in Experience Gained in Treating External Sores (Yangke Xinde Ji) both mentioned maternal infection through the infant's mouth pathogens during nursing.

Modern scholar Zhang[14] emphasizes “milk duct obstruction” as the core pathogenesis, attributable to either liver qi stagnation with heat accumulation or external pathogen invasion. Lin,[15] based on the etiology of “milk stasis” “liver qi stagnation–stomach heat” and “exposure to external pathogens” proposes that “prevention focuses on regulation” and summarizes clinical guidelines for diagnosis and prevention. He classifies causes into “internal” “external” and “non-internal–non-external” factors. “Internal causes involve emotional extremes damaging liver and spleen, with accumulation manifesting externally via meridians; external causes are six excess pathogens entering through skin/meridians, showing cold-like symptoms and local breast lesions; while improper diet and overexertion constitute non-internal–non-external causes.” He proposed that “yin–yang imbalance enables pathogen invasion, making treatment focus not on resisting pathogens but regulating yin–yang to restore visceral balance,” and emphasized prevention through internal and lifestyle regulation to strengthen healthy qi and prevent before disease occur.

In summary, historical records collectively indicate that postpartum blood deficiency deprives the liver of nourishment. Emotional disturbances may disrupt liver qi flow, impair milk discharge; liver–stomach disharmony with liver fire attacking stomach; or external pathogen invasion with heat toxins can all lead to phlegm–heat obstruction of milk ducts, and drive disease progression.

 

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Treatment Methods

TCM has accumulated rich clinical experience in treating Ruyong (breast abscess), which can be broadly categorized into internal treatment, external treatment, and combined internal–external treatment, including oral herbal formulas, topical applications, acupuncture, and massage. The primary treatment principle focuses on dredging and clearing obstructions, aiming to relieve acute pain and promote lactation to reduce swelling.

Internal Treatment Methods

Herbal internal treatment is a commonly used approach in TCM that allows flexible integration of systemic and local therapies. Research shows that while different physicians throughout history employed varying specific treatments for Ruyong (breast abscess), their approaches generally revolved around principles such as promoting lactation to reduce swelling, clearing heat and detoxifying, soothing the liver and purging stomach fire, expelling pus from within, regulating liver qi and activating blood circulation, or warming yang to dissipate nodules. However, notable differences existed in individual physicians' medication preferences. For instance, Yin Zan of the Tang Dynasty recorded in Tested Treasures in Obstetrics (Jingxiao Chanbao): “If pus formation occurs, called Duru (stagnation in breast), which rapidly develops into abscess, Lianqiao decoction should be administered orally to purge heat toxins, combined with external application of powdered Chixiaodou (Vignae Semen) mixed with water for complete recovery. Alternatively, repeatedly express milk manually, or have the infant massage the breast, or have an adult suck out the milky fluid (which resembles pus) after holding water in the mouth.” Qingsou Yang of the Ming Dynasty, however, cautioned against using cooling medications in early-stage Ruyong (breast abscess). As stated in his Empirical Formulas from Immortal Transmission for External Diseases (Xianchuan Waike Jiyan Fang): “For women's Ruyong (Breast Abscess)…at initial onset, cooling medications must never be applied to congeal the condition.” Dezhi Qi of the Yuan Dynasty proposed that early-stage Ruyong (breast abscess) should primarily employ the “dredging” method, valuing “dissipation”. His Essentials of External Medicine (Waike Jingyi) describes white clove powder for this condition: “For women's blowing breast, at initial signs of fever, headache, chills, and breast induration…this formula (white clove powder) can promote lactation, unblock blood vessels, leading to spontaneous resolution.” Zaoge powder was also recommended: “When women exposed to wind have external pathogens invading the breast, initially manifesting as a blowing breast that persists unrelieved and develops into abscess, this formula drains the fluid, disperses wind pathogens through sweating, and achieves natural recovery.” These approaches identified external pathogen invasion as one cause of blowing Ruyong (breast abscess), which maintains dredging and dissipating as fundamental treatment principles.

Modern physicians have adopted the following approaches based on inherited treatment experiences[5] [16]: For liver–stomach stagnant heat syndrome, modified Gualou Niubang Decoction can be used; for intense heat toxin syndrome, modified Wuwei Xiaodu Decoction combined with pus-expelling powder can be used; for deficiency with pathogen stagnation syndrome, modified Tuoli Xiaodu Powder can be used; and for qi–blood stagnation syndrome, modified Sini Powder can be used. National TCM Master, Lin,[17] clinically diagnoses mostly liver qi stagnation syndrome, advocating treatment principles of soothing liver qi stagnation and promoting lactation to reduce swelling. Zhang[14] proposed a dual resolution strategy for early-stage disease—simultaneously releasing the exterior and dispersing pathogens while soothing liver and clearing stomach—clinically favoring modified Chaihu Qinggan Decoction. Lu inherited and developed the formula composition concept from the Orthodox Manual of External Medicine's (Orthodox Lineage of External Medicine) Gualou Niubangzi Decoction, creating an effective clinical formula for Ruyong (breast abscess).[18] Yin et al.[19] innovated upon Wushen Decoction's composition principles to develop Pugongying Gualuo Decoction, establishing a synergistic “moving qi-dredging collaterals-dissipating nodules” therapeutic model. Jin et al.'s[20] Gualou Xiaoyong Decoction, based on “simultaneous liver–stomach regulation” theory, achieves strong anti-inflammatory and lactation-promoting integrated effects through multipathway modulation. Deng[21] applied self-formulated Xiaoru Drink containing large-dose Chishao (Paeoniae Radix Rubra) root (>60 g) to treat 69 patients with 100% total effectiveness. Gao[22] revealed the multitarget mechanisms of Xiakucao (Prunellae Spica) in treating Ruyong (breast abscess) through systematic pharmacological analysis. Xie and Wan,[23] based on TCM surgical characteristics, noted most Ruyong (breast abscess) patients manifest qi stagnation with heat accumulation, treated mainly with heat-clearing and wind-dispersing methods.

Overall, oral herbal treatments for Ruyong (breast abscess) predominantly follow “dredging” and “dissipating” principles with good clinical efficacy. The rich and extensive clinical formula applications have been progressively validated through modern experimental and pharmacological research.

 

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External Treatment Methods

TCM external therapies primarily employ localized treatment and meridian theory, including topical applications, acupuncture, massage, scraping, and cupping. Key acupoints focus on local Ashi points and those along the liver meridian of foot-Jueyin and stomach meridian of foot-Yangming. These methods have achieved certain therapeutic effects for Ruyong (breast abscess), which offers irreplaceable advantages like rapid efficacy, no need to discontinue breastfeeding, simple operation, and good acceptability, and warrants further clinical promotion.

Herbal Topical Applications

Herbal topical treatment for Ruyong (breast abscess) has ancient origins. Qingshou Yang of the Ming Dynasty recorded in the Empirical Formulas from Immortal Transmission for External Diseases (Xianchuan Waike Jiyan Fang): “For women's Ruyong (breast abscess)…at initial onset, cooling medications must never be applied…use equal parts Nanxing (Arisaema cum Bile) and ginger juice with wine for topical application to achieve internal resolution.” Treatment guidelines[5] recommend: For significant skin redness and heat—Yulu Powder, Jinhuang Powder, or Shuangbai Powder mixed with cold boiled water or honeysuckle distillate for topical application; alternatively, fresh chrysanthemum leaves, fresh dandelion, or cactus singly pounded for external use; or Jinhuang Ointment/Yulu Ointment application. For mild or no skin redness—Chonghe Ointment can be used for topical application.

Wan et al.[24] focused on the mechanism research of external therapies. Through a lipopolysaccharide (LPS)-induced rat model, they confirmed that hibiscus gel could significantly inhibit MPO expression and inflammatory factor release in mammary tissues, with its anti-inflammatory effect showing dose dependency. Chen et al.[25] demonstrated in clinical research that anti-inflammatory analgesic ointment combined with Western medicine increased the total effectiveness rate to 92.3%, verifying the synergistic effect of external application. Liu[26] innovatively integrated herbal external application, ductal perfusion, and three-technique therapy, reducing skin temperature normalization time to 24.3 hours with 76.4% C-reactive protein (CRP) decrease while maintaining excellent safety. Mi et al.[27] showed through comparative study that swelling-reducing detoxification ointment was significantly more effective than instrument therapy, with 62.4% reduction in IL-6 levels, highlighting the anti-inflammatory advantages of TCM external treatments. Che[28] dedicated to innovation and evaluation of external treatment techniques, proved that purple-ice oil external application combined with massage shortened treatment course by 41.8% (4.2 vs. 6.8 days) compared with antibiotic therapy, with better breastfeeding safety. Shi et al.[29] systematically evaluated external application protocol of Qingbao Powder, showing 78.4% transdermal absorption rate and 54.3% of 24-hour pain relief rate, which combines operational convenience with cost-effectiveness. Both approaches broke through traditional limitations of external therapies and achieved a balance between efficacy and breastfeeding compatibility. Lyu et al.[30] analyzed mechanisms of classical external formulas and found that Lou's external application formula achieved anti-inflammatory and analgesic effects by regulating thromboxane B2 (TXB2) /prostaglandin F1α (PGF1α) balance and inhibiting cyclooxygenase (COX)-2, with microcirculation velocity increasing by 158 μm·s⁻¹. Wang et al.[31] revealed through analyzing Professor Naiqi Li's formula that Tanxiang (Santali Albi Lignum)–Chenxiang (Aquilariae Lignum Resinatum) combination could regulate 5-hydroxytryptamine (5-HT) to relieve central pain sensitization; Gualou (Trichosanthis Fructus)–Meiguihua (Rosae Rugosae Flos) inhibited NF-κB pathway; and Wuzhuyu (Euodiae Fructus)–Tubiechong (Eupolyphaga Steleophaga) promoted the expression of basic fibroblast growth factor (bFGF) expression. Combined with directional massage, the transdermal rate increased by 38.7%, forming a “herbs-manipulation” synergistic model.

 

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Acupuncture, Massage, and Cupping Therapy

Acupuncture, as a treasure of TCM, has undergone an internationalization process spanning thousands of years with far-reaching influence. Mi Huangfu of the Jin Dynasty recorded in the A-B Classic of Acupuncture and Moxibustion (Zhenjiu Jiayi Jing) the use of acupuncture to treat Ruyong (breast abscess): “For Ruyong (breast abscess) with fever, Zusanli (ST-36) is the main point.” In 2010, “Chinese acupuncture” was inscribed on UNESCO's Representative List of the Intangible Cultural Heritage of Humanity. Currently, acupuncture has spread to 183 countries and regions worldwide, with treatable diseases expanding from 107 in 2002 to more than 460.[32] The World Health Organization has evaluated it as “the most widely used and most accepted traditional medicine.”

Guo and Wu[33] conducted a clinical study on acupuncture therapy. A 48-case randomized controlled trial (RCT) showed that acupuncture at lactation-promoting points combined with Ashi points for early acute mastitis achieved a clinical response rate of 79.2%, with the efficacy increasing to 92.4% for patients with disease duration of ≤3 days. Huang et al.[34] confirmed through meta-analysis that the acupuncture group was significantly more effective than the Western medicine group, and summarized the core acupoint combination: Jianjing (GB21)–Danzhong (RN17)–Rugen (ST18). Chen[35] innovatively combined bloodletting cupping at Tianzong (SI11) with massage at Shaoze (SI1), increasing the clinical remission rate to 98.6% and shortening the milk stasis resolution time to approximately 18.4 hours. Chen et al.[36] found through multimodal intervention research that acupuncture combined with massage significantly improved efficacy compared with single therapy, and reduced breastfeeding-related complications by 67.3%. Hu[37] adopted back-shu point moxibustion, which was proven to reduce visual analog scale (VAS) pain scores by 64.7% and TCM symptom scores by 58.4%. Liao[38] developed an innovative comprehensive physical therapy program, created a seven-step therapy (including acupoint massage and meridian dredging modules). Clinical studies showed that the total remission rate of the treatment group was significantly better than that of the control group, with increased milk sufficiency rate and reduced complication rate. Quantitative evaluation showed that this program reduced VAS scores by 41.3%, increased microcirculation perfusion index by 2.3 times, and achieved a treatment compliance rate of 93.6%, demonstrating good clinical efficacy.

 

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Combined Internal and External Treatment

Although single external treatment or oral Chinese medicine shows significant efficacy in treating Ruyong (breast abscess), comprehensive TCM therapy (oral administration + external treatment) with more outstanding clinical effects has been gradually adopted by more and more modern physicians, which demonstrates considerable clinical application potential.

Du[39] conducted an RCT where the treatment group received Ruyong decoction combined with massage therapy, while the control group received ceftriaxone intravenous drip with an electric breast pump. Results showed significantly higher total effectiveness in the treatment group. Liu et al.[40] confirmed through a 90-case RCT that Xiaoyong Tongru Decoction combined with external application of Furong Powder was significantly more effective than conventional Western anti-infective treatment. Ai[41] demonstrated in an 88-case RCT that the group receiving Ruyongxiao Decoction orally combined with anti-inflammatory ointment topically showed 18.2% higher total remission rate, reduced breast lump resolution time to approximately 3.2 days, and 76.3% decrease in CRP levels compared with antibiotic treatment alone. Chen[42] verified through a 90-case controlled study that Gualou Niubang Decoction combined with topical application of Xiaoyong Ointment improved total effectiveness by 12.4% over oral medication alone. Duan[43] achieved a 93.5% clinical remission rate in early-stage patients treated with acupuncture combined with Gualou Lianqiao Decoction, significantly outperforming the Western medicine group. Liu and Jing[44] found in large-sample research that external application combined with massage improved efficacy by 9.4% and reduced milk stasis resolution time by 41.7%. Huang et al.[45] discovered through a comparative study that adding a herbal external application to massage increased the total remission rate by 16% and reduced the breastfeeding interruption rate by 73.5%. Tang et al.[46] confirmed that manual milk duct clearance combined with high-frequency therapy shortened skin temperature normalization time to approximately 18 hours with a 69.3% reduction in IL-6 levels. Gao et al.[47] innovatively integrated alternating hot–cold compress with Western treatment, reduced breast hardness score by 58.4%, and increased breastfeeding success rate to 92.3%. Kong et al.[48] demonstrated in multicenter research that manual massage combined with antibiotics shortened the treatment course by 32.7% and reduced VAS scores by 64.2% compared with medication alone.

In summary, combined TCM therapies demonstrate significantly higher total effectiveness than Western medicine or single-modality treatments, with more pronounced improvement in inflammatory markers and substantially shortened treatment duration.

 

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Summary

The study of TCM treatment for Ruyong (breast abscess) has developed a unique theoretical system and practical model through millennia of accumulation. Physicians across dynasties progressively refined clinical characteristics and disease staging through differential understanding of alternate terms like “Duru (stagnation in breast)” “Naichuang (breast sore)” “Chuiru (blowing breast)” as the core etiology combined with “liver–stomach heat” and “external pathogen invasion”. a systematic etiology–pathogenesis theory was established. TCM treatment emphasizes syndrome differentiation, adopts principles including promoting lactation to reduce swelling, clearing heat and detoxifying, soothing liver and purging stomach, expelling toxins and promoting tissue regeneration, regulating liver qi and activating blood circulation, and warming yang to dissipate nodules—valuing “dredging” as the method and “dissipating” as the priority, while advocating synergistic effects of internal and external therapies. Modern research further validates the scientific connotation of classical treatments, which shows significant advantages in shortening disease course, enhancing efficacy, and improving safety.[15] The internationalization and modernization of TCM will provide new perspectives for Ruyong (breast abscess) treatment and research, though deeper integration of classical knowledge with modern evidence-based medicine remains to be achieved.

 

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Conflict of Interest

The authors declare no conflict of interest.

CRediT Authorship Contribution Statement

Qi Liu: Conceptualization, funding acquisition, and writing -original draft. ke Li: Formal analysis, and writing-review & editing. Yazhou Han: Investigation, and writing-review & editing. Mingru Wang: Validation, and writing-review & editing. Xufeng Cheng: Formal analysis, methodology, and writing-review & editing.

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Publication History

Received: 21 January 2025

Accepted: 10 March 2025

Article published online:
27 June 2025