Article 137: Symptoms, Examination, and Traditional Chinese and Western Medicine Treatment of Gynecomastia

◇A Guide to Caring for Your Husband's Health as a Good Wife◇

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Treatment and recuperation of common diseases

Clinical manifestations of gynecomastia

Gynecomastia is more common in men with unilateral breast involvement, accounting for about 90% of cases, while bilateral involvement accounts for about 10%. The course of the disease ranges from several weeks to more than 10 years, with an average of about 3 months.

What tests should be done?

1. For those with discharge, a smear examination can be performed.

2. Considering the possibility of malignancy, fine-needle aspiration cytology can be performed to determine the nature of the mass.

3. All surgically removed masses should undergo pathological examination for differential diagnosis. In addition, liver function tests should be performed to identify possible causes; if thyroid disease is suspected, T3 and T4 levels should be checked; if adrenal disease is suspected, abdominal ultrasound, retroperitoneal pneumography, urinary 17-ketosteroids, and serum electrolytes should be tested; if pituitary or hypothalamic tumors are suspected, fundus examination, skull X-ray, and CT scan should be performed; for patients with significant swelling and pain, a complete blood count should be performed.

How does Western medicine treat this?

Physiological cases usually resolve spontaneously and generally do not require treatment. Drug-induced cases will disappear upon discontinuation of the medication. Pathological cases require treatment of the underlying disease. Treatment options include:

1. Drug treatment:

(1) Tamoxifen: It is an estrogen receptor antagonist. It is effective for estrogen receptor positive patients. The dose is 10 mg twice a day. After clinical cure, the dose is 5 mg twice a day for half a month to one month.

(2) Danazol: 0.2~0.3g each time, twice a day, can reduce the pain and severity of breast enlargement.

(3) Clomiphene: Start with 50 mg daily, then 50 mg orally every other day. If ineffective within 8 weeks, discontinue use.

(4) Androgen therapy: This can be helpful for those with androgen deficiency, but treatment often fails because androgens are converted into estrogens in the body. Testosterone propionate is administered via intramuscular injection at a dose of 25-50 mg, 2-3 times per week. Methyltestosterone is no longer used due to its hepatotoxicity. Non-aromatic androgens-dihydrotestosterone-may be tried.

(5) Testosterone: It can inhibit the aromatization of androgens in the body, thereby reducing the production of estrogen.

2. Surgical Treatment: If a man's breasts are excessively large, causing swelling, pain, and discomfort, and resulting in psychological distress, and medication is ineffective, or if a tumor is suspected, a subcutaneous mastectomy can be performed through an incision under the areola. However, postoperative complications may include nipple inversion or distortion accompanied by decreased sensation, and noticeable scarring. Liposuction can be used to treat male breast development; it is simple and easy to perform, resulting in a natural breast shape and small, inconspicuous scarring.

How does Traditional Chinese Medicine differentiate syndromes and treat diseases?

1. Liver Qi Stagnation and Phlegm Accumulation Type: Symptoms include breast lumps, distending pain, tenderness, accompanied by irritability, anxiety, tension, depression, dark red tongue or ecchymosis, and wiry and thready pulse.

Treatment principle: Soothe the liver and relieve depression, resolve phlegm and dissipate nodules.

Prescription: Bupleurum 10g, Cyperus rotundus 10g, Fritillaria thunbergii 10g, Citrus reticulata peel 10g, Pinellia ternata 10g, Citrus reticulata leaf 10g, Sargassum fusiforme 10g, Laminaria japonica 15g, Prunella vulgaris 12g, Salvia miltiorrhiza 15g, raw oyster shell (decocted first) 30g, Gardenia jasminoides 10g.

2. Spleen and Kidney Yang Deficiency Type: Symptoms include breast enlargement, mild distending pain, normal skin color, sparse facial hair, cold limbs, soreness and weakness of the lower back and knees, decreased libido, impotence and premature ejaculation, pale complexion, clear and copious urine, pale tongue, white coating, and deep and thready pulse.

Treatment principle: warm and tonify the spleen and kidneys, resolve phlegm and dissipate nodules.

Prescription: Epimedium 15g, Curculigo orchioides 15g, Rehmannia glutinosa 15g, Morinda officinalis 10g, Cervi cornu powder 12g, Angelica sinensis 12g, Paeonia lactiflora 12g, Lycium barbarum 12g, Fritillaria thunbergii 10g, Sargassum fusiforme 15g, Laminaria japonica 15g, Ostrea gigas (decocted first) 30g.

3. Liver and Kidney Yin Deficiency Type: Symptoms include breast swelling and lumps, dull pain and discomfort, dizziness and tinnitus, five-center heat (heat in the palms, soles, and chest), irritability and thirst, soreness and weakness of the lower back and knees, night sweats, red tongue with little coating, and thready pulse.

Treatment principle: Nourish the liver and kidneys, resolve phlegm and dissipate nodules.

Prescription: 20g Rehmannia glutinosa, 12g Cornus officinalis, 12g Poria cocos, 10g Alisma plantago-aquatica, 15g Dioscorea opposita, 10g Paeonia suffruticosa, 12g Prunella vulgaris, 10g Fritillaria thunbergii, 15g Sargassum fusiforme, 15g Laminaria japonica, 20g raw oyster shell (decocted first), 10g Bombyx mori, 6g Pangolin scales.

4. Qi stagnation and blood stasis type: Symptoms include enlarged breasts, stabbing pain upon pressure, chest tightness and irritability, dark purple tongue or ecchymosis, thin white coating, and wiry or hesitant pulse.

Treatment principle: Promote the flow of qi and blood, eliminate phlegm and dissipate nodules.

Prescription: Angelica sinensis 10g, Paeonia lactiflora 10g, Salvia miltiorrhiza 15g, Curcuma zedoaria 10g, Sparganium stoloniferum 10g, Curcuma longa 10g, Citrus reticulata seed 30g.