Ji Mai San 蒺麦散:

Case 1 from the practice of Dr. Qiu Xiao-mei

The relationship between the breasts and women’s disharmonies such as amenorrhea, dysmenorrhea and infertility.

Her menstruation came regularly but premenstrually she had breast pain and distention for two weeks.  When her breast was palpated, there were many scattered small seed-like lumps.  The pain extended to below her armpit and when she bent and stretched her arm it was uncomfortable.

Ji Mai San Case Example 1

I treated a woman named Guo who was 35 years old.  She had been married 7 years with no pregnancy.  Her menstruation came regularly but premenstrually she had breast pain and distention for two weeks.  When her breast was palpated, there were many scattered small seed-like lumps.  The pain extended to below her armpit and when she bent and stretched her arm it was uncomfortable.  She had suffered with this for 10 years.  The surgery department diagnosed her with breast lobular hyperplasia.  Her Traditional Chinese diagnosis was breast lump.  Her pulse was deep and thin and her tongue had a thin moss.

I gave her Ji Mai San for two months after which the breast distention, pain and knotting was gone.  She was without discomfort.  I advised her to continue and follow-up in three months.  When I saw her she had not menstruated for 5 days and the urine test came back positive for pregnancy.

Sharon’s commentary:

This case shows not only how Ji Mai San can treat hyperplasia of the breast, it also illustrates the relationship between the presence of breast distention, pain and lumps to infertility.  As Dr. Qiu wrote in the last blog entry, this formula is prescribed to treat the Qi dynamic and, in particular, the Liver Qi.  What is important to see here is that congestion above, in this case in the breasts, indicates stasis and a general lack of receptivity below, in the womb.  In some women this can manifest to the extent that the breasts actually discharge milk while there is amenorrhea below.  The directionality of this formula is downward.  Ji Mai San descends the Qi from the Shao Yang breast area back to the womb.

What I have found in the clinic is that all or parts of Ji Mai San can be used to treat women who are suffering from PMS in which breast distention is a symptom, as well as women suffering from stasis type amenorrhea or infertility.  We will see in some of the cases to come how Dr. Qiu modified and combined Ji Mai San to treat women with combined stasis and phlegm, stasis and congealed blood and stasis and various deficiencies.

Comment from Steven Clavey:

I love Dr. Qiu’s formulas, as they are gentle and so effective. She is an excellent example of the style of Zhejiang gynecology: gentle, even ‘food’ herbs, focus on the interaction between Spleen and Liver (rather than heavily Kidney directed), and a liking for the simple and practical. Good stuff!