By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
From sandalwood paste to neem, Ayurveda offers a variety of treatment options for breast abscess. Breast abscess is called Stana Vidradhi in Ayurveda.
A special emphasis has been given on the description of stana vidradhi which means breast abscesses and has been elaborated in the ancient texts.
Read – Granthi: Cystic Swelling, Types, Features, Ayurvedic Treatment
According to modern texts and references, breast abscesses are lumps / swelling caused due to infection. They are often called as subareolar breast abscess because they occur beneath the areola. There is collection of pus in the breast tissues along with pain.
Mastitis is an inflammation of the breast or udder. Breast abscess is said to be a complication of mastitis.
In Sushruta Samhita, Madhava Nidana and Bhavaprakasha we can find mention of a disease named ‘Stana Roga’ which actually means ‘disease of breasts’ but describes breast abscesses. Therefore ‘breast disease’ is used interchangeably with ‘breast abscesses’.
Master Vagbhata gives a small description of breast abscesses along with the description of general external abscesses.
Charaka Samhita which deals with general medicine and principle doesn’t give details of these surgical disorders. In fact, master Charaka gives a short description of abscesses in Sutra Sthana chapter 17.
Master Kashyapa has described a disease named ‘stanavajra’ or ‘stanakilaka’ in place of ‘stanavidradhi’.
There is a difference of etiological factors of all these conditions but they seem to be identical conditions. The clinical features of all these conditions are identical.
Classification of breast abscess
According to master Sushruta the same causes and doshas responsible for the causation of general abscesses is also responsible for manifestation of breast disorders. The causes are vitiated vata, pitta, kapha, simultaneous vitiation of all three doshas and trauma.
Read – Vidradhi: Causes, Pathogenesis, Types, Treatment, Medicines
There are 5 types breast abscesses
- Vataja – caused by vitiation of vata
- Pittaja – caused by vitiation of pitta
- Kaphaja – caused by vitiation of kapha
- Sannipataja – caused by simultaneous vitiation of all doshas
- Abhighataja – due to trauma
Both Vagbhatas have given the same opinion of Sushruta but have included the breast abscess caused by vitiated blood as the sixth type.
Though master Kashyapa hasn’t given the classification of sthanakilaka breast disorder, he has mentioned the clinical features caused by vata, pitta and kapha in the disorder.
Sharangadhara Samhita has mentioned the word kshataja in place of agantuja while Bhavaprakasha treatise has mentioned the same condition as agantuja.
Read – Recurrent Abscess Ayurvedic Treatment Options
Etiology and Pathogenesis
Etiology and pathogenesis of breast abscess
According to Sushruta and Dalhana – The vitiated Doshas reach the breasts, especially in the dilated veins of the breasts. The doshas on reaching the breasts cause vitiation of blood and muscles therein and cause hard swelling. These swellings are characterized with features of five types of external abscesses, the symptoms of vitiated Doshas are also seen.
In a lactating mother, if the breast milk is not expressed out from the engorged breasts, the doshas compressed by the milk will get vitiated and will produce the breast disorders.
Read – Human Breast Milk Benefits, Ways To Increase Production
According to Arunadatta – The doshas get vitiated due to excessive consumption of stale food and other blood contaminating factors as explained in the case of general abscesses. These doshas contaminate the skin and muscles of the breast and produce abscess.
According to Kashyapa – Consumption of vajra i.e. piece of grass / straw, insect, chaff of grains, bristle, fly, piece of stone, hair, wool or bone is said to be the main cause for breast abscess.
These materials are not digested because of being foreign bodies. They get moistened and are propelled by vata along with lymph. They then reach the milk carrying channels of the breasts. Due to excessive dilatation of the breast channels these foreign substances reach the breasts and produce abnormality immediately. This causes breast abscess.
Read – Breast Milk Detoxification Based On Dosha
Other causes for breast abscess –
- Excessive consumption of stale, hot and dry food
- Foods which tend to produce burning sensation / corrosive foods
- Sleeping over uneven beds
- Abnormal acts
- Blood vitiating factors
Read – Blood Formation, Causes of Impurity, Diseases, Treatment – Charaka Sutra 24
Symptoms of breast abscess
The features of the abscess and associated symptoms are enumerated according to the cause of abscess.
1. Symptoms of breast abscess caused due to vitiated vata
Features of abscess –
- Black or reddish color
- Hard, stiff, rough or rugged
- Unusual / variable type of beginnings, swellings and suppuration
- Develops and suppurates slowly
- Abnormally situated – swelling is uneven / increases or decreases alternatively
- Thin discharges after the abscess bursts open
- Pulsation over the abscess
- Spreading in nature / has wide base
- Presents sound if pressed
Associated symptoms –
- Presence of severe pain, piercing or tearing type of pain
- Presence of flatulence
- Presence of giddiness
Read – Dizziness: Causes, Symptoms, Ayurvedic Remedies, Treatment
2. Symptoms of breast abscess caused due to vitiated pitta
Features of the abscess –
- Resembles ripe fruit of in shape and size
- Blackish / red / coppery / yellow color
- Sudden onset
- Quickly suppurates
- Marked severity at the time of suppuration
- Yellow discharge comes out when the abscess gets burst open
Associated symptoms –
- Burning sensation
3. Symptoms of breast abscess caused due to vitiated kapha
Features of the abscess –
- Resembles earthen plate, slightly protuberant in the center with wide base
- Yellowish white in color
- Cold in touch
- Stiff / firm in texture / smooth / unctuous
- Develops and suppurates gradually
- White discharges are seen after the abscess ruptures
Associated symptoms –
- Mild pain
Read – Itching And Pruritus: Ayurvedic Understanding
4. Symptoms of breast abscess caused due to simultaneous vitiation of all the three doshas
Features of the abscess –
- Manifestation of multiple colors i.e. black, yellow or white
- Different kinds of discharges i.e. thin, yellow or whitish
- Various kinds of shape and size i.e. raised, irregular or incurable
- Suppurates irregularly
- Superficial or deep
- Raised or flat
Associated symptoms –
- Various kinds of pain or discomfort i.e. piercing pain, burning sensation and itching
- Presence of constant pain
Read – Abnormal Vitiation Of Doshas – Vaikruta Dosha Dushti
Symptoms due to trauma
5. Symptoms of breast abscess caused due to trauma
A person consuming non congenial diet, when gets injured or suffers from a wound due to respective causes, like fall from a horse back / strong blow with a blunt weapon but no bleeding, injury with sharp weapon causes bleeding, heat increases in the body. The heat of the injury is spread by vata, withholding blood aggravates pitta. The person has below mentioned symptoms –
- Burning sensation
- Features of abscess caused by vitiated pitta
Injury in these conditions refers to blow by stone, rock, wood, metal etc. In this abscess vata, pitta and blood are vitiated.
Read – Injury, Wound care -Ayurvedic Remedies, Medicines
Blood vitiated symptoms
6. Symptoms of breast abscess caused due vitiated blood
While most authors do not accept the manifestation of this type of abscess, master Vagbhata have included this type in breast abscess.
This type of abscess is covered with black blisters, is blackish and is associated with severe burning sensation, pain, fever and other features of abscess caused due to vitiation of pitta.
Read – Shothahara Gana Of Charaka – Anti Inflammatory Group Of Herbs
Note: The clinical features explained above for each type of breast abscess are those of external abscesses because specific symptoms of breast abscess are not mentioned in the classics.
Therefore the local symptoms too have to be considered. Abscess of the breasts may be associated with marked tenderness and net of veins appearing all around the breasts. This condition is said to be more common in lactating women according to modern texts. In this case the flow of breast milk may be obstructed due to swelling resulting in marked engorgement, redness, tenderness of breasts with high fever.
Treatment principles and treatment strategies for breast abscess
Specific treatment of breast abscess has not been given in Ayurveda. Only master Kashyapa has given specific treatment for this condition.
This condition shall be treated on the lines of treating –
- Vidradhi – abscess in general
- Vrana shotha – ound inflammation / inflammation of the ulcer
- Vrana – wounds and ulcers
- Shotha / Shwayathu – inflammation
Master Sushruta has included breast diseases under the category of ‘fit for splitting’ and ‘fit for drainage’ treatments.
Read – Sushruta’s 8 Types Of Surgical Procedures – Astavidha Shastra Karma
Principles of treating breast abscess / mastitis
- Breast abscess shall be treated on the lines of treating general abscess occurring anywhere in the body, ulcer or swelling.
- In the beginning stages of suppuration, poultice or sudation should not be used. Poultices can cause quick putrefaction of the breast. Suppuration of abscess should be enhanced by oral use of appropriate herbs or diet.
- Once the abscess has suppurated, instrumentation should be done protecting the lactiferous ducts, areola and nipples.
- Milking should be repeatedly done in all the stages of the abscess i.e. in the stage of inflammation, beginning of suppuration and suppuration of abscess. This would prevent beginning of suppuration, suppuration and formation of sinus respectively.
- The herbs and medicines which are capable of mitigating pitta and medicines of cold potency shall be used.
- Bloodletting should be done using leeches.
Read – Leech Therapy Procedure, Benefits, Side Effects, Treatment
Specific remedies for breast abscess
- Application of paste of roots of Citrullus colocynthis – for pain relief
- Application of paste of turmeric and leaves of Datura metal – relieves pain
- Application of paste of root of Momordica dioica
- Drinking water in which heated iron has been dipped
- Drink plenty of fluids throughout the day. It keeps good blood circulation around the abscess area.
- Apply cabbage leaves – Studies have shown that the women applying cabbage leaves over mastitis have reported less engorgement than those receiving routine breast cares. (research)
- Use turmeric paste – Mix turmeric powder with little water to make a thick paste and apply it on the afflicted breast and can cover with a cotton cloth to avoid staining your clothes. Rinse after 15-20 minutes. In one study application of curcumin cream has shown to significantly reduce pain, breast tension and irritation within 72 hours. (research)
- Aloe Vera Gel – it has antimicrobial and anti-inflammatory properties. The gel taken by cutting open a leaf of Aloe vera is applied on the inflamed breasts. (research)
- Neem leaf juice – Neem leaves have anti-inflammatory properties and can be used by women having mastitis. The leaves of neem shall be ground with water and the resultant juice is applied on the breast having mastitis. Antibacterial neem ointments too can be used instead. (Research)
- Application of Calendula – C Studies have shown that Calendula has anti-inflammatory agent, antibacterial and healing properties. Calendula ointment relieves inflammation and pain associated with mastitis when it is applied over the afflicted breast. (research)
- Vitamin C – Indian gooseberry powder or juice can be consumed when you have mastitis.
- While feeding, completely empty the breast and see baby is latching on properly. This prevents residual accumulation of milk, which later can invite infection.
- Empty one breast completely at a time. When both the breasts are filled, still empty only one side. Only after ensuring that it is completely emptied, feed from the other side.
- Maintain nipple hygiene
- Use of sterile equipment for nipple piercing
- Wear loose clothing. Tight bra can lead to sweat collection and bacteria development.
- Wash your breasts daily with mild soap and water and keep them clean, wipe off dried secretions and gently dry the breast thoroughly using a clean and sterile towel.
General principles of treatment of inflammation applicable for treating breast abscess
- Administration of anointment of medicinal pastes of herbs having anti-inflammatory properties, massage and irrigation of breasts with medicinal decoctions and liquids should be done in chronological order.
- Following this the abscess should be gently rubbed to cause its softening.
- After softening the abscess, bloodletting should be done.
- During the stage of inflammation constant cold treatment measures including diet, anointment, irrigation etc should be administered.
Read – Ayurvedic Herbal Pastes – Kalka Uses, Preparation, Examples
Note – These measures should be followed in the stage of inflammation.
General principles of treatment of inflammation of ulcers applicable for treating breast abscess
- Cooling measures should be followed by application of paste of or sprinkling with decoction of prepared with coolant herbs of Nyagrodadi group of herbs mixed with ghee, milk and sugar.
- Cooling should be done by anointing with mixture of sugar, flour of parched barley, licorice and ghee.
- Application of lukewarm poultice made with licorice, powdered barley, oil and ghee relieves pain and burning sensation.
- Irrigation of the abscess with lukewarm water, milk, ghee or oil medicated with dashamula group of herbs relieves inflammation and pain.
Read – Dashamula Kashayam With Castor Oil For Low Back Pain
Dosha inflammation treatment
General principles of treatment of inflammation according to involved doshas
Just like the fire is put off when sprinkled with water, the heat generated by the doshas subsides with irrigation treatments.
- In abscess caused by vitiated vata – irrigation should be done with luke-warm ghee, oil, fermented liquid, meat soup and decoction of bhadradaru group of herbs.
- In abscess and inflammation caused by vitiated pitta, blood and trauma – irrigation should be done with milk, ghee, honey, and sugar-water and sugarcane juice along with lukewarm decoction of kakoli etc group of herbs or with cold decoctions of herbs capable of suppressing these doshas.
- In inflammation caused due to vitiated kapha – irrigation should be done with hot or cold oil urine; water mixed with alkali, wine, vinegar and herbs capable of suppressing kapha.
Read – Activities And Diet For Kapha Balance
General abscess treatment
Treating breast abscess on the lines of general abscesses
In breast abscesses caused due to vitiated vata –
- Paste of Bhadradarvadi group of herbs or roots of drumstick or Solanum xanthocarpum roots mixed with ghee, oil or muscle fat should be used for anointment and should be used in the form of lukewarm thick paste.
- Paste of barley, wheat and green gram mixed in ghee should be pasted on the unripe abscess.
- Sudation with decoction prepared with roots of drumsticks.
- Continuous sudation with minced meat, olio, milk or rice cooked with milk and sweetened and bloodletting should be done.
- When the abscess gets suppurated it should be incised and irrigated with decoction of panchamula. After that oil mixed with paste of bhadradarvadi group of herbs, licorice and salt should be applied.
In breast abscess caused due to vitiated pitta –
- Sugar, puffed rice, licorice, Hemidesmus indicus should be ground with milk and the resultant paste should be applied over the abscess.
- Irrigation of breast abscess with the decoction or cold infusion of the above said herbs, milk, sugarcane juice or Jivaniya ghrita ghee mixed with sugar.
- Anointment with pestled panchavalkala mixed with ghee should be done.
- Leech should be used for bloodletting.
- Purgation should be given with powder of Operculina turpethum and Terminalia chebula with honey or decoction of triphala mixed with powder of Operculina turpethum.
- When the abscess gets suppurated, the abscess should be incised and the wound cleansed with decoction of latex yielding trees or plants growing in water. Then anointment should be done with paste of sesame and licorice mixed with honey and ghee.
In breast abscess caused by vitiated kapha –
Decoction of triphala, bark of drumstick, bark of Crataeva nurvula and dashamula should be mixed with Commiphora mukul and urine of cow and given to drink.
Constant sudation should be done with heated bricks, sand, stone, iron, dried cow dung or horse dung, husk, dust etc.
The doshas should be removed by use of decoctions, emetics, anointments and bloodletting.
After suppuration of abscess, it should be incised after cleaning the wound with decoction of Cassia fistula, it should be filled with mixture of powdered turmeric and Operculina turpethum, flour of parched barley, paste of sesame and honey and then bandaged.
Read – Aragvadha – Cassia fistula: Uses, Qualities, Side Effects
In breast abscess caused by vitiated blood or trauma –
- The treatment prescribed for abscess due to pitta should be adopted in the abscess caused by vitiated blood or trauma.
- Anointment of paste prepared with red sandalwood, Rubia cordifolia, turmeric, licorice and red ochre ground with milk shall be done.
Diet, congenial and non-congenial things for abscess
Below mentioned are beneficial before suppuration or at the stage of inflammation –
- Anointment of medicinal pastes
- Horse gram
- Bitter gourd
- Boerhavia diffusa
- Plumbago zeylanica
- Honey etc
Below mentioned are congenial after suppuration of abscess –
- Old red variety of rice
- Soup of green gram
- Semisolid gruel
- Meat soup of wild animals
- Pointed gourd
- Heated and cooled water
Tentative modern comparison with doshic type of breast abscesses
- Vata type of breast abscess – abscess having little pus developing near the nerve endings on the breast, which develops slowly i.e. chronic abscesses
- Pitta type of breast abscess – very acute abscess with good quantity of pus specially developing in the soft part or muscular part of the breast
- Kapha type of breast abscess – tubercular abscess / tubercular mastitis presenting as breast abscess
- Breast abscess caused due to simultaneous vitiation of all the three doshas – acute abscess associated with necrosis
- Breast abscess caused due to injury – local suppuration of accumulated blood by pyogenic bacteria in the breast
- Breast abscess caused by vitiated blood – acute abscess associated with very early stage of breast gangrene
Causes of breast abscess –
Bacterial infection of breast tissue that starts with cracks in the nipple. These cracks in the breast nipples can develop during breastfeeding.
infection can also happen due to bacterial overgrowth due to blocked ducts. Staphylococcus aureus is the commonest bacteria. Less common ones are Streptococcus pyogenes, E. coli, Corynebacterium, Pseudomonas, Proteus etc.
Breast abscess can also happen due to mastitis – local inflammation.
Injury to breast, uncontrolled diabetes, low immunity can also lead to abscess.
Signs and symptoms:
Painful lumps, discharge, pus, fever, chills. (read related)
Diagnosis: X-ray, Ultrasonography.
Initially antibiotics are given.
NSAIDs to control pain
Drainage of Pus – Needle aspiration or drainage with a catheter is done (research)