从肝论治经行乳房胀痛经验

Experience in the Treatment of Breast Distending Pain During Menstruation

经行乳房胀痛是妇科常见的一种病症,中医学认为,经行肝血不足,肝失条达,致气血运行不畅,乳络欠通,不通则痛。文章从肝角度分析,认为经行乳房胀痛病因病机为:七情内伤,肝气郁滞;肝肾阴虚,气血不足;肝郁脾虚,水湿停留;瘀血阻络,脉络欠通。临床辨证治疗,肝气郁结型以疏肝解郁、理气消胀为主,方用柴胡疏肝散;肝郁血虚型以疏肝解郁、行气养血为主,方用逍遥散;肝肾阴虚型以滋肾养肝、解郁通络为主,方用一贯煎;肝郁脾虚型以疏肝解郁、健脾和胃为主,方用自拟疏肝健脾方;气滞血瘀型以活血化瘀、理气止痛为主,方用血府逐瘀汤。

Breast distending pain during menstruation is a common disease of department of gynecology.Traditional Chinese medicine holds that the deficiency of liver blood and liver failing to regulate cause unsmooth circulation of qi and blood and blockage of breast collaterals,manifesting as pain. The cause and mechanism of breast pain include：internal injury due to emotional disorder leading to stagnation of liver qi;yin deficiency of liver and kidneys causing deficiency of qi and blood;stagnation of liver qi and spleen deficiency leading to retention of water and dampness;blood stasis obstructing the collaterals leading to obstruction of collaterals. The disease should be treated based on syndrome differentiation. The syndrome of stagnation of liver qi should be treated with Chaihu Shugan powder to disperse stagnated liver qi,relieve qi stagnation,regulate qi- flowing,and remove distention;the syndrome of stagnation of liver qi and blood deficiency should be treated with Xiaoyao powder to soothe the liver,resolve constraint,promote qi circulation,and nourish blood;the syndrome of yin deficiency of liver and kidney should be treated with Yiguan decoction to nourish kidneys and liver,resolve constratint and unblock the collaterals;the syndrome of liver qi and spleen deficiency should be treated with Shugan Jianpi formula to soothe the liver,strengthen the spleen,and harmonize stomach. The syndrome of qi stagnation and blood stasis should be treated with Xuefu Zhuyu decoction to promote blood circulation,resolve blood stasis,regulate qi movement and relieve pain.