李坤寅“三分法”论治子宫肌瘤

Li Kunyin’s "Trichotomy" in Treatment of Uterine Fibroids

岭南地区子宫肌瘤患者体质共性为齿痕舌,薄白或白苔,沉细脉;特性为暗红舌质,多有瘀。岭南地区潮热多雨,汗液将卫阳从表而散,卫阳根于肾阳,久即伤及肾中阳气见沉细脉。李坤寅教授提出了适合本地区女性子宫肌瘤治疗的三分法--分年龄、分阶段、分周期。三分法治疗的主要特点包括祛痰化瘀、扶正、调经、衷中参西和心理疏导等。其中祛痰化瘀为治疗的根本。用药方面,祛痰湿多用温药,行瘀血多用气药。岭南地区虽为湿热地带,但黄腻、黄厚苔并不多见,反而白腻、白滑苔多见。故李师临床祛痰湿非用大苦大燥之品,而用温燥或药性平和之品,如白术、砂仁、蒸陈皮等,慎用大苦大寒之药。扶正尤重脾肾,注意顾护脾肾之阳气,重在调理脾肾,调经贯穿始终。

The shared characteristics of patients with uterine fibroids in Lingnan area are indented tongue thin white or white moss,and thin veins;the characteristics are dark red tongue,with stasis in most of the cases. Lingnan area is hot and rainy. Sweat spreads Weiyang from the surface. Weiyang is rooted in Kidney yang,and the veins of Shenyang would be damaged when Weiyang is injured for a long time. Professor Li Kunyin proposed a "trichotomy" method,which is suitable for the treatment of female uterine fibroids in this area-by dividing patients into three categories according to age,stage and cycle. The main characteristics of this treatment include dispelling Phlegm and Blood stasis,tonifying Zheng Qi,regulating menstruation,being helped with Integrative medicine and psychological counseling,in which the first two are the basis of treatment. In terms of medications,drugs with warm characters are usually used for dispelling phlegm and that can tonify Qi are used for resolving Blood stasis. Although the Lingnan area is a hot and humid area,yellow greasy and thick yellow moss are rare,but white greasy and white slippery are common. Therefore,in Li’s clinical practice,drugs with great bitterness and coldness are rarely used but those which are warm or dry or mild,such as Baizhu (atractylodes),Sharen (Amomum villosum) and steamed Chenpi (pericarpium citri reticulatae),are usually used. The Yang of Spleen and Kidney is especially important and should be taken care of in tonifying Zheng Qi,with regulating menstruation throughout the whole treatment process.