哺乳期乳腺炎应用清热法和温通法治疗争议探析

Discussion on the Controversy of Heat Clearing Method and Warming Method in the Treatment of Lactating Mastitis

对于哺乳期乳腺炎的治疗,中医目前常见清热法和温通法两个观点。从病机而言,清热派医家认为乳痈多由感受外邪或婴儿口中热毒侵入乳孔,或肝郁胃热致乳络郁滞,郁久化热;温通派认为乳痈红肿仅为本病之标,产后妇女阳虚为本,阳虚阴寒则凝。从治疗而言,清热派以疏肝清热解毒治疗为主,辅以多法清热通乳;温通派多以温阳散结、通乳消肿法治疗本病。两种学说看似截然相反,存在分歧,实则殊途同归。盖因哺乳期乳腺炎患者并非单一体质,既有阳热质也有阳虚质;疾病发展中证候也在动态演化,如初期为实热证,但过用寒凉则会转化为半阴半阳证甚或阴证。故很难以某一种治则治法统领所有患者治疗。

For the treatment of lactation mastitis, there are two common viewpoints in traditional Chinese medicine: clearing heat method and Wentong method.In terms of pathogenesis, Qingre school doctors believe that breast carbuncle is mostly caused by feeling external evil or the heat toxin in the baby′s mouth invading the milk hole, or stagnation of milk collaterals caused by liver depression and stomach heat, and depression turns into heat for a long time;Wentong school believes that the redness and swelling of breast carbuncle is only the target of this disease.Postpartum women are based on yang deficiency, and yang deficiency and Yin cold are coagulated.In terms of treatment, Qingre school focuses on the treatment of soothing the liver, clearing away heat and detoxification, supplemented by multiple methods of clearing heat and dredging milk;Wentongpai mostly treats this disease with the methods of warming yang, dispersing mass, dredging milk and detumescence.The two theories seem to be diametrically opposed and have differences, but in fact they have the same goal by different paths.The patients with breast-feeding mastitis have not only yang heat quality but also Yang deficiency quality;In the development of the disease, the syndrome is also evolving dynamically.For example, the syndrome of excess heat in the initial stage will be transformed into semi yin and semi yang syndrome or even yin Syndrome after excessive use of cold and cool.Therefore, it is difficult for a certain principle and method to guide the treatment of all patients.