从肝脾辨治乳头溢液经验总结

Syndrome differentiation and treatment of nipple discharge from the perspective of the liver and spleen

乳头溢液属中医“乳泣”“乳汁自出”范畴,血性溢液属“乳衄”范畴。房家外科在乳腺等各类外科疾病诊疗方面经验丰富,本文总结房家外科从肝脾辨治乳头溢液的经验。临床以辨病为先。病机上,病责肝脾,认为乳头溢液和肝郁化火及脾虚失统关系密切;治疗上,针对肝郁化火、血热妄行和脾虚失统、痰凝血瘀两类证候,分别予疏肝清热、凉血止血及健脾行气、活血化痰之法;同药异治,根据同一味中药炮制方法、采摘时机、入药部位等不同而辨证使用;在乳头溢液治疗中擅用玄参和仙鹤草两味中药。

Nipple discharge belongs to the category of ru qi(nipple dripping) and ru zhi zi chu(spontaneous secretion of milk) in traditional Chinese medicine, while bloody discharge is referred to as ru nu(thelorrhagia). The Fang’s School of Surgery has rich experience in the diagnosis and treatment of various surgical diseases such as breast diseases. This paper summarizes the experience of the Fang’s School of Surgery in treating nipple discharge from the perspective of the liver and spleen. Syndrome differentiation is the priority in the clinical diagnosis and treatment of the disease. The pathogenesis is believed to lie in the liver and spleen, and it is suggested that nipple discharge is closely related to liver constraint transforming into fire and spleen deficiency causing it to lose control of the blood. In terms of treatment, the method of soothing liver and clearing heat, cooling blood and stanching bleeding is adopted for liver constraint transforming into fire and frenetic flow of the blood caused by blood heat, and in the case of spleen deficiency and the result ant loss of its function to control the blood, phlegm coagulation, and blood stasis, it is needed to invigorate the spleen and promote the flow of qi, invigorate blood and dissolve phlegm. The Fang’s school believes that one herb can have different medical efficacy based on how it is processed, when it is picked, and which part of the plant is used, etc. In the treatment of nipple discharge, Radix Scrophulariae and Herba Agrimoniae are the key ingredients.