基于络病理论探讨乳腺增生症的辨治思路

Discussion on differentiation and treatment of mammary hyperplasia based on collateral disease theory

乳腺增生症是中年女性最常见的疾病,既非炎症也非肿瘤,以乳房疼痛和乳房肿物严重影响女性的身心健康及生活质量,且有一定癌变风险。针对乳腺增生症,西医暂未发现有效的治疗方法,而中医药在治疗乳腺增生症方面,尤其具有自身特点和优势。近年来络病理论的兴盛为本病的临床治疗提供新思路,络病理论是中医重要病机学说,乳腺增生症的辨治与络病理论密切相关,目前少见从络病理论探讨乳腺增生症的辨治研究。文章从络病理论探讨乳腺增生症,认为乳腺增生症具有“久病入络、由气及血、络脉本虚”的病理特点,符合络病的疾病特征。文章通过文献溯源的方式梳理络病理论的发展历程,提出乳腺增生症始生、演进的基本病机为“气络不利,血络瘀阻”,由气及血,由浅入深,后期“络瘀-络损-络虚”。乳腺增生症微环境体现“浓、黏、凝、聚”的病理状态,文章结合络病理论与乳腺增生症的关联,提出乳腺增生症始生期、演进期以通为主,后期络虚通补的治疗大法。故就络病理论与乳腺增生症的辨治思路进行探赜,以期为临床治疗乳腺增生症提供新方法。

Breast hyperplasia is the most common disease in middle-aged women,which is neither inflammation nor tumor.Breast pain and breast mass seriously affect women’s physical and mental health and quality of life,and there is a certain risk of cancer.For mammary hyperplasia,Western medicine has not yet found effective treatment methods,while TCM has its own characteristics and advantages in the treatment of mammary hyperplasia.In recent years,the developmet of the theory of collateral disease provides new ideas for the clinical treatment of this disease.The theory of collateral disease is an important pathogenesis theory of TCM,and the treatment of mammary hyperplasia is closely related to the theory of collateral disease.At present,it is rare to study the differentiation and treatment of mammary hyperplasia from the theory of collateral disease.This paper discusses mammary hyperplasia from the theory of collaterals disease,and holds that mammary hyperplasia has the pathological characteristics of“chronic disease enters into collaterals,which causes deficiency of Qi(气)and blood,and the deficiency of collaterals”,which is in line with the characteristics of collaterals disease.The paper combs the development course of collaterals disease theory by tracing the source of literature,and proposes that the basic pathogenesis of breast hyperplasia is“unfavorable Qi collaterals,blood collaterals stasis’,which transit from Qi to blood,from the exterior to the interior,and forms“collaterals stasis-collaterals damage-collaterals deficiency”in the later stage.The microenvironment of mammary hyperplasia reflects the pathological state of being“thick,sticky,coagulated and clustered”.Combining with the theory of collateral disease and the association of mammary hyperplasia,the treatment of mammary hyperplasia in the initial and evolving stages is put forward.It is suggested that the treatment of breast hyperplasia in the initial stage and the evolution stage gives priority to thoroughfare,and gives priority to tonifying in the later stage.Therefore,the article explores the theory of collateral disease and the differentiation and treatment of mammary hyperplasia,in order to provide a new method for the clinical treatment of mammary hyperplasia.