基于“邪气阻络,络息成积”探析子宫腺肌病病机

Discussion on the pathogenesis of adenomyosis based on the theory of evil energy causes obstructed collateral vessel and pathogenic stagnation

络病是许多疑难杂病的共同发展趋势与归宿,子宫腺肌病作为妇科常见疑难杂病,临床多表现为进行性加重的痛经、月经延长、不孕等症状,患者的主要体征为子宫增大、子宫局限性或弥散性结节及包块,以及子宫结合带增厚、形态异常。本病缠绵难愈。在临床治疗中发现中医药治疗本病有独特优势。子宫生理功能的正常发挥离不开气、血、津液的供养,而络脉在其中发挥重要作用。临床发现子宫腺肌病与络病在病理特点方面具有相关性,且二者的病程和临床表现一致。本研究基于络病理论,认为先天体质或机体正气不足或兼夹他邪,导致痰、瘀等病理产物阻滞络脉,络息成积,发为子宫腺肌病。基于其病机特点,采用扶正祛邪、化瘀通络的治疗方法,一方面重视补气益血,调补脾肾,以扶助正气,避免过度攻伐;另一方面清热祛痰、活血化瘀以通络,配伍应用补虚药、清热药、活血药、化痰药,以期为子宫腺肌病提供新的治疗思路。另外,应重视自身调养,以达到未病先防的目的。

Collateral disease is the common trend and destination of many complicated diseases.Adenomyosis is a common gynecological miscellaneous disease,its clinical manifestations are progressive aggravation of dysmenorrhea,prolonged menstruation,infertility and other symptoms.The main physical signs of patients are uterine enlargement,localized or diffuse uterine nodules and masses.The uterine junction of the patient is thickened and abnormal in shape.The disease is lingering and difficult to cure.In clinical practice,it is found that traditional Chinese medicine has shown unique advantages in the treatment of this disease.The normal physiological function of uterus is inseparable from the support of Qi(气),blood and body fluid,and collateral vessel plays an important role in the process.Clinical findings show that the pathological characteristics of adenomyosis and collateral diseases are correlated,and the course and clinical manifestations of the two are consistent.Based on the theory of collaterals disease,the author believes that due to the lack of congenital constitution or insufficient vital energy in the body,or mixed with other pathogenic factors,collateral vessel was blocked by phlegm,blood stasis and other pathological products,and then pathogenic stagnation appeared,resulting in adenomyosis.Based on the pathogenesis,it is proposed the treatment method of strengthening vital energy to dispel pathogenic factors,remove blood stasis,and dredge collateral vessels.On the one hand,it pays attention to tonifying Qi and blood,and regulating spleen and kidney,so as to aid vital energy and avoid excessive attack.On the other hand,the methods of clearing heat and expelling phlegm,and activating blood stasis to remove static blood are used to dredge collateral vessels.The combination of tonifying drugs,clearing heat drugs,activating blood drugs and eliminating phlegm drugs is applied clinically,so as to provide a new therapeutic idea for the treatment of adenomyosis.In addition,attention should be paid to self-recuperation of patients,in order to achieve the purpose of preventing disease before it occurs.