摘要
肉芽肿性小叶性乳腺炎(Granulomatous Lobular Mastitis,GLM)是一种以乳腺小叶的非干酪性肉芽肿性炎症为病理特征的慢性炎症性乳腺疾病,具有起病迅速、病程长、容易复发等特点,临床常表现为单乳或双乳突发疼痛性肿块,伴随红肿发热等症状,并随病程进展逐渐形成乳腺多发性脓肿,溃脓后导致溃疡、窦道、瘘管。目前,GLM的病因尚不明确,可能与自身免疫性疾病、棒状杆菌感染等有关。中医学中GLM属于“粉刺性乳痈”范畴,其发病与多种致病因素有关,如虚毒瘀、痰、脏腑风湿等。中医药治疗GLM具有复发率低、不良反应少的显著优势。中医学“痞坚之处,必有伏阳”理论认为,阳主升发,不宜潜藏,当体内出现阻拦气化之邪,如气滞、血瘀、痰湿、水饮、寒凝等,或在局部形成结块时,阳气受阻而不得伸,遂伏而不散,郁而化热。文章立足于“痞坚之处,必有伏阳”理论,探讨GLM的病因病机与治疗思路,从情志失调、外力撞击、先天禀赋三个维度剖析GLM发病原因,阐释其病机演变,提出邪气闭阻肝经引起阳郁化热之“伏阳”状态是GLM局部疼痛性肿块“痞坚难消”的关键病机,因此“痞坚伏阳”是影响GLM发生发展的关键所在。基于这一病机认识,主张辨证运用“宣、托、消三法”宣伏阳、托毒出、消痞坚合治GLM,化解“郁热互结”之势,在临床取得较好疗效。
Granulomatous lobular mastitis(GLM)is a chronic disease characterized pathologically by non-caseating granulomatous inflammation of the mammary lobules.It is marked by rapid onset,prolonged disease course,and high recurrence tendency.Clinically,it presents as sudden painful masses in one or both breasts,accompanied by symptoms such as redness,swelling,and fever.As the disease progresses,abscesses gradually form.After the abscesses rupture and discharge pus,they may lead to ulcers,sinuses,and fistulas.Currently,the etiology of GLM remains unclear,but it is believed to be associated with factors such as autoimmune diseases and corynebacterial infections.From the perspective of traditional Chinese medicine(TCM),GLM falls into the category of“comedomastitis”.Its onset is related to multiple pathogenic factors,including deficiency,toxin,stasis,phlegm,and Zang-Fu(脏腑)wind-dampness.TCM treatment for GLM has the significant advantages of low recurrence rate and few adverss reaction.The theory of“where there is stuffiness and rigidity,there must be latent Yang(阳)”holds that Yang Qi(气)is responsible for upward and outward dispersion and should not be trapped inside the body.When pathogenic factors that block Qi transformation—such as Qi stagnation,blood stasis,phlegm-dampness,fluid retention,and cold congelation—appear in the body,or when local masses form,the normal circulation of Yang Qi is obstructed and cannot disperse smoothly.As a result,Yang Qi becomes trapped,fails to dissipate,and accumulates to transform into heat.Based on the theory of“where there is stuffiness and rigidity,there must be latent Yang”,this study explores the etiology,pathogenesis,and treatment approaches of GLM.The study analyzes the pathogenic causes of GLM from three dimensions:emotional disturbance,external impact,and congenital endowment,and explains the evolution of its pathogenesis.It proposes that the“Fu Yang(扶阳)”state—caused by pathogenic factors blocking the liver meridian,leading to Yang stagnation and heat transformation—is the key pathogenesis underlying the“Pi Jian Nan Xiao(痞坚难消)”in GLM.Therefore,“Pi Jian Fu Yang(痞坚伏阳)”is the core factor influencing the occurrence and development of GLM.Based on this understanding of pathogenesis,this article advocates the syndrome differentiation-based application of the“Three Methods of Xuan(宣),Tuo(托),and Xiao(消)”in the combined treatment of GLM.Specifically,the“Xuan Method”is used to disperse latent Yang Qi,the“Tuo Method”is used to promote the outward discharge of toxins,and the“Xiao Method”is used to resolve hard masses.This combined approach alleviates the pathological state of"intermingled stagnation and heat"and has achieved favorable clinical efficacy.
出处
《中医临床研究》
2025年第30期60-64,共5页
Clinical Journal Of Chinese Medicine
基金
国家自然科学基金面上项目(82474519)
湖南省中医药管理局“十四五”第一批中医药领军人才培养项目(〔2022〕5号)
2024年湖南中医药大学研究生创新课题(2024CX023)
2020年中国医药民族学会科研项目(2020ZY077-360005)。
关键词
肉芽肿性小叶性乳腺炎
粉刺性乳痈
痞坚之处
必有伏阳
伏阳理论
理论探讨
Granulomatous lobular mastitis
Comedomastitis
Where there is stuffiness and rigidity,there must be latent Yang
Fu Yang theory
Theoretical discussion
