佀雪平教授运用三仁汤治疗湿热瘀阻型流产后宫腔残留临证经验

Professor Si Xueping’s Clinical Experience in Treating Post-Abortion Uterine Retention of the Damp-Heat and Blood Stasis Type with Sanren Decoction

摘要: 流产后宫腔残留是目前临床上发病率越来越高的一种产后并发症。传统医学将其归属于“胎堕不全”“胞衣不下”“恶露不绝”等范畴，产后失血耗气，导致气血两虚，加之素体虚弱，湿热邪毒可乘虚上行侵袭胞宫；或素体脾虚湿盛，湿浊内生，郁久化热，湿热与瘀血相互搏结、相互依附，互为因果，恶性循环。佀雪平教授认为其主要病因病机为湿热瘀阻，在临证中本着“勿拘于产后，亦勿忘于产后”及辨病与辨证相结合，基于“分消走泄”理论，遵循“标本同治、攻补兼施、分消与补益并举”的核心原则，治以清热利湿化痰、补气活血化瘀，选用三仁汤加减化裁，临床疗效显著。

Abstract: Retained products of conception following a miscarriage is a postpartum complication with an increasingly high incidence in clinical practice. Traditional medicine classifies this condition under categories such as “incomplete abortion”, “retained placenta”, and “prolonged lochia”. Postpartum blood loss and depletion of qi lead to deficiency of both qi and blood; combined with constitutional weakness, pathogenic damp-heat toxins can take advantage of this vulnerability to ascend and invade the uterus. Alternatively, in cases of constitutional spleen deficiency with excessive dampness, internal damp turbidity may arise; when stagnant for a long time, it transforms into heat. Damp-heat and blood stasis then intertwine and interdepend, creating a vicious cycle where one condition causes the other. Professor Si Xueping believes that the primary pathogenesis lies in the obstruction caused by damp-heat and blood stasis. In clinical practice, adhering to the principle of “not being confined to the postpartum period, yet not neglecting it”, and combining disease identification with syndrome differentiation, he bases treatment on the theory of “dispersing and draining” and follows the core principles of “treating both the root and the branch, combining purgation with tonification, and simultaneously employing dispersing and tonifying methods”. Treatment focuses on clearing heat, draining dampness, and resolving phlegm, as well as tonifying qi, invigorating blood, and resolving blood stasis. He selected Sanren Decoction with appropriate modifications, achieving significant clinical efficacy.