基于《金匮要略》“因虚、积冷、结气”理论探讨肉芽肿性乳腺炎的辨治

Exploring the Differentiation and Treatment of Granulomatous Lobular Mastitis Based on the Theory of “Deficiency, Accumulated Cold, and Qi Stagnation” from Synopsis of the Golden Chamber

摘要: 肉芽肿性小叶性乳腺炎(GLM)属中医“粉刺性乳痈”范畴，临床以乳房肿块、脓肿、溃后难愈为主要表现，具有病程迁延、易于复发等特点，为本虚标实之证。本文基于《金匮要略》“因虚、积冷、结气”理论，探讨其与GLM发病的内在联系，提出“虚”为发病之本，责之脾肾阳虚、气血亏虚；“积冷”为发病之关键，乃阳虚寒凝、痰瘀互结；“结气”为发病之标，系肝郁气滞、经络不通。三者交互为患，形成“因虚致冷、因冷致结、因结更虚”的恶性循环，终致痰瘀凝滞乳络而发病。因而治疗当以温阳补虚以治本，散寒通滞以治标，调畅气机以通络，分期辨治，疗效显著，以期为中医药治疗GLM提供新思路。

Abstract: Granulomatous lobular mastitis (GLM) belongs to the category of “comedo mastitis” in traditional Chinese medicine, clinically characterized by breast masses, abscesses, and refractory ulcers after rupture, with a protracted course and high recurrence rate, constituting a syndrome of deficiency in origin and excess in superficiality. Based on the theory of “deficiency, accumulated cold, and qi stagnation” from Synopsis of the Golden Chamber, this paper explores its intrinsic relationship with the pathogenesis of GLM. It is proposed that “deficiency” is the root cause of the disease, attributed to spleen-kidney yang deficiency and qi-blood depletion; “accumulated cold” is the key pathogenesis, manifested as yang deficiency-induced cold coagulation and intermingled phlegm and stasis; “qi stagnation” is the branch manifestation, arising from liver qi depression and meridian obstruction. The interplay of these three factors forms a vicious cycle of “deficiency leading to cold accumulation, cold accumulation leading to qi stagnation, and qi stagnation further aggravating deficiency”, ultimately resulting in phlegm and stasis congealing in the breast collaterals and causing the disease. Accordingly, the treatment principle is to warm yang and tonify deficiency to address the root, disperse cold and unblock stagnation to address the branch, and regulate qi movement to dredge the collaterals, with stage-specific differentiation and treatment, so as to provide a new perspective for the TCM treatment of GLM.