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全生妇科十讲10: 乳腺增生(11/21/2011)
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全生妇科十讲9: 急性乳腺炎(11/9/2011)

 卢全生医师,北京中医药大学中医硕士,中国中医科学院中西医结合博士,美国乔治城大学医学院博士后,河南中医学院客座教授。
 
 急性乳腺炎是由细菌感染所致的急性乳房炎症,常在短期内形成脓肿,多由金黄葡萄球菌或链球菌沿淋巴管入侵所致。 多见于产后2~6周哺乳妇女,尤其是初产妇。病菌一般从乳头破口或皲裂处侵入,也可直接侵入引起感染。一般来讲,急性乳腺炎病程较短,预后良好,但若治疗不当,也会使病程迁延,甚至可并发全身性化脓性感染。 

其临床特征为患侧乳房疼痛,炎症部位(多位于乳房的外下象限)红肿、变硬、压痛,以后形成脓肿。脓肿常位于乳晕下、乳管内、乳腺内或乳腺后,深部脓肿波动不显著。局部红、肿、热痛,触及痛性硬块,脓肿形成后可有波动感。同侧腋窝淋巴结肿大,常在数天内化脓,压痛。可有寒战、高热、倦怠及食欲不佳等症状。血白细胞增多。大多数有乳头损伤,皲裂或积乳病史。临床可分为三期:早期,化脓期和后期。 

急性乳腺炎,中医称为乳痈,病机为乳汁郁积,内有肝郁胃热,或夹风热毒邪侵袭,引起乳络闭阻,气血瘀滞,从而腐肉酿脓而成乳痈。常分为气滞热壅、热毒炽盛、正虚毒恋、气血凝滞几种证型。 中医药在治疗本病方面积累了丰富的经验,根据不同的发病阶段,分别采用疏肝清胃,通乳消肿;清热解毒,托里透脓;益气和营,驱除余邪等法.
 
尽管急性乳腺炎的治疗通常会以清热解毒为主导,然而产后妇女体质偏阳虚,此时不能过用寒凉之药,否则会导致乳房结块经久不消,日后易反复发作乳腺炎.   
对于初期乳腺炎,症见发热恶寒,乳房胀痛肿硬,乳汁不通,口干苦,时有呕逆,纳物不香,倦怠,苔薄黄或黄腻者;治以疏肝清胃,通乳消肿。方药:柴胡10克、黄芩10克、半夏10克、牛蒡子10克、连翘15克、山栀10克、夏枯草15克、瓜篓15克、金银花30克、天花粉15克,当归15克、漏芦10克、王不留行10克。同时,针刺内关穴治疗急性乳腺炎(未化脓者),疗效显著. 

从根本上说,乳汁瘀积和细菌感染是本病的两大原因,因此,预防乳腺炎的主要措施是防止乳汁瘀积和细菌感染。防止乳头损伤,有损伤时要及时治疗。保持乳房清洁,防止细菌感染;不要给孩子养成含乳头睡觉的习惯。少吃有刺激性的食物,如葱、姜、蒜等。少吃热性食物,以免助火生疮。可以常吃些海带,软坚散结,可预防急性乳腺炎。哺乳期用橘核30克煎水服,可防止乳汁淤滞。 

急性乳腺炎先期症状者,可用蒲公英30克,陈皮6克,水煎服,每日1剂。或用鲜菊花叶30克、鲜蒲公英30克,捣汁调敷。也可用仙人掌1-2片,去刺捣烂外敷。 

下期敬请关注全生妇科十讲10: 乳腺增生病. 更多全生讲中医, 敬请访问卢全生中西医结合博士的网站www.wholelifeherb.com,或直接拨打中文热线电话301-340-1066,301-919-9898约诊. 全生中医针灸医疗中心地址:  416 Hungerford Dr, Suite 215, Rockville, MD 20850. 或 9801 Georgia Ave, Suite 337, Silver Spring, MD 20902

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