▲He Chengyao, Master of Traditional Chinese Medicine (1938.4-)
He Chengyao, master of traditional Chinese medicine, chief physician and professor of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, under the tutelage of Mr. Zhuo Yunong's third son, Mr. Zhuo Qiqi, has long been engaged in the clinical and teaching work of gynecology of traditional Chinese medicine, gynecology of traditional Chinese and Western medicine, and is good at treating common gynecological diseases, frequent diseases and incurable diseases with good results. His academic thinking is mainly reflected in the emphasis on basic research and female physiological characteristics, and he is good at grasping the whole thing, and the idea of regulating the liver runs throughout. In the treatment, we insist on seeking the root cause and taking into account the symptoms, and focus on the root cause. Professor He Chengyao's experience in the treatment of menstrual breast tenderness is summarized as follows for colleagues.
Menstrual breast tenderness refers to breast tenderness before or during menstruation, or nipple tenderness and pain, the main symptom is breast tenderness within two weeks before menstruation, periodic recurrence, and severe cases cannot touch the clothes. Menstrual breast tenderness is more common in young and middle-aged women and is a common gynecological disease. In recent years, the incidence of menstrual breast tenderness has been on the rise, often accompanied by negative emotions such as irritability, irritability, and restlessness, which seriously affects women's physical and mental health, daily work and study. At present, Western medicine classifies it as premenstrual syndrome, and most of them are treated symptomatically, and the long-term effect is not good. He Chengyao started to treat the disease from the perspective of liver regulation, and the results were remarkable.
Etiology and pathogenesis
He Chengyao believes that menstrual breast tenderness is mostly caused by emotional depression and liver disorders, and the main responsibility lies in the liver, which is related to the imcommunication of the breast network. "Lingshu: Five Sounds and Five Flavors" cloud: "A woman's life is more than qi, not enough blood." "This disease mostly occurs before menstruation or during menstruation, when the qi and blood are betting on the sea of blood, which is easy to make the liver blood temporarily underfilled, and the liver qi is more than excessive. From the distribution of the meridians, it can be seen that the foot and yin liver travel around the nipple through the chest and flank. Yan Chunxi's "Fetal Heart Method" in the Qing Dynasty has a cloud that "the liver meridian rushes upward, and the breast swells and overflows", the liver meridian is abnormal, and if it is not passed, it will be painful, which can cause breast tenderness and discomfort. If the mood is excessive, depression is not reached, anger is angry, depression hurts the liver, it will cause liver excretion disorder, qi and blood flow is not smooth, and the veins are stagnant. The mammary stagnation is not smooth, and then menstrual breast tenderness can be seen. Therefore, the main responsibility for menstrual breast tenderness lies with the liver, which is related to the obstruction of the breast network. Zhang Yizhou of Zhejiang University of Traditional Chinese Medicine believes that modern women are mostly affected by work pressure and mental emotion, resulting in emotional depression, which leads to liver disorders and poor qi blockade over time. "Women's Science Jinglun, Volume 1, Menstrual Gate" said: "All women's diseases are mostly qi and blood stagnation, so the treatment is mainly to open depression and qi. He Chengyao believes that the liver belongs to the wood in the five elements, the initiative, the main ascension, the joy of the strip, and the depression. Women are born with the liver, so in the treatment of breast tenderness, it is advisable to take into account the specimens and regulate the liver and channels. Regulates the liver and regulates qi, accesses the breast meridians, and the liver is unobstructed, and the disease will heal itself.
Typical medical cases
Wu, female, 35 years old at the time, complained of recurrent premenstrual breast tenderness for more than 3 months, and the recurrence was aggravated for 2 days. First diagnosis on December 25, 2018: normal menstrual regularity, menstrual period of 5~7 days, cycle of 28~30 days, moderate menstrual flow, red color, occasional blood clots, menstrual abdominal pain and other symptoms. 3 months ago, due to an argument with others, I was very angry, and I had breast tenderness a week before menstruation, and I was upset and unbearable, so I did not pay attention to it and diagnose it, and I felt that my breast tenderness was reduced after menstruation. The symptoms of the appeal were recurring, coinciding with 1 week before menstruation, the patient stayed up late and drank alcohol continuously, and had breast tenderness 2 days before the visit, which could not be touched, the pain was unbearable, restless, and had no intention of working, so he came to the doctor. The tongue is red, thin and white, and the veins are stringy. Mental fatigue, anxious countenance, poor sleep, and two stools. BP: 100/70mmHg, heart rate: 79 beats/min, no palpable mass on palpation of both breasts, widespread tenderness in both breasts, no redness and swelling of the local skin, no nipple discharge. Auxiliary examination: no abnormalities were found in mammal ultrasound.
Diagnosis: (liver stagnation and qi stagnation type) breast tenderness and pain.
治则：疏肝解郁、行气止痛。
▲ Chai Hu
Prescription: Bupleurum 20g, Angelica Sinensis 15g, White Peony 15g, Green Bark 15g, Xiangfu 15g, Qianghuo 9g, Chuanxiong 9g, Cinnamon 9g, Gardenia 6g, Tulip 6g, Acacia Bark 6g. Take 7 servings, 1 dose per day, divided into 3 doses. Patients are instructed to take the drug before menstruation, stop menstruation, and take the drug after menstruation. Do not drink alcohol before and after menstruation, eat lightly during the period of taking medicine, and avoid raw and cold food.
Second diagnosis on January 7, 2019: The patient complained that the bilateral breast tenderness and pain were significantly reduced after taking the drug, and the menstrual flow was slightly higher than before, the color was dark red, there was no blood clot, and he felt cold pain in the lower abdomen, his tongue was red, his moss was white, and his pulse was thin. Give the original prescription plus 9g of mugwort leaves, and then take 7 servings, 1 servings per day, divided into 3 doses. Advise patients to eat and rest regularly to maintain a comfortable mood. After 2 months of telephone follow-up, the patient complained of the disappearance of premenstrual breast tenderness.
Note: The patient in this case is a young woman with poor mood, depression and anger hurting the liver, and liver qi stagnation. And because the patient's diet and rest are irregular, he stays up all night continuously, and "Suwen Wuzang Sheng" says: "The blood of people lying down is returned to the liver." "The patient stays up all night before menstruation, the blood does not return to the liver, the liver blood deficiency is very serious, the liver loses nourishment, the excretion function is abnormal, the liver qi is depressed but not reached, the qi and blood flow is abnormal, the stasis of the mammary network, and the pain is not passed, so there is menstrual breast tenderness and discomfort, and the pain is unbearable. Combined with the patient's symptoms, tongue and pulse, the syndrome was characterized by liver stagnation and qi stagnation, and the treatment was to relieve liver depression and relieve pain. Fangzhong reuses the important medicine of soothing the liver and relieving depression, Bupleurum as the Jun medicine, with green skin and incense to soothe the liver and open the depression and dissipate the qi, so that the liver qi can reach. Chuanxiong is a medicine for blood qi, tastes pungent and yang, invigorates blood and relieves pain, and the combination of two medicines of Yujin and Chuanxiong can help Bupleurum to soothe the liver and promote qi, and reach the breast to relieve breast tenderness. Angelica sinensis nourishes blood and invigorates blood, white peony nourishes blood and softens the liver, the two drugs are combined, nourishing liver and blood to nourish the liver, and are shared with the medicine of opening depression and qi to restore the normal excretion function of the liver. Qianghuo is warm and pain-relieving, and the cinnamon branch is warm and through the meridians, and it is compatible with a little bitter cold gardenia, so that the side is warm but not dry. Acacia skin soothes the nerves and relieves depression, asks for medicine for the pleasure of the mind and calms the nerves, and improves the patient's anxiety state. The symptoms of the second diagnosis were significantly reduced, but the lower abdomen was cold and painful, so mugwort leaves were added on the basis of the original prescription to strengthen the function of warming the meridian and dissipating cold. Looking at this case, He Chengyao mainly regulates the liver and regulates qi, and relieves pain.
Zheng reiterates:
Since each person's constitution and condition are different, the prescription and dosage in this case are only applicable to the patient's condition at that time. Without TCM syndrome differentiation diagnosis and treatment, the prescription and dosage in this case must not be copied. If necessary, readers should go to a regular hospital for diagnosis and treatment to avoid delaying their condition. ■
[Source: China Traditional Chinese Medicine News, content selected from the fifth edition of "China Traditional Chinese Medicine News" on March 13, 2023, Chen Yonghui, Guizhou University of Traditional Chinese Medicine, Cao Junyan, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine]