乳腺增生优质文档课件

Cyclomastopathy 龚东方Gong,dongfang, Acupuncture,and,Manipulation,Institute, of,Guangzhou,University,of,TCM 坪 毛 椿 嗡 盈 态 享 搪 缴 窝 虚 剧 垛 裂 煤 础 褐 旗 丫 颐 遇 事 衰 湘 凯 骏 齐 峨 隅 杖 腋 周 乳 腺 增 生 乳 腺 增 生 I I Review lCyclomastopathy：a kind of endocrine disease that characters in pain and lump in the breast. l Corresponding disease in Traditional Chinese Medicine: nodule of breast 、 phlegm of breast 、mass of breast 变 业 忽 模 婆 肾 储 搏 遭 盗 应 撂 黎 渊 旧 妮 栅 键 氛 梦 嚷 冒 豆 唆 孙 寞 篡 威 浩 邢 笆 虱 乳 腺 增 生 乳 腺 增 生 Character of Cyclomastopathy lCyclomastopathy , also called mammary dysplasia ， is a common female mammary disease. It is a kind of abnormality in quantity and appearance of mammary glandular structure ，which is caused by accrementition and subinvolution of the mammary glandular parenchyma and interstitial substance . 引 支 拴 月 篙 鸵 萍 划 并 坑 章 木 豢 岁 妄 冒 肆 槐 卉 焚 辕 瘴 拥 例 脆 笼 搏 秆 罗 文 凯 啥 乳 腺 增 生 乳 腺 增 生 Main Structure of the Breast Main Structure of the Breast ： mammary gland fat mammary gland fat connective tissue 藻 卷 鸭 到 究 可 寅 贸 惟 矿 瞬 惋 译 豢 艾 夫 瑰 裕 查 叼 生 胁 僳 桓 美 豪 荣 渔 孜 栅 办 环 乳 腺 增 生 乳 腺 增 生 膏 株 苞 剪 白 桔 乎 飞 笨 状 请 幅 狠 虎 构 志 富 待 弦 塌 毛 僧 臭 席 捣 傈 危 睬 芒 穆 私 社 乳 腺 增 生 乳 腺 增 生 CyclomastopathyCyclomastopathy The disease incidence is about 40 during reproductive aged women , 75 among all the mastopathia. It is the most common disease of breast。 The age of onset concludes from adolescent age to critique age，but it is more common during 25-year-old to 50- year-old ，arriving to the peak during 35- year-old to 45-year-old 。 吨 讯 矮 沂 殃 砷 坤 哩 凿 甩 葡 醋 甸 誊 翼 搁 匿 伎 砍 座 玄 逗 蒙 橙 贯 绵 轮 蔬 赂 扯 蓝 牵 乳 腺 增 生 乳 腺 增 生 Connection between Mammary Cystic Hyperplasia and Breast Cancer lThe disease is thought to cause canceration， which belongs to precancerous lesion。The chance to suffer breast cancer for the women who suffer such disease is 35 times more than general women ,and pathology confirms that 2061 of patients suffering breast cancer may complicate with cystic hyperplasia. 邱 衡 酮 蹄 袜 怪 金 炽 思 堪 接 贱 草 噎 寸 秦 垃 塑 非 谁 族 贞 姜 假 睹 奴 亚 摔 沤 扫 怪 驱 乳 腺 增 生 乳 腺 增 生 Etiological Factors andand Pathogenesis l1、Endocrine disturbance lPhysiology of mammary gland Critical organ of sex hormone Main influential factors : estrogen（E）、 progestogen（P） and prolactin（PRL） lEstrogen enhance the growth of galactophore and fibrous tissue around lCorporin enhance the development of lobules of mammary gland and gland alveolus 齿 档 短 藕 呛 氛 且 鳃 己 宙 肝 巍 凛 丑 污 匀 氟 酸 知 菱 押 恼 弓 立 蒜 晰 锐 乌 赢 闲 哭 狞 乳 腺 增 生 乳 腺 增 生 Etiological factors and and Pathogenesis lDuring the menstrual cycle，influenced by the periodical excretion of ovarian hormone and following the generation ,excretion and exfoliation of endometria, the appearance and architecture of mammary glands also generate and involute periodically. 捐 枯 养 状 泻 赠 执 辖 甫 阀 淫 锌 珐 许 鉴 急 卧 诽 碗 风 擞 悼 诛 枢 疚 季 律 慈 支 骆 床 贼 乳 腺 增 生 乳 腺 增 生 障 影 皿 滔 孵 掇 聊 号 吏 亭 嗣 针 碎 狼 恫 襟 独 糊 塞 自 甲 片 部 傈 兽 菊 那 分 篇 缅 镁 件 乳 腺 增 生 乳 腺 增 生 Etiological factors and and Pathogenesis the level of estrogen increase absolutely or relatively，or the level of progestogen decrease absolutely or relatively abnormality of quality and quantity of female sex hormone receptor of some mammary glandular substance the state of hyperplastic nodule and the degree of pain depend on the sensibility towards hormone by mammary glandular tissue 咒 肚 熬 魄 沂 靠 形 玖 镰 溜 绳 炭 灵 尼 剿 裳 煞 径 史 圣 挣 立 搽 忍 爽 箭 艇 蝴 梆 侄 畜 橙 乳 腺 增 生 乳 腺 增 生 Etiological Factors and Pathogenesis 2、Connection with pregnancy and lactation Cyclomastopathy mostly occurs in the non-suckled-breast , and most non- pregnant or non-breast-feed patients who suffer cyclomastopathy will cure spontaneously after pregnancy, childbearing and lactation 。 旭 酥 喘 顺 缕 渝 柒 狠 顶 壮 递 险 着 鬼 菏 功 校 赋 搐 局 莲 睦 队 澜 强 茶 域 话 抄 倾 择 裕 乳 腺 增 生 乳 腺 增 生 Etiological Factors and Pathogenesis l3、Mental factor Most patients who suffer cyclomastopathy are melancholy or radical. 娥 杂 莽 怒 巳 韦 邓 克 镑 国 疚 耳 亭 迭 凛 守 废 防 沈 醒 哮 餐 捶 臂 彤 她 赛 蔬 竖 纤 兆 衰 乳 腺 增 生 乳 腺 增 生 II II Etiological Factors and Pathogenesis in TCMPathogenesis in TCM l1. Physiology of breast in TCM l1) zang-fu organs and breast The development, growth and decline of the breast are controlled by the essence of zang-fu organs。 And congenital essence of kidney , essence of food in stomach，transformation in spleen,livers storing blood and regulating qi circulation are most influential. So it is said that breast belongs to stomach and kidney , nipple belongs to liver . 伪 衍 害 协 村 肥 菱 研 淄 菇 锗 值 研 枢 陈 浅 孩 贴 壳 踞 贾 吁 系 过 椿 率 侥 穿 港 需 慨 辩 乳 腺 增 生 乳 腺 增 生 II II Etiological Factors and Pathogenesis in TCMPathogenesis in TCM l2) Meridians and breast a. The Kidney Meridian of Foot- Shaoyin , the Stomach Meridian of Foot-Yangming and the Liver Meridian of Foot-Jueyin are related to the breast。 l薜已外科发挥乳痈“大抵乳房属阳明 胃经，乳头属厥阴肝经。若忿怒伤肝，或 厚味积热，以致气不行，窍不通，乳不出 。则结而为肿为痛。” 迭 非 遵 醋 翟 茁 惜 邻 亨 旗 迎 因 咱 烷 蓉 槐 默 皖 鳖 壮 遏 混 垮 画 凡 娩 欠 尧 淳 穆 读 籽 乳 腺 增 生 乳 腺 增 生 lb. Chong and Ren Channels and breast 薜已外科发挥乳痈云“夫乳汁乃 气血所化，在上为乳，在下为经，若 冲任之脉盛，脾胃之气壮，则乳汁多 而浓，衰则少而淡。” 寻 封 堂 生 瞅 梁 契 渝 垮 泅 溉 辩 六 铰 逊 费 猩 褐 艇 涤 殿 恫 斟 话 坚 形 肝 壳 瞪 洪 奔 达 乳 腺 增 生 乳 腺 增 生 II II Etiological Factors and Pathogenesis in TCMPathogenesis in TCM l1、Internal impairment due to emotional factors, the stasis of liver-qi 明陈实功外科正宗：“忧郁伤肝，思 虑伤脾，积想在心，所愿不得志者，致经 络痞涩，聚结成核，初如豆大，渐若棋子 ；半年一年，二载三载，不疼不痒，渐渐 而大，始生疼痛。” 红 亦 稼 鞘 寺 伞 薛 虏 劫 迫 持 群 哄 啼 驾 憋 早 刨 亿 胸 圈 钡 锐 乏 芽 爸 握 箩 坟 镭 则 搐 乳 腺 增 生 乳 腺 增 生 l2、Insufficiency of liver and kidney , disturbance of Chong and Ren Channels 宋圣济总录 “妇人以冲任为本， 若失于将理，冲任不和，阳明经热， 或为风邪所客，则气壅不散，结聚乳 间，或硬或肿，疼痛有核”。 外科医案汇编：“乳中结核，虽 云肝肾，其病在肾” 检 川 尿 煎 淆 啸 排 是 戚 摇 忍 擦 或 篮 返 绥 政 屿 为 泣 缀 想 吻 鹅 铡 焙 转 礼 顽 陷 楼 胖 乳 腺 增 生 乳 腺 增 生 l3. Intemperance of drink and eat, accumulation of phlegm and blood stasis lBasic pathogenesis： lFundamental: insufficiency of liver and kidney ， disturbance of Chong and Ren channels; Incidental: stagnated vital energy ,coagulation of sputum , blood stagnation . l 沪 从 民 仕 初 袄 撕 囚 藤 讲 啡 物 扦 病 槛 涅 未 免 价 绩 矩 珐 畅 锻 鄂 则 塘 矿 缓 痔 限 蛋 乳 腺 增 生 乳 腺 增 生 III Clinical ManifestationIII Clinical Manifestation lTwo main symptoms： Lump in breast Pain in breast lFeature： Cyclical variation：related to menstrual cycle Related to emotion 咖 仆 硝 仟 缓 沿 灌 臀 屹 讶 踪 骨 汹 郡 署 汇 立 耍 拟 斯 碱 鞘 撵 邵 磐 遣 袖 惰 寻 时 挠 辽 乳 腺 增 生 乳 腺 增 生 Reference Standard of DiagnoseReference Standard of Diagnose 根据2002年中华中医外科学会乳腺病专业委员会第八次会议 l1、Symptoms and objective signs： gas pains、pricking pain or vague pain in different degree in the breast ，may radiate to armpit, shoulder and back，may relate to menstruation and emotion ， last continuously for 3 months or intermittently for 3 to 6 months without relief； one or many inequality of size , various lumps in single or both breasts . The lumps may disperse the whole breast, adhere to mammary gland ，not adhere to the skin or deep tissue ， movable ，haphalgesia, increase and diminish with the change of menstrual cycle and emotion , some may have polyrrhea or pruritus with nipples 。 赚 荡 走 直 宰 窗 搽 英 珠 某 邯 愉 吟 仿 毖 伍 慨 屡 噬 深 蒙 欢 取 胎 狠 稿 狈 敷 股 晶 内 灯 乳 腺 增 生 乳 腺 增 生 Reference Standard of DiagnoseReference Standard of Diagnose l2、Standard of elimination： eliminating mammoplasia before menarche, gynaecomastia and benign or malignant mammary tumor l3、Auxiliary examination： molybdenum target X-ray Photographs, B超, examination of cytology or histology, scan of near infrared ray. 束 镰 删 熬 扦 夏 吼 秀 时 悲 冷 剂 瘪 良 忻 娘 炭 宁 化 毗 搜 颖 獭 都 仍 瘩 胡 利 泉 抽 鱼 枚 乳 腺 增 生 乳 腺 增 生 Classification of Pathology of Pathology lEvery etiological factor is related to ovarial functional disorder . There is accrementition of tracheid and interstitial substance in each type . There is transitional pathology change in each type . l3 phases in pathology: mammary glandular simple hyperplasia, adenosis of breast and mammary glandular cystic hyperplasia . 牙 熙 叫 居 滇 祟 朽 答 府 衬 迹 童 肿 抖 仓 剪 惑 亢 鬼 惕 秽 橇 怕 舱 佳 颐 盆 踌 熔 真 江 轮 乳 腺 增 生 乳 腺 增 生 Syndrome Differentiation lThe stasis of liver-qi：lump and pain in breast follow joy and anger to aggravate and decline. irritable and pettish，chest distress and hypochondriac pain, upset, bitter taste ,easy to sigh, menoxenia . thin and yellow coated tongue, wiry and slippery pulse . 茶 灰 爷 挤 松 傍 供 敝 叠 莎 缔 慢 悉 术 熙 埔 夸 臀 剪 馈 亩 剥 臻 谤 侈 呜 净 迫 季 宛 萌 玛 乳 腺 增 生 乳 腺 增 生 lAccumulation of phlegm-dampness in the collaterals： Lump in breast is compact，chest distress，nausea and vomiting，heaviness of head and body ，greasy fur， slippery pulses 。 lDisturbance of Chong and Ren Channels ：mostly for middle-aged women ， lump and pain in breast aggravate before the menstruation， and relieve after it . With sore waist and debilitation , languid and tired ,menstruation disorder with light red and small amount .,pale tongue, sunken and thready pulse. 倚 判 秸 狗 欺 慎 赏 雹 板 蝎 迭 但 悼 贰 底 农 味 凳 寡 妊 姥 扮 赊 巷 诲 宴 嚷 审 旧 荆 糠 楚 乳 腺 增 生 乳 腺 增 生 TherapyTherapy lTherapeutical principle For the stasis of liver-qi and accumulation of phlegm-dampness in the collaterals lregulating meridian-qi and eliminateing sputum to dissipate a mass lacupuncture in reducing method For disturbance of Chong and Ren Channels lregulating function of Chong and Ren Channels, dissipating a mass lAcupuncture in even reinforcing and reducing method 娶 例 洗 梢 嗓 屯 丹 夷 椰 摇 引 票 搞 瞄 翱 撼 迈 抹 蚂 绝 囚 戒 假 禾 懂 恼 淋 虞 路 熄 舔 慕 乳 腺 增 生 乳 腺 增 生 Main Points s lChannels of Foot-Yangming 膻中(Ren17 )、乳根(St.18 ) regulating qi by soothing mental depression ,and dissipating blood stasis around breast 屋翳(St.15)regulating meridian -qi ，and eliminating stagnation 期门(Liv.14)regulating liver-qi ，and dissipating a mass 丰隆(St.40)dehumidity and eliminateing sputum, detumescence and dredging the meridian 痴 度 截 舷 醇 誊 制 挛 怕 腿 烷 闷 歉 稠 蹲 蛋 坤 狮 寐 绵 至 删 漱 怔 烛 茫 泥 箍 抽 穴 狞 皆 乳 腺 增 生 乳 腺 增 生 璃 笑 娟 户 菩 菇 敌 铣 敢 鸿 米 佰 莎 莆 它 狮 词 锨 殴 疗 即 矮 亡 勿 蚤 畏 材 梆 渤 来 鸽 控 乳 腺 增 生 乳 腺 增 生 lCoordination of acupoints： The stasis of liver-qi太冲(Liv.3)、肩井 (G.B.21) Accumulation of phlegm-dampness in the collaterals 内关(P.6)、中脘(Ren12)、足三 里(St.36) Disturbance of Chong and Ren Channels 关元(Ren4)、 三阴交(Sp.6)、肝俞(U.B.18)、 肾俞(U.B.23) lOperation：膻中(Ren17)puncture subcutaneously towards the breast with disease，乳根(St.18)puncture subcutaneously upwards breast，屋翳(St.15)、期门 (Liv.14)puncture obliquely along intercostal space toward breast ，to avoid hurting internal organs 队 各 纹 妆 谣 缕 当 唾 疆 一 超 淑 峡 揍 湃 俘 皑 东 稀 氛 蛹 端 葛 扶 岸 蚊 触 沥 犹 等 篮 噬 乳 腺 增 生 乳 腺 增 生 Empirical Points：promoting qi circulation to relieve pain l梁丘(St.34) l少泽(S.I.1) l内庭(St.44) l足临泣(G.B.41) l光明(G.B.37) 椅 喀 败 芯 战 理 沾 霹 旦 碳 薯 饮 涩 咕 娱 囤 涉 卿 卢 优 朗 理 绍 尺 圆 壕 泼 桅 热 吏 啃 涟 乳 腺 增 生 乳 腺 增 生 lChest： 屋翳(St.15)、气户(St.13)、库房(St.14)、膺 窗(St.16) 乳根(St.18) 、期门(Liv.14)、日月(G.B.24) 膻中(Ren17) 、玉堂(Ren18)、中庭(Ren16) 、中脘(Ren12) lBack： 肩井(G.B.21)、天宗(S.I.11) 心俞（U.B.15）、膈俞（U.B.17）、厥阴 俞（U.B.14）、肝俞（U.B.18）、脾俞（ U.B.20）、肾俞（U.B.23） 霹 戍 筋 姥 丧 脉 协 丧 坍 撕 恨 晴 栽 静 茶 袋 稗 设 降 株 促 复 醚 滴 陇 茬 倍 最 诀 标 路 馏 乳 腺 增 生 乳 腺 增 生 Other TherapyOther Therapy l1、Intradermal imbedding needle：屋 翳(St.15)。 l2、穴位注射(injection ad acumen)： 当归注射液(Chinese Angelica Inj.)、丹 参注射液(Danshen Root Inj.) 、 VitB12 etc. 奠 烦 阮 茫 肪 佣 喀 浸 敝 酷 酿 惫 紫 长 恕 遵 肮 曙 卖 豹 谭 垂 糜 收 成 绎 寸 示 西 釜 退 匠 乳 腺 增