程志清教授补血和血、平肝通络法论治经期头痛临床经验

Professor CHENG Zhiqing’s Clinical Experience in the Treatment of Menstrual Headache by Tonifying and Harmonizing Blood and Calming the Liver and Dredging Collaterals

[目的]总结程志清教授治疗经期头痛的辨证思想、治则治法和用药规律。[方法]通过跟随程志清教授抄方侍诊,总结程师运用辨证思维治疗经期头痛的临床诊疗思路及用药经验,并列举一则典型医案加以分析。[结果]程师认为女子经期头痛不离血虚、肝火、血瘀三因,根本病机为肝血亏损、肝气郁结、血瘀气滞,且程师认为这三者之间有密切联系,往往互为因果,又共为肝经病变。程师整体认识证型之间的病机传变规律,以补血和血、平肝息风、通络止痛为治疗大法,并自拟和血平肝通络饮治之。和血平肝通络饮全方包括四物汤、全蝎、珍珠母、牛膝、茺蔚子等药物,临床辨证加减使用,治疗效果明显。所选医案中患者为典型经期头痛,辨证为肝气不舒、血瘀血虚之证,故用补血和血、平肝通络法治之,方用自拟和血平肝通络饮加减,获满意疗效。[结论]程师治疗经期头痛遵循补血和血、平肝通络的治则治法,精准合理选择药物,疗效确切,其治疗经验有较高临床参考价值,值得深入学习和推广运用。

[Objective]To summarize Professor CHENG Zhiqing’s thoughts of syndrome differentiation,principles of treatment and rules of medication in the treatment of menstrual headache.[Methods]Through following Professor CHENG Zhiqing and copying formulas,the clinical diagnosis and treatment ideas and medication experience of Professor CHENG in the treatment of menstrual headache was summarized,and a typical medical case was listed to analyze the clinical diagnosis and treatment of menstrual headache.[Results]Professor CHENG believes that there are three causes of menstrual headache,which are blood deficiency,liver fire and blood stasis,and the fundamental pathogenesis is deficiency of liver and blood,liver Qi stagnation,blood stasis and Qi stagnation.Professor CHENG thinks that the relationship among these three factors is close,which often influences each other,and all belongs to liver meridian lesions.Professor CHENG has overall understanding of the regulation of transmission between pathogenesis and syndrome types,and adopts tonifying and harmonizing blood,calming liver and extinguishing wind,dredging collaterals and relieving pain as main methods,and uses self-made Hexue Pinggan Tongluo Yin in treatment.Hexue Pinggan Tongluo Yin includes Siwu Decoction,scorpion,centipede,Concha Margaritifera Usta,Achyranthes bidentata,Leonurus,Rhodiola rosea L.,Corydalis decumbens and other drugs,the therapeutic effect is obvious while the formula is modified according to clinical syndrome differentiation.In the selected medical case,the patient was a typical menstrual headache,and differentiated as the syndrome of disorder of liver Qi,blood stasis and blood deficiency,achieved satisfactory curative effect after treated with modified self-made Hexue Pinggan Tongluo Yin according to therapeutic principles of tonifying and harmonizing blood,calming the liver and dredging collaterals.[Conclusion]Professor CHENG follows the principles of tonifying and harmonzing blood,calming the liver and dredging collaterals in treatment of menstrual headache,his selection of drugs is accurate and reasonable,and achieves definite curative effect.His treatment experience has high clinical reference value,which is worthy of further study and application.