王克穷审症求因-先证而治辨治脾虚瘀热互结经前期综合征

WANG Keqiong(王克穷) Seizing the Main Syndromes Treatment of Premenstrual Tension Syndrome Experience

王克穷教授强调病有轻重缓急,先证而治,顿挫病势,防止传变是治患精髓。通过审症求因-先证而治辨治脾虚瘀热互结经前期紧张综合征验案,彰显仲景“观其脉症,知犯何逆,随证治之”之旨,诸多症状并非施一剂重方,针对刻下最痛苦之症状,使之缓解后再着手次要症状。女,26岁,经前期乳房胀痛3年,加重20d。乳房胀痛,甚者乳头不敢沾衣,胃脘坚胀,食难用饱,形体消瘦,面色萎黄发青,面颊及额头有少许脓疱,硬结,烦躁易怒,入睡困难,睡则夜梦烦多。双侧腋窝未触及肿大淋巴结,双乳外观正常,无乳头凹陷、溢液及橘皮样改变,双乳可触及腺体及包块,有压痛,尤以左乳外上象限为著,痛甚连及后背;腹部平软,心下痞硬,腹力偏强,左侧少腹急结;舌暗红,苔薄黄,脉沉弦。观其脉症,属瘀热互结,肝郁脾虚,用逍遥散似有病重药轻之嫌,尊“太阳病不解,热结膀胱,其人如狂,……但少腹急结者,乃可攻之,宜桃核承气汤”,“伤寒五六日,呕而发热者,……但满而不痛者,此为痞,柴胡不中与之,宜半夏泻心汤”,二方合用（生半夏65g,干姜45g,黄连15g,黄芩45g,甘草炙30g,大枣12枚,人参45g,大黄60g,芒硝30g,桃仁20g,桂枝30g。2剂。水煎500m L,早中晚温服）,重药轻投,下瘀血,除痞满,诸症自缓。二诊易上方为逍遥散合止痉散（柴胡、当归、白芍各20g,茯苓、白术各40g,甘草炙10g,煨姜1块,薄荷8g,全蝎15g,蜈蚣3条）3剂,水煎300m L,早中晚温服,舒肝理气,柔肝止痉以再挫病势;三诊止痉散加入生半夏、夏枯草、连翘各30g,12剂,清体内之实热以收功。诸恙若失,面颊及额头有少许脓疱,硬结已无,体重增加,双乳柔软丰满。

Professor WANG Keqiong stressed that the disease has the order of priority, syndrome after the first treatment, to prevent disease transmission is abortive, treatment with essence. By trial disease for because of - the first card and rule in treating spleen deficiency and blood stasis and heat stasis the premenstrual tension syndrome test case, highlighting Zhongjing ＂view of the pulse symptom and know what the inverse, the rule with the certificate of＂ the purpose, many of the symptoms are not applied a dose of the heavy, for at the moment the most painful symptoms and relieved after and then proceed to secondary symptoms. Female, 26 years old, premenstrual breast pain for 3years, 20d. Breast pain, nipple not stained clothing, expansion of epigastrie Caine, difficulty in eating to the full, emaciation, sallow complexion pale, cheeks and forehead with a little pustules, induration, irritability, difficulty falling asleep, sleep in the night dream more trouble. Bilateral axillary with no palpable lymph nodes, breasts of normal appearance, no nipple, nipple discharge and orange peel like change, breasts can be touched glands and mass, tenderness, especially in milk left upper quadrant for pain even and back; the abdomen is soft, hard glomus heart, abdominal force on the strong side, left hypogastric pain; dark red tongue, moss thin yellow, sunken pulse string. The symptoms and pulses, is stagnation of blood stasis and heat, stagnation of the liver Qi and deficiency of the spleen, Xiaoyao Powder seems to be gently drugs too ill, statue of the ＂Sun disease puzzled, thermal binding in the bladder, the person such as crazy but the hypogastric pain, but the attack, appropriate Taohe Chengqi Decoction＂ , ＂typhoid five or six, vomiting and fever But with no pain, such as Pi, Radix bupleuri and, should Banxia Xiexin Decoction＂ , second party combination （raw pinellia ternata 65g, ginger 45g, 15g of Coptis, Scutellaria baicalensis 45g, licorice sunburn 50g, jujube 12pieces, ginseng 45g, 60g rhubarb, Glauber＇s salt 30g, peach seed 20g, cassia twig 30g. 2agent. Decoction of 500mL, early in the evening.）, heavy drug light cast, Xiayuxue, in addition to fullness, all the symptoms of corrosion. Two easy to diagnose above Xiaoyao San and Zhijing San, （bupleururn root, angelica, Radix Paeoniae Alba, 20g, Poria, Atractylodes, 40g, sunburn licorice 10g, simmer ginger 1, mint 8g, 15g of the scorpion, centipede 3） 3 agent, decoction 300mL, early late take lukewarm, Shugan Qi, soft liver Zhijing to contusion and lysis; three diagnosis Zhijing powder adding raw pinellia, Prunella vulgaris, forsythia each 30g, 12 agent, clear in the excess heat to closing. The sound lost, cheeks and forehead with a little pustules, no induration, weight gain, soft and plump breasts.