张晓东通经止痛汤“四辨(痛-经-兼证-舌脉)”从瘀论治痛经

ZHANG Xiaodong(张晓东) Tongjingzhitong Decoction(通经止痛汤) "Four Discrimination(Pain-Menstruation-Associated Symptoms-Tongue Pulse)" Treating Dysmenorrhea from Yu(瘀)

张晓东教授认为"痛经"有虚实寒热,核心为瘀。先天禀赋、贪凉饮冷、感受外邪等均可引起气血阴阳失衡,形成瘀阻,瘀存则气血难以通流全身,补虚之力难以畅达,尤以肝、肾、胞宫为甚,故化瘀为治疗之首。有虚实之分,虚则风寒乘袭使气血不畅,积冷结气而成瘀阻;实则风寒湿等邪客胞中,凝于经络,淫于冲脉及胞宫,发为瘀阻,更有瘀而化热等机变。据痛、经、兼证、舌脉,四辨之法全面分析,辨明虚实,痛经本源:"凡经来腹痛,在经后痛则为气血虚弱,经前痛则为气血凝滞""大多可揉可按为虚,拒揉拒按为实,有滞无滞于此可察,但实中有虚,虚中亦有实,此当于形气禀质兼而辨之""经水先期而至者,血热也……后期而至者,血虚也……";创立通经止痛汤,小茴香、炮姜各10g,延胡索、香附各15g,五灵脂、蒲黄各10g,荔枝核15g,肉桂10g,白芍15g,炙甘草10g,温化瘀滞、兼顾活血,化瘀止痛,辅以兼证之药;临证病因各异,表现不同,既要抓住辨治根本,又须据不同兼证,加减化裁,因证制宜,药到病除;对未发现有形实邪的痛经,疗效显著;兼有癥瘕等有形实邪的痛经,也有较好疗效,疗程更长。附痛经(寒凝血瘀)验案一则。

Professor ZHANG Xiaodong believes that Yu is the core of dysmenorrheal. Owning congenital endowment, prefer cold food and place, feeling exogenous pathogens and other reasons can cause the body of qi-blood, yin-yang imbalance and the formation of stasis, stasis to block the yin-yang transport caused by disease. Because of the existence of Yu, the operation of qi and blood can not flow smoothly throughout the body, especially the liver, kidney and uterus. External energy can not reach the body, so Yu is the first to be treated. Dysmenorrhea is divided into empirical and virtual disease. When the body is weak, the cold takes the opportunity to hurt the body to make the gas and blood unobstructed, and the air conditioning condenses on the body to form Yu. When suffering from empirical evidence, wind, cold, wet and other evil invasion of the uterus, condensation in the meridian, the formation of Yu. According to the situation of pain,menstruation, associated symptoms, tongue pulse, a comprehensive analysis of four aspects, to distinguish between deficiency and evidence. ＂All dysmenorrhea, pain after menstruation is due to the weakness of qi and blood, pain in the menstrual cramps before because of the coagulation of Qi and blood.＂ ＂In most cases,when rubbing the abdomen, the symptom relief is a deficiency syndrome, the exacerbation of the symptoms is positive.＂ ＂Menstrual cramps before the abdominal pain is due to blood heat...... after menstruation abdominal pain is due to blood deficiency......＂ The Tongjingzhitong Decoction created by Professor ZHANG Xiaodong includes： fennel, ginger 10 g, corydalis, incense attached to the 15 g, Wulingzhi, Puhuang each10 g, litchi nuclear 15 g, cinnamon 10 g, white peony root 15 g, licorice 10 g. This traditional Chinese medicine prescription has the effect of dispelling Yu, making gas and blood flow, relieving pain and other related symptoms. Although each patient＇s etiology and symptoms are different, but as long as the root cause of the disease, and flexible use, we can achieve good results. This method for the treatment of primary dysmenorrhea effect is significant, but also for the treatment of secondary dysmenorrhea also have good results, but longer treatment time. The article contains a typical case of dysmenorrhea introduced. ea.