从4个维度应用经方治疗痛经的体会

Experience from four dimensions application of classic formulas for treatment of dysmenorrhea

中医临床应用《伤寒杂病论》的经方治疗痛经的经验历史悠久。但目前中医界对如何使用经方治疗痛经认识不足,思维多局限于辨证论治和方证相应两端。辨证论治灵活多变,但过程繁琐,难以复制,经验不易于总结传承,初学者很难领会其精髓。方证相应精准速效,但主观性强,过于机械,选错方时副作用明显,面对复杂疾病或多病集于一身时,应对乏效。笔者剖析二者的优势和局限性,创立了集二者优势于一身的＂四维疗法＂,临床上通过辨病症、辨证机、辨时间、辨体质4个维度应用经方治疗痛经,疗效满意。四维疗法是一种思维方式,指导临床医生精准诊断,精准选方用药,同时因人因时,个性化针对性地予以健康指导,这对于＂上工治未病＂也具有一定的意义。

The application of classic formulas from Shanghan Zabing Lun has a long history in treatment of dysmenorrhea. However,the understanding on how to use classic formula in treatment of dysmenorrhea is still insufficient in the traditional Chinese medicine（ TCM）,mainly limited to syndrome differentiation and the formula-syndrome correlation. The treatment method of syndrome differentiation is flexible and changeable,but the process is tedious and difficult to copy. In addition,its experience is not easy to summarize and pass on,and it is difficult for beginners to comprehend the essence. Formula-syndrome correlation method is accurate,quick acting,but subjective,too mechanical,and will have obvious side effects in case of prescription mistakes. For complex diseases or when suffering from a variety of diseases,the efficacy of formula-syndrome correlation method is not so obvious. By analyzing the advantages and limitations of these two methods,the author has created a four-dimensional therapy which combines the advantages of these two,from four dimensions including disease differentiation,syndromes differentiation,time differentiation,and constitution differentiation in clinical application for dysmenorrheal. Its clinical curative effect is satisfactory. Four-dimensional therapy is a way of thinking,to guide clinicians for accurate diagnosis and precisely choosing drugs; meanwhile,the personalized health guidance is given according to different constitutions and different seasons,which also has certain significance to treat the undiseased.