张晋峰分期论治经行头痛的临证经验

ZHANG Jinfeng’s clinical experience in treating menstrual headache by stages

经行头痛,西医称其为月经性偏头痛,属经前期综合征,临床较常见。其发病机制目前尚不明确,研究发现主要与雌激素、前列腺素有密切的关系,治疗上以对症止痛为主,临床效果较差。不同医家对该疾病的认识不同,根据中医“整体观念”“辨证论治”的理论特点,导师张晋峰认为该疾病多与肝、肾有密切关系,加之气血不畅而致,将病机归纳为肝肾阴虚为本,气机逆乱,瘀血阻络为标;治疗上遵循分期论治,经前及经期行气活血、因势利导以治其标,选方常用血府逐瘀汤加减,针对月经量少,伴有痛经者,导师常认为寒热错杂,多加用足浴方;经后期补益肝肾,调畅气血以固其本,在杞菊地黄汤的基础上随症加减。导师张晋峰,全国名老中医,临床上擅长治疗月经病、不孕症、妊娠病及妇科杂病等,笔者有幸跟师学习,现将其治疗经行头痛经验介绍如下。

Menstrual headache is called menstrual migraine by western medicine,which belongs to premenstrual syndrome and is common in clinic.Its pathogenesis is still unclear.Studies have found that it is closely related to estrogen and prostaglandin.The treatment is mainly symptomatic and analgesic,and the clinical effect is poor.Different doctors have different understanding of the disease.According to the theoretical characteristics of“holistic concept”and“syndrome differentiation and treatment”of TCM,Tutor ZHANG Jinfeng believes that the disease is closely related to the liver and kidney,and is caused by the obstruction of Qi(气)and blood.The pathogenesis is summarized as liver and kidney yin deficiency,Qi disorder and blood stasis;In terms of treatment,it follows the principle of treatment by stages.Before and during menstruation,it is necessary to promote Qi and blood circulation,and make the best of the situation to treat the symptoms.Xuefu Zhuyu decoction(血府逐瘀汤)is commonly used in the selection of prescriptions.For those with less menstruation and dysmenorrhea,the tutor often thinks that cold and heat are mixed,and foot bath prescription is often used;in the later period of menstruation,treatment should tonify the liver and kidney,regulate Qi and blood,and consolidate the essence.On the basis of Qiju Dihuang decoction(杞菊地黄汤),add and subtract with symptoms.Tutor ZHANG Jinfeng,a national famous old Chinese medicine doctor,is good at treating menstrual disease,infertility,pregnancy disease and gynecological miscellaneous diseases.The author has the honor to learn from Tutor ZHANG,and now introduces his experience in treating menstrual headache as follows.