痛经病因病机古文献研究进展

A Summary of the Progress in Understanding the Etiology and Pathogenesis of Dysmenorrhea in Ancient Literature

痛经是最常见的妇科疾病之一,严重危害女性工作生活,其病因病机复杂,中医经过几千年的经验积累对痛经的发病有颇深的见解,故该文系统梳理了从东汉时期开始至今的古现代文献对痛经病因病机的认识。整理后发现痛经的发病有虚有实,虚者多由气血及肝、脾、肾三脏之虚导致,实者则由寒热湿瘀或气郁导致。该病病位在冲任、胞宫,变化在气血,表现为痛证。历代医家对痛经病因病机的认识从外感实邪到本虚标实,从六淫辨证到脏腑辨证,将痛经的病因病机主要归纳为外感风寒湿邪、虚寒、虚热、气血失和(气滞血瘀、气血虚弱、气虚血滞)、脏腑功能失调(肝气乘脾、肝郁化火、肝肾亏虚、肾虚),当代医家在继承前人观点的同时加入新的认识,认为痛经是由六淫、情志所伤及起居不慎所引起,并且与体质强弱、经期前后体内环境改变有着密切关系。作者通过对痛经的古文献整理与概述,以期为现代中医临床辨证论治痛经提供丰富的理论基础。

Dysmenorrhea is one of the most common gynecological diseases,which seriously endangers women's work and life.The etiology and pathogenesis of this disease are complex.Traditional Chinese medicine has profound insights into the pathogenesis of dysmenorrhea after thousands of years of experience.The ancient and modern literature from the beginning of the period to the present understands the etiology and pathogenesis of dysmenorrhea.After sorting out,it is found that the onset of dysmenorrhea is both insufficiency and solidity.Deficiency is mostly caused by deficiency of Qi and blood and the three storages of liver,spleen,and kidney,while actual cases are caused by cold,heat,dampness stasis or Qi stagnation.The disease is located in Chongren and the uterus,and changes in Qi and blood,manifesting as pain syndrome.The understanding of the etiology and pathogenesis of dysmenorrhea by physicians in the past dynasties has changed from exogenous real evil to intrinsic deficiency and real,from six evil syndrome differentiation to visceral syndrome differentiation.The etiology and pathogenesis of dysmenorrhea are mainly summarized as exogenous wind-cold dampness pathogens,deficiency-cold,deficiency-heat,Qi-blood disharmony(Qi stagnation and blood stasis,Qi-blood weakness,Qi-deficiency and blood stagnation),visceral dysfunction(liver-Qi multiplying spleen,liver stagnation transforming fire,liver and kidney deficiency,kidney deficiency).Contemporary physicians,while inheriting the views of predecessors,add new understandings,and believe that dysmenorrhea is caused by six evils,emotional injury and carelessness in daily life,and is closely related to physical strength and changes in internal environment before and after menstruation.The author organizes and summarizes the ancient literature on dysmenorrhea in order to provide a rich theoretical basis for the modern Chinese medicine clinical syndrome differentiation and treatment of dysmenorrhea.