王昕退膜汤与益气固冲汤分期辨治崩漏

Treatment of Uterine Bleeding by WANG Xin's Tuimo Decoction and Yiqi Guchong Decoction

王昕教授认为崩漏主要为气虚血瘀,气虚为本,血瘀为标;排卵障碍型异常子宫出血(AUB-O)临床表现与"崩漏"类似。治疗以"急则治其标,缓则治其本"为原则,灵活运用"塞流""澄源""复旧"治崩三法。先活血化瘀以治标,退膜汤(党参、黄芪、莪术、三棱、茜草、补骨脂、海螵蛸、赤石脂、三七粉);瘀血祛除后,益气固冲摄血以调其本,益气固冲汤(党参、续断、黄芪、白术、白芍、茜草、山茱萸,荆芥炭、棕榈炭、牡蛎、海螵蛸、龙骨、赤石脂)。伴心烦加香附、郁金疏肝解郁;伴胃脘不适加瓦楞子煅制酸止痛;伴夜寐欠佳加酸枣仁、首乌藤养心安神。阴道流血停止后,运用中医四期调周疗法,结合不同生理时期的阴阳转化、消长、气血变化规律,周期性用药,经后阴血亏虚,加熟地、白芍、当归滋阴养血,充盈胞宫、血海;排卵期重阴转阳,加丹参、五灵脂、红花等补肾活血,促进排卵;经前期是重阳维持期,加鹿角霜、补骨脂、杜仲等补肾阳,推动经血来潮;经期为重阳转阴期,宜活血化瘀,重在祛瘀,加赤芍、五灵脂、益母草等,使经血排出通畅。附崩漏-气虚血瘀(异常子宫出血)验案1则。

Professor WANG Xin believes that the etiology and pathogenesis of utrine bleeding are complex,mainly manifested as Qi deficiency and blood stasis,Qi deficiency as the basis,blood stasis as the standard,and the clinical manifestation of anomalous uterine bleeding(AUB-O)with ovulation disorder is similar to metrorrhagia.The treatment is based on the principle of'treating the symptoms with urgency and treating the root with slowness',and flexibly applies the three methods of'plugging flow','clarifying source'and'reviving old'to treat collapse.First,activating blood circulation to relieve stasis,Tuimo decoction(Dangshen,Huangqi,Ezhu,Sanleng,Qiancao,Buguzhi,Haipiaoxiao,Chishzhi,Sanqi powder).After removing blood stasis,Yiqi Guchong absorbs blood to regulate its origin,Yiqi Guchong decoction(Danshen,Xuduan,Huangqi,Baizhu,Baishao,Qiancao,Shanzhuyu,JingJie charcoal,Zhonglu charcoal,Muli,Haipiaoxiao,Longgu,Chishizhi).Accompanied by upset,adds Xiang fu、Yu jin,Stagnation of liver and relieving stagnation of liver;With stomach discomfort plus Wa Lengzi to make acid to relieve pain;With poor night sleep adds Suanzaoren and Shou Wuteng to nourish heart and calm the mind.After the cessation of vaginal bleeding,the four-stage periphery-regulating therapy of traditional Chinese medicine was used,combined with the regularity of Yin-yang transformation,growth and decline,Qi-blood change in different physiological periods,and periodically used drugs.After menstruation,deficiency of yin and blood,adds Shudi,Danggui,Baishao,nourishing Yin and nourishing blood,enriching uterus and blood sea;during ovulation period,replenishing Yin and Yang,invigorating kidney and activating blood,such as Danshen,Wulingzhi and Honghua,promote ovulation;during early menstruation period,replenishing kidney-yang by adding Lujiaoshusang、Buguzhi and Duzhong to promote menstrual influx;the menstrual period is from Yang to Yin.It is advisable to activate blood circulation and remove blood stasis.The emphasis is on removing lood stasis and adding Chishao,Wulingzhi and Yimucao to make the blood expelled smoothly.With 1 case of uterine bleeding-qi deficiency and blood stasis(abnormal uterine bleeding)