从“痛由心生”探析内伤头痛  

An Analysis of Headache due to Internal Injury Based on"Pain Coming from the Heart"

作　　者：胡春雨[1] 丁元庆[1] 温雅[1] 王瑾[1] 黄鑫磊 贾雪雯 HU Chun-yu;DING Yuan-qing;WEN Ya;WANG Jin;HUANG Xin-lei;JIA Xue-wen(Shandong University of Traditional Chinese Medicine,Jinan,Shandong,China,250355;Rizhao Hospital of Traditional Chinese Medicine,Rizhao,Shandong,China,276800;Yantai Hospital of Traditional Chinese Medicine,Yantai,Shandong,China,264000)

机构地区：[1]山东中医药大学,山东济南250355 [2]日照市中医医院,山东日照276800 [3]烟台市中医医院,山东烟台264000

出　　处：《河南中医》2021年第6期815-819,共5页Henan Traditional Chinese Medicine

基　　金：全国中医学术流派传承工作室第二轮建设项目{国中医药人教函[2019]62号};山东省名老中医药专家丁元庆学术传承工作室建设项目{鲁卫中发展字[2018]1号};国家中医药管理局第六批全国老中医药专家学术经验继承工作建设项目{国中医药人教发[2017]29号};山东省中医药科技发展计划项目(2019-0016)。

摘　　要："痛由心生"所致内伤头痛,虽症状在头,病机关键却在心。情志刺激、饥饱失常、劳逸失度、因痛而发、外伤久病是其常见病因,可单独致病,亦能交互为害,致心主血脉、藏心神功能失调,营涩卫滞,脉道不利,心神被伤,五脏生克制化失序,气机逆乱,化火生风,风火挟痰瘀上扰清窍,引发头痛,久痛可入络,络脉瘀滞或绌急,致头痛反复发作。治宜形神兼顾,补虚泻实同用,在应用理气祛湿、化痰散瘀、益气养阴方药的同时,选择兼有清心、宁心、舒心作用的药物,以调神、通血脉、止头痛。常用方剂有热郁汤、四神散、开心散、陈茶芽煎及酸枣仁汤等。七情郁结化火、思虑过度、饮食蕴积化火者,用开心散合热郁汤加减;痰热、湿热、瘀热在体内蓄积日久者,用陈茶芽煎和除湿化瘀汤加减;过食辛辣、情志化火、久病耗伤者,选酸枣仁汤合炙甘草汤加减。In terms of headache due to internal injury based on"pain coming from the heart",although the symptoms are in the head,the key pathogenesis is in the heart.Emotional stimulation,abnormal hunger and satiety,imbalance of work and rest,pain and long-term illness are the common causes of the disease.Each factor can cause disease alone,but also interact with each other,resulting in dysfunction of heart governing blood vessels and storing heart and mind,astringent nutrient qi and defensive stagnation,unfavorable channels,heart and mind being injured,disorder of five zang-organs′generating-restricting relations,disorder of qi mechanism,transforming fire and generating wind,wind and fire with phlegm and blood stasis disturbing the orifices,causing headache,and long-term pain can enter the collaterals.Blood stasis or blocked collaterals lead to recurrent headache.The treatment should give consideration to both body and spirit,tonifying deficiency and reducing excess.At the same time,the formulas for regulating qi and eliminating dampness,resolving phlegm and removing blood stasis,supplementing qi and nourishing yin should be used.Besides,the medicinals with the functions of clearing heart,calming heart and relaxing heart should be selected to regulate spirit,unblock blood vessels and stop headache.The commonly-used formulas include Heat Stagnation Decoction,Four Spirit Powder,Kaixin Powder(开心散,KXP),Aged Tea Bud Decoction,Sour Jujube Decoction,etc.For emotional depression transforming into fire,over thinking and diet accumulation,Kaixin Powder combined with Modified Heat Stagnation Decoction is often used.For phlegm heat,dampness-heat and blood stasis heat accumulated in the body for a long time,Aged Tea Bud Decoction combined with Modified Decoction for Removing Dampness and Resolving Blood Stasis is commonly used.For people who have eaten too much spicy food,with emotional disorder transforming into fire,and long-time illness,Sour Jujube Decoction combined with Modified Honey-Fried Licorice Decoction is often use

关 键 词：内伤头痛 “痛由心生” 形神共病 热郁汤 四神散 开心散 陈茶芽煎 酸枣仁汤 炙甘草汤 除湿化瘀汤 

分 类 号：R255.9[医药卫生—中医内科学]