经方联合针刺治疗难愈性腹痛验案1则  

Treating one case of refractory abdominal pain by classical prescription plus acupuncture

作　　者：邰世斌 刘秀珂 郝晓臣 游光栋 TAI Shibin

机构地区：[1]安丘市人民医院,山东安丘262100

出　　处：《中医临床研究》2023年第22期82-85,共4页Clinical Journal Of Chinese Medicine

基　　金：潍坊市卫生健康委员会科研项目(WFWSJK-2020-234,WFWSJK-2020-279)。

摘　　要：腹痛多为气机阻滞、脉络痹阻或经脉失养导致的一种临床疾患,而对于迁延日久的腹痛,中医诊疗讲究虚实辨证,并通过内治、外治联用可达较好的治疗效果。外治针刺多取腹痛病证常用主穴,依据证候不同酌加腧穴,辅以配穴以缓解患者疼痛之急,操作中采用实泻虚补的针刺手法。内治方剂通常需查辨病机、甄别虚实,而后组方施治,随诊疗中疾病的传变,往往多次更方试药,才能达到较好的临床结局。本例患者针刺主穴取中脘穴、天枢穴、关元穴、气海穴、足三里穴、三阴交穴、合谷穴、太冲穴,前两穴以平补平泻针之,中三穴以补法针之,后三穴施行泻法;配穴取肝俞穴、脾俞穴、胃俞穴,以补法补益阴阳、气血之不足;予电针连续波,起到了缓急止痛的功效。方剂先以柴胡疏肝散化裁主之,用以疏肝理气、活血止痛;二诊予以柴胡加龙骨牡蛎汤加减,发挥和解少阳、镇惊安神之效;三诊辨病机乃脾胃虚弱为本,寒湿阻滞、气机不畅为标,证属虚实夹杂,治以健脾利气、温运宽中,以厚朴生姜半夏甘草人参汤治疗;四诊效不更方,续以原方4剂,患者服毕后临床治愈。笔者在取穴针刺的基础上,依据病情传变多次换方,终以经方——厚朴生姜半夏甘草人参汤治愈1例难愈性腹痛患者,特整理验案以期为类似病例诊疗提供借鉴和参考。Abdominal pain is a common clinical disease caused by Qi(气)movement stagnation,blockage of collaterals or malnutrition of meridians.And for prolonged abdominal pain,TCM diagnosis and treatment stresses the differentiation of syndromes of deficiency and excess,and through the combination of internal and external treatment can achieve better therapeutic effects.In the treatment of external acupuncture,the main acupoints commonly used in abdominal pain syndrome are mostly selected,and other acupoints are added as appropriate according to the different syndroms,moreover,supplemented by matching acupoints to relieve the urgency of the pain of the patient.In the operation,we adopt the acupuncture technique of reducing symptoms due to excess syndrome and reinforcing symptoms due to deficiency syndrome.In the treatment of internal treatment,TCM prescription usually need to identify pathogenesis,identify deficiency and excess,and then formulate prescription for treatment.With the change of diseases in diagnosis and treatment,we often need to change the prescription and experiment the prescription several times to achieve a better clinical outcome.In this case,the main acupuncture points of the patient were Zhongwan(RN12),Tianshu(ST25),Guanyuan(RN4),Qihai(RN6),Zusanli(ST36),Sanyinjiao(SP6),Hegu(LI4)and Taichong(LR3).The first two points were reinforcing-reducing method acupuncture,the middle three points were invigoration method acupuncture,and the last three points were reducing method acupuncture.We took Ganshu(BL18),Pishu(BL20),Weishu(BL21)as matching acupoints to supplement Yin(阴)-Yang(阳),Qi-blood deficiency.We gave the patient continuous wave electroacupuncture,which finally had the effect of slow pain relief.The prescription was first formulated with the Chaihu Shugan powder(柴胡疏肝散),which was used to soothe the liver,regulate Qi,promote blood circulation,and relieve pain.The second diagnosis prescription was the addition and subtraction of the Chaihu plus Longgu Muli decoction(柴胡加龙骨牡蛎汤)

关 键 词：腹痛 虚实辨证 厚朴生姜半夏甘草人参汤 针刺 

分 类 号：R245[医药卫生—针灸推拿学]