国医大师张磊从气血津液辨证治疗热郁头痛  

Zhang Lei′s Experience of Treating Heat⁃Stagnation Headache from the Syndrome Differentiation of Qi and Blood and Body Fluid

作　　者：闫淑婷 高洁 陈霞 李姗珊[1] 黄庆松 王雪羽 罗天帮 YAN Shuting;GAO Jie;CHEN Xia;LI Shanshan;HUANG Qingsong;WANG Xueyu;LUO Tianbang(Jiading Hospital of Traditional Chinese Medicine of Shanghai,Shanghai,China,201800;Shanghai Jiading District Nanxiang Hospital,Shanghai,China,201802;Traditional Chinese Medicine Master Zhang Lei Heritage Studio of Third Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,China,450008)

机构地区：[1]上海市嘉定区中医医院,上海201800 [2]上海市嘉定区南翔医院,上海201802 [3]河南中医药大学第三附属医院张磊国医大师传承工作室,河南郑州450008

出　　处：《河南中医》2024年第5期700-704,共5页Henan Traditional Chinese Medicine

基　　金：上海市嘉定区中医重点学科:中医脑病学项目(2020-JDZYYZDZK-03)。

摘　　要：国医大师张磊教授将郁热头痛分为郁热表证、郁热里证,从气血津液辨证治疗热郁头痛。其治疗头痛郁热表证选方用药以“辛散轻清”为主,以宣散表邪、恢复气机出入正常为主,临床常用经验方谷青汤,选奇汤、芎芷石膏汤、清空膏、川芎茶调散、川芎散等加减化裁也为其常用方,多用羌活、防风、白芷等风药。热郁里证头痛为气、血、津液郁滞于脏腑,郁久化热,灼热上扰清窍所致。气壅于内宜清宜泄,头痛合并阳明里热炽盛者,可加石膏,肠道燥屎内结者可用承气汤、大柴胡汤;气滞血瘀宜疏宜和,可用逍遥散、小柴胡汤、散偏汤、镇肝熄风汤等加减治疗;痰热内郁宜消宜导,对于痰热头痛者多以温胆汤、涤痰汤治之;瘀热内结宜行宜下,常用川牛膝、大黄以引血、引热下行。此外,张老师认为,久病瘀阻经络宜通络和络。Professor Zhang Lei,a TCM master,divides headache with heat⁃stagnation into exterior syndrome and interior syndrome,and treats it from the syndrome differentiation of qi,blood and body fluid.For heat⁃stagnation headache with exterior syndrome,he mainly chooses drugs with"pungent,dispersing,light and clearing"properties,focuses on dispersing exterior pathogens,restores qi movement′s exiting and entering to normal,so in clinical practice,he often adopts the following proven formulas,such as Guqing Decoction,Mar⁃velous Selection Decoction,Chuanxiong and Radix Angelicae Dahuricae and Gypsum Decoction,Chuanxiong Powder,etc.For modifica⁃tion,and wind drugs such as Qianghuo(Radix et Rhizoma Notopterygii),Fangfeng(Radix Saposhnikoviae),Baizhi(Radix Angelicae Dahuricae),etc.Heat⁃stagnation headache with exterior syndrome s caused by stagnation of qi,blood and body fluid in the viscera,long⁃time⁃stagnation transforming into heat,turbid heat disturbing the lucid orifices.Internal interior stagnation can be cleared or discharged.For headache combined with excessiveyang brightness heat,Shigao(Gypsum Fibrosum)can be added.For intestinal dry stools,Major Purgative Decoction,and Major Bupleurum Decoction are often used.Qi stagnation and blood stasis should be dispersed and harmo⁃nized,so Free Wanderer Powder,Minor Bupleurum Decoction,Sanpian Decoction,Liver⁃Sedating and Wind⁃Extinguishing Decoction,etc.are often used flexibly.Phlegm⁃heat internal depression should be eliminated or guided.For headache with phlegm⁃heat,Gallblad⁃der⁃Warming Decoction,and Phlegm⁃Flushing Decoction are often used.Internal accumulation of phlegm⁃heat should be moved or low⁃ered,so Chuanniuxi(Radix Cyathulae),and Dahuang(Radix et Rhizoma Rhei)are often used to induce blood and heat downward.In addition,Professor Zhang believes that long⁃time blockage of the meridians should be dredged and harmonized.

关 键 词：热郁头痛 气血津液辨证 郁热表证 郁热里证 张磊 

分 类 号：R259[医药卫生—中西医结合]