从肝寒理论探讨偏头痛的中医治疗  

Discussion on TCM treatment of migraine from the theory of liver cold

作　　者：卢恩仕 刘祖发[2] 何丽云[1] LU Enshi;LIU Zufa;HE Liyun(Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700;Wangjing Hospital,China Academy of Chinese Medical Sciences)

机构地区：[1]中国中医科学院中医临床基础医学研究所,北京100700 [2]中国中医科学院望京医院

出　　处：《现代中医临床》2024年第3期69-72,共4页Modern Chinese Clinical Medicine

基　　金：首都卫生发展科研专项(No.首发2022-1-4301)。

摘　　要：偏头痛以一侧或两侧头部交替疼痛为主,易反复发作,属中医“头痛”范畴,病机复杂,以内伤头痛为主。内伤头痛多责之于肝,临床辨证不仅要注重肝阳上亢、肝火上炎等基本病机,还应兼顾肝寒,注重温补肝阳、散寒止痛。肝寒头痛以头部两侧及巅顶疼痛为主,常伴胁肋胀满、少腹冷痛、胸闷太息等肝气郁滞的症状,以及呃逆呕吐、腹胀便溏、畏寒肢冷等脾肾阳虚的表现。肝寒头痛的辨证论治包括:(1)肝寒犯胃、浊阴上逆。头痛以巅顶疼痛为主,伴干呕、吐涎沫、畏寒喜暖、手足逆冷等,予吴茱萸汤加减治疗。(2)肝风内动、寒热错杂。以头痛、口干渴、纳呆、自觉气上撞心、便溏等为主,予乌梅丸加减治疗。(3)肝血亏虚、寒凝血瘀。以头痛、手足厥冷、少腹冷痛、脉沉细涩等多见,予当归四逆汤为主治疗。并结合临床病案对基于肝寒理论治疗偏头痛进行介绍。Migraine,characterized by alternating pain on one or both sides of the head and prone to recurrent episodes,falls within the realm of toutong(headache) in TCM,with a complex pathogenesis primarily rooted in internal damage.While clinical differentiation emphasizes liver hyperactivity and inflammation,attention to liver cold,focusing on warming liver yang and dispelling cold to alleviate pain,is also essential.Liver cold-induced headache primarily manifests as pain on both sides and the parietal part of the head,often accompanied by symptoms of liver qi stagnation such as hypochondriac distention,cold sensations and pain in the lesser abdomen,chest tightness,as well as signs of spleen and kidney yang deficiency such as hiccup vomiting,abdominal bloating,and loose stools.Syndrome differentiation and treatment for liver cold headache include:(1) Liver cold invading the stomach,causing turbid yin to rise upwards.Headache predominantly at the parietal part of the head,accompanied by clinical manifestations such as retching,salivation,aversion to cold,preference for warmth,and cold extremities,treated with modified Wuzhuyu Decoction(Evodia Decoction).(2) Liver wind stirring internally,with mixed cold and heat.Main symptoms include headache,thirst,lethargy,sensation of qi rushing up to the heart,and loose stools,treated with modified Wumei Pill(Mume Pill).(3) Liver blood deficiency leading to cold coagulation and blood stasis.Common symptoms include headache,cold extremities,old sensations and pain in the lesser abdomen,and a thin and astringent pulse,treated primarily with Danggui Sini Decoction(Chinese Angelica Frigid Extremities Decoction).Through clinical case studies,this article introduces the treatment of migraine based on the theory of liver cold.

关 键 词：偏头痛 肝寒论治 理论探讨 临证经验 

分 类 号：R255.9[医药卫生—中医内科学]