于红娟教授从心-肾-子宫轴理论辨证治疗顽固性痛经的临床经验  

Professor Yu Hongjuan's experience in the syndrome diff erentiation and treatment of intractable dysmenorrhea based on the theory of the heart-kidney-uterus axis

作　　者：张霈涵 王宇慧 于红娟[1,2] ZHANG Peihan;WANG Yuhui;YU Hongjuan(Nanjing University of Chinese Medicine,Nanjing 210000,China;Nanjing Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Nanjing 210000,China)

机构地区：[1]南京中医药大学,南京210000 [2]南京中医药大学附属南京中医院,南京210000

出　　处：《吉林中医药》2024年第12期1423-1427,共5页Jilin Journal of Chinese Medicine

基　　金：南京市卫健委中医药科技专项项目(ZYYB202209);南京中医药大学自然科学基金项目(XZR2021048);于红娟名中医工作室项目(2023-NJSMZYGZS-YHJ)。

摘　　要：顽固性痛经多在原发性痛经的基础上发展而成,于红娟教授认为顽固性痛经的病因在肾虚感寒、日久气滞血瘀、肝肾亏虚等致使经期胞宫胞脉气血不畅或气血亏虚而经行腹痛且痛久五志过极化火而至心火亢盛使之痛甚而发病。病机多为肾寒偏于下,加之心火亢于上,属心肾不交,水火失济,病机关键当属心火亢盛。临证特点为发病疼痛时间长、程度重,常规止痛措施效果不佳,常出现心理因素,加重痛经程度。故于红娟提出心是痛经的主导因素,重视情志因素对痛经的影响,坚持益肾填精,养心安神原则,治疗上行经期从养心、治血、通脉三方面论述,临床中常在辨证准确基础上,再根据月经周期,尤其重视经前期与经期的治疗,用药轻灵,效果显著。Intractable dysmenorrhoea mostly develops on the basis of primary dysmenorrhoea.Professor Yu Hongjuan believes that the causes of intractable dysmenorrhoea lie in cold invasion due to deficient kidney,prolonged stagnation of qi and blood stasis,and deficiency of the liver and kidney,which result in poor blood circulation in the uterus during menstruation,or deficiency of qi and blood and menstrual abdominal pain,as well as pain for a long period of time,caused by the over-excessiveness of the five wills,resulting in the heart fire over-exuberance,which makes the pain get worse and leads to the onset of the disease.The pathogeneses of the disease involve cold in the lower due to the deficient kidney,coupled with the exuberant heart fire in the upper,belonging to the disharmony between the heart and kidney,water failing to restrict fire,with the core of its pathogeneses lying in the heart fire hyperactivity.The onset of dysmenorrhea is characterised by a prolonged and severe pain,and conventional pain relief measures are ineffective,inducing psychological impacts on patients,which may in turn aggravate the degree of dysmenorrhoea.Therefore,Professor Yu Hongjuan proposes that the heart is the dominant factor in dysmenorrhoea,paying attention to the influence of emotional factors on it.She adheres to the principle of benefiting the kidney and reinforcing the essence,nourishing the heart and tranquillising the spirit.She treats dysmenorrhoea by nourishing the heart,regulating the blood,and dredging collaterals.In clinic,on the basis of an accurate syndrome diff erentiation,she observes the menstrual cycle,paying particular attention to its treatment before and during the menstrual period,applying moderate dosage and exquisite compatibility of medicines,with a remarkable result.

关 键 词：原发性痛经 心主神明 心主血脉 心-肾-子宫轴 顽固性痛经 

分 类 号：R271.1[医药卫生—中医妇科学]