偏头痛的多病因假说及一种“全证候递减”的治疗策略  

Multi etiology hypothesis of migraine and a treatment strategy by “decreasing with total syndromes”

作　　者：顾雪轩 杨咸之 倪敬年[1] 李婷[1] 魏明清[1] 时晶[1] GU Xuexuan;YANG Xianzhi;NI Jingnian;LI Ting;WEI Mingqing;SHI Jing(Department of Encephalopathy,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing100010,China)

机构地区：[1]北京中医药大学东直门医院脑病科,北京100010

出　　处：《中国医药导报》2025年第7期134-137,170,共5页China Medical Herald

基　　金：国家自然科学基金资助项目(82074362);中国工程院战略研究与咨询项目(2023-PP-05);北京中医药大学“解码中医”协同攻关项目(BZY-JMZY-2022-002)。

摘　　要：偏头痛是一种常见的原发性头痛,症状包括单侧或双侧搏动性头痛。中医在偏头痛治疗中强调辨证施治,认为其病因复杂,涉及风、痰、瘀、虚等多种证候因素。“外因学说”认为,偏头痛与风寒、风热等外邪有关,“内伤学说”将偏头痛与气血亏虚、瘀血阻络、肝阳上亢等内在失调联系起来,“伏邪学说”则解释其慢性和反复发作的特性。本文基于其多病因、多证候及轻重缓急不同,提出治疗偏头痛的“全证候递减”治疗策略,即对急性期进行全证候干预,缓解疼痛,缓解期缩减证候靶标,小剂量长期服药,预防复发。该策略有助于避免早期辨证不准脱靶对效果的影响,同时避免过早停药带来症状反复。Migraine is a common primary headache with a pulsing sensation on one or both sides of the head.Traditional Chinese medicine emphasizes treatment based on syndrome identification in migraine,believes that its etiology is complex,involves a variety of syndrome factors such as wind,phlegm,stasis,and deficiency.“Theory of external cause”suggests that migraine is related to external pathogens such as wind cold and wind heat,“theory of internal injury”links migraine with internal imbalances such as qi and blood deficiency,blood stasis obstructing collaterals,and liver yang hyperactivity,“theory of hidden pathogen”explains its chronic and recurrent characteristics.This article proposes a“decreasing with total syndromes”treatment strategy for migraine based on its multiple etiologies,multiple syndromes,and varying degrees of severity.The strategy involves intervening with the entire syndrome in the acute phase to alleviate pain,reducing the syndrome target during the remission phase,taking low-dose long-term medication,and preventing recurrence.This strategy helps to avoid the impact of early inaccurate identification on syndrome,and the recurrence of disease associated with premature discontinuation.

关 键 词：偏头痛 中医病机 辨证论治 治疗策略 

分 类 号：R255.9[医药卫生—中医内科学]