叶海敏运用自拟柴附四物汤治疗偏头痛肝郁血虚、气滞血瘀证经验  

Ye Haimin′s Experience in Treating Migraine with Liver Depression and Blood Deficiency and Qi Stagnation and Blood Stasis Syndrome Using Self-Formulated Bupleurum and Aconite Four Substances Decoction

作　　者：李卓燕 赵梦圆 刘叶辉[1] 叶海敏[1] LI Zhuoyan;ZHAO Mengyuan;LIU Yehui;YE Haimin(The Second Affiliated Hospital of Hunan University of Chinese Medicine,Changsha,Hunan,China,410005;The Second Clinical College of Traditional Chinese Medicine,Hunan University of Chinese Medicine,Changsha,Hunan,China,410005)

机构地区：[1]湖南中医药大学第二附属医院,湖南长沙410005 [2]湖南中医药大学第二中医临床学院,湖南长沙410005

出　　处：《河南中医》2025年第5期712-717,共6页Henan Traditional Chinese Medicine

基　　金：湖南中医药大学2021年度校级科研基金与联合基金项目(2021XJJJ057)。

摘　　要：叶海敏老师认为,偏头痛病位在脑,发病涉及五脏,以肝郁血虚、气滞血瘀证多见,核心病机为肝郁气滞,气滞而血瘀,不通则痛,兼有肝血亏虚,脑窍失于濡养,不荣则痛。抑郁、焦虑和睡眠障碍是导致患者偏头痛发作的重要原因,也是偏头痛患者年轻化的主要原因。叶老师根据偏头痛肝郁血虚、气滞血瘀证虚实夹杂的特点,倡导治疗时应注重疏肝养血、通络止痛,兼以理气、祛风,自拟柴附四物汤治疗临床疗效颇佳。肝血不足,魂不守舍,出现入睡困难,多梦,易醒,醒后难以入睡者,加茯神、远志或酸枣仁汤养血安神,以助睡眠;脾虚湿盛,出现食少,腹胀,便溏,舌苔白腻者,加茯苓、薏苡仁以利水渗湿、健脾止泻;风痰上扰,出现头晕,胸闷,恶心欲吐者,合半夏白术天麻汤以化痰熄风;出现胆怯易惊,心烦,口干,苔黄腻等胆胃不和、痰热内扰症状者,合温胆汤以理气化痰、清胆合胃,同时出现心神不宁、失眠多梦,则合十味温胆汤以益气养血、化痰宁心;受风寒湿侵袭,出现颈部僵硬、疼痛者,加葛根、威灵仙以通经活络;出现手部麻木感者,加鸡血藤以舒筋通络;出现畏寒、自汗、盗汗等气虚卫表不固症状者,加黄芪、白术以补气、固表止汗;出现口苦、呕吐泛酸等肝郁化火犯胃症状者,加黄连、吴茱萸以疏肝泻火和胃;出现胸闷呕恶,侧头痛疼痛剧烈且反复发作者,加黄芩加强引药入少阳经之效。Associate Professor Ye Haimin thinks that migraine originates in the brain,but involves dysfunction of the five zang organs,with liver depression,blood deficiency,qi stagnation,and blood stasis syndrome being the most common pattern.The core pathogenesis lies in liver depression and qi stagnation,which leads to blood stasis causing pain,compounded by liver blood deficiency that deprives the brain of nourishment causing deficiency resulting in pain.Depression,anxiety,and sleep disorders are significant triggers for migraine attacks and key factors contributing to its increasing prevalence among young people.Based on the complex interplay of deficiency and excess in this syndrome of liver depression with blood deficiency,qi stagnation and blood stasis.Professor Ye advocates a treatment strategy focusing on soothing the liver,nourishing blood,unblocking collaterals,and relieving pain,supplemented with regulating qi and dispelling wind.Her self-formulated Bupleurum and Aconite Four Substances Decoction has shown notable clinical efficacy.For insomnia,dreaminess,and difficulty in sleep due to liver blood deficiency failing to anchor the ethereal soul,Fushen(Sclerotium Poriae Pararadicis),Yuanzhi(Radix Polygalae)or Sour Jujube Decoction can be added to nourish blood and calm the mind.For poor appetite,abdominal distension,loose stools,and white greasy tongue coating due to spleen deficiency and dampness,Fuling(Poria)and Yiyiren(Semen Coicis)can be added to induce diuresis and drain dampness,fortify the spleen and stop diarrhea.For dizziness,chest tightness,and nausea due to wind-phlegm ascending,Pinellia and White Atractylodes and Gastrodia Decoction is combined to resolve phlegm and extinguish wind.For timidity,irritability,dry mouth,and yellow greasy tongue coating from gallbladder-stomach disharmony and phlegm-heat,Gallbladder-Warming Decoction is combined to regulate qi,resolve phlegm,and clear heat.If accompanied by restlessness and insomnia,Ten-Ingredient Gallbladder-Warming Decoction can be used to boost qi,nour

关 键 词：偏头痛 肝郁血虚、气滞血瘀证 柴附四物汤 叶海敏 

分 类 号：R259.472[医药卫生—中西医结合]