王昕退膜汤与益气固冲汤分期辨治崩漏
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摘要
王昕教授认为崩漏主要为气虚血瘀,气虚为本,血瘀为标;排卵障碍型异常子宫出血(AUB-O)临床表现与"崩漏"类似。治疗以"急则治其标,缓则治其本"为原则,灵活运用"塞流""澄源""复旧"治崩三法。先活血化瘀以治标,退膜汤(党参、黄芪、莪术、三棱、茜草、补骨脂、海螵蛸、赤石脂、三七粉);瘀血祛除后,益气固冲摄血以调其本,益气固冲汤(党参、续断、黄芪、白术、白芍、茜草、山茱萸,荆芥炭、棕榈炭、牡蛎、海螵蛸、龙骨、赤石脂)。伴心烦加香附、郁金疏肝解郁;伴胃脘不适加瓦楞子煅制酸止痛;伴夜寐欠佳加酸枣仁、首乌藤养心安神。阴道流血停止后,运用中医四期调周疗法,结合不同生理时期的阴阳转化、消长、气血变化规律,周期性用药,经后阴血亏虚,加熟地、白芍、当归滋阴养血,充盈胞宫、血海;排卵期重阴转阳,加丹参、五灵脂、红花等补肾活血,促进排卵;经前期是重阳维持期,加鹿角霜、补骨脂、杜仲等补肾阳,推动经血来潮;经期为重阳转阴期,宜活血化瘀,重在祛瘀,加赤芍、五灵脂、益母草等,使经血排出通畅。附崩漏-气虚血瘀(异常子宫出血)验案1则。
Professor WANG Xin believes that the etiology and pathogenesis of utrine bleeding are complex, mainly manifested as Qi deficiency and blood stasis, Qi deficiency as the basis, blood stasis as the standard, and the clinical manifestation of anomalous uterine bleeding(AUB-O) with ovulation disorder is similar to metrorrhagia. The treatment is based on the principle of "treating the symptoms with urgency and treating the root with slowness", and flexibly applies the three methods of "plugging flow", "clarifying source" and "reviving old" to treat collapse. First, activating blood circulation to relieve stasis, Tuimo decoction(Dangshen, Huangqi, Ezhu, Sanleng, Qiancao, Buguzhi, Haipiaoxiao, Chishzhi, Sanqi powder).After removing blood stasis, Yiqi Guchong absorbs blood to regulate its origin, Yiqi Guchong decoction(Danshen, Xuduan, Huangqi, Baizhu, Baishao, Qiancao, Shanzhuyu, JingJie charcoal, Zhonglu charcoal,Muli, Haipiaoxiao, Longgu, Chishizhi). Accompanied by upset, adds Xiang fu、Yu jin, Stagnation of liver and relieving stagnation of liver; With stomach discomfort plus Wa Lengzi to make acid to relieve pain; With poor night sleep adds Suanzaoren and Shou Wuteng to nourish heart and calm the mind.After the cessation of vaginal bleeding, the four-stage periphery-regulating therapy of traditional Chinese medicine was used,combined with the regularity of Yin-yang transformation, growth and decline, Qi-blood change in different physiological periods, and periodically used drugs. After menstruation, deficiency of yin and blood, adds Shudi, Danggui, Baishao, nourishing Yin and nourishing blood, enriching uterus and blood sea; during ovulation period, replenishing Yin and Yang, invigorating kidney and activating blood, such as Danshen,Wulingzhi and Honghua, promote ovulation; during early menstruation period, replenishing kidney-yang by adding Lujiaoshusang、Buguzhi and Duzhong to promote menstrual influx; the menstrual period is from Yang to Yin. It is advisable to activate blood circulation and remove blood stasis. The emphasis is on removing lood stasis and adding Chishao, Wulingzhi and Yimucao to make the blood expelled smoothly. With 1 case of uterine bleeding-qi deficiency and blood stasis(abnormal uterine bleeding)
Professor WANG Xin believes that the etiology and pathogenesis of utrine bleeding are complex, mainly manifested as Qi deficiency and blood stasis, Qi deficiency as the basis, blood stasis as the standard, and the clinical manifestation of anomalous uterine bleeding(AUB-O) with ovulation disorder is similar to metrorrhagia. The treatment is based on the principle of "treating the symptoms with urgency and treating the root with slowness", and flexibly applies the three methods of "plugging flow", "clarifying source" and "reviving old" to treat collapse. First, activating blood circulation to relieve stasis, Tuimo decoction(Dangshen, Huangqi, Ezhu, Sanleng, Qiancao, Buguzhi, Haipiaoxiao, Chishzhi, Sanqi powder).After removing blood stasis, Yiqi Guchong absorbs blood to regulate its origin, Yiqi Guchong decoction(Danshen, Xuduan, Huangqi, Baizhu, Baishao, Qiancao, Shanzhuyu, JingJie charcoal, Zhonglu charcoal,Muli, Haipiaoxiao, Longgu, Chishizhi). Accompanied by upset, adds Xiang fu、Yu jin, Stagnation of liver and relieving stagnation of liver; With stomach discomfort plus Wa Lengzi to make acid to relieve pain; With poor night sleep adds Suanzaoren and Shou Wuteng to nourish heart and calm the mind.After the cessation of vaginal bleeding, the four-stage periphery-regulating therapy of traditional Chinese medicine was used,combined with the regularity of Yin-yang transformation, growth and decline, Qi-blood change in different physiological periods, and periodically used drugs. After menstruation, deficiency of yin and blood, adds Shudi, Danggui, Baishao, nourishing Yin and nourishing blood, enriching uterus and blood sea; during ovulation period, replenishing Yin and Yang, invigorating kidney and activating blood, such as Danshen,Wulingzhi and Honghua, promote ovulation; during early menstruation period, replenishing kidney-yang by adding Lujiaoshusang、Buguzhi and Duzhong to promote menstrual influx; the menstrual period is from Yang to Yin. It is advisable to activate blood circulation and remove blood stasis. The emphasis is on removing lood stasis and adding Chishao, Wulingzhi and Yimucao to make the blood expelled smoothly. With 1 case of uterine bleeding-qi deficiency and blood stasis(abnormal uterine bleeding)
引文
[1]张玉珍.中医妇科学[M].北京:中国中医药出版社,2002:106.
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[3]张仲景.金匮要略[M].北京:人民卫生出版社,2005:77.
[4]巢元方.诸病源候论[M].北京:中国医药科技出版社,2011:213-214.
[5]中华医学会妇产科学分会妇科内分泌学组.异常子宫出血诊断与治疗指南[J].健康管理,2017,49(6):74-79.
[6]古健.无排卵型异常子宫出血的诊治[J].中国计划生育和妇产科,2014,6(4):14-17.
[7]王莉莉,夏天,许扬.从气血论崩漏病因证治[J].山东中医杂志,2016,35(4):291-293.
[8]张慧珍,山书玲,赵纯.通因通用治疗崩漏[J].中医杂志,2014,55(15):1341-1342.
[9]李玲美,刘楠楠,傅迎霞,等.从气血理论谈中医养生之法[J].世界中医药,2018,13(2):309-311.
[10]谢洪,蓝婧,冯佳佳,等.浅谈崩漏治血四法[J].光明中医,2015,30(12):2519-2521.
[11]陆柳如,吴克明.《血证论》补脾摄血法治疗崩漏的学术思想探析[J].云南中医中药杂志,2016,37(3):8-10.
[12]万云慧,李道成.从脾虚论治崩漏[J].辽宁中医药大学学报,2013,15(4):162-163.
[13]贺丰杰,牛锐,李小宁.崩漏从瘀论治[J].陕西中医学院学报,2011,34(4):5-7.
[14]王紫媛,王昕.王昕教授从气虚血瘀论治崩漏[J].中国民族民间医药,2017,26(21):75-77.
[15]黄川雨,蓝婧,冯佳佳,等.曾倩治崩三法临证治验浅析[J].中华中医药杂志,2016,31(8):3144-3146.
[16]李知行.浅述张锡纯应用三棱、莪术经验[J].广州中医药大学学报,2011,28(5):546-547.
[17]骆赟韵,胡玲娟,黎小斌.当代中医妇科名家崩漏用药规律数据挖掘[J].山东中医杂志,2016,35(3):179-181.
[18]张琳,胡本祥,安衍茹,等.茜草本草考证[J].吉林中医药,2018,38(3):317-321.
[19]李冀.方剂学[M].北京:高等教育出版社,2011:192.
[20]薛方,许占民.中国药物大全·中药卷[M].北京:人民卫生出版社,2005.
[21]刘春泥,廖鑫波,周莉云.中医四期疗法合达英-35治疗多囊卵巢综合征的临床研究[J].光明中医,2017,32(9):1335-1338.
[2]黄帝内经[M].北京:中医古籍出版社,2010:276.
[3]张仲景.金匮要略[M].北京:人民卫生出版社,2005:77.
[4]巢元方.诸病源候论[M].北京:中国医药科技出版社,2011:213-214.
[5]中华医学会妇产科学分会妇科内分泌学组.异常子宫出血诊断与治疗指南[J].健康管理,2017,49(6):74-79.
[6]古健.无排卵型异常子宫出血的诊治[J].中国计划生育和妇产科,2014,6(4):14-17.
[7]王莉莉,夏天,许扬.从气血论崩漏病因证治[J].山东中医杂志,2016,35(4):291-293.
[8]张慧珍,山书玲,赵纯.通因通用治疗崩漏[J].中医杂志,2014,55(15):1341-1342.
[9]李玲美,刘楠楠,傅迎霞,等.从气血理论谈中医养生之法[J].世界中医药,2018,13(2):309-311.
[10]谢洪,蓝婧,冯佳佳,等.浅谈崩漏治血四法[J].光明中医,2015,30(12):2519-2521.
[11]陆柳如,吴克明.《血证论》补脾摄血法治疗崩漏的学术思想探析[J].云南中医中药杂志,2016,37(3):8-10.
[12]万云慧,李道成.从脾虚论治崩漏[J].辽宁中医药大学学报,2013,15(4):162-163.
[13]贺丰杰,牛锐,李小宁.崩漏从瘀论治[J].陕西中医学院学报,2011,34(4):5-7.
[14]王紫媛,王昕.王昕教授从气虚血瘀论治崩漏[J].中国民族民间医药,2017,26(21):75-77.
[15]黄川雨,蓝婧,冯佳佳,等.曾倩治崩三法临证治验浅析[J].中华中医药杂志,2016,31(8):3144-3146.
[16]李知行.浅述张锡纯应用三棱、莪术经验[J].广州中医药大学学报,2011,28(5):546-547.
[17]骆赟韵,胡玲娟,黎小斌.当代中医妇科名家崩漏用药规律数据挖掘[J].山东中医杂志,2016,35(3):179-181.
[18]张琳,胡本祥,安衍茹,等.茜草本草考证[J].吉林中医药,2018,38(3):317-321.
[19]李冀.方剂学[M].北京:高等教育出版社,2011:192.
[20]薛方,许占民.中国药物大全·中药卷[M].北京:人民卫生出版社,2005.
[21]刘春泥,廖鑫波,周莉云.中医四期疗法合达英-35治疗多囊卵巢综合征的临床研究[J].光明中医,2017,32(9):1335-1338.