徐志华-经行头晕 – Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle

徐志华 - 经行头晕

Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle
Translated by XU Zhi-jun & J. Heaverlo

经行前后或经期,出现头目眩晕,并伴随月经周期发作者,称 “经行头晕”。徐老着重于”无痰不作眩”,施用半夏天麻自术汤而获效.

Dizziness may develop before, during or after the menstrual period.  When this occurs it is called “dizziness during menstrual cycle”.   Xu Zhi-hua emphasizes the concept “Without phlegm, there can be no dizziness”.  He achieves excellent results with the formulation ban xia tian ma bai zhu tang.

经行头晕责痰障  施用半夏天麻汤
Menstrual cycle dizziness due to phlegm – use ban xia tian ma tang

半夏天麻白术汤
组成:天麻 10g   姜夏 10g    白术10g  神曲lOg   麦芽 lOg    泽泻lOg   党参 10g   夜苓 10g   黄柏 10g   陈皮lOg 于姜 10g   生姜 3 片

Ban Xia Bai Zhu Tian Ma Tang
Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces

功用:健脾燥湿,桂痪降浊。

主治:经行头晕。

Functions:  Strengthens the Spleen and dries damp.  Expels phlegm and descends turbidity

Primary Treatment: dizziness during the menstrual cycle

方解:天麻性味辛微温,善能祛风化痰,为治疗肝风而夹痰湿之眩晕要药;二陈汤加浑泻、黄柏化湿除痰、降逆止呕;党参、白术健脾益气;神曲、麦芽健胃和中;生姜宣散水湿。

Explanation:  Tian ma is acrid and slightly warming.  It can expel wind and transform phlegm.  It serves as the chief herb when there is liver wind and phlegm damp causing dizziness.  This formula also contains er chen tang with ze xie and huang bai.  Together these herbs can transform damp and expel phlegm, descend counterflow and stop vomiting.  Dang shen and bai zhu strengthen the spleen and benefit the qi.  Shen qu and mai ya strengthen the stomach and harmonize the center.  Sheng jiang disperses water dampness.

案例:
例一:女,42岁。初诊日期: 1987 年 5 月5 日。患者近年来每至经行之时即觉头晕,后脑作胀微痛,不能见行驶车辆。发作严重时恶心呕吐,不能起坐。头重如蒙,胸闷纳少,整日昏昏欲睡。月经初潮 15 岁,3 - 5 / 2 6 - 3 0天,量中色红无块,末次月经:  1987 年 4 月 11  日,舌质淡,苔白腻,脉濡。

Case Study 1:
A 42 year old female patient reports, in the past few years, at the time of her menstrual period, she has  dizziness and occipital distention with slight pain.   She cannot even bear to see moving vehicles. When the dizziness worsens she also experiences nausea and vomiting, and cannot sit up.   The head feels heavy and foggy.  She has chest oppression and is unable to eat much.  She feels tired all day and only desires sleep.  Her menstrual cycle began when she was 15 years old.   The cycle lasts 26-30 days and the period is 3-5 days.  It is medium in amount, red in color and without clotting.   Her last menstrual period was 3 weeks prior to the time of diagnosis.   The tongue body is pale-red and the coating is white and greasy.  The pulse is soggy.

此由痰浊蒙蔽清阳,故头晕头重如蒙;痰浊中阻,浊阴不降,气机不利,故胸闷恶心,脾阳不振则少食多寐,加之经行气血下注,其气益虚,清阳不升,痰湿上扰所致。投半夏天麻白术汤。

This condition is due to phlegm turbidity obstructing the clear yang, causing dizziness and a sensation of fogginess and heaviness in the head.  When phlegm turbidity obstructs the center, the turbid yin cannot descend causing the Qi mechanism to become obstructed.  Therefore, there will be chest oppression and nausea.  The spleen yang is unable to ascend, causing diminished appetite and excessive sleepiness.   In addition, during the menstrual cycle, the Qi and blood pour downward, causing the Qi to be even more vacuous.  The clear yang is unable to ascend causing phlegm-damp to harass the upper body. Administer ban xia tian ma bai zhu tang.

天麻 10g,姜夏  10g,臼术 1 g,泽泻  10g,党参 10g夜苓lOg ,干姜 10g,陈皮 10g,黄柏 10g,麦芽10g,神曲10g,生姜 3 片。4 剂。水煎服。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, ze xie 10g, dang shen 10g, fu ling 10g, gan jiang 10g, chen pi 10g, huang bai 10g, mai ya 10g, shen qu 10g, sheng jiang 3 pieces.  4 formulas were administered for decoction.

二诊: 1987 年 5 月 10 日。此次经行已 3 天,精神明显好转,仅觉轻度头晕,尚能坚持正常教学。舌质淡,苔白微腻,脉濡滑。嘱下次经前 5天按上方再服 4 剂。3 月后随访,头晕己愈。

Follow up:  At the time of the second visit (5 days later) the patient was on day 3 of her period.  Her vitality had clearly improved.  Not only was the dizziness less intense but she was able to return to work.  The tongue body was pale-red.  The tongue coating was white and slightly greasy.  The pulse was moist and slippery.  The patient was urged, next time to start taking the herbal formulation 5 days before her menstrual cycle begins.  She was instructed to take 4 formulations at that time.  After 3 months, follow up showed that her dizziness had already recovered.

例二:付某,女,37 岁,干部,已婚。1990 年 11 月 7日初诊。患者经前头晕反复发作 2 年,头晕多在月经前 1 周发作。头晕头重如裹,胸院痞塞,恶心欲呕,纳呆,肢重乏力。末次月经,1990 年 10 月 12 日。舌质淡红,苔白腻而厚,脉滑。证属痰湿中阻,风痰上扰。方用半夏臼术天麻汤:

Case Study 2:
A 37 year old female patient reports dizziness occurring one week before her menstrual cycle begins.  This has been repeatedly occurring for 2 years.  The head feels heavy as if wrapped.  There is a sensation of chest and stomach glomus and blockage, nausea with a desire to vomit, torpid intake, and heavy limbs without strength.  Her last menstrual cycle was 3 1/2 weeks prior.  The tongue is pale-red.  The tongue coating is white, greasy and thick.  The pulse is slippery.  The diagnosis is phlegm-damp obstructing the center with wind-phlegm harassing the upper body.  Administer ban xia bai zhu tian ma tang.

天麻lOg ,姜夏 10g,自术 10g,神曲 10g,麦芽 10g,浑海  10g,党参 10g,夜苓 10g,黄柏 10g,陈皮 10g,干姜10g,生姜 3 片。5 剂。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces.  5 formulas were administered.

二诊: 1990 年 11 月 13 日。头晕减轻,纳可。现月经将至,舌脉同前,原方加泽兰叶lO g,再进 7 剂,经净晕止,一切正常,以后每临经前,继续宗方调治半年,痊愈。

Follow up:  After one month, the dizziness was mitigated and the appetite returned.  At the time of the follow up, the menstrual period was about to begin.  The pulse and the tongue were unchanged.  The same formulation was administered with the addition of ze lan ye 10g.  Seven formulations were prescribed.   After the period, the dizziness stopped and the symptoms were no longer present.  At each follow up visit, prior to the beginning of the menstrual cycle, the same formulation was prescribed.  After 6 months the patient recovered completely.

按1 经行头晕是妇科临床常见症候之一。轻者闭目即止,重者如坐舟车,旋转不定。加之经行之时,营血趋向于下,髓海空虚,肝阳偏亢,阳扰于上,则头目为之昏眩。正如《内经》云:”诸风掉眩,皆属于肝”、”上虚则眩”、”髓海不足则脑旋耳鸣”,     <金匮要略》云:”心下有痰饮,胸胁支满目眩,”刘河间认为眩晕由风火所致;朱丹溪认为”无痰不作眩”,张景岳认为”无虚不作眩”等。因此,眩晕之由,不外风、火、痰、虚。而以风阳上扰及气血亏虚者最为多见。治疗中必须首先审证求因,分清虚实,然后再确立治法。本类患者脾虚水湿失运,聚而成痰,经行痰浊上扰,蒙闭清窍,清阳被遏,故经行头晕。

Discussion:  Clinically, in gynecological medicine, dizziness during the menstrual cycle is a commonly seen condition.  In less severe cases, if the patient closes their eyes the dizziness will stop.  In more severe cases, however, it may feel as if one is riding on a boat, causing a continuous spinning sensation.  In addition, during the menstrual period, the construction blood are moving downward leaving the sea of marrow empty and depleted.  The inclination is for the  liver yang  then to ascend and harass the upper body causing dizziness.  The Nei Jing states “All wind with shaking and dizzy vision is ascribed to the liver.”“when the upper body is vacuous there will be dizziness”, “when the sea of marrow is insufficient there will be dizziness and tinnitus.”.   The Jin Gui Yao Lue states, ” when there is phlegm-rheum below the heart there will be distention in the chest and rib-side, and dizziness.”  Liu He-jian  believes dizziness is caused by wind-fire.  Zhu Dan-xi states ” without phlegm there cannot be dizziness.”  Zhang Jing-yue states “without vacuity there cannot be dizziness”.  Therefore, the causes of dizziness are nothing more than external wind, fire, phlegm and vacuity.  Among these causes the  most commonly seen are due to  the liver yang rising to harrass the upper body and qi and blood depletion and vacuity.  Treatment first must be determined by seeking the root cause and distinguishing between vacuity and repletion.  After this, the correct treatment method can be established.  Typically, these are patients with spleen vacuity and water damp causing loss of transportation.  This allows for the accumulation of phlegm.  At the time of the menstrual cycle, this phlegm turbidity will ascend and harass the upper causing fogginess and obstruction of the clear orifices.  The clear yang will be blocked leading to “dizziness during the menstrual cycle”.

徐老几十年的临床实践中,对东垣指出的”足太阴痰厥头晕非半夏不能疗,眼黑头旋,虚风内作,非天麻不除”体会尤深。遵其所论,以半夏天麻臼术汤加减屡用皆效。《本草从新》称:”天麻入肝经,通血脉,疏痰气,治诸风掉眩, 头眩眼黑”、”半夏体滑性燥,能走能散,治咳逆头眩,痰厥头痛”,浑泻利水行饮下走水道,小便一行,水湿有其出路,三焦阳气通达,表里通畅,故头晕病解。
Xu Zhi-hua has numerous years of clinical practice that has brought about a deep understanding of this condition.  As Li Dong-yuan points out ” ban xia is capable of treating foot tai-yin  phlegm-rheum causing dizziness.  When the eyes are black and the head is spinning, and there is vacuity wind internally occurring, tian ma is indispensable”.  Following this theory, the usage of modified ban xia tian ma bai zhu tang will bring results.   The Ben Cao Cong Xin states, ” tian ma enters the liver channel, opens the blood vessels, dredges the phlegm-qi and thereby treats all wind with shaking and dizzy vision, as well as, dizzy head and dim eyes.  Ban xia is slippery in body and dry in nature.  It is capable of moving and dispersing and can treat cough, counterflow, dizziness, and phlegm reversal  headaches.”  Ze xie opens waterways, moves fluids downward and promotes urination.   Once urination is unblocked,  water-damp finds a passage out and the Yang Qi of the Triple Burner becomes open and free. Thus, both the exterior and interior are open and unblocked and the dizziness can be relieved.

中医中药治疗头痛之浅谈 - Discussion on Shi Pei-qing’s Treatment of Headaches

中医中药治疗头痛之浅谈 -Discussion on Shi Pei-qing’s treatment of headaches

史培卿 张 锦

Translated by: Xu Zhi-jun & J. Heaverlo

摘要:目的:自拟中药方剂治疗头痛的有效性。方法:临床辨证论治,实际运用。结果:治疗患者159例,外感头痛一号方应用患者73例,无效 者 0 例 , 有 效 7 3 例 , 治愈 7 1 例 , 有 效 率 1 0 0 % , 治愈率 : 9 7 . 2 6 %。 内 伤 头 痛 一 号 方 应 用 患 者 8 6 例 , 无 效 者 0 例 , 有 效 8 6 例 , 治愈 8 5 例 , 有 效 率 为100 % ,治愈 率 98 . 83 % ,两则方剂总体治愈率为 98 . 05 % 以 上 。 结 论 :两 则 方 剂 均 为 治 疗头痛的 有 效 方 剂 。

Abstract: This article introduces two custom herbal formulations for the treatment of headaches: one formulation for the treatment of externally contracted headaches and one formulation for the treatment of headaches due to internal damage. Clinically, 73 patients were treated with the herbal formula for externally contracted headaches. 71 patients made a full recovery. The efficacy rate is 100% and the cure rate is 97.26%.  86 patients were treated with the herbal formula for headaches due to internal damage. 85 patients made a full recovery. The efficacy rate is 100% and the cure rate is 98.83%.  The cure rate of the two formulations is 98.05%.  Both formulations have proved to be effective within clinical practice.

关键词:中医中药 治疗头痛
Key words: Chinese medicine, Headache treatment

头痛是临床常见的症状之一。 头痛病因多端,分为外感和内伤两大 类。 头为诸阳之会,清阳之府,凡五脏精华之血,六腑清阳之气,皆上注 于 头 , 故 六 淫 之 邪 外 袭 , 上 犯 巅 顶 邪 气 稽 留 , 阻 抑 清 阳 , 或 内 伤 诸 疾 , 导 致 气 血 逆 乱 , 瘀 阻 经 络 , 脑 失 所 养 , 均 可 致 头 痛 。

Clinically, headaches are one of the most commonly seen symptoms. There are various causes for headaches. Generally, it is divided into external contraction and internal damage. The head is the confluence of  Yang Qi and the house of the clear Yang.  Essence and blood, which are derived from the five viscera, and the clear Yang Qi, which is derived from the six bowels,  ascend upward to the head. Therefore, various factors may lead to headaches. It may be due to an external evil attack of the six excesses, which invade the vertex, store the evil Qi, and obstruct the clear Yang. Or, it may be due to disease caused by internal damage, which leads to the chaotic counterflow of Qi and blood, stasis and obstruction of the channels and vessels, and therefore, causing the brain to be deprived of nourishment.

外感六淫:六淫外袭起居不慎,均可致头痛,《素问· 太阴阳明论》云:“伤于风者,上先受之,故头痛以风邪所致者最为多见。”且风为百病 之长,多夹时气为患,若风寒袭表,寒凝血涩,则头痛而恶寒战栗,风热上犯清空,则头痛而身热烦心,风湿袭表,上蒙清阳,则头痛而重,若湿邪中阻,清阳不升,浊阴不降,亦可引起头痛。

Headaches due to external contraction of the six excesses: In “Plain Questions · Treatise on Greater Yin and Yang Brightness” states, “If a person is attacked by wind, the head is the first place to be affected; therefore, most headaches are due to wind evil.” In addition, wind is the chief of the one hundred diseases, and often combines with seasonal Qi. If wind-cold assails the exterior, there will be congealed cold and inhibited blood.  This will lead to headaches and aversion to cold with shivering. If wind-heat invades the brain, headaches will present with body heat and heart vexation. If wind-damp assails the exterior and clouds the clear Yang, there will be headaches and sensations of heaviness. If damp evil obstructs the center, the clear Yang will fail to bear upward and the turbid Yin will fail to bear downward. This may also lead to headaches.

内伤不足:“脑为髓海”,主要依赖肝肾精血及脾胃运化水谷精微濡养,气血不足,失却濡养可见头痛,三脏邪盛亦可引发头痛,故其发病与 肝、脾、肾三脏有密切关系。

Headaches due to internal damage: “The brain is the sea of marrow”, which is mainly nourished by the essence blood from the liver and kidney and the essence of grain and water transformed from the spleen and stomach. If the Qi and blood is insufficient, the brain will lack nourishment and headaches will follow. Exuberant evil of the three viscera may also lead to headaches. Therefore, the pathomechanisms of headaches are closely related to the liver, spleen and kidney.

头痛的辩证,要详问病史,根据各种症状不同表现,辨别致病之因以外,尤其注意头痛之久暂,疼痛之性质,特点及部位之不同,辨别外感和内伤,以便进行论治。

While identifying the patterns for headaches, the doctor should inquire about the patient’s medical history in detail.  After doing so, the doctor can make a differential diagnosis according to the various symptoms. What is more important, in order to determine the appropriate treatment, the doctor should clearly identify if the headache is: enduring or temporary; what type of pain is present; where the pain is located; and if the headache is due to external contraction or internal damage.

另外,头痛还应根据发病部位之异,参照经络循行路线加以判断-大抵太阳经头痛多在头后部,下连于颈,阳明经头痛多在眉棱骨等处,少 阳经头痛多在头之两侧,并连接耳部;厥阴经头痛多在巅顶部位,或连于目系。 临床辨证既应注意头痛的不同特点,同时还应结合整体情况及其有关兼症全面分析以便处方用药。

In addition, headache patterns should be diagnosed according to the channel pathways. The varying types of headaches can be located within the different regions of the head: generally, the greater Yang channel headache is located at the back of the head and connects with the nape of the neck. The Yang brightness channel headache is located at or around the orbital bone. The lesser Yang channel headache is located at the parietal sides of the head and connects to the ears. The reverting Yin channel headache is located at the vertex, and/or connects with the eye. Clinically, attention should be paid not only to the different types of headaches, but also to the condition of the whole body and other concurrent patterns.

本人行医30多年,对治疗头痛有很好的经验,根据外感、内伤两大类来自拟头痛外感一号方,内伤头痛一号方,应用于临床两年来,治疗患者97例,取得了良好的效果。

Based on 30 years of medical practice,  Shi Pei-qing has acquired outstanding clinical experience in the treatment of  headaches. He has devised herbal formulations for the treatment of externally contracted headaches, and headaches due to internal damage. They have been applied clinically for two years and have achieved great results.

1 资料与方法 外感头痛一号方

1. Formula for the treatment of externally contracted headaches

组 成 : 菊花一包 (10g), 川穹一包 (6g), 羌活一包 (10g), 白芷一包 (6g), 蔓荆子一包 (10g), 甘草一 包 (3g)。
Ingredients: chrysanthemum (ju hua) 10g, chuan xiong rhizoma (chuan xiong) 6g, notopterygium (qiang huo) 10g, dahurian angelica (bai zhi) 6 g, vitex (man jin zi) 10g, licorice (gan cao) 3g

功效: 祛风,散寒,止痛。

Function: dispel wind, dissipate cold, and relieve pain

主治: 外感头痛:头痛,恶寒恶风,肢体困重,脉浮。

Indications for externally contracted headaches: headache, aversion to cold and wind, heavy and cumbersome limbs, and a floating pulse

用法:一日一剂,温开水冲服。

Directions: one dose per day, decoct in boiling water and administer warm.

方义分析:菊花散风清热, 川穹、白芷祛风止痛,羌活除湿散寒,蔓荆子清头目止痛,甘草调和诸药。

Explanation: Chrysanthemum (ju hua) dispels wind and clears heat. Chuan xiong rhizoma (chuan xiong) and dahurian angelica (bai zhi) relieve pain. Notopterygium (qiang huo) eliminates dampness and dissipates cold. Vitex (man jing zi)  clears the head and eyes and relieves pain. Licorice (gan cao) harmonizes the formula.

加减:头痛而胀,发热而加石膏一包以助清热泻火之功。

Additions and subtractions: If there is pain, distention in the head and fever , add gypsum to help clear heat and drain fire.

内伤头痛一号方

Formula for the treatment of headaches due to internal damage

组 成 : 天 麻 一 包 (10g), 钩 藤 一 包 (10g), 石 决 明 一 包 (20g), 川 穹 一 包 (6g), 菊 花 一 包 (10g), 藁本 一 包 (10g), 当 归 一 包 (10g), 茯神 一 包 (10g), 蔓荆子一包(10g),甘草一包(3g)。

Ingredients: gastrodia (tian ma) 10g, uncariae (gou teng) 10g, abalone shell (shi jue ming) 20g, chuan xiong rhizoma (chuan xiong) 6g, chrysanthemum (ju hua) 10g, Chinese lovage (gao ben) 10g, Chinese angelica (dang gui) 10g, root poria (fu shen) 10g, vitex (man jing zi) 10g, licorice (gan cao) 3g.

功效:平肝养血,祛瘀止痛。

Function: Calm the liver, nourish the blood, dispel stasis, and relieve pain.

主治:内伤头痛势弱,时发时止,倦怠乏力,舌质红,苔薄黄,脉弦细。

Indications: Intermittent headaches that are due to internal damage, fatigue and lack of strength, red tongue, thin and yellow coating, fine and stringlike pulse.

方药:石决明潜镇以定肝阳上亢。 天麻、钩藤平肝熄风,菊花、蔓荆子、藁本、川穹清头目,祛风止痛。当归养阴补血, 茯神宁心安神,甘草调和诸药,共奏平肝养血祛瘀止痛之功。

Explanation: Abalone shell (shi jue ming) subdues and settles to calm ascendant hyperactivity of the liver Yang. Gastrodia (tian ma) and uncariae (gou teng) calm the liver and extinguish wind. Chrysanthemum, vitex, Chinese lovage and Chuan xiong rhizoma clear the head and eyes, dispel wind and relieve pain. Chinese angelica (dang gui) nourishes the Yin and supplements the blood. Root poria (fu shen) quiets the mind and spirit. Licorice harmonizes the formula.  Used together, this formula can calm the liver, nourish the blood, dispel stasis and relieve pain.

加减:气虚头痛甚者加人参一包(5g), 黄芪一包(10g),血虚者加熟 地养阴补血,痰浊甚者加半夏一包,健脾化痰,瘀血甚者加红花桃仁,增强活血化瘀。

Additions and subtractions: If the patient has Qi vacuity with severe headaches, add Ginseng (ren shen) 5g, astragalus (huang qi) 10g. If the patient has blood vacuity, add cooked rehmannia (shu di) to nourish the Yin and supplement the blood. If the patient has severe phlegm turbidity, add pinellia (ban xia) to fortify the spleen and transform phlegm. If the patient has severe blood stasis, add safflower (hong hua) and peach kernel (tao ren) to quicken the blood and transform stasis.

典型病例

Exemplar case

姓名:某某 性别:男 年龄:50岁 职业:务农

Male, 50 years old

就诊时间:2011年8月2日 发病季节:立秋

First visit: August 2, 2011. Onset of the disease: the beginning of Autumn

地址:山西襄垣
主诉:头痛如裹,肢体困重,恶风,面红目赤,渴喜热饮。

Complaints: the head is heavy as if wrapped, the limbs are heavy and cumbersome.  Patient has aversion to wind, red face and eyes, and a thirst with a desire for hot drinks.

四诊得之:面色少华,精神一般,舌质红,苔薄黄,脉浮。

Symptoms:  a lusterless complexion, a moderate essence-spirit, a red tongue, thin and yellow coating, and a floating pulse.

辩证:由于气候炎热,雨水连绵,致湿热之邪较盛,湿为阴邪,其性重浊,热为阳邪,其性炎上,湿热之邪外袭,上蒙清窍,故头痛如裹,肢体困重,舌红而赤,口渴喜饮。 脾主运化,主四肢,脾为湿困,故肢体困重。 苔薄黄,脉浮,为风热之邪炽盛之象。

Pattern identification: Hot weather and continuous rain bring about exuberant damp-heat evils. Dampness is a Yin evil. By nature it is heavy and turbid. Heat is a Yang evil. By nature it flames upward. If damp-heat evils attack the outer body, it will ascend upward to cloud the clear orifices. This is why the head feels heavy, as if it was wrapped; while, the limbs are heavy and cumbersome, the tongue is red, and the patient feels thirsty with a desire for fluids. The spleen governs movement, transformation, and the limbs. When the spleen is encumbered by dampness, the limbs will become heavy and cumbersome. When there is wind-heat evils present, the tongue will have a thin and yellow coating and the pulse will be floating .

中医诊断:外感头痛。

Diagnosis by Chinese medicine: headache due to external contraction (of evils).

治法:清热,祛湿,止痛。

Method of treatment: clear heat, dispel dampness and relieve pain.

方药:外感头痛一号方。

Formula: Formula for the treatment of externally contracted headaches

用法:,开水冲服,五剂,一日一剂。

Directions: Decoct in boiling water and administer warm. Five doses altogether. One dose per day.

分析:菊花祛风清热,羌活祛风胜湿,川穹, 白芷祛风止痛,蔓荆子清头目止痛,甘草调和诸药,口服五剂后症状好转,无其他不适症状。
Explanation: Chrysanthemum (ju hua) dispels wind and clears heat. Notopterygium (qiang huo) dispels wind and overcomes dampness. Chuan xiong rhizoma (chuan xiong) and dahurian angelica (bai zhi) dispel wind and relieve pain. Vitex (man jing zi) clears the head and eyes, and relieves pain. Licorice root harmonizes the formula. After taking five doses, the condition improved and the patient had no other abnormal symptoms.

3. 讨论
依治疗原则看,外感头痛多属实证,治疗应以驱邪为主,因风者疏之,因寒者散之,因湿者化之,因热者清之。 内伤头痛,多属虚证,治疗以扶正为主。风阳侵袭则熄风潜阳,气虚则益气升清,血虚则养阴补血,肾虚则益肾填精,至于痰浊,淤血所致头痛,本虚标实,或先祛其实,或扶正驱邪兼顾。 但本人通过多年临床经验,简化了诊疗过程,把外感,内伤头痛进行综合分析,制出了外感头痛一号方、内伤头痛一号方, 以便更加方便的应用于临床实践,并且取得了良好的效果。 凡前来就诊的头痛的患者,需辨清外感,内伤,方可用上方。 请各位同仁辩证用之,有不妥之处, 请指正。

3. Discussion
Most externally contracted headaches belong to repletion patterns; therefore, the treatment should focus on expelling evils. Wind-evil should be coursed, cold-evil should be dissipated, damp-evil should be transformed, heat-evil should be cleared. Most headaches due to internal damage belong to vacuity patterns. The treatment should focus on supporting the upright Qi. If it is due to the invasion of wind Yang, extinguish the wind and subdue the Yang; if it is due to Qi vacuity, boost the Qi and upbear the clear; if it is due to blood vacuity, nourish Yin and supplement blood; if it is due to kidney vacuity, boost the kidneys and replenish the essence.  Headaches caused by phlegm turbidity and blood stasis are due to a vacuity at the root and a repletion at the branch. In treatment, the repletion should be expelled first, or simultaneously support the upright Qi and expel evil. After many years of clinical practice,  Shi Peiqing simplified the diagnostic and treatment process and created the two above-mentioned formulas. Clinically, he has achieved great results.  Before using these formulations, it is important to identify whether the headache is due to external contraction or internal damage .

中医中药与针灸治疗脱发150 例 – Fu Mei-hua’s Treatment of 150 Cases of Hair Loss with Herbs and Acupuncture

中医中药与针灸治疗脱发150 例 – Treatment of 150 Cases of Hair Loss with Herbs and Acupuncture

富梅华
Translated by Xu Zhi-jun & J. Heaverlo

关键词: 中医中药;针灸;脱发
Key words: Chinese medicine; herbs; acupuncture; hair loss

现代医学将脱发分为斑秃、脂溢性脱发、症状性脱发等多种。中医学也有很多记载,如隋代《诸病源候论》称为“鬼舔头”;明代《外科正宗》有油风记载。症状性脱发从中医理论来看,也属于油风范畴,其病因不同,但治疗上有相同的地方。笔者用中医药、针灸治疗脱发150例,疗效显著,现报告如下。

Modern medicine classifies hair loss into many various types; such as alopecia areata, seborrheic alopecia, and symptomatic alopecia. There are also numerous accounts of hair loss in the Chinese medicine classics. For examples, hair loss is called “demon-licked head” in “The Origin and Indicators of Diseases” of the Sui Dynasty. It is recorded as “oil wind hair loss” in “Orthodox Manual of External Medicine” of the Ming Dynasty. According to Chinese medicine theory, symptomatic alopecia should be categorized into “oil wind hair loss”. Although the disease pathomechanisms may vary, there are commonalities within the treatments. The author has treated 150 cases of hair loss with herbs and acupuncture, and achieved notable results. The following is a report of his findings.

•    一般资料

150例患者中男性80例,女性70例,年龄11-46岁。

1. General information
Among the 150 cases, there are 80 males and 70 females. The age ranges from 11 to 46.

•    治疗方法

2.1 中药治疗:健脾祛湿、清利湿热、养血生发为主:白术12g、茯苓12g、泽泻12g、生薏米30g、 升麻12g、丹皮12g、当归12g、川芎12g、鸡血藤15g、干生地12g、熟地12g、柴胡12g、首乌12g、焦三仙45g. 每日一剂,每日二次。湿服;如皮脂溢出过多者加赤石脂12g、侧柏叶12g、猪苓12g;如腰腿酸软、遗精盗汗、夜寐不安,加龙骨12g(先煎) 、牡蛎12g(先煎) 、乌梅12g;气虚加黄芪20g;如突然大把脱落,急躁易怒,加女贞子12g、旱莲草12g、钩藤12g等进行辩证论治。

2. Treatment

2.1 Herbs-  The therapy focuses on the following treatment methods: fortify the spleen, dispel dampness, clear heat, nourish the blood and promote hair growth.
White atractylodes (bai zhu) 12g,  poria (fu ling) 12g,  alisma (ze xie) 12g, coix (yi mi ren) 30g, cimicifuga (sheng ma) 12g, moutan (mu dan pi) 12g, Chinese angelica (dang gui) 12g, chuanxiong rhizoma (chuan xiong) 12g, spatholobus (ji xue teng) 15g, dried rehmannia (sheng di huang) 12g, cooked rehmannia (shu di huang) 12g, bupleurum (chai hu) 12g, flowery knotweed (shou wu) 12g, scorch-fried three immortals (jiao san xian) 45 g.   Cook one dose a day and take twice while it is warm.

If there is too much seborrheic production, add happoysite (chi shi zhi) 12g, arborvitae leaf (ce bai ye) 12g, and polyporus (zhu ling) 12g.

If the patient has lumbar soreness and/or leg achiness, seminal emissions, night sweating, and restless sleep, add dragon bone (long gu) (predecocted) 12g, oyster shell (mu li): 12g (predecocted), and mume fruit (wu mei) 12g.

If the patient has Qi vacuity, add astragalus (huang qi) 20 g.

If there is great hair loss with irritability add ligustrum (nu zhen zi) 12g, eclipta (han lian cao) 12g, and uncaria (gou teng) 12g.

•    针灸法:以养血活血祛风、健脾祛湿生发为主:选穴:百会、风池、足三里、血海、
神门、内关。操作方法:以虚补实泻法针刺,除肝俞、肾俞针刺用补法外,其余配穴按实泄法针刺。

2.2    Acupuncture treatment principles are: quicken the blood, dispel wind, fortify the spleen, dispel dampness, and promote hair growth.

Selection of acupuncture points: GV-20 (one-hundred convergences), GB-20 (wind pool), ST-36 (Leg Three Li), SP-10 (sea of blood), HT-7 (spirit gate), and PC-6 (inner pass).

Manual needling methods should be used to supplement vacuity and drain repletion. Use supplementation method on BL-18 (liver transport) and BL-23 (kidney transport). Use draining method on all other points.

•    疗效标准

痊愈:脱发症状消失,脱发试验阴性;好转:脱发症状减轻,脱发试验阳性;无效:
脱发症状未减,脱发试验阳性。

•    Standard of Curative Effect

Full recovery: the symptom of hair loss disappears, and the test result is negative;
Improvement: the symptom of hair loss is alleviated, and the test result is positive;
No effect: the symptom of hair loss remains the same, and the test result is positive.

•    治疗结果

痊愈140例,好转9例,无效1例。

•    Therapeutic effect:

Full recovery: 140 cases;
Improvement: 9 cases;
No effect: 1 case.

•    病例

王某,男,37岁,脱发2个月,患者自述平素工作紧张,平时皮脂溢出过多。 查:脱
发试验阳性,头皮瘙痒,毛发稀疏,头油多,精神欠佳,神疲乏力,夜寐不安,二便正常,舌淡苔白,脉眩滑。诊断:中医:油风(脾虚蕴湿,湿热互结);西医:脂溢性脱发。治疗以健脾祛湿,清利湿热,养血生发为主。处方:生白术12g、茯苓12g、生薏米30g、川皮解15g、车前子15g、泽泻15g、当归12g、首乌12g、川芎12g、黄芪20g、乌梅20g、羌活12g、升麻12g、黄芩10g、黄连12g、龙骨12g先煎、牡蛎12g、枳壳12g、丹皮12g、焦山楂15g、炒麦芽15g。水煎400ml,每次200ml,早晚两次湿服。配合针灸选穴:百会、风池、三阴交、足三里、血海、神门、内关、肝俞、肾俞、按虚补实泻法针刺,每日一次,治疗3d,症状有所减轻;患者腰酸,头晕,故原方加赤石脂12g、侧柏叶12g、枳壳12g、灸山芋12g,以助除湿行气、补益肝肾。按以上方法治疗22d,症状全部消失,随访三个月,未复发,告痊愈。

5. Case Study

Examination:  Mr. Wang is 37 years old. He has been experiencing hair loss for two months. His work is very stressful. He has a considerable amount of seborrheic production. The test for hair loss is positive. His symptoms include itchy scalp, scant hair, and excessively oily hair. He appears listless, has a lack of strength, and restless sleep. His stool and urine are normal. His tongue is pale with a white tongue fur. His pulse is stringlike and slippery.

Chinese medicine diagnosis: :  “Oil wind hair loss” due to spleen vacuity and damp-heat binding.

Western medicine diagnosis: seborrheic alopecia.  TCM treatment principles should be: fortify the spleen, dispel dampness, clear heat, disinhibit dampness, nourish the blood, and promote hair growth.

Therapy: fresh white atractylodes (sheng bai zhu) 12g, poria (fu ling) 12g, coix (yi mi ren) 30g, rhizoma dioscorea (bi xie) 15g, plantago seed (che qian zi) 15g, alisma (ze xie) 15g, Chinese angelica (dang gui) 12g, flowery knotweed (shou wu) 12g, chuanxiong rhizoma (chuan xiong) 12g, astragalus (huang qi) 20g, mume fruit (wu me) 20g, notopterygium (qiang huo) 12g, cimicifuga (sheng ma) 12g, scutellaria (huang qin) 10g, coptis (huang lian) 12g,  dragon bone (long gu) (predecocted) 12g oyster shell (mu li) 12g, bitter orange (zhi ke) 12g,  moutan (mu dan pi) 12g, scorch-fried hawthorne fruit (jiao shan zha) 15g, stir-fried barley sprout (chao mai ya) 15g.

(Combine herbs and 1200 ml of water).  Decoct in water until 400 ml. remain. Drink 200 ml twice per day.  Drink once in the morning and once in the evening.  Should be consumed warm.

Acupuncture treatment was used in combination. Selections of acupuncture points: GV-20 (hundred convergences), GB-20 (wind pool), ST6 (three Yin intersection), ST-36 (Leg Three Li), SP-10 (sea of blood), HT-7 (spirit gate), and PC-6 (inner pass), BL-18 (liver transport) and BL-23 (kidney transport). Manual needling methods used should be supplement vacuity and drain repletion. Acpuncture is performed once a day.

After 3 days of treatment, the symptoms were alleviated to some extent. The patient also had sore and aching low back and dizziness.  Therefore additional herbs were utilized.  Additions include: halloysite (chi shi zhi) 12g, arborvitae leaf (ce bai ye) 12g,  mix-fried dioscorea (zhi shan yu) 12g.  These additions may help dispel dampness, move the Qi, supplement the liver and kidney.

The symptom completely disappeared after 22 days of treatment.   After 3 months, the symptoms had not returned.

•    讨论

皮肤病虽发于皮肤,但常是和内脏有密切的联系,有诸内必形于外,运用中医理论,
对疾病进行综合分析、归纳、总结,找出皮肤病与肌体内脏的关系,正确的辩证施治,是治疗皮肤病的关键。方中白术、茯苓、生薏米、生侧柏、赤石脂、枳壳、川皮解、车前子、泽泻,健脾行气除湿;升麻、龙骨、牡蛎、乌梅、以收敛固涩、升阳安神、益精开胃;当归、川芎、鸡血藤、首乌、黄芪、丹皮益气养血活血,祛瘀生新;黄芩、黄连清热燥湿,清上焦头目之热;灸山芋补益肝肾;山楂、炒麦芽调理脾胃功能,使枢机功能得以改善;配合针灸针刺,疏通经络,调理脾胃肝肾功能。综观,使气血大和,毛发得以精血充养,则诸症消失。可见中药,针灸联合治疗脱发,疗效快,复发率低。

•    Discussion:

Although skin diseases manifest on the skin, they are often closely related with the viscera. According to Chinese medicine theory, the key to treating skin diseases is to find the relationship between the disease and the viscera, and then to administer treatment according to the pattern. In the therapy, atractylodes (bai zhu), poria (fu ling), coix (yi mi ren), arborvitae leaf (ce bai ye), halloysite (chi shi zhi), bitter orange (zhi ke), rhizoma dioscorea (bi xie), plantago seed (che qian zi), and alisma (ze xie) can fortify the spleen, move the Qi and dispel dampness. Cimicifuga (sheng ma), dragon bone (long gu), oyster shell (mu li), and mume fruit (wu mei) can astringe and secure, upbear the Yang, quiet the spirit, boost the essence and increase the appetite. Chinese angelica (dang gui), rhizome chuanxiong (chuan xiong)  spatholobus (ji xue teng), flowery knotweed (shou wu), astragalus (huang qi), and moutan (mu dan pi) can boost the Qi, nourish and quicken the blood, dispel stasis, and engender the new. Scutellaria (huang qin) and coptis (huang lian) can clear heat, dry dampness, and clear  heat on the head and eyes. Mix-fried dioscorea (zhi shan yu) can supplement the liver and kidney. Hawthorne fruit (shan zha) and stir-fried barley sprout (chao mai ya) can regulate the stomach.   Acupuncture can free the channels, and regulate the spleen, stomach, liver and kidney. The overall effect is to greatly harmonize the Qi and blood so that the hair can be nourished by the essence and blood.

施今墨的降血压十法 - SHI Jin-mo’s 10 methods for reducing blood pressure

Translated by XU Zhi-jun & J. Heaverlo

高血压是以特续性动脉压增高为主要表现,久而久之,可导致心,脑,肾等重要器官损害,其临床病状归于祖国医学“眩晕”,“头痛”病的范畴。其病因复杂,尤其与精神因素(忧思,恼怒等)关系密切,此外,禀赋不足,脏腑虚损,饮食劳卷等诸多因素均可引起阴阳失调,气血紊乱,络道不畅,血脉瘀滞。为了提高生活质量,健康长寿,务必降低血压,使其维持在一定的水平甚为重要。施今墨将降压之法概括为十法,分述如下.

The chief manifestation of high blood pressure is a continued elevation of arterial blood pressure.  Over time, this can lead to damage of the heart, brain, and kidneys, as well as other vital organs.  Its clinical symptoms belong to the Chinese medicine category of “dizziness” and “headache”.  The disease etiology is complex, especially when psychological factors (such as anxiety and anger) are intimately related.  In addition, natural endowment insufficiency, zàng fǔ organ vacuity and damage, exhaustion of food and drink, plus many other factors can lead to yīn yáng imbalance, qì and blood disorder, and blood stasis of the luò pathways.
In order to enhance the quality of life, health and longevity, it is necessary to lower the blood pressure and important to maintain a certain level.  Below is a summary of  SHĪ Jīnmò’s ten methods for reducing (blood) pressure.

(一)苦寒降压法
肝胆火旺,炎至于上,气血沸腾,并走于脑,遂有头疼如裂,青筋怒张,面红耳赤,烦热易怒,大便硬结,小便短赤,舌红,苔黄腻。治宜清肝泻火,苦寒折逆。方用三黄石膏汤,龙胆泻肝汤。药用黄芩,黄连,知母,生石膏,槐花, 蔚子,夏枯草,知母,黄柏等。

(1) Method of using bitter and cold medicinals to reduce pressure

Use bitter and cold medicinals when there is liver and gall bladder effulgent fire, upward flaring fire, qì and blood seething upward towards the brain.  Hence, there will be splitting headaches, sudden distention of veins, red complexion and ears, easy to anger, heat vexation, bowels which are hard and bound, urination that is short and dark colored, tongue that is red with a thin, yellow coating.
The appropriate treatment is to the drain liver and gall bladder with bitter and cold medicinals.  The exemplar formulas are sān huáng shí gāo tāng, and lóng dǎn xiè gān tāng.  The medicinals used are huáng qín, huáng lián, zhī mǔ, shēng shí gāo, huái huā, wèi zi, xià kū cǎo, zhī mǔ, huáng bǎi.

(二)调气降压法
按“气为血之师,血随气行,行有一息之不运,血有一息之不行”之理,运用降气,顺气之法亦是降压有效治法。方用旋覆花,代赭石,桔梗,枳壳,杏仁,薤白,佛手,香橼等。

(2)  Regulate the qì to reduce blood pressure

It is said that “qì is the commander of the blood, when qì moves blood moves, when qì stops  blood stops”.  To regulate the qì is an effective method for treatment.  Medicinals used are xuán fù huā, dài zhě shí, jié gěng, zhǐ ké, xìng rén, xiè bái, fó shǒu, xiāng yuán.

(三)息风降压法
适用于肝风内动,眩晕面赤,烦躁不宁,夜卧不安。治宜熄风降压。方用天麻够腾饮。药用够腾,天麻,槐花,菊花,羚羊角,水牛角等。

(3)     Extinquish wind to reduce blood pressure

This method is appropriate for use with liver wind internally stirring, with dizziness and a red complexion, vexation and agitation, restlessness, and inability to rest in the evening.
The appropriate treatment is to extinguish wind to reduce the blood pressure.  The exemplar formula is tiān má gòu téng yǐn.  Medicinals used include gòu téng, tiān má, huái huā, jú huā, líng yáng jiǎo, shuǐ niú jiǎo.

(四)镇逆降压法
适用于肝阳亢盛,血压甚高,头脑血管过于充盈诸症。治宜贝石重镇之品,以引血下行。方用镇肝熄风汤等。药用紫贝齿,紫石英,青龙齿,石决明,磁石,铁落,珍珠母,磁朱丸等。

(4) Settle counterflow to reduce blood pressure

This method is appropriate to use when there is liver yáng exuberance.  The blood pressure will be exceedingly high and the blood vessels of the head are excessively full.  The correct method of treatment is to select stones and heavy substances to settle, thereby, leading the blood downward.
The exemplar formula is zhèn gān xí fēng tāng.  Medicinals used are zǐ bèi chǐ, zǐ shí yīng, qīng lóng chǐ, shí jué míng, cí shí, tiě luò, zhēn zhū mǔ, cí zhū wán.

(五)化痰降压法
痰浊中阻,升降失常,眩晕头痛,头胀如裹,胸膈满闷,肢体麻木,言语不利,呕吐痰涎,苔白腻,脉弦滑。治宜和胃降浊,化痰降压。方用半夏白术天麻汤,十味温胆汤。药用半夏,竹茹,茯苓,白术,橘皮,远志,菖蒲,枳实,胆南星等。

(5)    Transform phlegm to reduce blood pressure

Transform phlegm to reduce blood pressure when there is turbidity obstructing the center causing abnormal upbearing and downbearing, dizziness, headaches, distention headaches as if bound, chest and diaphragm fullness and oppression, numbness of the limbs, inhibited speech, and vomiting of phlegm.  The tongue coating will be white and greasy.  The pulse will be bowstring and slippery.
The appropriate treatment is to harmonize the stomach, descend turbidity, and transform phlegm to reduce the blood pressure.  The exemplar formulas are bàn xià bái zhú tiān má tāng, and shí wèi wēn dǎn tāng.  Medicinals used are bàn xià, zhú rú, fú líng, bái zhú, jú pí, yuǎn zhì, chāng pú, zhǐ shí, dǎn nán xīng.

(六)滋阴降压法
肝肾阴虚,水不涵木,肝阳上扰,血随气升,血压增高。治宜滋阴降压。方用知柏地黄汤,杞菊地黄汤。药用枸杞子,菊花,白蒺藜,沙苑子,女贞子,旱莲草,知母,黄柏,生熟地,砂仁,杜仲,怀牛膝等。

(6) Enrich the yīn to lower blood pressure

When there is liver and kidney yīn vacuity, water will not be able to moisten wood and liver yáng will rise to harass the upper body.  The blood will follow the ascension of the qì thereby causing the blood pressure to increase.  The appropriate treatment is to enrich the yīn to decrease the blood pressure.  The exemplar formulas are zhī bǎi dì huáng tāng and qǐ jú dì huáng tāng.  Medicinals used would be gǒu qǐ zi, jú huā, bái jí lí, shā yuàn zi, nǚ zhēn zi, hàn lián cǎo, zhī mǔ, huáng bǎi, shēng shú dì, shā rén, dù zhòng, huái niú xī.

(七)通便降压法
适用于实热内积,升降失常(清阳不升,浊阴不降),腑行不畅。治宜通调腑气,泻热降压。方用承气汤。药用生川军,芒硝,瓜蒌,风化硝,枳实,厚朴,晚蚕砂,炒皂角子等。

(7) Open the bowels to reduce blood pressure

This method is appropriate for replete heat internally accumulating with abnormal upbearing and downbearing (the clear yáng will be unable to ascend while the turbid yīn will not be able to descend)  the bowels, therefore, will become blocked.
The appropriate treatment would be to open and regulate the bowel qì, drain heat to descend the blood pressure.  The exemplar formula would be chéng qì tāng.  Medicinals used are shēng chuān jūn, máng xiāo, guā lóu, fēng huà xiāo, zhǐ shí, hòu pǔ, wǎn cán shā, chǎo zào jiǎo zi.

(八)利水降压法
适用于气血紊乱,久久不愈,以致水液代谢障碍,兼见下肢水肿。治宜利水降压。方用真武汤,五苓散,二草丹。药用猪苓,冬瓜皮,冬瓜字,车前子,车前草,旱莲草,赤茯苓,赤小豆等。

(8) Disinhibit water to reduce blood pressure

This method is appropriate when the qì and blood have become chaotic with prolonged recovery.  Therefore, the water and fluids will become obstructed.  There will be concurrent lower limb swelling.  It is appropriate to disinhibit water to reduce blood pressure.  The exemplar formula is zhēn wǔ tāng, wǔ líng sàn, or èr cǎo dān.  Medicinals used are zhū líng, dōng guā pí, dōng guā zì, chē qián zi, chē qián cǎo, hàn lián cǎo, chì fú líng, and chì xiǎo dòu.

(九)通络降压法
络脉以通为顺,高血压之人,多有络脉不活之征,俗云:“久病入络”即是明证。治宜通络降压。方用六藤煎等。药用够藤,忍冬藤,海风藤,络石藤,青风藤,鸡血藤,桑寄生,桑枝,丝瓜络,炮甲珠等。

(9) Open the luò vessels to decrease blood pressure

The luò vessels can flow smoothly when they are unobstrcuted .  Among high blood pressure patients, many have improper circulation of the luò vessels.  It is said: “chronic disease enters the luò vessels”, (here) this is evident.  The appropriate treatment is to open the luò vessels to descend the (blood) pressure.  The exemplar formula is Six Vine Decoction (liù téng jiān).  The medicinals used are gòu téng, rěn dōng téng, hǎi fēng téng, luò shí téng, qīng fēng téng, jī xuè téng, sāng jì shēng, sāng zhī, sī guā luò, and pào jiǎ zhū.

(十)活血祛瘀降压法
高血压晚期多有血脉瘀滞征象,治宜活血祛瘀降压。方用血府逐淤汤等。药用桃仁,红花,当归,川芎,丹参,葛根,茺蔚子,夏枯草等。

(10) Quicken the blood and expel stasis to decrease blood pressure

In the later stages of high blood pressure many (patients) will exhibit signs of stasis in the blood vessels.  The appropriate treatment is to quicken the blood and expel stasis to reduce the blood pressure.  The exemplar formula is xuè fǔ zhú yū tāng.  The medicinals used are táo rén, hóng huā, dāng guī, chuān xiōng, dān shēn, gé gēn, chōng wèi zi, and xià kū cǎo.

加减法:眩晕加白薇汤(当归,党参,白薇,甘草);欲作中风者,加天麻,够藤,菊花,地龙;失眠,证属心肾不交者,加远志,菖蒲,酸枣仁,液交藤;心悸,心动过速者,加朱砂,琥珀,珍珠母,紫石英,仙鹤草,卧蛋草;心前区疼痛者,加檀香,降香,丹参,三七,蒲黄,五灵脂,蜈蚣,全蝎,乳香,没药等。

Methods for additions and subtractions:  If there is dizziness add bái wēi tāng (dāng guī, dǎng shēn, bái wēi, gān cǎo); if treating wind stroke add tiān má, gōu téng, jú huā, dì lóng; if there is insomnia and the pattern belongs to heart and kidney not communicating add yuǎn zhì, chāng pú, suān zǎo rén, yè jiāo téng; if there is palpitations or tachycardia, add zhū shā, hǔ pò, zhēn zhū mǔ, zǐ shí yīng, xiān hè cǎo, wò dàn cǎo; if there is precordial pain add tán xiāng, jiàng xiāng, dān shēn, sān qī, pú huáng, wǔ líng zhī, wú gōng, quán xiē, rǔ xiāng, mò yào.

慢性阻塞肺病急性发作期的辨治要点 – The Treatment of Acute Phases of Chronic Obstructive Pulmonary Disorder

慢性阻塞肺病急性发作期的辨治要点
作者:周仲瑛

译者:何安杰  (美国谦益翻译公司)

The Treatment of Acute Phases of Chronic Obstructive Pulmonary Disorder

Author:  ZHŌU Zhòngyīng
      Translated by XU Zhi-jun & J. Heaverlo

慢性阻塞性肺疾病 (COPD, 简称慢阻肺)是具有气流阻塞特征的慢性支气管炎和(或)肺气肿。气流阻塞进行性发展,但部分有可逆性, 可伴有气道高反应性。慢性支气管炎,某些支气管哮喘患者, 在疾病进程中发展为不可逆性气流阻塞, 当支气管哮喘与慢性支气管炎和(或)肺 气肿重叠存在或难以鉴别时,也列入慢性阻塞性肺疾病范围。在慢性阻塞性肺疾病发展过程中,根据病情可分为急性加重期和稳定期。急性加重期,患者在短期内咳 嗽,喘息加重,痰呈脓性或黏液脓性,量明显增加,可伴发热等炎性表现。稳定期,患者咳嗽,咳痰,气短等症状稳定或症状轻微。

Chronic Obstructive Pulmonary Disorder (C.O.P.D) is a condition that is characterized by an obstruction of the pulmonary airflow. It is commonly seen with chronic bronchitis or emphysema.  Obstruction of the airflow is typically a progressive development, however some cases may be reversible. It is possible that an obstruction may accompanied by a hyperreactive airway.  Chronic bronchitis and some bronchial asthma patients, during the course of their illness, will develop irreversible pulmonary obstruction.  With bronchial asthma and chronic bronchitis patients, there may be some overlapping occurrences of emphysema, as well as the development of Chronic Obstructive Pulmonary Disorder.  This makes for difficulty in differentiating the separate diseases.  During the development process of COPD, it is possible to divide each case into one of three stages: acute stage, mid-term stage, and a stable stage.  In the acute and mid-term stage, the patient within a short period of time will develop coughing, panting, and gasping for breath that becomes increasingly severe.  There will be phlegm and pus, or sticky mucus with pus.  Symptoms will become increasingly obvious and possibly accompanied by fever and other inflammatory conditions.  During the stable stage, the patient will experience coughing, coughing with phlegm, and shortness of breath.  Symptoms will not increase in severity and will be relatively light in nature.

中医学把慢阻肺归于慢性咳嗽,喘证,肺胀等疾病。外邪侵袭,饮食不当,情志刺激,体虚劳卷等都可以导致慢性阻塞性肺疾病。急性期以实证邪盛为主,如风寒犯 肺,谈热,痰湿等蕴肺,缓解期以肺脾肾虚为主,兼有痰浊与瘀血阻肺。发作期治疗,主要集中在清热化痰,清热活血,化痰祛瘀,通腑泄热等方面,也有并用益气 活血,补肾健脾,温阳扶正者。对于缓解期治疗,基本以补肺,健脾,益肾为主,兼以祛邪。总之,通过临床观察证候规律大致为发作期多伴有热象,治以清热化痰 活血;迁延期多以痰,瘀,虚为主,治从化痰活血,兼加补益,或益气,或益气养阴,或助阳;缓解期以虚为主,兼有痰瘀,治疗在益肺健脾补肾基础上化痰,活 血。

Chinese Medicine categorizes COPD as chronic cough, panting, and lung distention.  In addition, external evil attack, improper diet, irritability, weak constitution, and fatigue can all lead to the development of COPD.  An acute-stage of COPD is governed by replete exuberant evils.  Such as, wind-cold invading the lungs, phlegm-heat, and phlegm-damp collecting in the lungs.

During the non-acute stages, , the organs governed by vacuity are lungs, spleen, and kidney.  Simultaneously, there will be phlegm turbidity and blood stasis obstructing the lungs.  In an acute stage, the chief concentration of the treatment should be to clear heat and transform phlegm, clear heat and quicken the blood, transform phlegm and expel stasis, open the  organs and drain heat.  In addition, boost the and quicken the blood, supplement the kidneys, strengthen the spleen, warm the yáng, and support the upright .
During a stable-stage, the treatment principles are to supplement the lungs, strengthen the spleen, and boost the kidneys while simultaneously expelling evil.

Furthermore, during an acute-stage, after completing an examination to determine the patterns for treatment, it is possible to find various overlapping signs of heat.  The treatment method is to clear heat, transform phlegm, and quicken the blood.  Periods of long delays between symptoms are governed by phlegm, stasis, and vacuity.  Therefore, the treatment principles are to transform phlegm, quicken the blood, while simultaneously supplementing and boosting, or boosting the , or boosting the  and nourishing the yīn, or assisting the yáng.

The stable-stage is governed by vacuity.  Additionally, there will be phlegm and stasis.  The treatment principles are to boost the lungs, strengthen the spleen, and supplement kidneys while employing a foundational treatment to transform phlegm and quicken the blood.

周民认为,慢性阻塞性肺病的临床表现主要为咳嗽,咳痰,气喘,属于中医学肺胀,痰饮,咳喘等病症范畴。主病之脏在肺,可累及脾,肾和心,病理性质多属标实本虚,寒热错杂,病机特点为肺虚痰瘀。  由于本病多为发作与缓解交替,发作期偏于标实,多属感受外邪诱发;缓解期偏 于本虚,多属脏气不足。本着急则治标,缓则治本的原则,应矛分别处理。慢性阻塞性肺病急性发作期以邪实为主,治疗重在缓解标急,外解表邪,内祛痰瘀,且应杂合。

ZHŌU Zhòngyīng believes the chief clinical manifestations of chronic obstructive pulmonary disorder are coughing, coughing with phlegm, and asthma.  He believes it belongs in the Chinese medicine disease category of lung distention, phlegm-rheum, coughing and panting.  The primary organs involved in this disorder are the lungs, exhaustion reaching the spleen, the kidneys, and the heart.  The main pathological nature is; repletion in the branch, vacuity at the root, cold and heat combined, lung  vacuity with phlegm, and stasis.

With COPD there will be an alternating between acute stages and periods of symptom relief.  During the acute-stage the branch becomes replete, mostly due to externally contracted evils.  During stable periods where there is relief from symptoms, there is a tendency towards the root being vacuous, which is largely categorized as organ insufficiency.  In the acute-stage treat the branch.  In the stable-stage treat the root.  There should be a clear distinction between the two methods of treatment.  Acute stages of COPD are governed by replete evils.  The chief objective of the treatment is to settle the acute branch by releasing the exterior and resolving external evils, while simultaneously expelling phlegm and stasis internally.

1。祛邪
久病咳喘,肺虚卫外不固,外邪每易反复侵袭,诱使急性发作。对外邪的班证,既应区别其寒热属性,分风寒,风热治疗,更要重视其内外合邪,同气相召,互为关联影响。如寒痰(饮)蕴 肺者易为风寒所乘,表现外寒内饮证,治当解表散寒,温肺化饮,方如小青龙汤;痰热郁肺者,易为风热所伤,治当解表清理,清肺化痰,方如越脾加半夏汤,麻杏 石甘汤;若外寒束表,肺热内郁,客寒包火,又当加重辛散解表药的药味和用量,如小青龙加石膏汤;若寒邪入里化痰,则当清肺化痰,入桑白皮汤。必须注意外邪 的病理性质,每与内在宿邪及体质有关, 阳虚寒痰蕴肺者,外邪易从寒化而表现为内外皆寒,甚至因机体外邪的反应能力低下,虽为感受邪热,仍可见邪从寒化者;阴虚痰热郁肺者,外邪又易从热化,表现 为表里皆热。基于反复感邪的病理根由是正虚,或耗气,或伤阴,若气虚可配党参,黄芪,太子参,阴虚可配沙参,麦冬,知母。治疗时要做到祛邪不忘扶正,但又 忌恋邪。

1.  Expel Evil
In chronic diseases of coughing and panting the lungs will become vacuous allowing for the defensive  and exterior to become insecure.  This insecurity will make it possible for wind evil to easily attack, thereby causing an acute episode.  When diagnosing the nature of the exterior evil pattern, one should clearly differentiate between either a hot condition or a cold condition.  Thereby, separating the treatment into either wind-cold or wind-heat.  Equally important, one must carefully inspect to determine whether the internal and external evils have mutually combined or if they are conjointly influencing one another.

For example, cold phlegm collecting in the lungs is easy to be taken advantage by cold evil.  It will manifest as a pattern of exterior cold with internal phlegm.  The treatment principles are to release the exterior and disperse cold, warm the lungs and transform rheum.  The exemplar formula is xiǎo qīng lóng tāng.

In cases of phlegm heat depressing the lungs it is easy for wind and heat to cause damage.  The treatment principles are to release the exterior and clear interior, clear the lungs and transform phlegm.  The exemplar formula is yuè pí jiā bàn xià tāng, and má xìng shí gān tāng.

With the diagnosis of external cold evil binding the exterior, lung heat internal depression, and guest cold binding heat, use acrid, dispersing, exterior resolving medicinals.  The exemplar formula is xiǎo qīng lóng tāng jiā shí gān tāng.

With cold evil entering the interior and transforming heat the treatment methods are to clear the lungs and transform phlegm.  The exemplar formula is sāng bái pí tāng.

It is very important to pay close attention to the pathological nature of the exterior evil. Each external evil has a particular relationship with evils currently lodged within the interior of the body.  In yáng vacuity with cold phlegm collecting in the lungs, an external cold evil readily transforms in to an interior-exterior cold pattern.  Even though the body’s ability to react is lowered and it has contracted an exterior heat evil, it is still possible to see the evil transforming from cold; In yīn vacuity with phlegm heat depressing the lungs, an externally contracted evil easily transforms into heat.  It will manifest as both internal and external heat.  When there is repeated contraction of external evils it will lead to a vacuity of the upright  or will eventually damage the yīn.  If there is  vacuity use dǎng shēn, huáng qí, and tài zǐ shēn.  If there is  yīn vacuity use shā shēn, mài dōng, zhī mǔ.  When treating, one should not only expel evil without forgetting to support the upright  but also separate from evil.

麻黄辛温解表散寒,宣肺止咳平喘,故为久病咳喘,感邪诱发之首先药,历来用治咳喘的麻黄类方甚多,且可根据辩证配药,较广泛地应用多种证候。如麻黄配石膏 辛凉宣泄,外解在表之风寒,内清肺经之郁热,适用于表寒里热证;配黄芩清宣肺热,适用于痰热郁肺,肺失宣降之证;配葶苈子泻肺祛饮,宣泄肺气,适用痰饮壅 肺,肺气上逆之证; 配大黄宣上导下,适用于肺胃热盛,痰饮壅肺,肺气不通之证;配五味子,散敛相合,适用肺虚气逆,寒饮内停,肺失宣降之证;配熟地滋肾平喘,适用于肺实痰 壅,肾阴亏耗,肺气上逆,肾虚不纳之证;配黄芪一散一固,宣肺平喘,益气固表,适用于寒痰阻肺,气虚卫弱之证。

Má huáng is acrid and warm.  It releases the exterior and disperses cold, diffuses the lungs, stops coughing, and arrests wheezing.  Therefore, it is appropriate to select this herb in chronic diseases of cough and panting or externally contracted evils. According to the individual diagnosis, má huáng may also be paired with other herbs and has a relatively wide range of suggested usage for many types of patterns.  For example, má huáng may be paired with shí gāo.  Where one herb is acrid, the other is cold.  Where one herb diffuses, the other drains.  Together, they release the exterior and expel wind-cold, while at the same time internally clear depressed heat in the lung channel.  It is suitable to use in cases of exterior cold with internal heat.  When combined with huáng qín, the pairs herbs are capable of diffusing lung heat and can be used with patterns of phlegm heat depressing the lungs, or lungs failing to diffuse and down-bear.  The combination of má huáng and tíng lì zi can drain lungs and expel phlegm-rheum, as well as diffuse and descend lung qi.  This combination of herbs is suitable for use with phlegm-rheum obstructing the lungs or lung qi counter-flowing upwards.  When combined with dà huáng, the combination can diffuse the upper and simultaneously guide downward.  It is appropriate to use with lung and stomach heat exuberance, phlegm-rheum obstruction and binding, and blocked organ Má huáng with wǔ wèi zi, where one herb disperses, the other astringes.  It is suitable to use with lung  vacuity with counter-flow, cold rheum internally collecting, and lungs failing to diffuse and descend.  Má huáng with shú dì enriches the kidneys and calms panting.  It is suitable in cases of lung repletion with phlegm stagnation, kidney yīn depleted and consumed, lung  counter-flow, and kidney vacuity not receiving.  Má huáng paired with huáng qí, where one herb disperses and the other herb secures.  Together they can diffuse the lungs and calm panting, boost the and secure the exterior.  This combination is appropriate for cold phlegm obstructing the lungs, and  vacuity with weakened defensive 

另一方面,特别要注意掌握麻黄治喘的禁忌证,如额头汗出清冷,心悸喘促,气短息弱,有喘脱征象者;痰少而黏,不易咯出,咽干,手足心热,舌红苔少或光剥,脉细数等肺肾阴液亏竭者;平素肝阳上亢,头痛眩晕者,均不宣用。

In addition, it is especially important to have a firm understanding of the contra-indications for má huáng in regards to its application of treating cough patterns.  For example, it is contra-indicated when there is sweating of the forehead with chills, heart palpitations, rapid panting, shortness of breath with weak inhalations,panting leading to desertion, small amounts of phlegm or sticky phlegm that is difficult to expectorate, dry throat, five palm heat, a red tongue with little coating or peeled; a rapid, thin pulse, or lung and kidney yīn fluid depletion and exhaustion.  Commonly, these patients will also have liver yáng overbearing with headaches and dizziness.  The use of má huáng is contra-indicated for use with all the above conditions.

2。涤痰
感受外邪诱致本病急性发作时,每因外邪引触肺中伏痰而致痰浊壅阻气道,肺气不 利,痰涌气闭,导致窒息危候,此时痰黏稠浊腻,难化难消,已属顽痰,老痰一类,故涤痰利肺最为当务之急。如能及时祛除气道的胶痰,通过吐利荡涤排出,则窒 息之势自可逆转,方如六安煎,三子养亲汤,葶苈泻肺汤,药如半夏,白芥子,桔梗,莱菔子,葶苈子,海浮石,礞石,泽漆,皂荚等,并伍沉香,苏子,陈皮,厚 朴顺气导痰。寒痰可加干姜,细辛,热痰加知母,黄芩,竹沥,肺热腑实加大黄,风化硝。

2。 Flush Phlegm
When the contraction of an external evil occurs it is possible for it to cause an acute episode of COPD.  No matter which external evil it is, it can lead to the lungs being overcome by phlegm or phlegm turbidity obstructing the air passages, which in turn causes the lung  to become inhibited.  The phlegm bubbles upward to obstruct the air circulation leading to choking sensations and other critical signs.  At this time the phlegm will be sticky, thick, turbid, greasy, difficult to transform, and difficult to eliminate.  This type of phlegm belongs to the category of “stubborn” phlegm.  Phlegm that has been retained for a long period of time is another example.  Therefore, the treatment must flush the phlegm and disinhibit the lungs.  It is important to promptly expel and eliminate the glue-like phlegm from the airways by means of vomiting or disinhibiting.  It is likely, once the phlegm has been expelled and cleaned up, that the sensation of choking will naturally resolve.  The exemplar formula is liù ān jiān, sān zi yǎng qīn tāng, tíng lì xiè fèi tāng, with medicinals such as bàn xià, bái jiè zǐ, jié gěng, lái fú zi, tíng lì zi, hǎi fú shí, méng shí, zé qī, zào jiá, together with chén xiāng, sū zi, chén pí, hòu po to assist in smoothing the  to help guide out the phlegmIn the case of cold phlegm add gān jiāng and xì xīn.  In the case of hot phlegm add zhī mǔ, huáng qín, and zhú lì.  When there is lung heat organ repletion add dà huáng or fēng huà xiā.

猪牙皂与皂荚同功而祛痰开闭尤佳,历来用于痰喘气闭,顽痰壅塞气道,黏稠难咯,胸满,气逆,闷塞绝之急症。虽属劫夺之品,劫有开上导下,利肺通腑之神功,周民用于咳喘壅气闭之实证,屡获奇效。每次用量2-3g,可入煎剂,或配入丸散中。入属痰热闭肺,喘促气粗,胸满胁胀,痰涎壅盛,甚则动风痉厥者,可用猴枣散(药物组成:猴枣,羚羊角,天竺黄,川贝,礞石,沉香,麝香,硼砂),清热豁痰,息风开窍。用法:每次服0。3-0。6g, 每日2次。验之临床,中药祛痰药颇具尤势,其疗效机理多端,轻者可化,可豁,进而可祛,可涤,甚者予以吐利攻逐。若能辩证选药,根据治痰药的性味,功用特点组方配药,合理使用,更能提高疗效。

Other herbs that are particularly effective in expelling phlegm and opening obstruction are zhū yá zào and zào jiá.  Historically these herbs are used with cases of; phlegm panting and  obstruction, stubborn phlegm obstructing the airways, sticky, dense and difficult to expectorate phlegm, chest fullness,  reversal, plus oppression and congestion that is inconsolable.  Even though these herbs belong to the category of “expelling” nevertheless they can miraculously open the upper and guide downward, disinhibit the lungs and open the zàng organs.  ZHŌU Zhòngyīng is able to repeatedly receive wonderful results when administering these herbs for repletion patterns such as coughing and panting, phlegm obstruction, and  blockage.  With phlegm heat obstructing the lungs with hasty panting, rough breathing, chest fullness, rib-side distention, phlegm-drool encumberance and congestion leading to stirring wind and tetanic reversal use hóu zǎo sàn (hóu zǎo, líng yáng jiǎo, tiān zhú huáng, chuān bèi, méng shí, chén xiāng, shè xiāng, péng shā) to clear heat, sweep phlegm, extinguish wind and open the orifices.  Directions: each dose administer 0.3g-0.6g, twice per day.
Through clinical examinations, Chinese herbal medicines have displayed outstanding potential for expelling phlegm.  The mechanisms by which its curative effects are attained are multi-fold.  They can gently gently transform phlegm, clear phlegm, even penetrate deeper to expel lodged phlegm.  Chinese herbal medicines are commonly used to expel phlegm and re-open air passages.  When selecting herbs according to the identified patterns, selections will be based on the herb’s nature, flavor and special characteristics. When used appropriately,they can increase the efficacy of treatment.

3。化痰
久病咳喘,痰浊潴留,肺气不利,治节失司,心血营运不畅,而致肺病及心,瘀血阻碍肺气,瘀滞心脉,表现久病入络,痰瘀互结同病的病理变化。不仅要痰瘀同治,且应重在治瘀。
若痰饮壅阻肺气,喘而气逆痰涌,胸部憋闷,胁肋胀痛,面黯,唇甲青紫,舌苔浊,质紫,脉细滑者,当化痰祛瘀,选用杏苏二陈汤合加味旋覆花汤,药如苏子,白芥子,葶苈子,法半夏,杏仁,桃仁,当归,旋覆花,茜草根,降香等。
如痰瘀壅肺,肺失吸清呼浊之职,浊邪害清,上蒙神机,以致神志淡漠,恍惚,烦 躁,昏昧,面黯,唇紫,喘促气逆,痰黏难咯,舌苔浊腻,质紫,脉细滑数,治当涤痰泄浊,化瘀开窍,选用涤痰汤合通窍活血汤,药如半夏,南星,天竺黄,炙远 志,陈皮,茯苓,菖蒲,郁金,丹参,赤芍,川芎,桃仁,红花,麝香等。

3. Transform Phlegm
In chronic illnesses of coughing and panting phlegm turbidity pools and lodges, therefore causing the lung  to become inhibited and lose its management and regulation. Cardiovascular transportation will become impeded as the lung disease reaches the heart.  Static blood will in turn obstruct the lung, as well as stagnate the heart channel.  Chronic disease manifests in the luò channels.  Phlegm and blood stasis will eventually combine and transform into one disease. In this situation it is not sufficient to merely treat the phlegm stagnation but it is equally necessary to treat blood stasis.
If phlegm-rheum obstructs the lung  there will be panting,  counterflow with phlegm regurgitation, chest oppression and stifling, rib-side distention and pain, and a dark complexion.  The lips and nails will be greenish purple.  The tongue coating will show turbidity and the tongue body will be purple in color.  The pulse will be thin and slippery.  The treatment principle is to transform phlegm and expel stasis.  The exemplar formula is xìng sū èr chén tāng with xuán fù huā tāng, with such medicinals as sū zi, bái jiè zǐ, tíng lì zi, fǎ bàn xià, xìng rén, táo rén, dāngg uī, xuán fù huā, qiàn cǎo gēn, jiàng xiāng. 

如痰瘀壅阻气机,脉络不通,气化失宣,津液失于输化,则可导致血瘀水停,身肿 足浮,腹满,喘急咳逆,心慌动悸,颈脉动甚,面唇,爪甲,舌质暗紫,脉来三五不调,表现肺心同病之候,治疗当重在瘀利水,药用苏木,泽兰,路路通,当归, 丹参,桃仁,茯苓,泽泻,汉防己,泽漆,万年青根,蟾皮,茶树根等。苏木咸能入血,辛能走络,功能活血祛痰消肿。参苏饮,取人参,苏木二味,一补肺气,一 降瘀血。周民常用苏木以治肺心喘满,咳逆胸胀,面浮色紫之症。泽漆辛苦而凉,功能行水消肿,祛痰散结,主药,用治喘咳痰多,身肿。周民曾用治肺心病房颤, 喘咳面浮,手臂肿胀之患者。而苏木与泽漆合用,祛痰散结以行水,相得益彰。

If there is phlegm-stasis obstructing the  dynamic, the vessels and network channels will become blocked causing the  transformation to lose its ability to diffuse.  Hence, there will be a loss of fluids and fluid transformation, which, in turn can lead to blood stasis with water collecting.  The entire body will be swollen and the feet will have floating edema. There will be abdominal fullness, rapid panting, cough with counterflow, flustered emotions, palpitations and stirring of the neck vessels.  The face, lips, fingernails, and tongue body will all be dark purple.  The pulse will be irregular.  In addition, there will be clinical manifestations of a lung and heart combined illness. It is important for the treatment to transform phlegm and disinhibit water.  Use medicinals such as sū mù, zé lán, lù lù tōng, dāng guī, dān shēn, táo rén, fú líng, zé xiè, hàn fáng jǐ, zé qī, wàn nián qīng gēn, chán pí, chá shù gēn.

Sū mù is salty and therefore capable of entering the blood.  Its acrid nature allows it to reach the luò vessels.  Its functions include quickening the blood, expelling stasis, and dispersing swelling.  The formula  shēn sū yǐn combines rén shēn and sū mù.  One herb boosts the lung  while the other descends bloods stasis.  ZHŌU Zhòngyīng often uses sū mù to treat lung and heart patterns characterized with panting and fullness, cough with counterflow, chest distention,and a facial complexion that is transient purple.
Zé qī  is acrid, bitter, and cool.  Its functions are to move water and disperse swelling, expel phlegm, and disperse binding.  It is mainly used to treat water swelling with lower abdominal fullness, phlegm-rheum, panting and coughing, plus scrofula patterns. Zé qī tāng utilizes zé qī as the chief ingredient to treat panting and coughing with copious amounts of phlegm and swelling of the entire body.  ZHŌU Zhòngyīng uses this formulation to treat lung and heart illnesses characterized by atrial fibrillation, panting and coughing, facial edema with hand and arm swelling, plus distention.  Furthermore, su mu and ze qi can be combined together to expel phlegm, disperse binding and move water.  As a pair herb combination they achieve a synergistic effect to maximize efficacy.

[周仲瑛。慢性阻塞肺病急性发作期的辨治要点。江苏中医药2006;27(7):5]