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 .

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