摘要
《诸病源候论》提出“膈痰风厥头痛”,阐明头痛疾病“膈痰蕴结为本、风厥发动为标、久病入络成瘀”的病机演变规律。本文在传统单一病证认识基础上,将此病机演变规律扩展至原发性头痛的共性认识,论证其在偏头痛、紧张型头痛、丛集性头痛等不同类型头痛中的普遍适用性。膈痰蕴结是头痛发病的病理基础,痰湿阻滞膈间、扰乱气机升降,导致清阳不升、浊阴不降,为头痛发作埋下病理隐患;风厥发动是头痛急性发作的关键要素,风邪挟痰上冲清窍,气血逆乱,脑络受扰而发头痛,发病急骤、痛势剧烈;久病入络、痰瘀互结是头痛慢性迁延的核心病机,病邪深入脑络,痰瘀胶结难解,痹阻脑络,导致头痛缠绵难愈。三者之间动态演变,相互转化。基于此规律,本文提出间歇期调膈化痰、急性发作期息风止厥、慢性期通络补虚的分期论治原则,体现“治未病”思想与标本兼治理念,为临床辨治头痛疾病提供新的理论指导。
General Treatise on Causes and Manifestations of All Diseases introduces the concept of"headache due to diaphragmatic phlegm and wind syncope"and elucidates the evolutionary pattern of headache pathogenesis:"the accumulation of diaphragmatic phlegm is the root cause,the attack of wind syncope is the manifestation,and long-term illness invading the collaterals leads to blood stasis."Building upon the traditional understanding of single-disease syndromes,this study extends this pathogenic evolution to the broader context of primary headaches,demonstrating its universal applicability across different types,including migraine,tension-type headache,and cluster headache.The accumulation of diaphragmatic phlegm is the fundamental pathological basis for headache onset.It obstructs the region between the diaphragms and disrupts the ascending-descending movement of qi,resulting in the failure of clear yang to ascend and turbid yin to descend,thus laying a pathological risk for the onset of headache.The attack of wind syncope serves as the key trigger for acute headache episodes.When wind pathogens,accompanied by phlegm,surge upward to the clear orifices,they disturb qi and blood flow and disrupt brain collaterals,triggering acute and severe headache.Chronic and persistent headaches arise from long-standing invasion of the collaterals,where phlegm and blood stasis become deeply intertwined and difficult to disperse,causing prolonged obstruction of the cerebral vessels and refractory pain.These three factors undergo dynamic evolution and mutual transformation.Based on this understanding,a staged treatment principle is proposed:regulating the diaphragm and resolving phlegm during the remission phase;calming wind and relieving syncope during the acute attack period;and dredging collaterals and tonifying deficiency during the chronic period.This approach embodies the principle of"preventive treatment of disease"and the concept of treating both the root cause and manifestations,providing new theoretical guidance for the clinical differentiation and treatment of headaches.
作者
陈燚
魏竞竞
付国静
贾敏
曹晓璇
郭春艳
张云帆
张允岭
CHEN Yi;WEI Jingjing;FU Guojing;JIA Min;CAO Xiaoxuan;GUO Chunyan;ZHANG Yunfan;ZHANG Yunling(Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)
出处
《北京中医药大学学报》
北大核心
2025年第12期1724-1730,共7页
Journal of Beijing University of Traditional Chinese Medicine
基金
首都卫生发展科研专项(No.2020-2-4173)
中国中医科学院西苑医院具有知识产权的医疗机构制剂和中药新药的研发与转化专项(No.XYZX0303-12)
中国中医科学院基本科研业务费新入职青年科研人员培养专项(No.ZZ18-XRZ-004)
中国中医科学院西苑医院能力提升项目(No.XYZX0405-09)。
关键词
膈痰
风厥
痰瘀互结
原发性头痛
诸病源候论
diaphragmatic phlegm
wind syncope
intermingling of phlegm and blood stasis
primary headache
General Treatise on Causes and Manifestations of All Diseases
