从寒瘀致痛探讨敦煌疗风虚瘦弱方治疗子宫内膜异位症痛经及验案举隅

李莉 1，2，武权生 1，3，崔宇红 1，3，段永强 1，3，张小花 1，杜娟 1

1.甘肃中医药大学，甘肃 兰州 730020；2.甘肃省第二人民医院，甘肃 兰州 730020；

3.敦煌医学与转化省部共建教育部重点实验室，甘肃 兰州 730020摘要：子宫内膜异位症痛经发生机制之一是与盆腔解剖学和血液循环动力学改变密切相关。中医认为，寒

瘀交阻胞宫是痛经发生的主要病机之一。敦煌医学卷子（P.3930）疗风虚瘦弱方组方精当，以活血、袪寒、益气、养血四法合用，共奏温经散寒、养血祛瘀之功，临床治疗寒瘀交阻型痛经疗效显著，且此方以羊肉汤纳药煎煮，体现了敦煌医学古医方食疗与药疗兼用的地域特色。关键词：子宫内膜异位症痛经；寒瘀交阻；敦煌疗风虚瘦弱方

DOI：10.3969/j.issn.1005-5304.2017.11.030

中图分类号：R271.917.4 文献标识码：A 文章编号：1005-5304(2017)11-0118-03

Discussion on Dunhuang Liao Fengxu Shouruo Formula for Treatment of Endometriosisdysmenorrhea Based on Theory of Pain Caused by Cold-coagulation and Blood-stasis and Medical Cases

LI Li1,2, WU Quan-sheng1,3, CUI Yu-hong1,3, DUAN Yong-qiang1,3, ZHANG Xiao-hua1, DU Juan1 (1. Gansu University of Chinese Medicine, Lanzhou 730020, China; 2. The Second People’s Hospital of Gansu Province, Lanzhou 730020, China; 3. Key Laboratory of Dunhuang Medicine and Transformation, Ministry of Education, Lanzhou 730020, China)

Abstract: One of the mechanisms of endometriosis-dysmenorrhea is closely related to the changes of pelvic anatomy and hemodynamics. TCM holds that cold-coagulation and blood-stasis that alternate and resist the cell palace is one of the main pathogenesis of dysmenorrheas. Dunhuang Liao Fengxu Shouruo Formula (P.3930), a precise and appropriate formulating prescription, plays an important role in activating blood, dispelling cold, tonifying qi and nourishing blood, which can warm the maridians and disperse cold, nourish blood and dissolve stasis and it achieves significant results. And in this prescription, the method of decocting herbs in mutton soup embodies the local characteristic of foodtherapy combined with medication of ancient Dunhuang medical prescriptions.

Key words: endometriosis-dysmenorrhea; cold-coagulation and blood-stasis; Dunhuang Liao Fengxu Shouruo Formula

子宫内膜异位症（endometriosis，EMT）伴发痛经是目前临床诊治热点和难点。近年来，EMT 发病率逐渐升高，特别是在西北地区，由于地势海拔较高，气候寒冷，EMT 痛经患者体质特点以寒凝血瘀为主而多见，而实践表明临床应用中医药防治EMT痛经，能够减轻患者躯体疼痛症状，改善生活质量，具有独

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特优势和确切疗效 。笔者临床应用敦煌医学卷子

（P.3930）疗风虚瘦弱方（以下简称“敦煌疗风虚瘦弱

基金项目：甘肃省自然科学基金（1508RJZA020）；敦煌医学

诊疗技术与临床应用建设项目（DHYX1415-004）

通讯作者：段永强，E-mail：dyqgs2008@163.com 方”）加减治疗 EMT 痛经，效果显著，现从其理法方药阐释如下。

1 古医籍关于子宫内膜异位症痛经的论述

根据 EMT伴发痛经临床表现，可归属中医学“痛经”“少腹痛”范畴。如《金匮要略•妇人杂病脉证并治》所载温经汤主治证即有“经水不利，少腹满痛”，提示此症多由寒瘀交阻胞宫所致，此与《诸病源候论•妇人杂病诸候》记载“血瘕病，妇人月水新下……若大饥寒，汲汲不足，呼吸未调，而自劳动，血下未定，左右走肠胃之间，留络不去，内有寒热，与月水合会，为血瘕之聚。令人腰痛，不可以俯仰，横骨下有积气，牢如石，小腹里急苦痛，背膂疼，深达腰腹下挛，阴