头痛

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缨良贾
5 years ago
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1 头痛 Headache Dr Igor Micunovic Ph.D

2 概述 summary 定义 concept : 指患者自觉头部疼痛的一类疾病 main complains as headache 分类 :classifications: 1 根据发病的缓急 : 急性 ( 二周内 ) 亚急性 ( 三个月内 ) 和慢性头痛 ( 三个月以上 );acutewithin 2 weeks, over 3 months-chronic 2 根据头痛的严重程度 : 轻度中度和重度头痛 ; we can divide headache into severe, intermittent, and light condition according to the degree of headache 3 根据病因 : 原发性和继发性头痛 primary and secondary

3 病因病机 pathogenesis 外感头痛 exogenous headache( 风邪多兼寒湿热 wind with cold, damp or heat factors) 内伤头痛 internal headache ( 肝阳上亢肾虚血虚痰浊瘀血 liver yang ascending, kidney deficiency, blood deficiency, phlegm retention, or blood stagnation)

4 辨证 differentiation 阳明头痛 yang ming 前额痛 forehead; 少阳头痛 shao yang 侧头痛 side; 太阳头痛 tai yang 后枕痛 back; 厥阴头痛 jue yin 巅顶痛 vertex 外感头痛 exogenous: 起病急, 病程短 ; 痛连项背, acute onset, short course, pain reflex to back 内伤头痛 internal: 起病缓, 病程长 chronic onset, long course

5 辨证 differentiation 外感头痛 headache due to exogenous factors: 起病急, 病程短 ; 痛连项背, 痛无休止, 兼见外感 acute onset, short course, pain reflex to back with superficial symptoms 1. 风寒 wind cold: 恶风寒, 口不渴, 苔薄白, 脉浮紧 aversion to cold, thin white coating and floating tense pulse 2. 风热 wind heat: 头痛而胀, 发热, 口渴欲饮, 小便黄, 苔黄, 脉浮数 distending pain, fever, thirsty and desire to drink, yellow urine, yellow coating with floating and rapid pulse. 3. 风湿 wind damp: 头痛如裹, 肢体困重, 苔白腻, 脉濡 fullness on head with heavy and pain of body, white greasy coating, slippery pulse

6 辨证 differentiation 内伤头痛 headache due to internal damage: 起病缓, 病程长, 伴头晕, 痛势绵绵, 时止时休, 遇劳或情志加重 chronic onset, long course, accompanied with dizzy, slight pain, more severe after over work and emotional attack 1. 肝阳上亢 liver yang ascending: 头胀痛, 目眩, 心烦易怒, 面赤口苦, 舌红, 苔黄, 脉弦数 distending pain, dizzy, irritability, red face and bitter taste, red tongue and yellow coating. 2. 肾虚头痛 kidney deficiency: 头痛兼头晕耳鸣, 腰膝酸软, 神疲乏力, 遗精, 舌红, 少苔, 脉细数 headache and dizzy, lumbago, fatigue, nocturnal emission, red tongue with little coating and thread rapid pulse

7 辨证 differentiation 内伤头痛 headache due to internal damage: 3. 血虚头痛 blood deficiency: 头部空痛兼头晕神疲乏力, 面色少华, 舌淡, 脉细弱 Empty pain with dizzy, fatigue, pale face, pale tongue and thread pulse. 4. 痰浊头痛 phlegm retention: 头痛昏蒙, 脘腹痞满, 呕吐痰涎, 苔白腻, 脉滑 Headache with unclear mind, abdominal fullness, lots of sputum, white greasy coating and slippery pulse. 5. 瘀血头痛 blood stagnation: 头痛迁延日久, 或头部有外伤史, 痛处固定不移, 痛如锥刺, 舌暗, 脉细涩 Lingering headache for long time, fixed place as puncturing sensation, dark tongue with thread and choppy pulse.

8 阳明头痛前额痛 Yang ming headache

9 少阳头痛侧头痛 Shao yang headache

10 太阳头痛后枕痛 Tai yang headache

11 厥阴头痛巅顶痛 Jue yin headache vertex

12 治疗 treatment 外感头痛 headache due to exogenous factors: 治法 Principle: 祛风通络止痛 relieving wind, promoting meridians and stopping pain 主穴 main points: 列缺 lie que(lu.7) 百会 bai hui (Du.20) 太阳 tai yang 风池 feng chi(g.b.20)

13 Matching points: 1. 前头痛 forehead: 印堂 yin tang 攒竹 cuan zhu(u.b.2) 合谷 he gu(l.i.4), 内庭 nei ting(st.44) 2. 后头痛 back headache: 天柱 tian zhu(u.b.10) 后溪 hou xi(s.i.3) 申脉 shen mai(u.b.62) 3. 侧头痛 side headache: 外关 wai guan(s.j.5) 率谷 shuai gu(g.b.8) 足临泣 zu lin qi(g.b.41) 4. 头顶痛 vertex pain: 四神聪 si shen cong 太冲 tai chong(liv.3) 内关 nei guan(pec.6)

14 Matching points: 风寒头痛 wind cold: 风门 feng men(u.b.12) 风热头痛 wind heat: 曲池 qu chi(g.b.20) 大椎 da zhui(du.14) 风湿头痛 wind damp: 阴陵泉 yin ling quan (Sp.9) 手法 : 泻法 reducing methods

15 百会 bai hui (Du.20)

16 太阳 tai yang

17 风池 feng chi (G.B.20)

18 中药治疗外感头痛 Chinese herbs for exougenous headache 风寒 wind cold 川芎茶调散川芎 chuan xiong10 荆芥 jing jie6 薄荷 bo he3 羌活 qiang huo10 细辛 xi xin3 白芷 bai zhi10 防风 fang feng10 甘草 gan cao6 风热 wind heat 芎芷石膏汤川芎 chuan xiong10 白芷 bai zhi10 石膏 shi gao15 菊花 ju hua10 藁本 gao ben10 羌活 qiang huo10 风湿 wind damp 羌活胜湿汤羌活 qiang huo10 独活 du huo10 川芎 chuan xiong10 蔓荆子 man jing zi10 防风 fang feng6 藁本 gao ben10 甘草 gan cao6

19 内伤头痛 headache due to internal damage 实证 excess syndrome 治法 Principles: 疏通经络, 清利头窍 promoting meridians and clear head 主穴 main points: 百会 bai hui(du.20) 头维 tou wei (St.8) 风池 feng chi (G.B.20)

20 Matching points: 肝阳上亢 liver yang ascending 太冲 tai chong(liv.3) 太溪 tai xi(kid.3) 侠溪 xia xi((g.b.43) 痰浊头痛 phlegm retention 太阳 tai yang 丰隆 feng long (St.40) 阴陵泉 yin ling quan(sp.9) 瘀血头痛 blood stagnation 阿是穴 a-shi 血海 xue hai(sp.10) 膈俞 ge shu(u.b.17) 内关 nei guan(pec.6)

21 太冲 tai chong (Liv.3)

22 头维 Tou wei(st.8)

23 侠溪 xia xi (G.B.43)

24 内伤头痛 headache due to internal damage 虚证 deficiency syndrome 治法 Principles: 疏通经络, 滋养脑髓 nourishing brain and promoting meridians 主穴 main points: 百会 bai hui(du.20) 风池 feng chi (G.B.20) 足三里 zu san li (St.36)

25 Matching points: 血虚头痛 blood deficiency 三阴交 san yin jiao(sp.6) 肝俞 gan shu(u.b.18) 脾俞 pi shu(u.b.20) 肾虚头痛 kidney deficiency 肾俞 shen shu(u.b.23) 太溪 tai xi(kid.3) 悬钟 xuan zhong(g.b.39) 手法 :methods 实证泻法 reducing for excess 虚证补法 reinforcing for deficiency

26 足三里 zu san li (St.36)

27 肝俞 gan shu (U.B.18)

28 脾俞 pi shu(u.b.20)

29 肾俞 shen shu(u.b.23)

30 中药治疗内伤头痛 Chinese herbs for internal headache 肝阳上亢 liver yang ascending 天麻钩藤饮天麻 Tian ma10 钩藤 Gou teng10 石决明 Shi jue ming15 牛膝 Niu xi15 桑寄生 Sang ji sheng15 杜仲 Du zhong10 栀子 Zhi zi15 黄芩 Huang qin10 益母草 Yi mu cao15 茯神 Fu shen10 夜交藤 Ye jiao teng15 痰浊 phlegm retention 半夏白术天麻汤半夏 Ban Xia15 白术 Ban zhu10 天麻 Tain ma10 陈皮 Chen pi15 茯苓 Fu ling15 甘草 Gan cao6 生姜 Sheng jiang10 大枣 Da zao10 瘀血 blood stagnation 通窍活血汤赤芍 Chi shao10 川芎 Chuan xiong10 桃仁 Tao ren10 红花 Hong hua10 麝香 She xiang1 葱 cong10 生姜 Sheng jiang10 大枣 Da zao10 酒冲

31 中药治疗内伤头痛 Chinese herbs for internal headache 血虚 blood deficiency 八珍汤人参 Ren shen10 白术 Bai zhu10 茯苓 Fu ling15 甘草 Gan cao10 当归 Dang gui15 白芍 Bai shao10 川芎 Chuan xiong10 熟地黄 Shu di huang15 生姜 Sheng jiang10 大枣 Da zao10 肾虚 kidney deficiency 大补元煎人参 Ren shen10 山药 Shan yao10 熟地黄 Shu di huang30 杜仲 Du zhong10 枸杞子 Gou ti zi15 当归 Dang gui10 山茱萸 Shan zhu yu10 炙甘草 zhi gan cao6

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