Treatment Of Dizziness During The Menstrual Cycle

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

Translated by J. Heaverlo & Xu Zhijun

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.