四逆散加减治疗妇人腹痛的辨证应用与机制研究进展
Recent Advances in the Differential Diagnosis, Clinical Application, and Mechanism of Action of Modified Si Ni San for the Treatment of Abdominal Pain in Women
DOI: 10.12677/tcm.2026.155276, PDF,   
作者: 霍格格：黑龙江中医药大学研究生院，黑龙江 哈尔滨；佀雪平*：黑龙江中医药大学附属第二医院妇科一病房，黑龙江 哈尔滨
关键词: 妇人腹痛；四逆散；肝脾不和；辨证论治；作用机制；Abdominal Pain in Women； Si Ni San； Disharmony between the Liver and Spleen； Pattern Differentiation and Treatment； Mechanism of Action
摘要: 妇人腹痛是妇科常见病症，其核心病机在于肝脾不和、气血失调。四逆散作为疏肝理脾的基础方，其调和气血的功效高度契合该病的治疗原则。本文系统梳理了基于气滞血瘀、寒凝胞宫、湿热下注及气血亏虚等不同证型的四逆散加减用药规律，总结了随症灵活配伍的临床经验。同时，探讨了四逆散加减方通过调节神经–内分泌功能、发挥抗炎免疫效应以及改善盆腔微循环等多靶点、多途径的现代药理学作用机制，以期为该方在妇人腹痛中的精准辨证应用与深入研究提供参考。
Abstract: Abdominal pain in women is a common gynaecological condition, the underlying pathogenesis of which lies in disharmony between the liver and spleen, and an imbalance of qi and blood. As a foundational formula for regulating the liver and spleen, Si Ni San’s efficacy in harmonising qi and blood aligns closely with the therapeutic principles for this condition. This paper systematically reviews the patterns of modification in Si Ni San based on different syndromes—including qi stagnation and blood stasis, cold congealing in the uterus, damp-heat descending, and deficiency of qi and blood—and summarises clinical experience in flexible formula formulation tailored to specific symptoms. Concurrently, the paper explores the modern pharmacological mechanisms of Sini San modifications, which act through multiple targets and pathways—including the regulation of neuroendocrine function, the exertion of anti-inflammatory and immunomodulatory effects, and the improvement of pelvic microcirculation—with the aim of providing a reference for the precise syndrome differentiation and application of this formula in the treatment of abdominal pain in women, as well as for further research.
文章引用：霍格格, 佀雪平. 四逆散加减治疗妇人腹痛的辨证应用与机制研究进展[J]. 中医学, 2026, 15(5): 252-258. https://doi.org/10.12677/tcm.2026.155276

参考文献

[1] 石玲, 陈晓燕. 魏绍斌教授治疗子宫内膜息肉的经验[J]. 云南中医中药杂志, 2025, 46(1): 6-9.
[2] 田锋亮, 邱红. 基于扶阳理论从温通三阴法论治腹痛综合征[J]. 实用中医内科杂志, 2022, 36(9): 24-26.
[3] 程引, 王济, 李英帅, 等. 基于阳虚质探讨“四逆”类方的应用规律[J]. 北京中医药大学学报, 2023, 46(12): 1665-1669.
[4] Chang, X., Zhao, L., Wang, J., Lu, X. and Zhang, S. (2017) Sini-San Improves Duodenal Tight Junction Integrity in a Rat Model of Functional Dyspepsia. BMC Complementary and Alternative Medicine, 17, Article No. 432. [Google Scholar] [CrossRef] [PubMed]
[5] Zhu, C., Zhao, L., Zhao, J. and Zhang, S. (2020) Sini San Ameliorates Duodenal Mucosal Barrier Injury and Low-Grade Inflammation via the CRF Pathway in a Rat Model of Functional Dyspepsia. International Journal of Molecular Medicine, 45, 53-60. [Google Scholar] [CrossRef] [PubMed]
[6] 曾华蓉, 柯志福, 杨叔禹. 清代御医力钧经验撷菁[J]. 光明中医, 2024, 39(12): 2474-2477.
[7] Xu, W., Tian, S., Mao, G., Li, Y., Qian, H. and Tao, W. (2024) Sini San Ameliorates Lipid Metabolism in Hyperprolactinemia Rat with Liver-depression. Current Research in Food Science, 9, Article ID: 100853. [Google Scholar] [CrossRef] [PubMed]
[8] Zhao, J., Feng, X., Li, H., et al. (2020) Effect of Sini San Prescription on Apoptosis and Proliferation of Hepatocellular Carcinoma HepG2 Cells. Chinese Journal of Applied Physiology, 36, 489-493. (In Chinese)
[9] 林翠丽, 黄铭涵, 何友成. 赖义初教授治疗慢性萎缩性胃炎经验[J]. 福建中医药, 2024, 55(4): 54-56.
[10] 徐思雨, 周思敏, 姚魁武. 姚魁武巧用四逆散经验[J]. 吉林中医药, 2022, 42(2): 158-161.
[11] 谭莹莹, 施明慧, 阮楸婷, 等. 柴胡疏肝散临床应用研究进展[J]. 实用中医药杂志, 2025, 41(1): 215-218.
[12] 刘佳, 蒋小敏. 柯琴释《伤寒论》芍药之妙用[J]. 江西中医药, 2025, 56(1): 15-17, 20.
[13] Newman, P. and Davison, M. (1979) The Quality of Radiographs Produced by Automatic Processors. Radiography, 45, 15-18.
[14] 徐梦娇, 姜良铎, 湛韬, 等. 从透邪解郁角度浅析四逆散加味治疗膀胱过度活动症思路[J]. 环球中医药, 2022, 15(11): 2198-2200.
[15] 黄蓓, 胡雅君, 周月希, 等. 国医大师梅国强运用和解枢机法治疗痛经[J]. 湖南中医药大学学报, 2023, 43(9): 1617-1620.
[16] Chen, M.K. (1979) The Gross National Health Product: A Proposed Population Health Index. Public Health Reports, 94, 119-123.
[17] 征征, 张莉莉, 赵林华, 等. 基于态靶理论的子宫肌瘤治疗方略探析[J]. 吉林中医药, 2025, 45(1): 6-9.
[18] Miyamae, T. (1977) Immunofluorescent Study on Egg-Adapted Avian Encephalomyelitis Virus Infection in Chickens. American Journal of Veterinary Research, 38, 2009-2012. [Google Scholar] [CrossRef] 
[19] 张弩, 刘荣丰, 杨春燕, 等. 1200张中医皮肤门诊处方合理性分析与临床用药方案探讨[J]. 中国现代药物应用, 2025, 19(6): 153-156.
[20] Ivy, J.L. (1977) Role of Insulin during Exercise-Induced Glycogenesis in Muscle: Effect on Cyclic Amp. American Journal of Physiology-Endocrinology and Metabolism, 233, E509. [Google Scholar] [CrossRef] [PubMed]
[21] Robinson-Papp, J., Morgello, S., Vaida, F., Fitzsimons, C., Simpson, D.M., Elliott, K.J., et al. (2010) Association of Self-Reported Painful Symptoms with Clinical and Neurophysiologic Signs in HIV-Associated Sensory Neuropathy. Pain, 151, 732-736. [Google Scholar] [CrossRef] [PubMed]
[22] 毛春能. 叶时龙老师运用四逆散加减散治疗杂病验案举隅[J]. 健康女性, 2023(38): 297-298.
[23] Zhu, L., Hu, J., Li, J., Qu, X., Zhou, X., Gan, G., et al. (2025) Sini San Ameliorates Symptoms of Depression by Modulating Gut Microbiota Structure, Tryptophan Metabolism, and Short-Chain Fatty Acid Levels. BMC Complementary Medicine and Therapies, 26, Article No. 9. [Google Scholar] [CrossRef] 
[24] Wier, W.G., Zang, W., Lamont, C. and Raina, H. (2009) Sympathetic Neurogenic Ca2+ Signalling in Rat Arteries: ATP, Noradrenaline and Neuropeptide Y. Experimental Physiology, 94, 31-37. [Google Scholar] [CrossRef] [PubMed]
[25] Svensson, T.H. (1987) Stress, Central Neurotransmitters, and the Mechanism of Action of α2-Adrenoceptor Agonists. Journal of Cardiovascular Pharmacology, 10, S88-S92. [Google Scholar] [CrossRef] 
[26] Di Marco, A., Demartis, A., Gloaguen, I., Lazzaro, D., Delmastro, P., Ciliberto, G., et al. (2000) Leptin Receptor‐mediated Regulation of Cholinergic Neurotransmitter Phenotype in Cells of Central Nervous System Origin. European Journal of Biochemistry, 267, 2939-2944. [Google Scholar] [CrossRef] [PubMed]
[27] Jarskog, L.F., Xiao, H., Wilkie, M.B., Lauder, J.M. and Gilmore, J.H. (1997) Cytokine Regulation of Embryonic Rat Dopamine and Serotonin Neuronal Survival in Vitro. International Journal of Developmental Neuroscience, 15, 711-716. [Google Scholar] [CrossRef] [PubMed]
[28] Wang, Y., Fang, Y., Huang, W., Zhou, X., Wang, M., Zhong, B., et al. (2005) Effect of Sinomenine on Cytokine Expression of Macrophages and Synoviocytes in Adjuvant Arthritis Rats. Journal of Ethnopharmacology, 98, 37-43. [Google Scholar] [CrossRef] [PubMed]
[29] 魏伟莉, 郑智礼, 邓秀兰, 等. 基于TGR5/cAMP/PKA信号通路探讨疏肝、健脾疗法对肝损伤大鼠的作用及机制[J]. 现代中西医结合杂志, 2023, 32(19): 2629-2635.
[30] 闫弘颖, 王超. 软坚四逆散改善原发性肝癌术后患者免疫功能及肝纤维化的效果评价[J]. 中华养生保健, 2024, 42(20): 23-27.
[31] 曹艳芳, 汪雅莉, 王安慧, 等. 溃疡性结肠炎小鼠结肠及免疫组织中四逆散药源性成分的LC-MS分析[J]. 中国药科大学学报, 2025, 56(1): 73-79.
[32] Abiru, T., Kamata, K. and Kasuya, Y. (1991) Attenuation of Depressor Response Induced by Platelet Activating Factor and Acetylcholine in Streptozotocin-Induced Diabetic Rats. Journal of Pharmacobio-Dynamics, 14, 293-300. [Google Scholar] [CrossRef] [PubMed]
[33] Palacios, J., Asunción-Alvarez, D., Aravena, D., Chiong, M., Catalán, M.A., Parra, C., et al. (2024) A New Oxime Synthesized from Senecio nutans Sch. Bip (Chachacoma) Reduces Calcium Influx in the Vascular Contractile Response in Rat Aorta. RSC Advances, 14, 9933-9942. [Google Scholar] [CrossRef] [PubMed]
[34] Obermaier, R., von Dobschuetz, E., Muhs, O., Keck, T., Drognitz, O., Jonas, L., et al. (2004) Influence of Nitric Oxide on Microcirculation in Pancreatic Ischemia/Reperfusion Injury: An Intravital Microscopic Study. Transplant International, 17, 208-214. [Google Scholar] [CrossRef] [PubMed]
[35] Zhu, F., Ding, Y., Chen, L., Fang, R., Huang, C., Liu, E., et al. (2025) Regulatory Effects of Sini-San on Bile Acid Homeostasis in the Enterohepatic Circulation of Mice with Liver Fibrosis. Chinese Medicine, 20, Article No. 186. [Google Scholar] [CrossRef] 
[36] Jiang, M., Huang, C., Wu, Q., Su, Y., Wang, X., Xuan, Z., et al. (2023) Sini San Ameliorates CCl4-Induced Liver Fibrosis in Mice by Inhibiting AKT-Mediated Hepatocyte Apoptosis. Journal of Ethnopharmacology, 303, Article ID: 115965. [Google Scholar] [CrossRef] [PubMed]