【目的】 探讨月经后应用右归丸加减治疗肾阳虚型月经性偏头痛的临床疗效及作用机制。【方法】 回顾性筛选2024年2月 至2025年2月深圳市宝安区中医院脑病科门诊病历，纳入100例肾阳虚型月经性偏头痛患者，根据实际治疗方案分为暴露组 和对照组各50例。暴露组给予右归丸加减联合盐酸氟桂利嗪治疗，对照组单纯给予盐酸氟桂利嗪治疗，2组均以1个月经周 期为1个疗程，连续治疗3个疗程。观察2组患者治疗前及治疗3个月经周期后的偏头痛积分、头痛影响测评量表6（HIT-6） 评分及血清雌二醇（E2）、5-羟色胺（5-HT）水平的变化情况，并评价 2组患者的临床疗效及用药安全性。【结果】（1）疗效方 面，治疗 3 个月经周期后，暴露组的总有效率为90.0%（45/50），对照组为76.0%（38/50），组间比较（χ2 检验），暴露组的临床 疗效明显优于对照组（P＜0.05）。（2）偏头痛积分方面，治疗3个月经周期后，2组患者的偏头痛积分均较治疗前明显降低（P＜ 0.05），且暴露组的降低幅度明显优于对照组（P＜0.05）。（3）对生活的影响方面，治疗3个月经周期后，2组患者的HIT-6评分 均较治疗前明显降低（P＜0.05），且暴露组的降低幅度明显优于对照组（P＜0.05）。（4）血清学方面，治疗3个月经周期后，2组患 者的血清E2、5-HT水平均较治疗前明显升高（P＜0.05），且暴露组的升高幅度均明显优于对照组（P＜0.05）。（5）安全性方面， 治疗期间，2组患者均未发生严重不良反应，不良反应多为嗜睡、乏力、心情低落等，其中对照组的不良反应发生率为4.0% （2/50），暴露组为 2.0%（1/50），组间比较，差异无统计学意义（P＞0.05），且不良反应均较轻，无需特殊处理。【结论】 月经 后运用右归丸加减治疗肾阳虚型月经性偏头痛，可显著提高临床疗效，降低偏头痛发作程度、频率及持续时间，改善偏头 痛症状，且无严重不良反应，有利于促进患者康复，安全性良好。

Objective To investigate the clinical efficacy and mechanism of modified Yougui Pills in treating menstrual migraine with kidney-yang deficiency syndrome during the postmenstrual phase. Methods Medical records of 100 patients with menstrual migraine of kidney-yang deficiency syndrome from the Neurology Department of Shenzhen Bao’an Traditional Chinese Medicine Hospital between February 2024 and February 2025 were retrospectively screened，and the patients were divided into an exposure group and a control group （n= 50 each） based on actual treatment. The exposure group received modified Yougui Pills combined with flunarizine hydrochloride，while the control group received flunarizine hydrochloride alone. Both groups were treated for three consecutive courses，with for one menstrual cycle as one course. Migraine scores，Headache Impact Test-6（HIT-6） scores，and serum levels of estradiol （E2） and serotonin （5-HT） were observed before treatment and after three treatment courses. Clinical efficacy and medication safety were evaluated. Results （1） Regarding efficacy，after three treatment courses，the total effective rate was 90.0% （45/50） in the exposure group versus 76.0% （38/50） in the control group. Intergroup comparison （by chi-square test） showed significantly superior clinical efficacy in the exposure group （P＜0.05）. （2） Regarding migraine scores， after three treatment courses， migraine scores significantly decreased in both groups compared to those before treatment （P＜0.05），with a significantly greater reduction in the exposure group （P＜0.05）.（3） Regarding impact on life，after three treatment courses，HIT-6 scores significantly decreased in both groups compared to those before treatment （P＜0.05），with a significantly greater reduction in the exposure group （P＜0.05）.（4） Regarding serology，after three treatment courses，serum E2 and 5-HT levels significantly increased in both groups compared to before treatment （P＜0.05）， with significantly greater increases in the exposure group （P＜0.05）.（5） Regarding safety，no severe adverse reactions occurred in either group during treatment. Most adverse reactions were mild，such as drowsiness，fatigue，and low mood. The incidence of adverse reactions was 4.0% （2/50） in the control group and 2.0% （1/50） in the exposure group，with no statistically significant difference between groups （P＞0.05）. All adverse reactions were mild and required no special intervention. Conclusion Modified Yougui Pills administered during the postmenstrual phase for menstrual migraine with kidney-yang deficiency syndrome significantly improve clinical efficacy，reduce the severity attack frequency， and duration of migraine， alleviate migraine symptoms， and promote patient recovery with a favorable safety profile.

R276.1

广东省医疗卫生健康事业发展专项资金（传承发展中医药事业）中医药人才培养类项目（编号：粤中医办函 〔2018〕 5 号）