伍大华病证结合诊治眩晕经验  

Wu Da-hua′s Experience of Diagnosing and Treating Vertigo Based on Combination of Disease and Syndrome

作　　者：周静玮 伍大华[2] 李映辰 ZHOU Jing-wei;WU Da-hua;LI Ying-chen(Hunan University of Chinese Medicine,Changsha,Hunan,China,410208;Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine,Changsha,Hunan,China,410006)

机构地区：[1]湖南中医药大学,湖南长沙410208 [2]湖南省中医药研究院附属医院,湖南长沙410006

出　　处：《河南中医》2023年第2期198-202,共5页Henan Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81904173);2020年赣南医学院心脑血管疾病防治教育部重点实验室开放基金项目(XN202011);中医药脑病循证能力提升及平台建设项目(2019XZZX-NB004)。

摘　　要：伍大华教授认为,眩晕乃风眩内动、清窍不宁或清阳不升,脑窍失养所致。其病性以本虚标实为主,本虚为肝、脾、肾功能失调,导致气、血、津液、精、髓亏虚,不能上荣头目;标实或为风火痰瘀郁阻清窍,或痰浊中阻,清阳不升,浊气上扰,发为眩晕。周围性眩晕急性期病机为肝风裹挟痰浊上犯,应治以熄风化痰,以半夏白术天麻汤为主方;缓解期以补肾培元为基本治法,采用平眩定晕汤平补肝肾,熄风化痰。脑梗死或脑出血等急性脑血管疾病所致眩晕急性期,应以西医治疗为主,中西医结合;缓解期以中医治疗为主。其病机为肝肾亏虚兼痰瘀阻络,在补益肝肾的基础上,痰瘀同治,常以柔肝通络汤为主方。精神疾患相关眩晕常合并焦虑、抑郁或睡眠障碍,病机关键为肝郁气滞,且常兼夹血瘀、痰浊、火热、水湿等病理因素,以疏肝解郁为治疗法则,同时注重心理治疗,常以逍遥既济汤为主方。Professor Wu Da-hua believes that vertigo is caused by internal motion of wind, restlessness in clearing the orifices, or failure to raise the lucid yang, and loss of nourishment in the brain orifices.The disease is mainly characterized by deficient root cause and excessive manifestation.The dysfunction of the liver, spleen and kidney leads to deficiency of qi,blood, body fluid, essence and marrow, so head and eyes cannot be nourished.Excessive manifestation is caused by wind, fire, phlegm and blood stasis obstructing clear orifices, or phlegm turbidity leading to failure in ascending lucid yang, turbid qi disturbing the upper part of the body, resulting in vertigo.For peripheral vertigo, the pathogenesis in the acute stage is liver wind bears along turbid phlegm, and the treatment should focus on extinguishing wind and resolving phlegm, so Pinellia and White Atractylodes and Gastrodia Decoction can be mainly used.In the remission period, the basic treatment method is to invigorate the kidney and bank up original qi,so Vertigo-Pacifying Decoction can be used to calm the liver and kidney and eliminate wind and phlegm.For vertigo caused by acute cerebrovascular diseases such as cerebral infarction or cerebral hemorrhage, in the acute phase, Western medicine should be the main treatment, with the combination of traditional Chinese and western medicine.In the remission period, TCM treatment is mainly used.Its pathogenesis is liver and kidney deficiency intermingled with phlegm and blood stasis blocking collaterals.Phlegm and blood stasis should be treated with together on the basis of tonifying the liver and kidney.Therefore, Liver-Softening and Collaterals-Dredging Decoction can be mainly used.Mental disorder related vertigo is often associated with anxiety, depression or sleep disorder.The key pathogenesis is liver depression and qi stagnation, and it is often accompanied by such pathological factors as blood stasis, phlegm turbidity, fire and heat, and water dampness.The therapeutic principle is to soothe the live

关 键 词：眩晕 周围性眩晕 中枢性眩晕 精神疾患相关性眩晕 半夏白术天麻汤 平眩定晕汤 柔肝通络汤 逍遥既济汤 伍大华 

分 类 号：R255.3[医药卫生—中医内科学]