从肝郁论治持续性姿势感知性头晕的经验探析  

The experience for treating persistent postural perceptual dizziness from the perspective of liver depression

作　　者：唐超伟 张晋岳 范家玮 王爱梅 TANG Chaowei

机构地区：[1]山西中医药大学,山西太原030024 [2]山西中医药大学附属医院,山西太原030024

出　　处：《中医临床研究》2023年第17期57-60,共4页Clinical Journal Of Chinese Medicine

摘　　要：持续性姿势感知性头晕是临床常见的一种眩晕类型。患者表现为持续慢性头晕、不稳和非旋转性眩晕,姿势或体位改变时会出现明显的加重感,临床影像学检查或前庭功能检查难以发现明显异常,往往持续数月不见好转。目前持续性姿势感知性头晕的病因病机尚不明确,西医治疗只能缓解症状,无法完全根治。中医对本病的认识历史悠久,辨证论治及理法方药相对完善,治疗效果明显。山西中医药大学张晋岳教授结合临床经验,认为肝郁气滞是导致持续性姿势感知性头晕发病的主要病因病机,运用脏腑辨证、气血津液辨证相结合,完整地把握了其发病过程,主张通过疏肝解郁来治疗持续性姿势感知性头晕。他根据肝郁气滞、肝郁夹痰等证型应用柴胡加龙骨牡蛎汤加减治疗,同时注重调整机体内外环境的统一性,根据患者不同的病证采用不同的方药,辨证辨病,再立治法,以法统方,结合相应情绪和心理治疗,取得了良好效果。文章结合案例,介绍张晋岳教授从肝论治持续性姿势感知性头晕,希望为临床提供参考。Persistent postural perceptual dizziness(PPPD)is a common type of vertigo in clinic.The clinical manifestations of the patient are persistent chronic dizziness,instability and non-rotation dizziness.The dizziness is obviously aggravated when the posture or position changes.In clinical practice,it is difficult to find obvious abnormalities in clinical imaging examination or vestibular function examination,and the symptoms often persist for several months without amelioration.At present,the etiology and pathogenesis of PPPD are not clear,and Western medicine treatment can only relieve the symptoms,but cannot completely cure it.TCM has a long history of understanding of this disease,and the dialectical treatment and prescription medicine are relatively perfect,and the treatment effect is obvious.Based on his clinical experience,Professor ZHANG Jinyue from Shanxi University of Traditional Chinese Medicine believes that liver depression and Qi(气)stagnation are the main causes and pathogenesis of PPPD,the combination of internal organ differentiation and Qi,blood,and liquid differentiation was used to completely grasp the pathogenesis process,and advocates that PPPD should be treated by relieving liver depression.He applied the Chaihu Longgu Muli decoction(柴胡加龙骨牡蛎汤)according to the syndrome types such as liver depression and Qi stagnation,and liver depression with phlegm,and paid attention to adjusting the unity of the internal and external environment of the body,according to the different symptoms of the patient,different prescriptions are used,differentiation and differentiation,and then the treatment method is established,and the prescription is unified by law,combined with corresponding emotional and psychological treatment,and achieved good results.In this article,the experience of Professor ZHANG Jinyue in treating PPPD from the perspective of liver is introduced with a case analysis,hoping to provide a reference for clinical practice.

关 键 词：肝郁气滞 持续性姿势感知性头晕 眩晕 辨证论治 医案 

分 类 号：R255.4[医药卫生—中医内科学]