基于“诸风掉眩,皆属于肝”理论探析持续性姿势-知觉性头晕的病机及治疗原则  

The pathogenesis and treatment principles of persistent postural-perceptual dizziness based on the theory of“both wind diseases and dizziness are related to liver”

作　　者：冯瑞华 冷辉[2] 孙海波[2] 马梽轩[2] FENG Ruihua

机构地区：[1]辽宁中医药大学,辽宁沈阳110085 [2]辽宁中医药大学附属医院,辽宁沈阳110033

出　　处：《中医临床研究》2025年第2期56-60,共5页Clinical Journal Of Chinese Medicine

基　　金：国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教函[2022]75号)。

摘　　要：持续性姿势–知觉性头晕是临床常见的一种慢性功能性头晕,核心临床表现包括持续性头晕、非旋转性眩晕和不稳感,此外患者常伴有焦虑、抑郁等不良情绪,给患者的生活和工作产生了非常不利的影响。该病可能的发病机制为前庭通路与焦虑相关神经网络重叠。大量的研究表明,持续性姿势–知觉性头晕患者头晕持续时长及严重程度与焦虑、抑郁程度呈正相关。诸多中医学者根据主要症状特点将持续性姿势–知觉性头晕归属于“眩晕病”的范畴,也有学者认为该病合并“郁证”。随着对持续性姿势–知觉性头晕的研究逐步深入,发现该病以肝为主,涉及脾、肾,多与气、郁、风、火、痰、瘀、虚等因素密切相关。现代医学对于持续性姿势–知觉性头晕的治疗措施较为局限,且临床效果不佳,安全性较低。中医药对持续性姿势–知觉性头晕有一定的治疗优势,值得进一步研究探讨。“诸风掉眩,皆属于肝”这一理论阐明了“掉眩”病大多与肝的病变密切相关,而持续性姿势–知觉性头晕的头晕、不稳感等临床症状正符合“掉眩”病。本研究以“诸风掉眩,皆属于肝”为理论基础,结合古代中医经典认识和现代研究,剖析“肝”“风”与持续性姿势–知觉性头晕的病机联系,并从“滞则通之”“盛则泻之”“虚则补之”等方面进一步探讨持续性姿势–知觉性头晕的中医治疗原则,为今后临床治疗持续性姿势–知觉性头晕提供更多诊疗思路和理论依据。Persistent postural-perceptual dizziness(PPPD)is a common chronic functional dizziness in clinical practice.The core clinical manifestations of PPPD include persistent dizziness,non-rotational vertigo and sense of instability.In addition,PPPD patients are often accompanied by anxiety,depression and other bad emotions,which have a very adverse impact on the life and work of patients.The possible pathogenesis of the disease is the overlap of vestibular pathway and anxiety-related neural network.A large number of studies have shown that the duration and severity of dizziness in patients with PPPD are positively correlated with the degree of anxiety and depression.Many TCM scholars classify PPPD as vertigo disease according to its main symptom characteristics,and some scholars believe that the disease is combined with“depression syndrome”.With the gradual deepening of the research on PPPD,it was found that the disease was mainly caused by liver disorder,involving spleen and kidney,and was closely related to Qi(气),depression,wind,fire,phlegm,stasis,deficiency and other factors.Modern medicine has limited therapeutic measures for PPPD,with poor clinical effects and low safety.Traditional Chinese medicine(TCM)has certain advantages in the treatment of PPPD,which is worthy of further research and discussion.This theory of“Both wind diseases and dizziness are related to liver”explains that most of“dizziness”diseases are closely related to liver lesions,and the clinical symptoms such as dizziness and sense of instability of PPPD are in line with the above-mentioned“dizziness”diseases.In this paper,based on the theory of“Both wind diseases and dizziness are related to liver”,combined with the understandings of ancient TCM classical thoughts and modern research,the relationships among“liver”“wind”and PPPD pathogenesis is analyzed to further discuss the TCM treatment principles of PPPD from the aspects of“unchoking stagnation”,“expelling obstructed evil by catharsis”,and“treating defici

关 键 词：持续性姿势–知觉性头晕 眩晕 诸风掉眩 皆属于肝 病机 中医药疗法 

分 类 号：R255.4[医药卫生—中医内科学]