仲景“痰饮致眩”辨治梅尼埃病探析

Theoretical analysis and case studies on treating Meniere’s disease based on Zhang Zhongjing’s theory of “dizziness caused by phlegm-fluid retention”

摘要

梅尼埃病（meniere disease，MD）以发作性眩晕、波动性听力下降及耳鸣为核心症状，中医学将其归属于“眩晕”范畴。《伤寒杂病论》提出的“病痰饮者，当以温药和之”原则，为后世辨治痰饮眩晕的核心法则。痰饮致眩之脏腑辨证包括：心阳不振，水气凌心；肺失宣肃，饮停上焦；脾失健运，饮停中焦；肾失蒸化，饮停下焦。痰饮致眩之治法方药包括：心阳不振者桂枝加桂汤主之，肺寒饮停者甘草干姜汤主之，脾虚湿困者泽泻汤主之，肾阳虚衰者真武汤主之。痰饮致眩核心病机为水气上冲。并结合临床验案对仲景“痰饮致眩”辨治MD进行阐述。

Abstract

Meniere’s disease (MD) is characterized by episodic vertigo, fluctuating hearing loss, and tinnitus, and is classified under the category of xuanyun (vertigo) in Traditional Chinese Medicine. The principle proposed in Shanghan Zabing Lun (Treatise on Cold Damage and Miscellaneous Diseases)—that “phlegm-fluid retention disorders should be treated with warm herbs for harmonization”—has become the core rule for differentiating and treating xuanyun caused by phlegm-fluid retention in later generations. The zang-fu pattern differentiation of xuanyun due to phlegm-fluid retention includes: heart yang insufficiency with water qi overwhelming the heart; lung failing to disperse and descend with fluid retention in the upper jiao; spleen failing to transport and transform with fluid retention in the middle jiao; and kidney failing to vaporize and transform with fluid retention in the lower jiao. The corresponding herbal formulas are: Guizhi Jiagui Decoction (Cinnamon Twig Decoction with Extra Cinnamon) for heart yang insufficiency, Gancao Ganjiang Decoction (Liqorice and Dried Ginger Decoction) for lung cold with fluid retention, Zexie Decoction (Alisma Rhizome Decoction) for spleen deficiency with damp retention, and Zhenwu Decoction (True Warrior Decoction) for kidney yang deficiency. The core pathogenesis of xuanyun due to phlegm-fluid retention is rebellious water qi surging upward. This is further elaborated with a clinical case study to illustrate Zhang Zhongjing’s theory of “dizziness caused by phlegm-fluid retention” in the differentiation and treatment of MD.

关键词

梅尼埃病 / 痰饮致眩 / 水气上冲 / 理论探析

Key words

Meniere’s disease / dizziness caused by phlegm-fluid retention / rebellious water qi surging upward / theoretical analysis

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基金资助

国家自然科学基金项目(U21A20400)

河北省自然科学基金项目(H2024110042)