贾跃进从痰瘀论治眩晕

JIA Yuejin’s experience in treating vertigo from phlegm and blood stasis

贾跃进继承朱震亨六郁思想,强调百病生于气,临证重视中西医双重诊断,在四诊的基础上,结合现代仪器的诊断结果,即五诊合参,双重诊断,提倡辨病-辨证-辨体三者结合。在西医诊断之后,更能够辨别清楚患者眩晕的诱因是否为严重的脑血管疾病,避免延误病情,并使治疗更具有针对性,充分发挥中西医的优势。针对眩晕,需要善于有技巧的问诊,善于掌握每种证型的特异性症状,初步判定病机之后,再加以收集佐证症状,以快捷准确地辨证。贾跃进认为临床上单一病机或是与教材完全一致的证型的眩晕较为少见,多以复合病机、虚实夹杂出现,其中以痰瘀阻滞所致眩晕最为多见。因津液与脉道中血液相互渗透、相互补充、相互转化,具有同因、同源的特点,故痰瘀多互结并现。痰瘀互结胶着,阻于脑之清窍,浊阴不降,清阳不升,脑窍失养而发为眩晕。故贾师多从痰瘀论治眩晕,临证多以半夏白术天麻汤为治疗眩晕的基本方,随症加减治疗各种眩晕,认为莱菔子为化痰通腑治疗痰郁眩晕的要药,郁金化瘀开窍为治疗血郁眩晕的要药。

Jia Yuejin inherited Zhu Zhenheng’s thought of six depression,emphasized that all diseases were born of Qi(气),and paid attention to the dual diagnosis of traditional Chinese and Western medicine.On the basis of the four diagnoses,combined with the diagnostic results of modern instruments,that is,the combination of five diagnoses and double diagnosis,and advocated the combination of disease differentiation,syndrome differentiation and body differentiation.After Western medicine diagnosis,it is more able to identify whether the patient’s vertigo is caused by serious cerebrovascular disease,avoid delaying the disease,and make the treatment more targeted,giving full play to the advantages of traditional Chinese and western medicine.For vertigo is good at skillful consultation,good at mastering the specific symptoms of each type of syndrome,after the preliminary determination of the pathogenesis,and then collect the supporting symptoms,in order to distinguish the syndrome quickly and accurately.Jia Yuejin believed that the single pathogenesis or syndromic type of vertigo which is completely consistent with the teaching material is relatively rare in clinical practice,and most of them are complex pathogenesis with deficiency and accumulation,among which vertigo caused by phlegm and blood stasis is the most common.Because body fluid and blood in the veins penetrate,complement and transform each other,they have the characteristics of the same cause and the same origin,so phlegm and blood stasis are often intertwined and present.Phlegm and blood stasis are sticky,blocking the brain’s clear orifiums,turbidity Yin does not fall,Qingyang does not rise,and the brain orifiums lose their nourishment for vertigo.Therefore,Jia Shi mainly treated vertigo from phlegm stasis,clinical syndrome with the Banxia Baizhu Tianma decoction(半夏白术天麻汤)as the basic prescription for vertigo treatment,with the treatment of various vertigo,that the Laifuzi(Semen Raphani)is the key drug for resolving phlegm and relaxing bowels on phlegm depression.Yujin(Radix Curcumae)is the key drug for removing blood stasis to open the body to treat blood depression.