基于《伤寒杂病论》“眩、冒”辨证探讨梅尼埃病的辨治思路

Differentiation and treatment of Meniere's disease based on “Xuan and Mao” in Treaties on Febrile and Miscellaneous Diseases

经方被后世医家广泛应用于治疗梅尼埃病。通过挖掘《伤寒杂病论》"眩"的方证规律及临床应用,笔者认为梅尼埃病属于《伤寒杂病论》"眩""冒"的范畴;梅尼埃病病机本虚标实,且50岁以下的患者多三阳为患,50岁以上患者多表现为三阴开阖枢失常,这与《灵枢·天年》脏腑盛衰理论相符合;梅尼埃病发病以"阳气不利"为根本,少阳、少阴的枢转,太阴、太阳的温化,厥阴阳明的合阖与眩晕病机紧密不可分;临床主要表现为眩晕、耳鸣耳闷、胃肠症状三组主要症状群;病机主要表现为两方面:一是气化不利,三焦痰饮停滞,二是阳气升降出入,阴阳转化失职。

The classical herbal formulas are extensively used in the treatment of Meniere＇s disease by the medical masters of later generations. Through mining the rules between the formulas and syndromes and the clinical applications on＂Xuan＂（ dizziness and vertigo） in Treatise on Febrile and Miscellaneous Diseases,the authors believe that Meniere＇s disease is in the category of＂Xuan＂and＂Mao＂in Treatise on Febrile and Miscellaneous Disease. Regarding the pathogenesis,Meniere＇ s disease is the deficiency in the primary and the excess in the secondary. The patients younger than 50 years old mostly suffer from the disorders of three yang and those older than 50 years old is sickened as the dysfunction of opening,closing and pivot of three yin. It is coincident with the theory of the ups and downs of zangfu organs recorded in Miraculous Pivot：Natural Span of Life. Regarding the occurrence of Meniere＇ s disease,dysfunction of yang qi is the root. The pivot of shaoyang and shaoyin,the warming activity of taiyin and taiyang and the closing of jueyin and yangming are closely related to the pathogenesis of dizziness and vertigo. In Meniere＇s disease,dizziness and vertigo,tinnitus and blockage feeling in the ear,and the gastrointestinal disorders are the three groups of symptoms. The pathogenesis is reflected in two aspects. One of them refers to the dysfunction of qi activity and retention of phlegm in the three Jiao. Another one refers to the dysfunction of ascending,descending,existing and entering of yang qi and the impairment of yin-yang transformation.