慢性主观性头晕病机探讨与常见证候分析

On the Disease Mechanism and Common Syndromes of Chronic Subjective Dizziness

目的:探讨慢性主观性头晕(CSD)的病机与证候分布。方法:采集125例CSD头晕患者的一般资料、中医四诊信息,对年龄、性别、症状、证候、证素进行统计学描述、分析。结果:CSD患者以青中年为主,男女比例1.0∶1.6。男女平均年龄、年龄分布差异均无统计学意义(P>0.05)。核心症状除头晕沉、头痛、自觉走路不稳或晃动等,尚包含眠差、急躁、心烦等精神症状及易疲乏、健忘、心慌等躯体症状。证候以阴虚证、痰热证、瘀热证常见,三组证候年龄分布、证候性别分布差异具有显著统计学意义(P<0.01)。与阴虚证相比,痰热证、瘀热证皆以≤44岁青年人居多(P<0.05),与瘀热证相比,阴虚证以45~59岁中年人较多(P<0.05),在≥60岁年龄段,三组证候分布差异无统计学意义(P>0.05);阴虚证、瘀热证以女性为主(P<0.05),痰热证以男性为主(P<0.05)。结论:CSD病位在心,为形神共病,神病为主导。邪扰神躁、清窍不利、形神失和为其主要病机,阳躁不宁、火热内扰是其发病基础。常见证候不外虚实之分,实证责之因郁化热、阳动神躁,虚证责之阴虚热扰、阳旺神浮。临证治疗CSD,当分析病因,明晰体质,随证施治,总以恢复脏腑气化,神安形合为根本目标。

Objective:To investigate the disease mechanism and common syndromes of chronic subjective dizziness(CSD).Methods:The general information and four diagnoses of traitional Chinese medicine(TCM)in 125 patients with CSD were collected.The age,gender,symptoms,syndromes and syndrome elements were statistically described and analyzed.Results:The young and middle-aged patients were predominant.The ratio of male to female was 1∶1.6.There was no statistical difference in the average age and age distribution between the male and female(P>0.05).In addition to dizziness,headache,staggering or swaying feeling,the core symptoms include mental symptoms such as sleepiness,impatience,and upset,as well as physical symptoms such as fatigue,forgetfulness,and palpitation.The syndromes of yin deficiency,phlegm-heat,and stasis-heat were predominant,and there were significant statistical differences on the age distribution and gender distribution among each syndrome(P<0.01).Compared with the yin deficiency syndrome,patients of phlegm-heat syndrome and stasis-heat syndrome were at the age≤44 years old(P<0.05).Compared with stasis-heat syndrome,patients of yin deficiency syndrome were at the age 45~59 years old(P<0.05).There were no statistical difference on the distribution of the three syndrome groups in the age group at the age≥60 years old(P>0.05).Patients of yin deficiency syndrome and the stasis-heat syndrome were mainly female(P<0.05),and phlegm-heat syndrome was male(P<0.05).Conclusions:The disease location of CSD is the heart.CSD is a disease involving both the body and mind,with the mind disease as the core.Evil disturbing and upset mind,unsmoothness of clear orifices,and disharmony of body and mind is the major disease mechanism of CSD.Restlessness of yang and the disturbance of internal heat were the premises of the disease attack.Common syndromes are either deficiency or excess.The excess syndrome is due to depression transforming into heat,yang upset and mind restlessness.The deficiency syndrome is due to yin deficiency and heat disturbance,hyperfunction of yang and floating mind.In the clinical treatment of CSD,the disease cause should be analyzed,the body constitution should be determined,and the methods should be modified based on the symptoms.The utmost goal is to restore the qi transformation of zang-fu organs,and the harmony of body and mind.