张志明“异病同治”思想在上窍疾病治疗中的应用体会

Zhang Zhiming’s application of “homotherapy for heteropathy” in the treatment of upper orifices disease

辨证论治是中医学的精髓,而异病同治则是辨证论治的具体体现。异病同治是指几种不同的疾病,在其发展变化过程中出现了大致相同的病机,表现为大致相同证,因而采用大致相同的治法和方药来治疗。张志明教授认为头痛、眩晕、鼻渊、耳鸣等上窍疾病的主要病机为脾失健运,升降失常,清浊异位;在临床诊治时多从中焦脾胃论治,以健脾化痰、升清降浊为治则,意在使“中气轮转,清浊复位”,以自拟益气聪明汤为基础加减施治,取得了满意疗效,并有助于人们认识上窍疾病的共同规律,找到治疗上窍疾病大的方向,为临床从宏观的角度辨识治疗上窍疾病提供极大的方便,体现了中医重视辨证论治的理念和异病同治的内涵。现通过典型病案介绍张志明教授“异病同治”思想在上窍疾病治疗中的经验,与同道分享。

Treatment based on syndrome differentiation is the essence of traditional Chinese medicine,while“homotherapy for heteropathy”is the concrete embodiment of treatment based on syndrome differentiation.Homotherapy for heteropathy refers to when the pathogenesis and syndrome of various diseases are similar,similar therapeutic methods and formulas are applied.Professor Zhang Zhiming believes that the main pathogenesis of upper orifice diseases,such as headache,dizziness,nasosinusitis,and tinnitus is failure of the spleen in transportation and transformation,dysfunction of ascending and descending,disorder of the lucid and the turbid.The main treatment principle should be invigorating the spleen and resolving phlegm,ascending lucidity and descending turbidity,so as to promote middle qi and restore the clear qi.Self-made Yiqi Congming Decoction was applied to the patients with a satisfactory effect.This method has shown the regularity and orientation of treating upper orifices diseases,as well as the thought of syndrome differentiation and homotherapy for heteropathy.This paper introduces Professor Zhang′s experience in the treatment of upper orifices diseases through typical medical records.