王肯堂辨治眩晕特色探析

Analysis on the Characteristics of WANG Ken-tang's Syndrome Differentiation and Treatment of Vertigo

通过文献检索,从病因病机、处方用药特点等方面对《证治准绳》中有关眩晕等章节及医案进行分析,归纳总结王肯堂辨治眩晕的特色。王肯堂认为眩晕可由外感、痰饮、内伤虚损、情志不调等因素所致,病位可及心、肝、脾、肾等脏腑;治疗宜审证求因,分而治之,针对风邪、寒邪、暑邪、湿邪、风热、寒湿等,分别可予消风散、不换金正气散、黄连香薷饮、除湿汤、羌活汤、芎术除眩汤等;辨治痰涎尤为精妙,有澄、摄、复、坠四法,分别适用于属稠而难清、散而不收、下虚上溢、上壅下塞等候,常用小半夏加茯苓汤、五苓散等;针对内伤虚损,常予益气补肾汤、补肝养荣汤等;针对情志不调者,多予安肾丸、十四友丸等。王肯堂辨治眩晕之时,观其脉证,悉心洞察,尤其重视其病机的动态演变,体现了其注重调补脾胃、善权衡气机之升降等学术观点,对当今辨治眩晕具有重要意义。

Through literature retrieval,this paper analyzed the chapters and medical records related to vertigo in Zheng Zhi Zhun Sheng from the aspects of etiology,pathogenesis,prescription and drug use characteristics,and summarized the characteristics of WANG Ken-tang's syndrome differentiation and treatment of vertigo.Wang Ken-tang believed that vertigo can be caused by exogenous sensation,phlegm,internal injury,disorder of emotion,and etc.,and the location of the disease can reach the heart,liver,spleen,kidney and other internal organs.The treatment should be based on syndrome and cause,and divided and treated them.For wind evil,cold evil,heat evil,dampness evil,wind heat,cold and dampness,Xiaofeng San(消风散),Buhuan Jinzhengqi San(不换金正气散),Huanglian Xiangru Yin(黄连香薷饮),Chushi Decoction(除湿汤),Qianghuo Decoction(羌活汤),Xiongzhu Chuxuan Decoction(芎术除眩汤),and etc.can be given respectively.Syndrome differentiation and treatment of phlegm and saliva was particularly exquisite.There were four methods:clarification,photographing,recovery and falling.They were respectively applicable to thick and difficult to clear,scattered but not collected,lower deficiency and overflow,upper congestion and lower blockage,and commonly used Xiaobanxia plus Fuling Decoction(小半夏加茯苓汤),Wuling San(五苓散),and etc.For internal injury deficiency,often given Yiqi Bushen Decoction(益气补肾汤),Bugan Yangrong Decoction(补肝养荣汤),and etc.For those with emotional disorder,given Anshen Wan(安肾丸),Shiyou Wan(十四友丸),and etc.When WANG Ken-tang treated vertigo,he observed its pulse syndrome,carefully observed it,and paid special attention to the dynamic evolution of its pathogenesis,which reflected his academic views of paying attention to regulating and tonifying the spleen and stomach and balancing the rise and fall of Qi mechanism,which was of great significance to the treatment of vertigo today.