周洪彬基于“运脾转枢”法辨治非高血压性眩晕经验

Experience of ZHOU Hong-Bin in Differentiating and Treating Non-hypertensive Vertigo Through Activating the Pivot Function of the Spleen

总结周洪彬主任基于"运脾转枢"治疗非高血压性眩晕的经验。周洪彬主任认为,风、火、痰、虚、瘀、食滞诸端皆可引起清窍失养,导致眩晕的发病,病机尤以脾失转枢为关键。临证可将非高血压性眩晕分为以下6型:脾虚生痰,肝风上扰;脾肾两虚,虚风上扰;心脾两虚,气血双亏;阳虚土衰,木乘风动;肾元虚衰,阴虚阳浮;寒遏经脉,营卫失调。治法以健脾守中、益气补肾、养肝熄风为要,使气血互化、精血同生,则风熄晕停。除外感风寒、营卫失调之眩晕,各型眩晕在未确认证型之前均可首选健脾守中之方药先行服用,再作后续调整。健脾守中可选用香砂六君子汤、二陈汤、理中汤、平胃散及木香、砂仁、香附、藿香、陈皮、厚朴、茯苓、白术等。

The experience of Professor ZHOU Hong-Bin in differentiating and treating non-hypertensive vertigo through activating the pivot function of the spleen was summarized. Professor ZHOU Hong-Bin believes that all of the pathogenic factors of wind, fire, phlegm, deficiency, blood stasis, and dyspepsia can cause the upper orifices failing in nourishment,which results into the occurrence of vertigo,and the spleen failing in activating its pivot function contributes to the key pathogenesis of vertigo. In the clinic,the non-hypertensive vertigo can be differentiated into 6 syndrome types, namely type of spleen deficiency generating phlegm, and upward disturbance of liver wind,type of deficiency of both spleen and kidney,and upward disturbance of deficiency wind,type of deficiency of both heart and spleen,and insufficiency of both qi and blood,type of yang deficiency and earth(spleen)decline, and wood(liver)exuberance causing wind disturbance, type of kidney original qi deficiency,and yin deficiency inducing yang floating,and type of cold obstructing meridians,and disharmony between nutritive qi and defensive qi. The treatment of non-hypertensive vertigo should be focused on invigorating spleen and guarding middle energizer,replenishing qi and invigorating kidney,nourishing liver and suppressing wind,so as to enhance the mutual transformation of qi and blood as well as the simultaneous generation of essence and blood,and then achieve the therapeutic effect of suppressing wind and stopping vertigo. Except for the vertigo caused by the exogenous attack of wind-cold and the disharmony between nutritive qi and defensive qi,the vertigo of the other 5 types can all be treated by the formulae or herbs for invigorating spleen and guarding middle energizer before syndrome confirmation firstly,and then the modification of the formulae can be performed. For invigorating spleen and guarding middle energizer,the formulae of Xiangsha Liujunzi Decoction,Erchen Decoction,Lizhong Decoction,and Pingwei Powder can be adopted,and herbs of Radix Aucklandiae,Fructus Amomi,Rhizoma Cyperi,Herba Pogostemonis,Pericarpium Citri Reticulatae,Cortex Magnoliae Officinalis,Poria,and Rhizoma Atractylodis Macrocephalae can be used.