基于心肺相关理论探讨嗅觉障碍

Exploration of olfactory dysfunction based on the theory of heart-lung correlation

嗅觉障碍是指部分或全部嗅觉功能下降、丧失或异常。临床表现为嗅觉减退、嗅觉丧失、幻嗅等。心肺相关理论最早可追溯至《黄帝内经》《难经》时代,经过历代医家整理、研究,由邓铁涛教授总结提出五脏相关学说的子系统。它以中医整体观念为源,以气血为核心,以宗气为基础,阐释了心、肺两脏在位置、阴阳、五行、经络、功能之间的相关性。《素问·五脏别论篇》中的“心肺有病,而鼻为之不利也”最早指出了心、肺对鼻系疾病的影响。心肺间的相互作用,化气生血、形成宗气,上濡鼻窍,鼻司嗅觉,则嗅觉障碍的发病、论治与心、肺密切相关。而临床上,大多中医学者认为鼻失嗅者病在“肺”,多单一治“肺”;或有医家强调鼻与“心”的关系,着重于治“心”,但这些治法都忽视了“心”与“肺”间的相关性。肺、心两脏在失嗅症的发生、发展的过程中皆起着重要作用。在治疗中,可通过散肺邪、清心火、益心肺之法来治疗嗅觉障碍。文章结合案例,分析心肺相关理论的内涵,从心肺失和的角度探讨嗅觉障碍的发病与治疗,以期为临床拓展思路。

Olfactory dysfunction refers to the decline,loss or abnormality of some or all olfactory functions.The clinical manifestations are hypoesthesia,anosmia and hallucination and so on.The theory of heart-lung correlation can be traced back to Huangdi Neijing(《黄帝内经》)and Nanjing(《难经》).Professor DENG Tietao summarized the theory of the Five Zang(五脏)organs after the exploration and research of doctors in all dynasties.Based on the holistic idea of TCM,Qi(气)and blood as theO core,and Thoracic Qi as the basis,it explains the correlation between the position,Yin(阴)and Yang(阳),Five elements,meridians and collaterals,and functions of the heart and lung.In Suwen·five-zang organs(《素问·五脏别论篇》),the influence of heart and lung on nasal diseases was first pointed out.The interaction between heart and lung,transforming Qi into blood,forming pectoral Qi,and nose regulating olfaction,then the pathogenesis and treatment of olfactory dysfunction are closely related to heart and lung.In clinical practice,most TCM scholars believe that the disease of nasal anosmia lies in the lung,and most of them treat the lung only.Some doctors emphasize the relationship between the nose and the heart,focusing on the treatment of the heart,but these treatments ignore the correlation between the heart and the lung.The lung and heart both play an important role in the occurrence and development of anosmia.In treatment,olfactory dysfunction can be treated by dispersing lung pathogens,clearing heart fire and benefiting heart and lung.This paper analyzes the connotation of cardiopulmonary theory combined with cases,and discusses the pathogenesis and treatment of olfactory dysfunction from the perspective of cardiopulmonary disharmony,in order to expand ideas for clinical practice.