杨瑞龙基于“标本中气”理论辨治后循环缺血性眩晕经验

YANG Ruilong’s experience in treating posterior circulation ischemic vertigo based on the theory of“manifestation,root cause and medial Qi”

后循环缺血性眩晕(Posterior Circulation Ischemic Vertigo,PCIV)作为缺血性脑血管病之一,为神经内科常见病、多发病,主要以眩晕为主要症状,或伴有视物旋转,或伴有耳聋、耳鸣,恶心、呕吐等症状,治疗方式多种多样,但容易复发,预后不良,除常规的西医基础治疗之外,亦可通过中医中药及物理疗法等综合治疗,因PCIV的解剖位置、结构较复杂,周围神经、血管分布密集,其病因病机更是复杂多样,虚实夹杂,给临床诊断、鉴别、治疗带来困难。研究以古籍《黄帝内经》为依据,在经典理论的指导下,探讨“标本中气”理论与眩晕的联系,通过现代技术等手段进行相关的检验检查后明确诊断,采用中西医结合的诊疗方式,提高临床治疗效果,改善预后,减少复发率。标本中气理论以“少阳之上,火气治之,中见厥阴”为理论指导,深刻描述三阴三阳之少阳、厥阴二经和六气之风、寒、暑、湿、燥、热(火)之风、火二者,共同导致PCIV的发生、发展。研究还探讨PCIV中医的病因病机、治疗原则、谴方用药、随症加减等。杨瑞龙主任医师从事神经内科临床及教学多年,对中西医结合诊断、治疗、预后PCIV有着独到的见解和丰富的经验,为临床从不同角度认识眩晕提供新的思路和参考。

Posterior circulation ischemic vertigo,as one of ischemic cerebrovascular diseases,is a common and frequently-occurring disease in neurology.Vertigo is the main symptom,accompanied by visual rotation,deafness,tinnitus,nausea,vomiting and other symptoms.There are various treatment methods,but it is easy to relapse and has a poor prognosis.Besides the routine basic treatment of western medicine,it can also be treated by comprehensive treatment of traditional Chinese medicine and physical therapy.Due to the complex anatomical location and structure of posterior circulation ischemic vertigo and the dense distribution of peripheral nerves and blood vessels,its etiology and pathogenesis are more complex and diverse,and deficiency and excess are mixed,which brings difficulties to clinical diagnosis,differentiation and treatment.Based on the ancient book Huangdi Neijing(《黄帝内经》)and under the guidance of classical theories,this paper discusses the relationship between the theory of“manifestation,root cause and medial Qi(气)”and vertigo.Through modern technology and other means,after relevant examination and tests,the diagnosis and treatment method of integrated Chinese and Western medicine can improve the clinical treatment effect,promote the prognosis and reduce the recurrence rate.In the theory of“manifestation,root cause and medial Qi”“,Shaoyang is above,fire and Qi are treated,and Jueyin(厥阴)is seen in the middle”,is the theoretical guidance,and the Shaoyang(少阳)and Jueyin two channels of the three Yin(阴)and three Yang(阳)are deeply described,the wind and fire of the six Qi,cold,heat,dampness,dryness,heat(fire)and so on are profoundly described,which together lead to the occurrence and development of the posterior circulation ischemic vertigo,and the etiology,pathogenesis,treatment principle,prescription and medication of the traditional Chinese medicine of the posterior circulation ischemic vertigo are discussed.And the prescription and medication are modified according to the symptoms.Chief physician YANG Ruilong has been engaged in the clinical treatment and teaching of neurology for many years.He has unique insights and rich experience in the diagnosis,treatment and prognosis of posterior circulation ischemic vertigo with integrated Chinese and Western medicine,which provides new ideas and references for clinical understanding of vertigo from different perspectives and facilitates clinical guidance.