眩(xuan)暈頻作防中風,肝陽偏亢要注重。生活規律(lv)調情志,鎮肝熄風可收(shou)功。
眩是(shi)眼(yan)花,暈是(shi)頭暈。二者常(chang)同(tong)時出現,故(gu)統稱眩暈。輕者轉瞬即逝,閉目(mu)即止。重者旋轉不定,不能(neng)站立,可伴有惡心、嘔吐、出汗等(deng)癥,甚則(ze)導至暈厥(jue)。
眩(xuan)暈(yun)發(fa)生的(de)(de)原因很多,與肝、腎、心、腦、沖任脈的(de)(de)陰陽盛衰的(de)(de)關(guan)系最大。多數為(wei)虛癥(zheng)。《內經》認為(wei):“精(jing)虛則眩(xuan)”,“腎虛則頭重身搖”,“腦海不(bu)足則腦轉(zhuan)耳(er)鳴”。此外,還(huan)有“無痰(tan)不(bu)眩(xuan)”,“無火不(bu)暈(yun)”之說,等等。
眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)與中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng),屬(shu)(shu)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)醫分類學(xue)上的風(feng)(feng)(feng)門。中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)早(zao)期多無(wu)明(ming)顯(xian)癥(zheng)狀(zhuang),眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)是(shi)其主(zhu)(zhu)要特征。常(chang)(chang)見(jian)頭痛(tong)(tong)、失(shi)眠、健忘和注意力(li)不(bu)集(ji)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)等(deng)現(xian)象。也就是(shi)《素問·至真要大論(lun)》所說的“諸風(feng)(feng)(feng)掉眩(xuan)(xuan)(xuan)(xuan)(xuan),皆屬(shu)(shu)于(yu)肝(gan)(gan)”的肝(gan)(gan)風(feng)(feng)(feng)內(nei)動的表(biao)現(xian)。中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)與肝(gan)(gan)風(feng)(feng)(feng)同屬(shu)(shu)肝(gan)(gan)風(feng)(feng)(feng)內(nei)動,只是(shi)程度不(bu)同而已(yi)。肝(gan)(gan)風(feng)(feng)(feng)病(bing)輕,中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)病(bing)重(zhong)。肝(gan)(gan)風(feng)(feng)(feng)可(ke)出(chu)現(xian)頭痛(tong)(tong)眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)、肢麻、失(shi)眠等(deng)癥(zheng);中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)主(zhu)(zhu)要特點是(shi)發病(bing)急驟,突然暈(yun)倒(dao),出(chu)現(xian)口眼歪斜,語言蹇澀,半身偏癱(tan)的嚴重(zhong)癥(zheng)狀(zhuang)。這是(shi)由于(yu)長期眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)的進一步(bu)發展而導致的結果。這個過程可(ke)以從中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)病(bing)例的病(bing)史中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)得到驗證(zheng)。朱(zhu)丹溪(xi)曾(ceng)經提(ti)出(chu)“眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)者中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)之漸(jian)也”的論(lun)點,提(ti)示(shi)眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)是(shi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)的先兆,中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)是(shi)眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)的后果。中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)多見(jian)于(yu)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)年以上患者,且有隨人(ren)們壽命的延長而逐年增多的趨勢(shi),成為當前防(fang)治(zhi)老年病(bing)的一項重(zhong)要課題。古(gu)人(ren)早(zao)已(yi)認識到眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)是(shi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)的先兆,這點非常(chang)(chang)重(zhong)要,表(biao)明(ming)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)風(feng)(feng)(feng)可(ke)以預防(fang),而預防(fang)的關鍵,在于(yu)早(zao)期注意和治(zhi)療(liao)眩(xuan)(xuan)(xuan)(xuan)(xuan)暈(yun)。這是(shi)祖國醫學(xue)從大量(liang)臨床(chuang)實踐中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)總結出(chu)來(lai)的寶貴經驗,我們應當積(ji)極(ji)繼承(cheng)并加以發揚。
既(ji)然要(yao)早期注意和(he)治療眩(xuan)暈(yun),就(jiu)應了解眩(xuan)暈(yun)的發病(bing)和(he)病(bing)程進展情況,主要(yao)有以下(xia)幾(ji)種類型:
(一)腎(shen)陰(yin)不足,肝(gan)失所養,陰(yin)虛(xu)陽亢,內熱生風(feng),風(feng)水犯上(shang),心(xin)亂神昏(hun),甚至暈倒。
(二)氣(qi)虛(xu)血弱,腎(shen)元不固,經脈(mo)郁阻,虛(xu)陽內(nei)動,重者挾痰、挾火,心神受擾(rao),發(fa)為眩暈。
(三)七情刺(ci)激,惱怒傷(shang)肝,肝陽暴張,引動心火(huo),致使氣血逆亂,上犯清竅。
(四(si))高梁厚味,久而濕郁生痰,痰濕化熱(re),火(huo)旺犯上。
以(yi)上幾(ji)種類型是(shi)(shi)互(hu)(hu)相(xiang)(xiang)影(ying)響,互(hu)(hu)相(xiang)(xiang)制約和互(hu)(hu)相(xiang)(xiang)促進(jin)(jin)的(de),而其根本機理,歸納(na)起來,不(bu)外(wai)肝(gan)腎陰(yin)虛,臟腑(fu)功能失調(diao),是(shi)(shi)本病的(de)癥(zheng)(zheng)結所(suo)在。《景(jing)岳全書》說(shuo)的(de)明(ming)白:“凡病此(ci)者,多以(yi)素不(bu)能慎(shen),或七情內傷(shang),或酒色過度,先傷(shang)五臟真陰(yin)”,“陰(yin)虧于(yu)前而陽損于(yu)后,陰(yin)陷于(yu)下而陽乏于(yu)上,以(yi)致陰(yin)陽相(xiang)(xiang)失,精氣不(bu)交,所(suo)以(yi)忽爾昏饋。”葉天士在《臨癥(zheng)(zheng)指南(nan)》中說(shuo):“精血(xue)衰耗,水(shui)不(bu)涵木,木失所(suo)養,故肝(gan)陽偏亢(kang)。”進(jin)(jin)一步闡(chan)明(ming)了眩暈的(de)機理。
清(qing)·李(li)用(yong)粹在《證治匯補》中指出(chu):“平人手指麻(ma)術,不時眩暈,乃(nai)中風先兆,須預防(fang)(fang)之,宜慎起居,節飲(yin)食,遠(yuan)房(fang)幃,調(diao)清(qing)志。”這對防(fang)(fang)治眩暈,減少中風發病(bing)率(lv),至關(guan)重耍。故防(fang)(fang)治措施,首(shou)先要從生(sheng)活(huo)(huo)規律,思想情緒,限(xian)制飲(yin)食,戒絕煙酒等方(fang)面(mian)著(zhu)手,避免生(sheng)活(huo)(huo)無節制,氣(qi)血耗(hao)損(sun),陰陽(yang)失(shi)調(diao),進一(yi)步出(chu)現“卒然仆倒”的(de)中風嚴重證候。因(yin)此,必須把預防(fang)(fang)放在首(shou)要位(wei)置。
眩暈的辨證,須分清標本虛(xu)(xu)實(shi)。本虛(xu)(xu)以肝(gan)腎(shen)不足,氣血虧(kui)虛(xu)(xu)為主;標實(shi)有風火痰之別。治(zhi)療原則,本虛(xu)(xu)者(zhe)(zhe)應滋陰填精,補(bu)益(yi)氣血;標實(shi)者(zhe)(zhe)應熄風潛(qian)陽,除濕滌(di)痰;虛(xu)(xu)實(shi)挾雜者(zhe)(zhe),或養陰平肝(gan)清熱(re),或健(jian)脾和中豁痰。
臨(lin)床(chuang)見證,肝(gan)陽(yang)偏亢者,眩暈時作,情緒易于激動,耳鳴,口苦,多夢少寐,面時潮紅,舌質紅,苔黃,脈弦數,可用(yong)天(tian)麻鉤藤飲(yin)為主(zhu)治療,以(yi)熄風潛(qian)陽(yang),滋(zi)養(yang)肝(gan)腎。
腎陰虛者,眩暈頭空,精(jing)神萎靡,腰(yao)膝(xi)酸(suan)軟,五(wu)心煩(fan)熱,眠(mian)差,遺精(jing),苔少,脈(mo)弦細(xi),用杞菊地黃丸(wan)為主(zhu),以滋補(bu)腎陰。
心脾兩虛者,眩暈神(shen)衰,心悸(ji),面色白或萎黃,舌質淡,脈(mo)細弱,用歸(gui)脾湯(tang)為主,以補(bu)益心脾。
痰濁中阻者,眩暈陣作,頭重如裹,胸悶脘痞,舌(she)苔(tai)白(bai)膩,脈弦滑,用(yong)半夏白(bai)術天麻(ma)湯為主,以祛痰化濁。
張錫純主張用(yong)(yong)鎮肝(gan)熄風(feng)湯作為治(zhi)療本病(bing)的主方。他認為眩(xuan)暈是由(you)肝(gan)木失和,風(feng)自肝(gan)起,強調要(yao)區別于(yu)外風(feng),反對用(yong)(yong)祛風(feng)藥(yao)發表,不然,將(jiang)使臟腑之(zhi)血隨發表之(zhi)藥(yao)上(shang)(shang)升,造成腦充血而(er)不可救藥(yao)。作者在臨床(chuang)上(shang)(shang)遇到類似病(bing)例,按(an)照(zhao)鎮肝(gan)熄風(feng)湯意(yi),化(hua)裁應(ying)用(yong)(yong),每(mei)可獲(huo)得滿意(yi)效果。實踐證明(ming),張氏見解頗(po)有獨到之(zhi)處(chu),為治(zhi)療肝(gan)風(feng)眩(xuan)暈提供了良好(hao)范例。
——本文摘自《中(zhong)醫精華(hua)淺說(shuo)》
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