文章摘要
黄妍妍,南淑玲.朱丹溪耳鸣、耳聋证治思想探究[J].浙江中医药大学学报,2020,44(4):350-352, 361.
朱丹溪耳鸣、耳聋证治思想探究
ZHU Danxi's Thoughts about Tinnitus, Deafness
DOI:10.16466/j.issn1005-5509.2020.04.008
中文关键词: 朱丹溪  耳鸣  耳聋  虚实  气血痰郁  浙派中医  金元四大家
英文关键词: ZHU Danxi  tinnitus  deafness  deficiency and excess  Qi blood and phlegm stasis  TCM of Zhejiang faction  four TCM masters in Jin and Yuan Dynasties
基金项目:
作者单位
黄妍妍 安徽中医药大学 合肥 230038 
南淑玲 安徽中医药大学 合肥 230038 
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中文摘要:
      [目的]探讨朱丹溪对耳鸣、耳聋的辨治特色,以期为临床诊治本病提供有益思路。[方法]分析朱丹溪系列书籍中有关耳鸣、耳聋的相关条文,总结其从虚实两端、内外合邪、气血痰郁及内治外治等方面的辨治方法。[结果]朱丹溪强调“耳鸣、耳聋属火”,认为本病证型包括虚火、实火虚实两端。以“气血痰郁”为纲辨治,认为少阳、厥阴气郁化火挟痰为本病实证最常见的发病因素;少阴元气、精血亏损、相火妄动为本病虚证最多见的致病因素;正虚邪壅为本病发病的基本病机,四时邪气乘虚而入或致七情郁结生痰化火,从而诱发或加重耳鸣耳聋。临证“脉症相参,详察病机”,实证善用清、开、消、通、汗、补诸法助“行气活血解郁,清热祛痰通窍”,虚证善于补中兼缓、兼升、兼降,“阴血亏虚,相火妄动,四物为本;元气亏虚,相火妄动,温存以养”,并用“内治为主,兼容外治”等辨治方法。[结论]朱丹溪认为耳鸣、耳聋多为郁火挟痰之实证或气血不足、相火妄动之虚证,实证以行气活血解郁、清热祛痰通窍立法,虚证通过补血养阴或温补助阳之法以降虚火,其辨治思想具备临床价值。
英文摘要:
      [Objective]To explore the characteristics of ZHU Danxi in the treatment of tinnitus and deafness. [Methods] Based on the analysis of the relevant articles in ZHU Danxi's books on tinnitus and deafness, this paper summarizes the treatment methods in terms of the deficiency and the excess, the internal and the external combination of evil, Qi, blood, phlegm and stagnation, and the internal and the external treatment. [Results] ZHU Danxi emphasized that the tinnitus and deafness belonged to fire, and believed that the etiology of the disease included the deficiency fire and the excess fire. Taking "Qi, blood, phlegm and stagnation" as the key points, it was considered that stagnation of Qi in Shaoyang and Jueyin led to fire and phlegm, which was the most common pathogenic factors of this disease. Shaoyin vitality, blood loss, frenetic stirring of ministerial fire were the most common pathogenic factors of deficient syndrome; Asthenia of healthy Qi and sthenia of pathogenic factors were the basic pathogenesis of the disease, and the pathogen of four seasons can cause the seven emotions gloomy from the weak points, resulting in phlegm and fire, so as to trigger or aggravate tinnitus and deafness. In clinic, ZHU Danxi figured out the pathogenesis of disease through pulse tracings and symptoms. If the disease was classified as the excess kind, ZHU tended to use the methods like clearing, opening, eliminating, purgating, sweating, nourishing to enhance Qi and blood circulation, relieve stagnation, clear heat and transform phlegm, open ear. If the disease was classified as the deficiency kind, ZHU was good at putting the slowing, ascending, descending methods into the nourishing method, which meant that if the disease was caused by the frenetic stirring of ministerial fire because of deficiency of blood, the Decoction of Four Ingredients should be the basic one, and if the disease was caused by the frenetic stirring of ministerial fire because of the deficiency of Qi, the medicine with mild effects worked. Besides, ZHU also took the methods of external treatments.[Conclusion] So, ZHU Danxi believed that this disease was the excess kind or deficiency of Qi and blood, mostly the stagnation of fire carrying phlegm or deficiency kind featuring the frenetic stirring of ministerial fire. The excess kind was to promote flow of Qi and blood circulation so as to relieve stagnation, clear heat and eliminate phlegm while the deficiency kind was to reduce the deficient fire by nourishing Yin with blood or supplementing Yang with warming, so its critical treatment thought had clinical value.
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