文章摘要
石焱,孙晶,倪祥哲,等.方剑乔教授虚实辨证治疗耳鸣耳聋经验采撷[J].浙江中医药大学学报,2020,44(12):1190-1193.
方剑乔教授虚实辨证治疗耳鸣耳聋经验采撷
Professor FANG Jianqiao’s Experience in Treating Tinnitus and Deafness Based on Syndrome Differentiation of Deficiency and Excess
投稿时间:2020-07-12  
DOI:10.16466/j.issn1005-5509.2020.12.009
中文关键词: 耳鸣  耳聋  补虚泻实  耳前三穴  耳聋左慈丸  医案  方剑乔  名中医经验
英文关键词: tinnitus  deafness  reinforcing deficiency and reducing excess  three anterior auricular acupoints  Erlong Zuoci pill  medical cases  FANG Jianqiao  experience of famous TCM doctor
基金项目:全国名老中医药专家传承工作室建设项目(国中医药人教发[2013]47号)
作者单位E-mail
石焱 浙江大学医学院附属杭州市第一人民医院 杭州 310006  
孙晶 浙江中医药大学第三临床医学院  
倪祥哲 浙江中医药大学第三临床医学院  
梁宜 浙江中医药大学第三临床医学院  
方剑乔 浙江中医药大学第三临床医学院 fangjianqiao7532@163.com 
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中文摘要:
      [目的]总结方剑乔教授治疗耳鸣耳聋的临床经验,提炼其学术思想。[方法]通过临床跟师学习,收集病案,认真研习方师对耳鸣耳聋的诊疗思路与辨证施治要点,归纳整理方师针灸取穴与临证用药经验,从病因病机和治法治则两个方面总结分析方师论治本病的学术思想,并列举验案予以佐证。[结果]方师提出,耳鸣耳聋的诊治应重视虚实辨证,首辨虚实之病机,后辨病因,实证多责之于风火之邪上扰,虚症多责之于气虚或阴精亏损,主要是肾阴肾精的亏损。治疗上辨证与辨经相结合,采用针药相辅的治疗手段,补虚泻实,标本兼顾。针灸治疗方面以患侧的耳前三穴(耳门、听宫、听会)作为治疗耳聋耳鸣的基本穴,结合虚实辨证选择电针频率,虚证用疏波,实证用密波。中药治疗多以耳聋左慈丸加减,以奏三阴并补、利湿泄浊之效,对肝肾亏虚型患者尤为效佳。所举验案中患者为耳鸣耳聋(肾精亏虚证),治拟补肾益精、滋阴养窍,经针灸耳前三穴并随证加减,并结合左慈丸口服后,患者听力及耳鸣情况较前明显改善。[结论]方师治疗耳鸣耳聋,注重辨证与辨经相结合,采用针药相辅的治疗手段,补虚泻实,标本兼顾,临床疗效显著,能明显缓解患者耳鸣症状,提高听力水平。
英文摘要:
      [Objective] To summarize Professor FANG Jianqiao's clinical experience in treating tinnitus and deafness, and to refine the academic thoughts. [Methods] Through learning from teacher in clinical works, copying prescriptions, collecting medical records, further studying the thoughts of diagnosis and treatment and key points of syndrome differentiation, summarizing and sorting out the clinical experience of acupoints and herbs selection of Professor FANG on tinnitus and deafness, the academic thoughts and clinical experience of Professor FANG on the treatment based on syndrome differentiation of the disease were summarized and analyzed through following two aspects of the etiology and pathogenesis as well as therapeutic method and principle of tinnitus and deafness. A typical case was adopted as evidence. [Results] Professor FANG proposes that the diagnosis and treatment of tinnitus and deafness should focus on the differentiation of deficiency and excess, the first to identify the pathogenesis of deficiency and excess syndrome, and then to identify the etiology. According to Professor FANG, the pathogenic factors of wind and fire are the most common etiology of excess syndrome while the deficiency of Qi or Yin essence is more responsible for the deficiency syndrome, especially the deficiency of kidney Yin and kidney essence. Clinically, combining syndrome differentiation and meridian differentiation, acupuncture, electroacupuncture and traditional Chinese medicine should be combined to reinforce deficiency and reduce excess, concerning both the symptoms and root causes. In terms of acupuncture and moxibustion, the three preauricular acupoints, including Ermen(TE21), Tinggong(SI19), Tinghui(GB2) on the affected side were taken as the basic points for the treatment of deafness and tinnitus. The frequency of electroacupuncture was selected according to the syndrome differentiation of deficiency and excess, sparse wave was used for deficiency syndrome and dense wave was used for excess syndrome. The treatment of traditional Chinese medicine was mostly modified Erlong Zuoci pill, which can play the effect of reinforcing three Yin and removing dampness and turbidity, especially for patients with liver and kidney deficiency.In the case, the patient was of tinnitus and deafness(kidney essence deficiency syndrome), and the treatment principle was tonifying the kidney and essence, nourishing Yin and nourishing the orifices. After acupuncture at the three preauricular acupoints and modification according to symptoms,and oral administration of Erlong Zuoci pill, the patient's hearing and tinnitus were significantly improved. [Conclusion] In the treatment of tinnitus and deafness, Professor FANG pays attention to the combination of syndrome differentiation and meridians differentiation, uses acupuncture and medicine complementary treatment, reinforcing deficiency and reducing excess, concerning both the symptoms and root causes. The clinical effect is significant, which can significantly improve the tinnitus symptoms and improve the hearing level of patients.
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