摘要
纯音测听可评估听力损失类型和程度,其结果可分为低频下降型、高频下降型、平坦下降型和全聋型四型。认为突聋低频下降型多为脾虚湿盛证,高频下降型多为肝肾阴虚证,平坦下降型多为气血亏虚证,全聋型多为血瘀证。在此基础上提出“病证结合、针药相须、动态施治”的突发性聋全流程诊疗思路,即辨病与辨证相结合,针药并用,局部取耳门、听宫、听会、翳风穴位以疏通耳窍,并根据听力曲线分型辨证处方:低频下降型治宜健脾渗湿,远端选取脾经、胃经穴位针灸,参苓白术散内服;高频下降型治宜滋肾平肝,远端选取肾经、肝经穴位针灸,耳聋左慈丸内服;平坦下降型治宜益气养血,可取任脉、脾经、胃经、大肠经穴位针灸,益气聪明汤内服;全聋型治宜活血化瘀,常取血海、膈俞针灸,通窍活血汤内服,以达标本兼治之效。同时,充分考虑证型兼杂和病情演变,动态分析病因病机,随证治之,以期为突发性聋的临床证治提供新思路。
Pure-tone audiometry can be performed to evaluate the type and degree of hearing loss,whose results can be divided into four types including low-frequency descending,high-frequency descending,flat descending and total deafness.The low-frequency descending type of sudden hearing loss(SHL)is more likely to be spleen deficiency and dampness exuberance,the high-frequency descending type is often due to yin deficiency of liver and kidney,the flat descending type is commonly associated with qi and blood depletion,and the type of total deafness is often linked to blood stasis.Our team has further developed a comprehensive diagnostic and therapeutic approach for SHL,emphasizing"the integration of disease and syndrome,the combination of acupuncture and herbal medicine,and dynamically administering treatment".Firstly,it advocates integrating disease diagnosis with syndrome differentiation.Secondly,it recommends combining acupuncture and herbal medicine,with local acupoints such as Ermen(TE 21),Tinggong(SI 19),Tinghui(GB 2),and Yifeng(TE 17)used to unblock the auditory orifice,and herbal prescriptions tailored to the hearing curve patterns.For the low-frequency descending type,it is recommended to fortify the spleen and percolate dampness by taking distal points of spleen channel and stomach channel and using Shenling Baizhu Powder(参苓白术散).For the high-frequency descending type,the method of nourishing kidney and calming liver is recommended,using distal points of kidney and liver channels and taking Erlong Zuoci Pills(耳聋左慈丸).Regarding the flat descending type,tonifying qi and nourishing blood is advised,for which acupoints of Conception Vessel,spleen,stomach and large intestine channels can be needled,and Yiqi Congming Decoction(益气聪明汤)can be administered.For the total deafness type,it is recommended to activate blood and dissipate stasis,often with Xuehai(SP 10)and Geshu(BL 17)needled and Tongqiao Huoxue Decoction(通窍活血汤)administered.All these are conducted to treat the root and branch simultaneously.At the same time,it emphasizes the need to consider complex syndrome presentations and disease progression,dynamically analyze the disease causes and mechanisms,and adjust treatment according to the changing syndromes.In conclusion,this article is expected to inspire clinical diagnosis and treatment of SHL.
作者
王新茹
李阳
张佳佳
孟言
张重阳
邸学士
冯智伟
梁俊杰
白鹏
WANG Xinru;LI Yang;ZHANG Jiajia;MENG Yan;ZHANG Chongyang;DI Xueshi;FENG Zhiwei;LIANG Junjie;BAI Peng(Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing,100029;Dongzhimen Hospital,Beijing University of Chinese Medicine;Beijing Longfu Hospital)
出处
《中医杂志》
CSCD
北大核心
2024年第11期1126-1131,共6页
Journal of Traditional Chinese Medicine
基金
北京市自然科学基金(7222283)
青年岐黄学者培养项目(国中医药人教函[2022]256号)。
关键词
突发性聋
听力曲线
脾虚湿盛
肝肾阴虚
气血亏虚
血瘀
sudden hearing loss
hearing curve
spleen deficiency and dampness exuberance
liver-kidney yin deficiency
depletion of qi and blood
blood stasis
