《黄帝内经》清阳理论与鼻渊病机相关性的探讨
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摘要
五官七窍位于头面,通过经络与脏腑相连,表里相应。官窍的生理功能,有赖于清阳之气的上注,温煦濡养。清阳之气包括了起温煦作用的卫气和有濡润之功的津液。卫气生发于肾,取资于脾,源出于肺,其输布,有赖于肺的宣降,肝的升发,脾的升降功能。津液来源于脾胃,为水谷化生,其输布有赖于肺的宣发、脾的升降、肾的气化功能。清阳之气输布的通路是少阳三焦,三焦之膜,为肝所主,属于肝系。清阳之气的正常输布,需要2个条件:脏腑功能正常;三焦之道通畅。鼻居面中,属阳中之阳位,为血脉多聚之处,清阳之气流行交会之所,喜清润而恶燥浊,故鼻为清气道,有清虚之性。鼻渊的病位在窦窍,症状特点为"浊涕下不止",病机为脾胃失调、肺失宣降或肝胆郁滞,致清阳不升,窦窍失养,浊阴之邪乘虚而入,充塞窦窍而成,治疗当以调理脏腑功能,疏通三焦之道,升清降浊为法。
The five sense organs and the seven orifices are located on the head and face and they are connected through the channel and zang-fu viscera with action from superficies and interior. The physiological functions of the orifices depend on begging qi of qingyang for warm and nourishing. The qi of qingyang includes the defensive qi that plays the warming role and the body fluid that has the power of moisten. Defensive qi is ascending from the kidney, financed by the spleen and sourced from the lungs, and its transmission depends on the decline of the lung, the rise of the liver and the ascending and descending function of the spleen. The body fluid generated by water and cereals, which is sourced from the spleen and stomach. The transmission of the body fluid depends on the dissemination of the lung, the ascending and descending of the spleen, and the qi transformation function of the kidney. The path of qi of qingyang transmission is the shaoyang sanjiao, the membrane of sanjiao, which is governed by liver and belongs to the liver system. The normal transmission of qi of qingyang needs two conditions: The function of the zang-fu viscera is normal; The path of Sanjiao is smooth. Nose, that is in center of the face, it belongs to the yang position in the yang, which is the place where the blood vessels are gathered and the place where the qi of qingyang flows and joints, prefers fresh and wet but dislike dry and turbidity, so the nose is the path to clear qi and has the nature of clear-cut. The disease location of acute and chronic sinusitis is in the sinus fistula with symptom feature is ‘turbid snivel cannot stop flowing'. Its pathogenesis is qingyang not rising, sinus ridge dystrophy and turbid yin take advantage of the weak point to fill with sinus fistula caused by spleen-stomach disharmony, lung loses diffusion purification and descending or liver and gallbladder stagnation. The treatment should be to regulate the function of zang-fu viscera, dredge the path of Sanjiao, ascend clear and descend turbidity.
The five sense organs and the seven orifices are located on the head and face and they are connected through the channel and zang-fu viscera with action from superficies and interior. The physiological functions of the orifices depend on begging qi of qingyang for warm and nourishing. The qi of qingyang includes the defensive qi that plays the warming role and the body fluid that has the power of moisten. Defensive qi is ascending from the kidney, financed by the spleen and sourced from the lungs, and its transmission depends on the decline of the lung, the rise of the liver and the ascending and descending function of the spleen. The body fluid generated by water and cereals, which is sourced from the spleen and stomach. The transmission of the body fluid depends on the dissemination of the lung, the ascending and descending of the spleen, and the qi transformation function of the kidney. The path of qi of qingyang transmission is the shaoyang sanjiao, the membrane of sanjiao, which is governed by liver and belongs to the liver system. The normal transmission of qi of qingyang needs two conditions: The function of the zang-fu viscera is normal; The path of Sanjiao is smooth. Nose, that is in center of the face, it belongs to the yang position in the yang, which is the place where the blood vessels are gathered and the place where the qi of qingyang flows and joints, prefers fresh and wet but dislike dry and turbidity, so the nose is the path to clear qi and has the nature of clear-cut. The disease location of acute and chronic sinusitis is in the sinus fistula with symptom feature is ‘turbid snivel cannot stop flowing'. Its pathogenesis is qingyang not rising, sinus ridge dystrophy and turbid yin take advantage of the weak point to fill with sinus fistula caused by spleen-stomach disharmony, lung loses diffusion purification and descending or liver and gallbladder stagnation. The treatment should be to regulate the function of zang-fu viscera, dredge the path of Sanjiao, ascend clear and descend turbidity.
引文
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[17]庄瑞斐,周峰峰,顾庆华.鼻渊的病机探讨.四川中医,2016,34(8):19-21
[2]陈潮祖.中医治法与方剂.北京:人民卫生出版社,2014:11-12
[3]陈晟,郭盛楠,赵吉平.中医肝脏与过敏性鼻炎的相关性探析.中医杂志,2013,56(16):1354-1357
[4]熊继柏.熊继柏讲《内经》.长沙:湖南科学技术出版社,2016:45
[5]李凡成,徐绍勤.中西医结合耳鼻咽喉科学.北京:人民卫生出版社,2001:3
[6]忻耀杰,滕磊,高旭青.《内经》“胆移热于脑,则辛頞鼻渊”的再认识.四川中医,2014,32(1):29-30
[7]金·李东垣.脾胃论.北京:人民卫生出版社:2015:3,62-63
[8]清·张志聪.黄帝内经素问集注.北京:中国医药科技出版社,2014:5
[9]肖伊,刘真,李洵.疏肝清肝法治疗变应性鼻炎.世界中医药,2016,11(6):1052-1055
[10]王永钦.中医耳鼻咽喉口腔科学.北京:人民卫生出版社,2006:43
[11]谈钰濛,刘绍武.从升清降浊论治鼻渊.中国中西医结合耳鼻咽喉科杂志,2015,23(2):142-143
[12]平江涛,谢强.升降法在鼻窦炎治疗中的应用.中国中医药现代远程教育,2013,11(17):120
[13]何兴伟,谢强.通督升阳法论治鼻渊病理论探讨.中国中医基础医学杂志,2010,16(1):29-30
[14]明·周之干.慎斋遗书.北京:中国中医药出版社,2016:71
[15]明·张景岳.景岳全书.山西:山西科学技术出版社,2016:321
[16]清·陈士铎.辨证录.北京:中国医药科技出版社,2011:55
[17]庄瑞斐,周峰峰,顾庆华.鼻渊的病机探讨.四川中医,2016,34(8):19-21