张琳婧 闫占峰 矫璐璐

[摘要] 血府逐瘀汤出自《医林改错》，具有活血化瘀、行气止痛之效，为临床常用的行气活血方剂，凡因瘀血阻滞导致的身体某一部位的病变，均可用此方加减应用。近年来，临床上常见耳鼻咽喉疾病辨证多属瘀血阻窍证，瘀血上阻清窍，清阳被遏，诸窍失养，出现耳鼻咽喉部位的不适症状。血府逐瘀汤在耳鼻咽喉疾病治疗中应用较多，本文基于“异病同治”原则，介绍该方治疗耳鸣、慢性肥厚性鼻炎、声带息肉三则验案，以期为临床拓展思路。

[关键词] 血府逐瘀汤;活血化瘀;耳鸣;慢性肥厚性鼻炎;声带息肉

[中图分类号] 276          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0120-04

[Abstract] Xuefu Zhuyu Decoction is from Yilin Gaicuo， which has the effect of promoting blood circulation for removing blood stasis， activating qi and eliminating pain. It is a commonly used prescription for activating qi and blood. It is used for body′s lesion as a result of blood stasis block. In recent years， the common syndrome differentiation of otorhinolaryngology diseases is the orifices obstructed by blood stasis. If blood stasis obstructs the orifices， qing yang will be not rising， the orifices will be not nourished. So our body will appear some bad symptoms of otolaryngology. Xuefu Zhuyu Decoction is widely used in the treatment of otorhinolaryngology diseases. Based on the principle of co-treatment of different diseases， this article introduces its three cases of treating tinnitus， chronic hypertrophic rhinitis and vocal cord polyp. So we hope to expand the thinking for clinic.

[Key words] Xuefu Zhuyu Decoction; Promoting blood circulation for removing blood stasis; Tinnitus; Chronic hypertrophic rhinitis; Vocal cords polyp

耳鼻咽喉疾病属五官孔窍病，“孔小洞深”为其特点，诸窍以通为用，位居头面部，称之为清窍[1]。清窍得清阳濡养而诸窍通利，清阳有赖于脏腑化生气血的功能，气血生化有源，清阳得生[2]。近些年在临床上多见瘀血阻窍之证，瘀血为各种病因下形成的病理产物，或因寒凝、热灼，或因气虚、气滞，或因外伤、久病等形成，瘀血阻窍，清阳被遏，耳鼻咽喉诸窍失养，则出现各类症状，如耳鸣、鼻塞、咽异物感、声嘶等。血府逐瘀汤为临床上常用的行气活血方，该方由清代王清任在其著作《医林改错》中首次提出，原为胸中血府血瘀所设，但在其著作中也列举了适用范围的各种疾病，如头痛、胸疼、胸不任物、自汗盗汗、多梦、呃逆等[3]。据临床观察及查阅文献[4-6]，该方广泛应用于临床各科，收效较好。清代唐宗海在其著作《血证论》中亦提出瘀血阻滞是血证的主要病机之一，认为血府逐瘀汤治疗范围不仅局限于上焦血府血瘀，临床上众多疾病只要病机辨证为血瘀证，均可应用该方治疗[7]，这体现了中医“异病同治”的思想。……