基于络脉理论辨治脑小血管病——中医脑病理论与临床实证研究(二)
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摘要
脑小血管病隐匿起病、缓慢发展、部分可急性发作。根据脑小血管的临床特点,中医病机以脑络荣气虚滞为主。其病机特征是,病位隐曲,责之络脉;内邪杂合,病性复杂;症状广泛,复合证候;病程慢性进展,或有突变加重。系统防治脑小血管病需要全程动态管理,病证系统治疗,最优化治疗,辨病辨证结合,多系统多病同治,复方简药图治,杂合适宜以治。在辛味通络、芳香透络、虫蚁搜络、藤类行络等络病的常用治法基础上,选择使用多汁药物养阴、破血化瘀通络、开窍药物疏通玄府。从络脉荣气虚滞视角探讨脑小血管病,着眼恢复脑窍玄府气化,可以为中医防治脑小血管病的临床决策提供参考。
Cerebral small vessel disease has insidious onset and progresses slowly, and some have an acute exacerbation.According to the clinical features of cerebral small vessel disease, the traditional Chinese medicine(TCM) pathogenesis is mainly attributed to nutrient Qi deficiency and stagnation in brain collaterals. The characteristics of the pathogenesis are as follows: the indistinguishable disease location, and the responsible collaterals; the heterozygous internal evils, and the complex disease; the extensive symptoms, and the compound syndromes; and the chronic progression of disease, or with an acute exacerbation. Based on the whole process of dynamic management, systematic treatment of disease and syndrome, and optimization of treatment, the following items should be considered: disease differentiation and syndrome differentiation, multi-system and multi-disease treatment,simple medicine treatment with compounds, and suitable heterozygous treatment. On the basis of the common treatments for collateral diseases such as dredging collaterals by pungent drugs, penetrating collaterals by aromatic drugs, searching collaterals by insects, and walking collaterals by vines, we use succulent drugs to nourish Yin, blood-breaking and stasis-resolving drugs to dredge collaterals, and orifice-opening drugs to dredge Xuanfu. From the perspective of nutrient Qi deficiency and stagnation in collaterals, the study of cerebral small vessel disease, the restoration of cerebral orifice, and the Qi transformation of Xuanfu can provide a reference for the clinical decision-making in the TCM prevention and treatment of cerebral small vessel disease.
Cerebral small vessel disease has insidious onset and progresses slowly, and some have an acute exacerbation.According to the clinical features of cerebral small vessel disease, the traditional Chinese medicine(TCM) pathogenesis is mainly attributed to nutrient Qi deficiency and stagnation in brain collaterals. The characteristics of the pathogenesis are as follows: the indistinguishable disease location, and the responsible collaterals; the heterozygous internal evils, and the complex disease; the extensive symptoms, and the compound syndromes; and the chronic progression of disease, or with an acute exacerbation. Based on the whole process of dynamic management, systematic treatment of disease and syndrome, and optimization of treatment, the following items should be considered: disease differentiation and syndrome differentiation, multi-system and multi-disease treatment,simple medicine treatment with compounds, and suitable heterozygous treatment. On the basis of the common treatments for collateral diseases such as dredging collaterals by pungent drugs, penetrating collaterals by aromatic drugs, searching collaterals by insects, and walking collaterals by vines, we use succulent drugs to nourish Yin, blood-breaking and stasis-resolving drugs to dredge collaterals, and orifice-opening drugs to dredge Xuanfu. From the perspective of nutrient Qi deficiency and stagnation in collaterals, the study of cerebral small vessel disease, the restoration of cerebral orifice, and the Qi transformation of Xuanfu can provide a reference for the clinical decision-making in the TCM prevention and treatment of cerebral small vessel disease.
引文
[1]王媛,孟然,宋海庆,等.脑小血管病的研究进展[J].中华老年心脑血管病杂志,2018,20(3):326-330.
[2]周德生,陈湘鹏,胡华,等.脑梗死荣气虚滞病机特征之探讨[J].中西医结合心脑血管病杂志,2014,12(12):1560-1561,1576.
[3]GORELICK P B,SCUTEFI A,BLACK S E,et a1.Vascular contributions to cognitive impairment and dementia:a statement for healthcare professionals from the American Hcart Association/American Stroke Association[J].Stroke,2011,42(9)∶2672-2713.
[4]丁元庆.从“百病生于气”探讨络病病机与治法[J].疑难病杂志,2006,5(6):434-435.
[5]周德生,张雪花,谭静.荣气虚滞论[J].中医药通报,2005,4(2):22-25.
[6]于向东,崔军.络病的治法和用药特点[J].中国临床康复,2003,7(9):1456-1457.
[7]黄淼鑫,李雅婧,李鑫辉,等.叶天士《临证指南医案》诊治中风特色浅析[J].中国中医急症,2016,25(4):663-664,687.
[8]周俊,周德生.现代输液与六经辨证[J].甘肃中医,2009,22(8):3-4.
[9]江黎明,吴平,覃燕梅.125I-标记栓块溶解测定方法的建立与32种活血化瘀中草药溶栓活性的测定[J].广东医学院学报,2004,22(3):201-204.
[10]陈晓伟.活血化瘀中药在抗凝治疗中的作用[D].广州:广州中医药大学,2010.
[11]崔国祯,李惠民,李纳,等.从活血化瘀中药中虚拟筛选P2Y12受体拮抗剂及其抗血小板聚集作用的评价[J].世界中西医结合杂志,2018,13(8):1082-1085.
[12]杨薇,黎明全,李杨,等.缺血性中风病急性期中西药群组模块探索[J].中国中药杂志,2018,43(3):618-626.
[13]王开成,张莹,才迎春,等.开窍法治疗中风病研究进展[J].中国中医药现代远程教育,2018,15(19):157-160.
[14]何一川,高博文,于耀宇.脑小血管病诊断及治疗现状[J].中国临床神经外科杂志,2018,23(4):292-294.
[15]王丽娟,张玉虎.中国血管性帕金森综合征诊断与治疗专家共识[J].全科医学临床与教育,2017,15(4):364-367.
[16]倪俊,徐运.脑小血管病转化医学研究中国专家共识[J].中国卒中杂志,2018,13(8):853-870.
[17]脑小血管病诊治专家共识组.脑小血管病诊治专家共识[J].中国临床医生,2014,42(1):84-87,90.
[18]邱幸凡,陈刚.络脉的气血流注特点[J].天津中医药,2003,1(4):53.
[19]黄润超,李建婷,杨楠.化瘀通络汤治疗脑小血管病致认知功能障碍的近远期疗效观察[J].现代中西医结合杂志,2017,26(3):259-276.
[2]周德生,陈湘鹏,胡华,等.脑梗死荣气虚滞病机特征之探讨[J].中西医结合心脑血管病杂志,2014,12(12):1560-1561,1576.
[3]GORELICK P B,SCUTEFI A,BLACK S E,et a1.Vascular contributions to cognitive impairment and dementia:a statement for healthcare professionals from the American Hcart Association/American Stroke Association[J].Stroke,2011,42(9)∶2672-2713.
[4]丁元庆.从“百病生于气”探讨络病病机与治法[J].疑难病杂志,2006,5(6):434-435.
[5]周德生,张雪花,谭静.荣气虚滞论[J].中医药通报,2005,4(2):22-25.
[6]于向东,崔军.络病的治法和用药特点[J].中国临床康复,2003,7(9):1456-1457.
[7]黄淼鑫,李雅婧,李鑫辉,等.叶天士《临证指南医案》诊治中风特色浅析[J].中国中医急症,2016,25(4):663-664,687.
[8]周俊,周德生.现代输液与六经辨证[J].甘肃中医,2009,22(8):3-4.
[9]江黎明,吴平,覃燕梅.125I-标记栓块溶解测定方法的建立与32种活血化瘀中草药溶栓活性的测定[J].广东医学院学报,2004,22(3):201-204.
[10]陈晓伟.活血化瘀中药在抗凝治疗中的作用[D].广州:广州中医药大学,2010.
[11]崔国祯,李惠民,李纳,等.从活血化瘀中药中虚拟筛选P2Y12受体拮抗剂及其抗血小板聚集作用的评价[J].世界中西医结合杂志,2018,13(8):1082-1085.
[12]杨薇,黎明全,李杨,等.缺血性中风病急性期中西药群组模块探索[J].中国中药杂志,2018,43(3):618-626.
[13]王开成,张莹,才迎春,等.开窍法治疗中风病研究进展[J].中国中医药现代远程教育,2018,15(19):157-160.
[14]何一川,高博文,于耀宇.脑小血管病诊断及治疗现状[J].中国临床神经外科杂志,2018,23(4):292-294.
[15]王丽娟,张玉虎.中国血管性帕金森综合征诊断与治疗专家共识[J].全科医学临床与教育,2017,15(4):364-367.
[16]倪俊,徐运.脑小血管病转化医学研究中国专家共识[J].中国卒中杂志,2018,13(8):853-870.
[17]脑小血管病诊治专家共识组.脑小血管病诊治专家共识[J].中国临床医生,2014,42(1):84-87,90.
[18]邱幸凡,陈刚.络脉的气血流注特点[J].天津中医药,2003,1(4):53.
[19]黄润超,李建婷,杨楠.化瘀通络汤治疗脑小血管病致认知功能障碍的近远期疗效观察[J].现代中西医结合杂志,2017,26(3):259-276.