温胆汤及其类方在中风中的应用
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摘要
从痰论治的中风证型有风痰阻络证、痰湿蒙窍证、痰热(痰火)闭窍证、痰瘀互结证、痰热腑实证、气郁痰阻证、风痰瘀阻证,分别应用导痰汤、涤痰汤、黄连温胆汤、四物温胆汤、硝黄温胆汤、十味温胆汤、桑钩温胆汤治疗。风痰盛者,加半夏、白术化痰熄风;湿痰盛者,加泽泻、桂枝利湿化饮;痰热盛者,加黄连、胆南星、川贝母清热化痰;痰瘀互结者,加桃仁、红花逐瘀行血;痰热腑实者,加生大黄、玄明粉清热通腑导滞。但是目前对于温胆汤及相关类方究竟如何干预血管病的进程,如何有效逆转或延缓血管病相关痴呆的发展等相关方面还缺少深入的研究,因此从具有中医特征性的病理因素"痰"入手,进行温胆汤相关的研究是有必要的。
The syndrome types of stroke treated from phlegm include wind syndrome of phlegm blocking collaterals,syndrome of phlegm dampness blocking orifices,syndrome of phlegm-heat( phlegm-fire) blocking orifices,intermingled phlegm and blood stasis syndrome,phlegm-heat and fu excess syndrome,qi depression and phlegm blocking syndrome,wind phlegm and blood stasis blocking syndrome. They are treated with Phlegm-Expelling Decoction,Phlegm-Flushing Decoction,Coptis and Gallbladder-Warming Decoction,Four Substances and Gallbladder-Warming Decoction,Xiaohuang Gallbladder-Warming Decoction,Ten Substances and Gallbladder-Warming Decoction,Sangteng and Gallbladder-Warming Decoction respectively. For excessive wind and phlegm,Banxia( Rhizoma Pinelliae) and Baizhu( Rhizoma Atractylodis Macrocephalae) can be combined to resolve phlegm and extinguish wind. For excessive phlegm and dampness,Zexie( Rhizoma Alismatis) and Guizhi( Ramulus Cinnamomi) can be combined to remove dampness and transform retention. For excessive phlegm and heat,Huanglian( Rhizoma Coptidis),Dannanxing( Rhizoma Arisaematis cum Bile) and Chuanbeimu( Bulbus Fritillariae Cirrhosae) can be combined to clear heat and resolve phlegm. For intermingled phlegm and blood stasis syndrome,Taoren( Semen Persicae) and Honghua( Flos Carthami) can be combined to activate blood circulation. For phlegm-heat and fu excess syndrome,raw Dahuang( Radix et Rhizoma Rhei) and Xuanmingfen( Natrii Sulfas Exsiccatus) can be combined to clear away heat and dredge viscera and guide stagnation. However,there is still lack of in-depth research on how Gallbladder-Warming Decoction and its associated formulas intervene in the process of vascular disease and how to effectively reverse or delay the development of vascular disease-related dementia. Therefore,it is necessary to study Gallbladder-Warming Decoction from the perspective of phlegm,a pathological factor with TCM characteristics.
The syndrome types of stroke treated from phlegm include wind syndrome of phlegm blocking collaterals,syndrome of phlegm dampness blocking orifices,syndrome of phlegm-heat( phlegm-fire) blocking orifices,intermingled phlegm and blood stasis syndrome,phlegm-heat and fu excess syndrome,qi depression and phlegm blocking syndrome,wind phlegm and blood stasis blocking syndrome. They are treated with Phlegm-Expelling Decoction,Phlegm-Flushing Decoction,Coptis and Gallbladder-Warming Decoction,Four Substances and Gallbladder-Warming Decoction,Xiaohuang Gallbladder-Warming Decoction,Ten Substances and Gallbladder-Warming Decoction,Sangteng and Gallbladder-Warming Decoction respectively. For excessive wind and phlegm,Banxia( Rhizoma Pinelliae) and Baizhu( Rhizoma Atractylodis Macrocephalae) can be combined to resolve phlegm and extinguish wind. For excessive phlegm and dampness,Zexie( Rhizoma Alismatis) and Guizhi( Ramulus Cinnamomi) can be combined to remove dampness and transform retention. For excessive phlegm and heat,Huanglian( Rhizoma Coptidis),Dannanxing( Rhizoma Arisaematis cum Bile) and Chuanbeimu( Bulbus Fritillariae Cirrhosae) can be combined to clear heat and resolve phlegm. For intermingled phlegm and blood stasis syndrome,Taoren( Semen Persicae) and Honghua( Flos Carthami) can be combined to activate blood circulation. For phlegm-heat and fu excess syndrome,raw Dahuang( Radix et Rhizoma Rhei) and Xuanmingfen( Natrii Sulfas Exsiccatus) can be combined to clear away heat and dredge viscera and guide stagnation. However,there is still lack of in-depth research on how Gallbladder-Warming Decoction and its associated formulas intervene in the process of vascular disease and how to effectively reverse or delay the development of vascular disease-related dementia. Therefore,it is necessary to study Gallbladder-Warming Decoction from the perspective of phlegm,a pathological factor with TCM characteristics.
引文
[1]柴永宏,高敏,焦玉壮,等.脑血管病的遗传流行病学研究[J].中国临床神经科学,2018,26(5):514-522.
[2]方永奇,黄可儿,李小兵.痰证的血液循环特征初探[J].湖北中医杂志,1992,14(6):33-34.
[3]李以义,李普海,史玲,等.中医痰证现代研究指标的探讨[J].中国中医基础医学杂志,1997,3(6):51-52.
[4]赖少兰,袁茂华,张彩艳.脑卒中中医体质与脑血流动力学的相关性研究[J].中医药导报,2013,19(3):13-15.
[5]魏登科.高脂血症的中医药治疗思路[J].中国实用乡村医生杂志,1997,13(6):22-23.
[6]朱涛,郭仲之.从脾主运化认识高脂血症与痰浊的关系[J].中华综合医学,2002,2(3):159.
[7]杨惠民,韩丽蓓,盛彤.调脂通脉颗粒对老年高脂血症脂质及血流变和纤溶系统的的影响[J].北京中医药大学学报,2005,28(1):66-68.
[8]盛梅笑,郭惠芳.糖尿病与痰湿关系的临床观察[J].南京中医药大学学报,1996,12(1):12-13,63.
[9]方永奇,简柳军,刘立秋.心血管病痰证患者血液流变学及植物神经功能的变化[J].中国中西医结合杂志,1989,9(9):536.
[10]李伟.痰浊、瘀血与衰老相关性的理论探讨及临床研究[D].南京:南京中医药大学,2009.
[11]李小兵,林昌松.心脑血管病痰证患者T淋巴细胞亚群变化的初步观察[J].湖北中医杂志,2000,22(1):13-14.
[12]黄丽红.温胆汤临床应用研究进展[J].内蒙古中医药,2016,35(3):124-125.
[13]李冀.方剂学[M].北京:中国中医药出版社,2006:261.
[14]王本祥.现代中药药理学[M].天津:天津科学技术出版社,1997:636-637.
[15]李明爱.自拟熄风化痰汤治疗缺血性中风恢复期(风痰瘀阻型)的临床研究[D].吉林:长春中医药大学,2010.
[16]周盈,黄迟,赵杨.中风急救合剂治疗缺血性中风急性期的理论探析[J].中国中医急症,2019,18(1):106-108.
[17]李佳楠.温胆汤降脂作用研究[D].成都:四川大学,2003.
[18]范培蕊.黄连温胆汤加减治疗眩晕临床疗效观察[J].光明中医,2017,32(4):527-529.
[19]李雨庭,范琳琳,袁茵,等.黄连温胆汤药理作用及临床应用研究进展[J].中医药学报,2018,46(2):115-119.
[20]吴俊颖,张璐,谢铱子,等.基于网络药理学研究温胆汤治疗冠心病的作用机制[J].中国药房,2018,29(23):3227-3232.
[21]张彦海,迟丽屹.温胆汤化裁治疗中风析因[J].陕西中医,2004,25(2):166-168.
[22]龙娜.黄连温胆汤加味配合西药治疗痰热腑实证缺血性中风80例[J].陕西中医,2014,35(10):1276-1278.
[23]郭秀文.温胆汤联合半夏白术天麻汤治疗高血压的临床效果[J].世界最新医学信息文摘,2019,19(5):191.
[24]周亚丽,曲琳,周亚平,等.加味黄连温胆汤对糖尿病周围神经病变患者神经功能的保护作用观察[J].湖南中医药大学学报,2018,38(1):96-99.
[25]吕双宏.温胆汤临床应用研究进展[J].中医药导报,2018,24(20):123-125,133.
[26]赵欣.加味温胆汤治疗痰瘀阻络型中风恢复期的临床效果[J].临床医学研究与实践,2018,3(35):130-131.
[27]张令霖,连新福,李先涛.缺血性中风痰瘀互结证生物学机制研究进展[J].中华中医药学刊,2018,36(10):2474-2477.
[28]张雨芳.中西医结合治疗急性缺血性脑卒中风痰阻络型疗效观察[J].实用中医药杂志,2018,34(11):1341-1342.
[29]魏华,黄金秀,蔡海荣,等.急性脑出血患者中医证型与炎症因子的相关性研究[J].中医药信息,2018,35(4):91-94.
[30]陈慧.缺血性中风急性期中医各证型与经颅多普勒超声检查脑动脉血流速度变化的相关性临床研究[D].南宁:广西中医药大学,2018.
[31]苗治国,黄煌.黄煌辨治脑系病常用经方方证分析[J].上海中医药杂志,2018,52(11):30-31,38.
[32]柳迎春.桑钩温胆汤加味治疗缺血性中风(风痰瘀阻型)疗效观察[J].实用中医内科杂志,2010,24(8):53-55.
[33]史宇广,单书健.当代名医临证精华[M].北京:中医古籍出版社,2010:230-236.
[34]许启蒙.熊继柏运用温胆汤治疗心脑病证经验[J].中医杂志,2003,44(3):177-178.
[35]刘石坚.何炎老中医治疗眩晕经验介绍[J].新中医,1997,29(9):10-11.
[36]冀秀萍,汶鉴,马骋宇,等.温胆汤加减治疗椎-基底动脉供血不足性眩晕疗效观察[J].辽宁中医药大学学报,2015,17(3):7-9.
[37]贺海霞,易健,李丹丹,等.血管性痴呆患者中医证型与炎症因子相关性分析[J].湖南中医药大学学报,2018,38(12):1403-1406.
[38]刘要武.补肾化痰法治疗脑血管病引起痴呆疗效观察[J].光明中医,2014,29(2):283-284.
[39]张瑞杰.加味涤痰汤治疗痰浊阻窍型血管性痴呆疗效观察[J].现代中西医结合杂志,2016,25(21):2375-2377.
[40]杨华,潘智琴,张江涛,等.温胆汤联合茴拉西坦胶囊治疗痰浊阻窍型血管性痴呆30例观察[J].浙江中医杂志,2012,47(5):326.
[2]方永奇,黄可儿,李小兵.痰证的血液循环特征初探[J].湖北中医杂志,1992,14(6):33-34.
[3]李以义,李普海,史玲,等.中医痰证现代研究指标的探讨[J].中国中医基础医学杂志,1997,3(6):51-52.
[4]赖少兰,袁茂华,张彩艳.脑卒中中医体质与脑血流动力学的相关性研究[J].中医药导报,2013,19(3):13-15.
[5]魏登科.高脂血症的中医药治疗思路[J].中国实用乡村医生杂志,1997,13(6):22-23.
[6]朱涛,郭仲之.从脾主运化认识高脂血症与痰浊的关系[J].中华综合医学,2002,2(3):159.
[7]杨惠民,韩丽蓓,盛彤.调脂通脉颗粒对老年高脂血症脂质及血流变和纤溶系统的的影响[J].北京中医药大学学报,2005,28(1):66-68.
[8]盛梅笑,郭惠芳.糖尿病与痰湿关系的临床观察[J].南京中医药大学学报,1996,12(1):12-13,63.
[9]方永奇,简柳军,刘立秋.心血管病痰证患者血液流变学及植物神经功能的变化[J].中国中西医结合杂志,1989,9(9):536.
[10]李伟.痰浊、瘀血与衰老相关性的理论探讨及临床研究[D].南京:南京中医药大学,2009.
[11]李小兵,林昌松.心脑血管病痰证患者T淋巴细胞亚群变化的初步观察[J].湖北中医杂志,2000,22(1):13-14.
[12]黄丽红.温胆汤临床应用研究进展[J].内蒙古中医药,2016,35(3):124-125.
[13]李冀.方剂学[M].北京:中国中医药出版社,2006:261.
[14]王本祥.现代中药药理学[M].天津:天津科学技术出版社,1997:636-637.
[15]李明爱.自拟熄风化痰汤治疗缺血性中风恢复期(风痰瘀阻型)的临床研究[D].吉林:长春中医药大学,2010.
[16]周盈,黄迟,赵杨.中风急救合剂治疗缺血性中风急性期的理论探析[J].中国中医急症,2019,18(1):106-108.
[17]李佳楠.温胆汤降脂作用研究[D].成都:四川大学,2003.
[18]范培蕊.黄连温胆汤加减治疗眩晕临床疗效观察[J].光明中医,2017,32(4):527-529.
[19]李雨庭,范琳琳,袁茵,等.黄连温胆汤药理作用及临床应用研究进展[J].中医药学报,2018,46(2):115-119.
[20]吴俊颖,张璐,谢铱子,等.基于网络药理学研究温胆汤治疗冠心病的作用机制[J].中国药房,2018,29(23):3227-3232.
[21]张彦海,迟丽屹.温胆汤化裁治疗中风析因[J].陕西中医,2004,25(2):166-168.
[22]龙娜.黄连温胆汤加味配合西药治疗痰热腑实证缺血性中风80例[J].陕西中医,2014,35(10):1276-1278.
[23]郭秀文.温胆汤联合半夏白术天麻汤治疗高血压的临床效果[J].世界最新医学信息文摘,2019,19(5):191.
[24]周亚丽,曲琳,周亚平,等.加味黄连温胆汤对糖尿病周围神经病变患者神经功能的保护作用观察[J].湖南中医药大学学报,2018,38(1):96-99.
[25]吕双宏.温胆汤临床应用研究进展[J].中医药导报,2018,24(20):123-125,133.
[26]赵欣.加味温胆汤治疗痰瘀阻络型中风恢复期的临床效果[J].临床医学研究与实践,2018,3(35):130-131.
[27]张令霖,连新福,李先涛.缺血性中风痰瘀互结证生物学机制研究进展[J].中华中医药学刊,2018,36(10):2474-2477.
[28]张雨芳.中西医结合治疗急性缺血性脑卒中风痰阻络型疗效观察[J].实用中医药杂志,2018,34(11):1341-1342.
[29]魏华,黄金秀,蔡海荣,等.急性脑出血患者中医证型与炎症因子的相关性研究[J].中医药信息,2018,35(4):91-94.
[30]陈慧.缺血性中风急性期中医各证型与经颅多普勒超声检查脑动脉血流速度变化的相关性临床研究[D].南宁:广西中医药大学,2018.
[31]苗治国,黄煌.黄煌辨治脑系病常用经方方证分析[J].上海中医药杂志,2018,52(11):30-31,38.
[32]柳迎春.桑钩温胆汤加味治疗缺血性中风(风痰瘀阻型)疗效观察[J].实用中医内科杂志,2010,24(8):53-55.
[33]史宇广,单书健.当代名医临证精华[M].北京:中医古籍出版社,2010:230-236.
[34]许启蒙.熊继柏运用温胆汤治疗心脑病证经验[J].中医杂志,2003,44(3):177-178.
[35]刘石坚.何炎老中医治疗眩晕经验介绍[J].新中医,1997,29(9):10-11.
[36]冀秀萍,汶鉴,马骋宇,等.温胆汤加减治疗椎-基底动脉供血不足性眩晕疗效观察[J].辽宁中医药大学学报,2015,17(3):7-9.
[37]贺海霞,易健,李丹丹,等.血管性痴呆患者中医证型与炎症因子相关性分析[J].湖南中医药大学学报,2018,38(12):1403-1406.
[38]刘要武.补肾化痰法治疗脑血管病引起痴呆疗效观察[J].光明中医,2014,29(2):283-284.
[39]张瑞杰.加味涤痰汤治疗痰浊阻窍型血管性痴呆疗效观察[J].现代中西医结合杂志,2016,25(21):2375-2377.
[40]杨华,潘智琴,张江涛,等.温胆汤联合茴拉西坦胶囊治疗痰浊阻窍型血管性痴呆30例观察[J].浙江中医杂志,2012,47(5):326.