益气熄风化痰法抗癫痫的临床与实验研究
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摘要
癫痫（Epilepsy）是神经系统所见的常见病、多发病之一。罹患本
病，因其发复发作性、发作突然性、复杂性等特点，故其病程较长，
治疗不易，给患者的日常工作、学习、生活以及身心健康带来了诸
多压力，给社会带来了沉重的负担。癫痫发病，在年龄分布上，各
种年龄均可发病，但在10岁前的发病率最高，给患儿的身体和智
力正常发育带来了种种影响。临床治疗上，不但要早发现、早治疗，
而且要控制发作期，延长间歇期，最终达到完全治愈。目前对于癫
痫发病机理的认识尚不十分清楚，有绝对疗效的治疗手段尚未发
现，迄今为止仅仅停留在症状治疗的认识上。故要提高治愈率，有
效控制癫痫发作，开发高效低毒、价廉的抗痫药物，需要进行大量
浩繁而有实效的研究工作。
现代医学在近几十年来对癫痫的认识越来越深入，无论是在生
理、病理、免疫还是遗传学等领域都有较大的进展，近几年逐渐深
入到分子、基因水平，相关指标的检测和研究不断深化，但对癫痫
发病机制目前尚未能达到统一的认识。自1969年至今，学者先后
提出了三种有关癫痫发病机制的不同理论和假说，GABA（γ-氨
基丁酸）能系统缺陷假说目前研究最深入、最成熟，其中部分观点
已经为大多数专家和学者所认同。关于神经递质与癫痫发病关系的
报道相当广泛，在癫痫发病中作用机制的相关研究最早也最深入。
GABA和GLU（谷氨酸）是大脑中最主要的两类神经递质，两者
起到相互制约的作用。正常时，两类递质处于动态平衡；病态时，
两类递质的平衡关系——即GABA—GLU系统遭到破坏，引起癫
痫发作的概率成倍增加。目前的研究表明，这些递质在癫痫发作的
发生、扩散及终止中起重要作用。目前常规及大部分新型抗痫药物，
都是根据这一理论开发研制的，临床运用取得了一定的疗效，但并
益气熄风化痰法抗砌痛的临床‘。实验研究
人能完全控制所有痫性发作，且具有较大的毒、副作用，诱变性，
氦畸性等缺点，限制了其广泛规模运用。
祖国医学对于痈证的认识具有丰富的理论基础和临床实践经
验，并形成了完整的理、法、方、药辨证体系。病机上，当因风、
X、痰、瘀、虚等五方面所致；治疗上，则以熄风。清火、化痰。
E瘀等治法为多，运用补益培元之品治疗者较少见。中医药治痫在
临床和实验两方面进行了大量细致的二作。但大部分仅是经验总
圭，少有严谨的科研设计和对照观察，缺乏统－的诊断与疗效判定
打准，对fR临床疗效的真实性难以作出正确评价；实验方面，大
多停留在中药煎剂、丸剂、粗提取物对各种急慢性癫痈模型的药理、
药效机制研究上，在生物化学、分于基因水平的研究尤其鳞毛凤角，
对厂到述癫痫的发病机制、抗痈中药的效价等的认识尚不够深入。
临床研究：我们经过：：十多年的临床探索和实验研究，通过对
500例癫痈患者的临床脉证调研，对 sl个常见症状、54个舌脉象
进厅分析，认为痈证主要病机为：脾虚、风。火、痰、瘀阻滞致营
I。不和，枢机不利，脏气不平，阴阳气不相顺接而发病，脾气虚为
病机之本，风痰挟瘀为病机之标。我们采取发作期与问歇期并治侧
重益气健脾为论治之本，以益气为上，配合熄风、化痰、活血法临
床治疗各种类型癫痈患者取得满意疗效。
实验研究：益气组黄芙主要通过作用于脑内神经突触中
GABA、GABA转氨酶、GABA受体，提高突触内GABA的浓度，
促进GABA介导的神经突触内冲动兴奋性抑制。熄风组胆星、化痰
纠僵蚕卞要通过作用于 GLU、GAD（谷氨酸脱羟酶）和 GI刀受体，
降低突触内GLU浓度，降低GLU介导的突触内坤经兴奋性传导，
减少GLU的神经细胞毒性，降低神经元的损伤。对大鼠脑皮层电
图（ECOG）的研究表明：益气纠以频率下调为强，弱于振幅改善，
熄风、化痰组则以振幅改善为优，劣于频率改善。临床研究支持了
卜述观点的汀确性。
Epilepsy is very popular in nervous system diseases. Epileptic
seizure suddenly and complicatedly make it a long course of disease
and hard to treating, also bring the patients much pressure on their study,
living and working. Epilepsy comes on at different ages, but the highest
occurrence rate happens before the age of 10, and makes many
disadvantages to the normal growing of body and intelligence of the
little patient. So finding it out early and treating early is very important
to the curation of epilepsy. The cause of epilepsy is not very clear till
now, and there is not a treating measure with absolute curative effect.
So it is a very hard working before an exactly treating measure is
found.
The knowledge about epilepsy is more and more deeply in modern
medicine , and has achieved much progress on the aspect of
physiology,pathology,immunology et al, and gone deep into molecule
level or gene level. Though the cause of Epilepsy hasn't been totally
certained, since 1969 the scholars have posed three different hypothesis
about it: 1) hypothesis of destroying nerve colloid; 2) hypothesis of
losting energy-oxygen of GABA; 3) hypothesis in balance of GABA
system. The two later are considered as the deepest and mature ones.
On the other hand, neurotransmitter is also very related with Epilepsy
and is the earliest research. GABA and GLU are the most mainly two
types of neurotransmitter, which are under a dynamic equilibrium in the
normal state, while the equilibrium is destroyed in the morbid state, and
the occurancy rate of Epilepsy will increase as much as times.
Anti-epilepsy medicine are based on this theory, but still cannot totally
control all the kinds of Epileptic seizure, and have many serious
side-effects such as: the inducement of mutagenicity,distortion et al.
Epilepsy is the same name in TCM, and the cause of it in TCM
theory includes three aspects such as: emotion, congenital factor,
traumatas of head, et al. The pathology is the results of wind, heat,
phlegm, hypofunction in body, blood stasis, and the treating method
mainly includes Calming the wind, Dissipating the heat, Eliminating
the phlegm, Activating the blood.
Clinical rearch: 81 symptoms with 54 congenital diagnosis and
feeling of pulse from 500 cases have been analysisted during the past of
more than 20 years. The result we inferred is that Epilepsy is a
symptom complex-deficiency of Qi as BEN (the primary) and wind
involving phlegm with blood stasis as BIAO (the secondary). The
pathology basis is SHAOYANG unregulated and Q1 in both
spleen and stomach unstrengthened, disable action, which is the key of
it. Curations of more than 2000 cases were observed and we found that
epilepticus seizures repeatedly or alternated with intermittence is the
remarkable characteristic of Epilepsy. Treating, both based on
Tonifying QI and coordinated with Calming the wind, Eliminating the
phlegm, Activating the blood, can achieve significantly curative effect.
Animal experiment: The principle of Tonifying QI with Calming
the wind and Eliminating the phlegm treating Epilepsy had been known
in the animal experiment. The result is : Astragali seu Hedysari in group
of Tonifying Qi can act on GABA, GABA-CPT, GABA-receptor in
neuron synaptic in the brain and enhance the density of GABA in the
synaptic ; improving the inhibition of impulse excitability in nerve
synaptic induced by GABA. Arisaema cum Bile in group of Calming
the wind a
病，因其发复发作性、发作突然性、复杂性等特点，故其病程较长，
治疗不易，给患者的日常工作、学习、生活以及身心健康带来了诸
多压力，给社会带来了沉重的负担。癫痫发病，在年龄分布上，各
种年龄均可发病，但在10岁前的发病率最高，给患儿的身体和智
力正常发育带来了种种影响。临床治疗上，不但要早发现、早治疗，
而且要控制发作期，延长间歇期，最终达到完全治愈。目前对于癫
痫发病机理的认识尚不十分清楚，有绝对疗效的治疗手段尚未发
现，迄今为止仅仅停留在症状治疗的认识上。故要提高治愈率，有
效控制癫痫发作，开发高效低毒、价廉的抗痫药物，需要进行大量
浩繁而有实效的研究工作。
现代医学在近几十年来对癫痫的认识越来越深入，无论是在生
理、病理、免疫还是遗传学等领域都有较大的进展，近几年逐渐深
入到分子、基因水平，相关指标的检测和研究不断深化，但对癫痫
发病机制目前尚未能达到统一的认识。自1969年至今，学者先后
提出了三种有关癫痫发病机制的不同理论和假说，GABA（γ-氨
基丁酸）能系统缺陷假说目前研究最深入、最成熟，其中部分观点
已经为大多数专家和学者所认同。关于神经递质与癫痫发病关系的
报道相当广泛，在癫痫发病中作用机制的相关研究最早也最深入。
GABA和GLU（谷氨酸）是大脑中最主要的两类神经递质，两者
起到相互制约的作用。正常时，两类递质处于动态平衡；病态时，
两类递质的平衡关系——即GABA—GLU系统遭到破坏，引起癫
痫发作的概率成倍增加。目前的研究表明，这些递质在癫痫发作的
发生、扩散及终止中起重要作用。目前常规及大部分新型抗痫药物，
都是根据这一理论开发研制的，临床运用取得了一定的疗效，但并
益气熄风化痰法抗砌痛的临床‘。实验研究
人能完全控制所有痫性发作，且具有较大的毒、副作用，诱变性，
氦畸性等缺点，限制了其广泛规模运用。
祖国医学对于痈证的认识具有丰富的理论基础和临床实践经
验，并形成了完整的理、法、方、药辨证体系。病机上，当因风、
X、痰、瘀、虚等五方面所致；治疗上，则以熄风。清火、化痰。
E瘀等治法为多，运用补益培元之品治疗者较少见。中医药治痫在
临床和实验两方面进行了大量细致的二作。但大部分仅是经验总
圭，少有严谨的科研设计和对照观察，缺乏统－的诊断与疗效判定
打准，对fR临床疗效的真实性难以作出正确评价；实验方面，大
多停留在中药煎剂、丸剂、粗提取物对各种急慢性癫痈模型的药理、
药效机制研究上，在生物化学、分于基因水平的研究尤其鳞毛凤角，
对厂到述癫痫的发病机制、抗痈中药的效价等的认识尚不够深入。
临床研究：我们经过：：十多年的临床探索和实验研究，通过对
500例癫痈患者的临床脉证调研，对 sl个常见症状、54个舌脉象
进厅分析，认为痈证主要病机为：脾虚、风。火、痰、瘀阻滞致营
I。不和，枢机不利，脏气不平，阴阳气不相顺接而发病，脾气虚为
病机之本，风痰挟瘀为病机之标。我们采取发作期与问歇期并治侧
重益气健脾为论治之本，以益气为上，配合熄风、化痰、活血法临
床治疗各种类型癫痈患者取得满意疗效。
实验研究：益气组黄芙主要通过作用于脑内神经突触中
GABA、GABA转氨酶、GABA受体，提高突触内GABA的浓度，
促进GABA介导的神经突触内冲动兴奋性抑制。熄风组胆星、化痰
纠僵蚕卞要通过作用于 GLU、GAD（谷氨酸脱羟酶）和 GI刀受体，
降低突触内GLU浓度，降低GLU介导的突触内坤经兴奋性传导，
减少GLU的神经细胞毒性，降低神经元的损伤。对大鼠脑皮层电
图（ECOG）的研究表明：益气纠以频率下调为强，弱于振幅改善，
熄风、化痰组则以振幅改善为优，劣于频率改善。临床研究支持了
卜述观点的汀确性。
Epilepsy is very popular in nervous system diseases. Epileptic
seizure suddenly and complicatedly make it a long course of disease
and hard to treating, also bring the patients much pressure on their study,
living and working. Epilepsy comes on at different ages, but the highest
occurrence rate happens before the age of 10, and makes many
disadvantages to the normal growing of body and intelligence of the
little patient. So finding it out early and treating early is very important
to the curation of epilepsy. The cause of epilepsy is not very clear till
now, and there is not a treating measure with absolute curative effect.
So it is a very hard working before an exactly treating measure is
found.
The knowledge about epilepsy is more and more deeply in modern
medicine , and has achieved much progress on the aspect of
physiology,pathology,immunology et al, and gone deep into molecule
level or gene level. Though the cause of Epilepsy hasn't been totally
certained, since 1969 the scholars have posed three different hypothesis
about it: 1) hypothesis of destroying nerve colloid; 2) hypothesis of
losting energy-oxygen of GABA; 3) hypothesis in balance of GABA
system. The two later are considered as the deepest and mature ones.
On the other hand, neurotransmitter is also very related with Epilepsy
and is the earliest research. GABA and GLU are the most mainly two
types of neurotransmitter, which are under a dynamic equilibrium in the
normal state, while the equilibrium is destroyed in the morbid state, and
the occurancy rate of Epilepsy will increase as much as times.
Anti-epilepsy medicine are based on this theory, but still cannot totally
control all the kinds of Epileptic seizure, and have many serious
side-effects such as: the inducement of mutagenicity,distortion et al.
Epilepsy is the same name in TCM, and the cause of it in TCM
theory includes three aspects such as: emotion, congenital factor,
traumatas of head, et al. The pathology is the results of wind, heat,
phlegm, hypofunction in body, blood stasis, and the treating method
mainly includes Calming the wind, Dissipating the heat, Eliminating
the phlegm, Activating the blood.
Clinical rearch: 81 symptoms with 54 congenital diagnosis and
feeling of pulse from 500 cases have been analysisted during the past of
more than 20 years. The result we inferred is that Epilepsy is a
symptom complex-deficiency of Qi as BEN (the primary) and wind
involving phlegm with blood stasis as BIAO (the secondary). The
pathology basis is SHAOYANG unregulated and Q1 in both
spleen and stomach unstrengthened, disable action, which is the key of
it. Curations of more than 2000 cases were observed and we found that
epilepticus seizures repeatedly or alternated with intermittence is the
remarkable characteristic of Epilepsy. Treating, both based on
Tonifying QI and coordinated with Calming the wind, Eliminating the
phlegm, Activating the blood, can achieve significantly curative effect.
Animal experiment: The principle of Tonifying QI with Calming
the wind and Eliminating the phlegm treating Epilepsy had been known
in the animal experiment. The result is : Astragali seu Hedysari in group
of Tonifying Qi can act on GABA, GABA-CPT, GABA-receptor in
neuron synaptic in the brain and enhance the density of GABA in the
synaptic ; improving the inhibition of impulse excitability in nerve
synaptic induced by GABA. Arisaema cum Bile in group of Calming
the wind a
引文
1．华蓓苓，周长发，朱兴海主编 中医病证专辑·癫狂痫 中医古籍出版社1990．12
2．许沛虎主编 中医脑病学 北京：中国医药科技出版社1998．8：485—499
3．孙怡，杨任民主编 实用中西医结合神经病学 北京：人民卫生出版社1999：447—466
4．张登本主编 中医神经精神病学 北京：中国医药科技出版社2000：306—317
5．黄斌编著 癫痫中西医论治 北京：人民卫生出版社1999：23—88
2．许沛虎主编 中医脑病学 北京：中国医药科技出版社1998．8：485—499
3．孙怡，杨任民主编 实用中西医结合神经病学 北京：人民卫生出版社1999：447—466
4．张登本主编 中医神经精神病学 北京：中国医药科技出版社2000：306—317
5．黄斌编著 癫痫中西医论治 北京：人民卫生出版社1999：23—88