从脑出血的病理变化过程探讨活血化瘀法在出血性中风中的应用  

Application of activating blood and resolving stasis in hemorrhagic stroke from the pathological process of intracerebral hemorrhage

作　　者：彭伟献[1] 陈远园[1] 

机构地区：[1]浙江省杭州市中医院急诊科,310007

出　　处：《中华全科医学》2015年第5期831-833,844,共4页Chinese Journal of General Practice

摘　　要：目的脑出血属中医"出血性中风"范畴,近年来广泛采用活血化瘀法、分期辨证治疗脑出血,但在应用中未全面考虑脑出血各期病理损害特点,亦未根据这些特点采取相应的治则、治法,对出血性中风的分期较为笼统、混乱,未准确把握活血化瘀类方药的用药时机、用量、用法、种类、配伍及适应症、禁忌症等,这限制了活血化瘀法的运用。为此,本文拟深入探讨活血化瘀法在脑出血各病理阶段的具体应用。方法以脑出血的病理变化过程、分期为主线,从分期辨证视角探讨活血化瘀法,通过对各期病理变化和中医病机、证候特点的阐述,结合个人临证经验,参阅国内外最新文献,揭示出活血化瘀法在出血性中风各期的具体运用。结果脑出血可分为超急期、急性期、亚急性期、恢复期、后遗症期等。超急期应以防治血肿扩大为主,治当凉血散瘀止血;急性期要以活血利水为基础,随证施以开窍、平肝、通腑泄热等法;亚急性期需祛邪扶正,益气养血活血;恢复期主要是益气化瘀、滋阴化瘀、通络化瘀及祛痰化瘀等;后遗症期常需通络化瘀、温阳化瘀,并需运用活血化瘀法预防中风复发。结论活血化瘀治疗脑出血必须遵循分期辨证用药原则,根据不同病理阶段的不同证型选方遣药,与其它治法灵活配合运用,不可一味活血化瘀。Objective To explore the specific application of activating blood and resolving stasis in the pathological stage of intracerebral hemorrhage. Methods The pathological process of intracerebral hemorrhage,the stage as the main line,through expounding the change on the pathology and pathogenesis of traditional Chinese medicine,syndrome characteristics,combined with personal clinical experience,to reveal the specific application of promoting blood circulation and removing blood stasis in hemorrhage stroke each period. Results Intracerebral hemorrhage in hyperacute period should be based on prevention of hematoma enlargement,treated with cooling blood and removing blood stasis to stop bleeding; acute period on the basis of activating blood and diuresis,along with inducing resuscitation,calming the liver,purgatingfu-organs to eliminate heat; subacute stage need eliminating pathogen to support vital qi,nourishing qi and activating blood circulation; recovery period was mainly benefiting qi and removing blood stasis,nourishing yin and removing blood stasis,relaxing vein and removing blood stasis,and eliminating phlegm and resolving stasis etc. Sequela periodoften need relaxing vein and resolving stasis,warming yang and resolving stasis,and require the use of promoting blood circulation and removing blood stasis in preventing recurrent stroke. Conclusion We must follow the principle of staging and syndrome differentiation in the treatment of intracerebral hemorrhage with promoting blood circulation to remove blood stasis,choose medicine according to different syndromes in different pathological stages,together with other therapies.

关 键 词：脑出血 出血性中风 分期 辨证治疗 活血化瘀 病理 

分 类 号：R743.3[医药卫生—神经病学与精神病学]