“久病入络”与慢性偏头痛辨治  

Differentiation of Chronic Migraine with “Jiu Bing Ru Luo”( 久病入络 )

作　　者：李琰[1] LI Yah(Department of Encephalopathy,Suzhou Hospital of Traditional Chinese Medicine/Department of Encephalopathy,Suzhou Hospital Affiliated to Nanjing University of Chinese Medicine Suzhou 215000,Jiangsu,China)

机构地区：[1]苏州市中医医院脑病科/南京中医药大学苏州附属医院脑病科,江苏苏州215000

出　　处：《实用中医内科杂志》2018年第9期1-4,共4页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：慢性偏头痛有时间性、反复性、难治性、进展性特点,与"久病入络"理论内涵高度一致。"初病在经,久病入络,以经主气,络主血","久病入络"有空间、时间及脏腑、气血多维度特点,体现局部和整体统一,反映疾病病理基础,涉及神经递质传递、受体平衡、细胞因子表达、激素代谢、活性物质转换链等。脑动脉系统四通八达,侧支循环丰富,脑神经网络通路复杂,共同与脑脊液循环通路等组成颅脑神经血液网络体系,与"络脉为里,支而横者为络,络之别出为孙"的经络层次和空间位置不谋而合。"久发、频发之恙必伤血络",慢性偏头痛核心在"邪伏络瘀",辨治应注重祛邪通络,根据络瘀伏邪性质,益气通络、活血通络、化瘀通络、化痰通络、搜风剔络等,各有侧重,辨证可相互交叉及组合;重用涤清伏邪、疏通脑络瘀滞、安神定痛、恢复神机清灵之品;虫类及通络药多有抗凝、镇痛、抗血栓、促纤溶、抗癫痫、抗肿瘤等作用,临证巧用僵蚕、全蝎、蜈蚣、九香虫、蜣螂虫、地龙等可提高疗效,用量宜少,多则耗气动血;疼痛顽固剧烈可伍少量马钱子、土鳖虫等。＂Jiu Bing Ru Luo/久病入络 ＂ of time, repetition, refractory and progressive, which highly consistent with ＂Jiu Bing Ru Luo/久病入络＂, ＂Early disease in the main channels, pathogen usually intruding into collateral in protracted disease＂, ＂Jiu Bing Ru Luo/久病入络＂ has the characteristics of space, time, viscera, Qi and blood, reflecting local and overall unity, reflecting the pathological basis of disease, involving neurotransmitter transmission, receptor balance, cytokine expression, hormone metabolism, active substance transfer chain,etc. The cerebral artery system extends in all directions, has abundant collateral circulation, complex neural network pathways, combined with cerebrospinal fluid circulation and other components of cranial nerve blood network system. ＂Collaterals are inside, the transverse branches of a meridian being collateral, the minor branch of the collateral channels is minute collateral＂, network level and spatial location coincide. ＂Long time and frequent illness will hurt the blood collaterals＂. The core of Chronic migraine is ＂Evil volt and stasis of blood stasis＂, therapeutic method should be focus on dredge the channels and collaterals, according to the nature of collaterals and blood stasis, there are different emphases on tonifying qi and dredging collaterals,activating blood circulation and dredging collaterals, resolving blood stasis and dredging collaterals, resolving phlegm and dredging collaterals, searching wind and eliminating collaterals, etc. Syndrome differentiation can be crossed and combined. Choose the following drugs as far as possible, for example clearing away the Volt evil, dredging the obstruent collateral of brain, tranquilizing and relieve pain, restore the brain function.Insects herbal medicine have anticoagulant, analgesic, antithrombotic, fibrinolytic, antiepileptic and antitumor effects. Flexibly use Jiang Can/僵蚕, Quan Xie/全蝎, Wu Gong/蜈蚣, Xiang Jiu Chong/九香虫, Qiang Nang Chong/蜣螂虫, Di Long/地龙 e

关 键 词：慢性偏头痛 久病入络 邪伏络瘀 益气通络 涤清伏邪 疏通脑络 活血通络 化瘀通络 化痰通络 搜风剔络 安神定痛 虫类药 通络药 

分 类 号：R277.7[医药卫生—中医学]