基于络病学说论治椎动脉型颈椎病  

Discussion on Treatment of Cervical Spondylosis of Vertebral Artery Type Based onCollateral Disease Theory

作　　者：张啸宇 邓蓉蓉[2] 席志鹏[2] 徐文强[2] 李敬池 王轶[1] 谢林[1,2] ZHANG Xiaoyu;DENG Rongrong;XI Zhipeng;XU Wenqiang;LI Jingchi;WANG Yi;XIE Lin(The Third Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing 210028,China;Orthopedics Department of Jiangsu Province Hospital on Integration of Chinese and Western Medicine,Nanjing 210028,China)

机构地区：[1]南京中医药大学第三临床医学院,江苏南京210028 [2]江苏省中西医结合医院骨伤科,江苏南京210028

出　　处：《山东中医杂志》2020年第10期1051-1054,共4页Shandong Journal of Traditional Chinese Medicine

基　　金：江苏省中医药领军人才项目(编号:SLJ0210);江苏省卫生健康委员会项目(编号:H2018025);江苏省卫生和计划生育委员会项目(编号:BJ16026)。

摘　　要：椎动脉型颈椎病(CSA)与络病之间存在内在关联。根据络病学说,CSA具有易滞易瘀、易入难出的病机特点,以痰瘀互结为病理基础,易夹杂气滞、湿困、血虚、风动等兼证。治疗时当遵循“络以通为用”的原则,以痰、瘀为切入点,痰偏盛者治以温化痰浊、通经活络,瘀偏盛者治以活血化瘀、行气通滞。若见多证夹杂则应在通络思想指导下分清主次,针对不同的兼夹因素分别采用相宜的治法疏通络脉,兼顾理气、养血、息风、利湿等法。根据络病病机综合运用辛味、虫类、藤类、补虚四类药物,调节络脉病理状态,缓解CSA所致的眩晕、耳鸣、视物模糊等典型临床症状,同时预防继发性病理改变的出现,达到使络脉“通且久通”的目的。There is an inherent correlation between cervical spondylosis of vertebral artery type(CSA)and collateral disease.The collateral disease theory holds that the pathogenesis of CSA is characterized by susceptibility to stagnation and stasis,quick onset and difficult relief.Based on the pathological basis of mutual accumulation of phlegm and blood stasis,CSA is often mingled with syndromes such as qi stagnation,dampness obstruction,blood deficiency and stirring of wind.The treatment should follow the principle of“keeping the collaterals unobstructed in function”and stress should be put on the phlegm and stasis.Patients with excessive phlegm should be treated with the method of warming and resolving turbid phlegm,dredging channels and activating collaterals,while those with excessive blood stasis should be treated with the method of activating blood and resolving stasis,moving qi and removing stagnation.If multiple syndromes are present in an intermingled manner,the primary and secondary should be distinguished as guided by the idea of dredging collaterals,and appropriate treatment methods for dredging collaterals should be adopted according to different accompa nied factors. Besides,the methods of regulating qi,nourishing blood,dispelling wind and eliminating dampness also can be considered. In order to relieve the typical clinical symptoms of dizziness,tinnitus and blurred vision caused by CSA,as well as to prevent secondary pathological changes,four types of medicinals,including medicinals with pungent flavor,insect medicinals,rattan medicinals and tonifying medicinals should be used comprehensively according to the pathogenesis of collateral disease,so that the collaterals can be dredged and kept unobstructed for a long time.

关 键 词：椎动脉型颈椎病 络病学说 络脉 病机 治则治法 痰瘀互结 络以通为用 

分 类 号：R274.9[医药卫生—中西医结合]