从气血水理论探讨中风病分期诊疗新思路  

Discussion on the new idea of staging diagnosis and treatment of stroke from the theory of Qi-blood-water

作　　者：李昌明 陈健 黄佳钦 李晓琳[1] 董兴鲁[1] 李雁[2] 陶晓华 高颖[4] 常静玲[1] LI Changming;CHEN Jian;HUANG Jiaqin;LI Xiaolin;DONG Xinglu;LI Yan;TAO Xiaohua;GAO Ying;CHANG Jingling(Department of Encephalopathy,Dongzhimen hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院脑病科,100700 [2]北京中医药大学东直门医院教育处,100700 [3]北京中医药大学中医学院 [4]北京中医药大学中医脑病研究院

出　　处：《环球中医药》2021年第9期1598-1604,共7页Global Traditional Chinese Medicine

基　　金：国家重点研发计划(2019YFC1709200、2019YFC1709203);北京中医药大学名医培育计划(BUCM-2019-QNMYA0);中央高校基本科研业务费专项(2019-JYB-TD-003)。

摘　　要：气血水理论被广泛运用于多种临床疾病的治疗中,中风病的病机演变过程中各个时期的风、火、痰、瘀、虚各证候要素动态变化的根本在于气、血、水三者的动态变化。本文基于气血水理论,结合古代医家论述、现代研究及古今临床应用,为中风病的诊疗提供新的思路。中风病急性期的特点为肝风,肝阳上亢,肝气有余,瘀阻脑络,血水互化,水淫玄府;恢复期为气阴两虚,余邪未清,又易痰瘀互结,郁久成毒;后遗症期为气血虚弱,虚气留滞,血行不畅。前期痰浊、水湿较盛,而随着治疗的深入,痰浊、水湿的影响逐渐减少,虚证的影响逐渐增加。在治疗中,始终应注重保持血行通畅,对体内蓄积的浊毒、瘀毒、热毒及时清理,并且在前期注重对水湿的治疗,随着疾病的发展也应逐步注重固护正气。The theory of“Qi-blood-water”is widely used in the treatment of a variety of clinical diseases.The dynamic changes of wind,fire,phlegm,blood stasis and deficiency in each period during the evolution of pathogenesis of stroke,which are fundamentally due to the dynamic changes of“Qi-blood-water”.Based on the theory of“Qi-blood-water”with the ancient physicians'discussion,modern research and clinical application,this paper provides a new idea for the diagnosis and treatment of stroke.The acute stage of stroke is characterized by hyperactivity of liver-wind and liver-Yang,caused by excess liver Qi,mutual transformation of blood and water and excess of water over Xuanfu,caused by stagnation of brain collaterals.In the physical recovery period,Qi and Yin were deficient,together with residual pathogens,which were prone to mutual accumulation of phlegm and blood stasis,transforming stasis into toxin after a long period of stagnation.In the sequela period,patients suffer from Qi and blood deficiency,deficiency Qi stagnation,as well as dysfunction of blood circulation.In the early stage,phlegm and water dampness were relatively strong,with the deepening of treatment,the effects of phlegm and water dampness were gradually decreased,and the effect of deficiency was gradually increased.During the process of treatment,we should pay attention to maintain blood flow smoothly,as well as clean the accumulation of turbid toxin,blood stasis toxin,heat toxin timely.The treatment of water dampness needs attention during the early stage.We should also focus on solid protection of vital Qi gradually with the development of the stroke.

关 键 词：中风病 气血水理论 病机 证候 动态演变 脑卒中 

分 类 号：R259[医药卫生—中西医结合]