肾与血管性认知障碍辨治  

Treatment of vascular cognitive impairment based on kidney

作　　者：支洪伟 王康锋[1] 徐向青[1] ZHI Hong-wei;WANG Kang-feng;XU Xiang-qing(Department of Cerebrovascular Disease,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan250000)

机构地区：[1]山东中医药大学附属医院,山东济南250000

出　　处：《内蒙古中医药》2021年第9期91-93,共3页Inner Mongolia Journal of Traditional Chinese Medicine

基　　金：针刺督脉穴对AD模型大鼠神经细胞自噬改变的影响及机制研究.国家自然科学基金青年基金(81303028);基于Beclin1和mTOR信号通路交互调控研究针刺督脉穴对AD大鼠神经细胞自噬及凋亡的干预机制(ZR2015HL114)山东省自然科学基金2/7 2019.5;第十四批全国中医临床优秀人才研修项目(国中医药人教发[2017]24号)。

摘　　要：血管性认知障碍与肾密切相关,肾虚精亏、髓海不足、脑失所养是发病基础。现代医学研究脑神经细胞元和神经营养因子是中医学"脑髓"的现代生物学基础,脑神经营养因子减少、神经元大量萎缩和丢失造成"髓海不足",导致认知功能减退;性激素水平是反映肾虚衰老的一个重要指标,其受体在中枢神经分布程度与老年人学习记忆有关;老年人脑血管疾病后性激素水平降低是丘脑-垂体功能损伤引起性激素分泌异常,中枢神经系统损害、智力减退。血管性认知障碍乃虚实夹杂病证,以虚为本,以实为标,虚实并见;肾虚为本,痰瘀为标,由虚致瘀,血瘀是肾虚必然结果,又加重肾虚,宜补肾兼活血化瘀。初期以肾气亏虚为主,脑髓和神明失养;中期肾虚、痰瘀等实邪乘虚侵犯脑窍,神明逆乱,痰重于瘀;末期则肾精虚至极,阴阳失调加重,发展为阴阳离决,精气乃绝。肾虚贯穿整个发病过程,肾虚髓衰是基本病机;治疗须辨析肾虚、痰、瘀关系,在整体补肾的同时有侧重,标本兼治。附补肾活血、标本兼治,补肾填精方加通窍活血汤治疗验案一则。Vascular cognitive impairment is closely related to the kidney,insufficient kidney essence loss,SuiHai deficiency and brain displaced raising is the basis. In the research of modern medical,nerve cells and neurotrophic factors is the modern biology foundation of SuiHai in the traditional Chinese medicine. Cranial nerve neurotrophic factor reductionand neuronal atrophy or lost a lot caused SuiHai deficiency and lead to cognitive decline. Sex hormone levels is an important indicator to the kidney aging and its receptors in the central nervous degree distribution is associated with learning and memory in the elderly.The elderly sex hormone levels reducement after cere-brovascular is caused by sex hormone secretionabnormal after hypothalamus-pituitary function injury,which leads to central nervous system damage and mental decline. Vascular cognitive impairmen tintermingles Xu and Shi,which based on Xu and performed on Shi.The deficiency of the kidney is the root cause,the phlegm and blood stasis is the performance,the deficiency of the kidney lead to blood stasis. The blood stasis is the inevitable result of kidney deficiency and aggravates kidney deficiency. So we must Bushen and Huoxue-huayu. The mechanism of early vascular cognitive impairment is mainly because of kidney deficiency and brains and Shenming dystrophy.The middle stage,the kidney essence is also loss,phlegm and blood stasis invades brain orifices and Shenming is disordered. At this time,phlegm is more important than stasis.The final stage,the kidney essence is very empty,YinYang is imbalance. The final develop-ment is dissociation of yin and Yang and the lost of essence. Kidney empty throughout the process of disease.Kidney empty and marrow failure is the basic pathogenesis,we should Distinguish the relationship among kidney deficiency,phlegm,blood stasis. We should tonifykidney and put priority on other ways with a proven cases in addition.

关 键 词：血管性认知障碍 肾虚髓衰 虚实夹杂 痰瘀 脑神经细胞元 神经营养因子 性激素水平 丘脑-垂体 滋补肾精 活血化痰 标本兼治 中医药治疗 

分 类 号：R249[医药卫生—中医临床基础]