从《伤寒论》阳明病探讨针刺治疗卒中后抑郁的可行性  

Feasibility of acupuncture treatment for post-stroke depression based on Yangming disease in Treatise on Febrile Diseases

作　　者：张雪[1] 布赫 闫海鹏[1] 吕红艳 王紫玄 刘丽霞[1] 樊宇婷 ZHANG Xue;BU He;YAN Haipeng;LV Hongyan;WANG Zixuan;LIU Lixia;FAN Yuting(The Second Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology,Inner Mongolia,Baotou 014030,China)

机构地区：[1]内蒙古科技大学包头医学院第二附属医院,内蒙古包头014030

出　　处：《中国医药科学》2022年第19期118-121,共4页China Medicine And Pharmacy

基　　金：内蒙古自治区自然科学基金项目(2020MS08009);内蒙古自治区包头医学院科学研究基金项目(扬帆计划)(BYJJ-YF 201901);内蒙古自治区包头市青年创新人才项目;吴阶平医学基金会临床科研专项资助基金(320.6750.19089-92)。

摘　　要：卒中后抑郁作为继发于脑卒中后的一类精神疾病,具有脑卒中后偏瘫及抑郁的主要表现。而卒中后偏瘫患者因活动不利,常导致功能性便秘。因此,卒中后抑郁患者常表现为偏瘫、便秘和抑郁。《伤寒论》阳明病篇论述,“大便难者,此名阳明也。”“阳明证,其人喜忘者,必有蓄血。”指出阳明病之阳明腑实、阳明蓄血的便秘、神志表现。脑卒中患者多数都伴有肢体一侧偏瘫。从经络角度看,手足阳明经循行于上肢及下肢外侧面的前缘,《素问·痿论》中提出了“治痿独取阳明”,针刺阳明经穴位可以改善卒中后抑郁患者的偏瘫症状。《伤寒论》阳明病篇所述的症状(阳明腑实症、阳明蓄血症)主要以大便难及神志方面症状为主要表现,正洽和卒中后抑郁常见偏瘫之外的表现为便秘和抑郁。而脑卒中后患者偏瘫症状又可以采用针刺阳明经穴位为主治疗。因此,基于《伤寒论》阳明病篇思想指导,采用针刺手足阳明经穴位治疗卒中后抑郁具有广泛的理论基础。Post-stroke depression,as a mental disease secondary to stroke,has the main manifestations of hemiplegia and depression after stroke.Patients with post-stroke hemiplegia often suffer from functional constipation due to poor mobility.Therefore,patients with post-stroke depression often present with hemiplegia,constipation and depression.It is stated in the Chapter of Yangming Disease in Treatise on Febrile Diseases that"Yangming disease refers to difficulty in defecating"."If a forgetful person has Yangming disease,there must be congestion in his body".It points out the constipation and mental manifestation of abdominal distension and blood stasis of Yangming disease.Most stroke patients are accompanied by hemiplegia on one side of the limbs.From the perspective of meridians,the Yangming meridians of hands and feet run along the leading edge of the outer side of the upper and lower limbs.In Plain Conversation-Flaccidity Theory,it is proposed that"treatment for flaccidity aims at Yangming meridian".Acupuncture at the Yangming meridian can improve the hemiplegic symptoms of patients with post-stroke depression.The symptoms described in the Chapter of Yangming Disease of Treatise on Febrile Diseases(abdominal distension syndrome and blood stasis syndrome in Yangming disease)are mainly showed in the symptoms of constipation and mental manifestation.It just coincides with the common manifestations of post-stroke depression other than hemiplegia which are constipation and depression.The symptoms of hemiplegia after stroke can be mainly treated by acupuncture at Yangming meridian acupoints.Therefore,based on the ideological guidance of the Chapter of Yangming Disease in Treatise on Febrile Diseases,acupuncture at the Yangming meridian acupoints of the upper and lower limbs was adopted to treat post-stroke depression,which has a broad theoretical basis.

关 键 词：伤寒论 阳明病 卒中后抑郁 偏瘫 便秘 

分 类 号：R246.6[医药卫生—针灸推拿学]