益气活血化浊解毒法治疗假性延髓麻痹吞咽障碍验案举隅  

A case study on treating dysphagia of pseudobulbar paralysis by the Yiqi Huoxue Huazhuo Jiedu method

作　　者：晋琼 贾永森(指导) 赵见文[2] JIN Qiong;JIA Yongsen;ZHAO Jianwen

机构地区：[1]华北理工大学,河北唐山063000 [2]河北省沧州中西医结合医院,河北沧州061000

出　　处：《中医临床研究》2022年第33期73-75,共3页Clinical Journal Of Chinese Medicine

摘　　要：假性延髓麻痹为脑卒中常见并发症之一,多因脑血管病、颅脑外伤、脑部占位性病变、多发性硬化症等引起桥脑或桥脑以上部位病变,使双侧大脑皮质上运动神经元或皮质延髓束受损害所致,以吞咽障碍、饮水呛咳、构音障碍、声音嘶哑,甚至情感障碍等为其主要临床表现。其中吞咽障碍为假性延髓麻痹最常见亦最棘手的临床症状,其发生率极高,严重影响患者的预后及结局,但目前临床上对吞咽障碍的筛查工作相对不足,治疗方式也相对局限。随着中医学的发展,中医在治疗假性延髓麻痹吞咽障碍疾病中逐渐彰显其优势,极大地丰富了医疗治疗手段。假性延髓麻痹吞咽障碍归属于中医“喑痱”“舌謇”“喉痹”“噎嗝”等范畴。通过临床观察发现假性延髓麻痹吞咽障碍的主要病机为“气虚血瘀、浊毒内蕴”,认为“益气活血化浊解毒法”为其根本治疗大法。在临床工作中根据“益气活血化浊解毒法”辨证组方遣药,联合吞咽康复训练可有效改善假性延髓麻痹吞咽障碍患者的吞咽功能。在此以一例典型病案为例,进行诊疗过程的梳理和分析,期望为中医学治疗假性延髓麻痹吞咽障碍的临床推广工作提供临床依据,进一步拓展中医学浊毒致病理论在脑系疾病中的应用。Dysphagia in pseudobulbar paralysis is one of the common complications of stroke.Most of the dysphagia in pseudobulbar paralysis are caused by bridge brain or bridge above the brain lesions due to cerebrovascular disease,brain trauma,brain occupying lesions and multiple sclerosis.These lesions cause damage to bilateral cerebral cortex motor neurons or cortex and medulla oblongata beam,resulting in the dysphagia in pseudobulbar paralysis,with swallowing disorder,water choking cough,dysarthria,voice hoarse,and even emotional disorders as its main clinical manifestations.Dysphagia is the most common and difficult clinical symptom of pseudobulbar palsy.Its incidence is extremely high,which seriously affects the prognosis and outcome of the patient’s disease.With the development of traditional Chinese medicine,TCM method has gradually demonstrated its advantages in the treatment of pseudobulbar palsy dysphagia,which has greatly enriched the medical treatment methods.Dysphagia in pseudobulbar paralysis belongs to“aphasia and paralysis”,“tongue moving difficulty”,“inflammation of the throat”and“belch choking”category in TCM.Through clinical observation,it is found that the main pathogenesis of dysphagia in pseudobulbar palsy is Qi(气)deficiency and blood stasis,turbidity and toxin accumulation,and it is considered that the Yiqi Huoxue Huazhuo Jiedu method(益气活血化浊解毒法)is the fundamental treatment method.In clinical work,under the guidance of Huoxue Huazhuo Jiedu method,prescription plus swallowing rehabilitation training can effectively improve the swallowing function of patients with pseudobulbar paralysis dysphagia.In this paper,a typical medical case is taken as an example to sort out and analyze the diagnosis and treatment process,hoping to provide clinical basis for the clinical promotion of TCM in the treatment of pseudobulbar paralysis dysphagia,and further expand the application of TCM turbidity toxin pathogenic theory in treating brain diseases.

关 键 词：益气活血化浊解毒法 浊毒 假性延髓麻痹 吞咽障碍 验案分析 

分 类 号：R743[医药卫生—神经病学与精神病学]