论阿尔茨海默病“病证结合”分期辨治  

Stage-based syndrome differentiation and treatment of Alzheimer’s disease from the perspective of“combining diseases in modern medicine and TCM patterns”

作　　者：李傅尧 时晶[1] 田金洲[1] LI Fuyao;SHI Jing;TIAN Jinzhou(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《现代中医临床》2023年第3期83-87,共5页Modern Chinese Clinical Medicine

基　　金：中国工程院战略研究与咨询项目(No.2022-XY-33,No.2022-XBZD-15-04);北京中医药大学“解码中医”协同攻关项目(No.BZY-JMZY-2022-002)。

摘　　要：阿尔茨海默病(Alzheimer’s disease,AD)是一种神经退行性疾病,主要特点为认知功能损害。中医典籍中虽无此病名,但早已有相关记载,具有丰富的理论源流及临床经验积累。现代相关研究也提出了补肾、化痰、活血等多种不同治法。但是对于AD这一动态进展的疾病,中医治疗策略也应“病证结合”,有针对性的动态分期辨治:从疾病本身特点看,AD本身核心病机为肾虚,早期显著、贯穿全程,中期因痰、瘀、火等实邪进展,晚期恶化于毒盛正衰;从个体化辨证施治角度看,除了运用脏腑辨证对整体分型辨治外,更可结合“五脏藏神”针对认知、精神、行为症状进行深度辨识。基于此,本文从“病证结合”角度提出AD中医诊治的四个层次:(1)补肾为基础,尽早启动、贯穿全程;(2)化痰、祛瘀、泻火、解毒固脱分期论治;(3)脏腑辨证,整体施治;(4)“五脏藏神”理论治脏以调神。Alzheimer’s disease(AD)is a neurodegenerative disease characterized by cognitive impairment.Although the term cannot be found in traditional Chinese medicine(TCM)classics,the disease has long been recorded,providing a solid theoretical foundation and rich clinical experience.In the modern era,various TCM treatment methods have also been put forward for it,including supplementing the kidney,dissolving phlegm,and invigorating blood.However,for AD,a dynamically progressing disease,the principle of“combining diseases in modern medicine and TCM patterns”should be adopted,and stage-based syndrome differentiation and treatment in a targeted manner is key.In terms of disease characteristics,the core and throughout pathogenesis is kidney deficiency,especially in the early stage.With the disease progression,excess pathogens like phlegm,blood stasis,and fire stand out in the middle stage.In the late stage,the exuberance of toxin with decline of healthy qi accelerates the deterioration of the patient’s conditions.As for individualized syndrome differentiation,the theory of“five viscera storing spirit”can be applied for in-depth identification of cognitive,psychological and behavioral symptoms in addition to finding the overall pattern based on zang-fu pattern differentiation.This study puts forward a four-level TCM therapy of AD from the perspective of“combining diseases in modern medicine and TCM patterns”:1)supplementing the kidney as early as possible and throughout the stages;2)adopting the method of resolving phlegm,dispelling stasis,purging fire,removing toxin and preventing collapse at different stages;3)taking a global approach based on syndrome differentiation of zang-fu viscera;4)adopting the theory of“five viscera storing spirit”for cognitive,psychological and behavioral symptoms.

关 键 词：阿尔茨海默病 病证结合 肾虚 病机级联假说 五脏藏神 脏腑辨证 

分 类 号：R259[医药卫生—中西医结合]