从毒损络脉论治运动神经元病  

Discussion on treatment of motor neuron disease by toxins damaging collaterals

作　　者：陈琛 邹忆怀[1] 宁艳哲 喻鑫 陆梦馨 徐玲玲 陈天竹 吴康 CHEN Chen;ZOU Yihuai;NING Yanzhe;YU Xin;LU Mengxin;XU Lingling;CHEN Tianzhu;WU Kang(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing Anding Hospital,Capital Medical University,Beijing 100088,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]首都医科大学附属北京安定医院

出　　处：《北京中医药大学学报》2023年第8期1150-1155,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(No.81873257);北京中医药科技发展基金项目(No.QN2018-27)~~。

摘　　要：运动神经元病可归属于中医学“痿痉并病”范畴,属临床难治性疾病,对于该病的辨证治疗诸多学者各有创见,但并无明确的共识。毒损络脉从王永炎院士提出的“毒损脑络”学说发展而来,诸邪蕴积成毒,毒邪损络,扩散蔓延,直接损伤脏腑形质,形质败坏而使病情迅速恶化。结合中医学理论及现代研究,本文认为毒损络脉的病理改变与运动神经元病病变的隐匿性、广泛性、难治性等特点相吻合,提出毒损络脉可能是运动神经元病发生发展的核心病机,即外感、内伤之毒邪胶结壅塞于髓络,毒损髓络,气血失调,代谢失衡,继而脑髓与脊髓损伤则发为运动神经元病。进而由毒损络脉延伸出气虚、内风相关病机,气虚与毒损络脉互为影响导致患者病情日趋加重,运动神经元病筋脉之风象可能由毒损络脉引动,由此提出解毒通络以祛邪、补气育阴以固本的治疗原则,强调益气解毒、育阴熄风,兼以通络的治法,以期拓宽中医药治疗运动神经元病的思路,进一步提高临床疗效。Motor neuron disease(MND),a clinical refractory disease,can be classified as“a disease of flaccidity and spasticity”in traditional Chinese medicine(TCM).Many doctors have their own ideas regarding the treatment of syndrome differentiation,but there is no clear consensus.The concept of toxins damaging collaterals was developed from the theory of“toxins damaging brain collaterals”put forward by academicia Wang Yongyan,which marks the pathological process of toxicity accumulation and toxicity to collaterals,causing the spread of toxicity,directly damaging the shape and quality of the zang-fu organs and resulting in rapid deterioration of the disease.Combined with the theory of TCM and modern research,the pathological changes of toxins damaging collaterals are consistent with the characteristics of occult,extensive,and intractable lesions of MND.It is suggested that toxins damaging collaterals may be the core pathogenesis of the occurrence and development of MND,namely,the accumulation of toxins from external contraction and internal damage in the medullary collaterals leads to damage to the medullary collaterals,imbalance of qi and blood,metabolic imbalance,and subsequent brain and spinal cord injuries,leading to MND.Moreover,qi deficiency and internal wind-related pathogenesis are extended from toxins damaging collaterals.Qi deficiency and toxins damaging collaterals influence each other,leading to the worsening of disease.Wind images of MND muscles may be induced by toxins damaging collaterals.Therefore,the treatment principle of detoxifying and regulating collaterals to remove evil,replenishing qi,and nourishing yin to solidify the root is put forward,emphasizing supplementing qi and detoxifying,nourishing yin and dispelling wind,and regulating collaterals,in order to expand the options for MND treatment and further improve the clinical effect.

关 键 词：运动神经元病 毒损络脉 气虚 内风 益气解毒 育阴熄风 通络 

分 类 号：R259[医药卫生—中西医结合]