从“络损髓伤”探讨脑小血管病的病机  

Discussion on the Pathogenesis of Cerebral Small Vessel Disease from"Luo Injury and Marrow Damage"

作　　者：于苗 丁薇 王悦 张丽娜[1] 张根明[1] YU Miao;DING Wei;WANG Yue;ZHANG Lina;ZHANG Genming(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;College of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 102488,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学中医学院,北京102488

出　　处：《中医药导报》2023年第9期134-136,164,共4页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：北京中医药大学东直门医院横向专项课题资助项目(HX-DZM-2018004)。

摘　　要：基于脑小血管病的临床特点及现代医学研究认识,从中医病机角度,提出“络损髓伤”为脑小血管病的发病关键。其中,年老正虚为本病的促发因素,瘀、痰、浊毒有形实邪滞络所致的脑络病变为发病基础;脑髓失养、髓海失充的脑髓损伤为病变后果;发病过程中“络”“髓”相互影响、渐进损伤,最终形成“络髓同病”的病理结局。据此提出脑小血管病的总治法为通络养髓,但不同病变阶段的侧重点略有不同,“络损”以益气活血通络为主,“髓伤”以补肾养髓扶正为主,从而实现“络髓同治”。Based on the clinical characteristics and the modern medicine's research of cerebral small vessel disease,from the perspective of pathogenesis of traditional Chinese medicine,it is proposed that"luo injury and marrow damage"is the key to the pathogenesis of cerebral small vessel disease.Specifically,aging and deficiency is the precipitating factor of this disease,and the substantial pathogenic factors of stasis,phlegm and turbid poison retardant luo causing cerebral lesion is the basis of the disease.The insufficiency and depletion of brain marrow causing the damage of brain marrow is the lesion consequence.In the course of the disease,"luo"and"marrow"interact mutually,damaging gradually,finally forming the pathological outcome of"luo and marrow being the same disease".Accordingly,it is suggested that the total treatment of cerebral small vessel disease is to dredging luo and nourishing marrow,but the emphasis is slightly different in different pathological stages,"Luo injury"mainly focuses on supplementing Qi and activating blood to replenish luo,"marrow damage"mainly focuses on supplementing kidney and nourishing marrow,so as to achieve"the simultaneous treatment of luo and marrow".

关 键 词：脑小血管病 中医病机 络病 脑络 脑髓 络损髓伤 

分 类 号：R256.23[医药卫生—中医内科学]