基于气阳濡动学说的脑小血管病气虚血瘀证的病机与治疗  

Pathogenesis and treatment of cerebral small vessel disease of qi deficiency and blood stasis syndrome based on the theory of qi-yang nurturing and inspiring

作　　者：方锐 周月 李玉丽 谢乐 杜麒麟 谢瑶 葛金文 FANG Rui;ZHOU Yue;LI Yuli;XIE Le;DU Qilin;XIE Yao;GE Jinwen(Institute of Clinical Pharmacology of Chinese Materia Medica,Hunan Academy of Chinese Medicine,Changsha 410006,China;Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine(The Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine),Changsha 410006,China;Institute of Chinese Medicine Literature Information,Hunan Academy of Chinese Medicine,Changsha 410013,China;School of Integrated Chinese and Western Medicine,Hunan University of Chinese Medicine,Changsha 410208,China;Hunan Academy of Chinese Medicine,Changsha 410013,China)

机构地区：[1]湖南省中医药研究院中药临床药理研究所,长沙410006 [2]湖南省中西医结合医院(湖南省中医药研究院附属医院),长沙410006 [3]湖南省中医药研究院中医药文献信息研究所,长沙410013 [4]湖南中医药大学中西医结合学院,长沙410208 [5]湖南省中医药研究院,长沙410013

出　　处：《中华中医药杂志》2024年第2期561-565,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家重点研发计划中医药现代化研究重点专项(No.2018YFC1704904);芙蓉实验室科技攻关项目(No.2023SK2113-1);湖南省重点研发计划(No.2022SK2016);湖南省中医药科研计划项目(No.D2022071)。

摘　　要：脑小血管病(CSVD)即累及颅内小/微动脉、毛细血管、小/微静脉等引起的一系列临床常见的综合征,以卒中(深部小梗死、脑出血)、认知功能下降和情感障碍等为主要临床表现。围绕老年病及脑病的辨证论治方法,葛金文教授创新性提出气阳濡动学说,认为气阳不足,温化濡养或运动总摄失司,脑之元神失去濡养,总司五脏六腑、四肢百骸、气血精津、经脉血脉失常,故导致情感、记忆认知障碍,躯体功能异常等。气阳不足、血脉瘀滞为CSVD发生发展核心病机。文章从CSVD的发病机制出发,基于气阳濡动学说,提出CSVD气虚血瘀证的病机演变进程为气阳不足、阴津亏虚、气郁血瘀、痰湿内生、神明失养等,治疗当以益气(阳)活血为主要治则,灵活配伍益气(阳)养阴、调畅气机、温阳固摄、化痰袪湿、活血祛瘀、养魂安神等之品,为本病的临床辨证施治提供了不同视角的诊疗思路。Cerebral small vascular disease(CSVD)is a series of common clinical syndromes involving intracranial small/micro arteries,capillaries,small/micro veins,etc.,with stroke(deep small infarction,cerebral hemorrhage),cognitive function decline and emotional disorders as the main clinical manifestations.Focusing on the key factors of senile diseases and encephalopathy,professor GE Jinwen put forward the theory of qi-yang nurturing and inspiring.According to the theory,the deficiency of qi-yang leads to the inability of qi-yang to warm or promote,then the loss of the spirit in brain,and the disorder of the mechanism,including five viscera and six organs,four limbs and skeletons,qi-blood essence-fluid,and meridian and blood vessels,which both above eventually results in disorders of emotion,memory and cognition,and abnormalities of physical function.Insufficient qi and yang,blood stasis is the core pathogenesis of CSVD.In this paper,based on the pathogenesis of CSVD and the guidance of the theory of qi-yang nurturing and inspiring theory,the pathogenesis evolution of CSVD qi-deficiency and blood-stasis syndrome is proposed,including qi-yang deficiency,yin and fluid deficiency,qi stagnation and blood stasis,endogenous phlegm and dampness,and lack of nourishment of mind,and so on.In addition,the main treatment methods should be to benefit qi(yang)and promote blood circulation,and flexibly combining with other medicines,such as invigorating qi(yang)and nourishing yin,regulating qi mechanism,supplementing qi,warming yang and solidification,eliminating phlegm and dampness,promoting blood circulation and removing blood stasis,nourishing soul and calming the spirit,etc..The paper intends to provide different perspectives for the diagnosis and treatment of traditional Chinese medicine clinical syndrome differentiation.

关 键 词：脑小血管病 气阳濡动学说 气虚血瘀证 病机 治则治法 

分 类 号：R277.7[医药卫生—中医学]