金杰教授基于清阳理论治疗特发性低颅压综合征经验浅析  

A brief analysis of Professor Jin Jie’s experience in the treatment of spontaneous intracranial hypotension based on qingyang theory

作　　者：池明轩 赵敏[2] 金杰[2] 袁家乐 CHI Mingxuan;ZHAO Min;JIN Jie;YUAN Jiale(Department of Encephalopathy,the First Affiliated Hospital of Henan University of Chinese Medicine,Henan Province,Zhengzhou450099,China;National Regional Brain Disease Center,the First Affiliated Hospital of Henan University of Chinese Medicine,Henan Province,Zhengzhou450099,China;Collaborative Innovation Center of Prevention and Treatment of Major Diseases by Chinese and Westem Medicine,Henan University of Chinese Medicine,Henan Province,Zhengzhou450099,China)

机构地区：[1]河南中医药大学第一附属医院脑病科,河南郑州450099 [2]河南中医药大学第一附属医院国家区域脑病中心,河南郑州450099 [3]河南中医药大学中西医防治重大疾病协同创新中心,河南郑州450099

出　　处：《中国医药导报》2024年第27期137-140,145,共5页China Medical Herald

基　　金：国家重点研发计划“中医药现代化研究”重点专项(2022YFC3501103);河南省中医学“双一流”创建科学研究专项(HSRP-DFCTCM-2023-5-16)。

摘　　要：本文基于清阳理论结合金杰教授丰富的临床经验提出“湿蕴脾肾、清阳不升”的病机理论治疗特发性低颅压综合征,其中湿盛阳微为发病基础,清阳不升为关键,湿瘀阻络为发展;现代中医通过临床实践及现代医学研究认为,该病发病机制与脑脊液容量、颅内总体积减小密切相关。临证诊疗当抓其核心基础病机,提出“温肾醒脾、祛湿化瘀”为治疗法则,自拟温水燥土方。方中重用黄芪益气升阳为君药;人参、白术、茯苓、甘草、陈皮健脾益气化湿为臣药;佐半夏和胃降逆,与甘温补益人参、黄芪配伍,使清升浊降、脾胃安和,以桑寄生、杜仲为佐助药益肾填精及温补肾阳;配僵蚕、炙甘草为使药化瘀通络,调和诸药。临证权衡病情轻重缓急,灵活用药,以达清阳得升,气血得行,脉道通利,湿瘀得消。对金教授临证治疗特发性低颅压综合征的经验进行总结,以期为临床诊疗提供更多思路。This article is based on the theory of qingyang combined with Professor Jin Jie’s rich clinical experience to propose a pathogenesis theory of“dampness stagnating in spleen and kidney,qingyang not rising”in the treatment of spontaneous intracranial hypotension.Among them,dampness excess yang is the basis of the disease,qingyang not rising is the key,and dampness stasis obstructing collaterals is the development.Modern traditional Chinese medicine believes through clinical practice and modern medical research that the pathogenesis of this disease is closely related to the reduction of cerebrospinal fluid volume and total intracranial volume.Clinical diagnosis and treatment should focus on the core underlying pathogenesis,proposing the treatment principle of“warming the kidneys and awakening the spleen,dispelling dampness and removing blood stasis”,and self formulating warm water and dry soil.In the formula,Astragali Radix is highly valued as sovereign drug for nourishing qi and promoting yang;Ginseng Radix Et Rhizoma,Atractylodis Macrocephalae Rhizoma,Poria,Glycyrrhizae Radix Et Rhizoma,Citri Reticulatae Pericarpium are minister drug for strengthening the spleen,promoting qi and dampness;paired with Pinelliae Rhizoma harmonizing stomach for descending adverse qi,combined with sweet and warm Ginseng Radix Et Rhizoma and Astragali Radix,it can promote clear and turbid qi,calm the spleen and stomach;Taxilli Herba and Eucommiae Cortex are assistant drug that benefit the kidneys,replenish essence,and warm and nourish kidney yang;envoy drug of Bombyx Batryticatus and Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle are used to remove blood stasis and unblock collaterals,and to harmonize various drugs.In clinical practice,the severity and urgency of a patient’s condition should be weighed carefully.Medications should be administered flexibly to promote the ascending of vital energy,ensure proper circulation of qi and blood,unclog the meridians,and eliminate dampness and stasis.Summarize Professor Jin’s cl

关 键 词：清阳不升 特发性低颅压综合征 湿蕴脾肾 湿瘀阻络 温肾醒脾 

分 类 号：R277.7[医药卫生—中医学]