运用麝香从“痰、火、瘀、虚”论治最小意识状态  

Treatment of Minimally Conscious State with Musk Based on "Phlegm,Fire,Blood Stasis,and Deficiency"

作　　者：宋研博 孙永康 李明远 王新志[1,3,5] SONG Yanbo;SUN Yongkang;LI Mingyuan;WANG Xinzhi(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou,450099;The First Clinical Medical College of Henan University of Chinese Medicine;Henan Provincial Collaborative Innovation Center of Prevention and Treatment of Major Diseases by Chinese and Western Medicine;The Second People's Hospital of Jiaozuo;Institute for Brain Disorders of Henan Academy of Chinese Medical Sciences)

机构地区：[1]河南中医药大学第一附属医院脑病中心,河南省郑州市450099 [2]河南中医药大学第一临床医学院 [3]中西医防治重大疾病河南省协同创新中心 [4]焦作市第二人民医院 [5]河南省中医药科学院脑病研究所

出　　处：《中医杂志》2025年第2期188-192,共5页Journal of Traditional Chinese Medicine

基　　金：中医药传承与创新“百千万”人才工程(岐黄工程)(国中医药人教发[2018]284号);河南省“双一流”创建学科中医学科学研究专项(HSRP-DFCTCM-2023-5-07);河南中医药大学2023年度研究生科研创新类项目(2023KYCX035)。

摘　　要：认为最小意识状态为处于窍闭神匿到窍开神现的边缘状态,但仍属“中风闭证”范畴,病机总属邪气痹阻、窍闭神匿,病理因素为痰、火、瘀三端,风动和水饮可伴随其中,后期多因气血阴阳的耗伤而致虚闭。治疗上以麝香为君,注意配伍及用药缓急;以开窍为法,同时注重祛邪与扶正。痰、火重者以小承气汤开其下窍、以泄热通腑,以麝香配牛黄开其上窍,以醒神导气。痰浊较甚者以白芷暂代麝香,以涤痰汤豁痰开窍,待痰浊渐消再加用麝香。瘀血为主者以通窍活血汤活血通窍,以求血行风自灭,血利则无水患,瘀血除则窍开神现。窍闭体虚者应开窍扶正、标本兼顾,气虚者以补阳还五汤益气扶正,阴虚者以芍药甘草汤合封髓丹养阴柔筋、封固肾中精气,阳虚者以地黄饮子滋阴补阳开窍。Minimally conscious state(MCS)is at the edge between closed and open consciousness,but it still belongs to the category of"wind-strike block"syndrome.The basic pathogenesis of MCS is the obstruction of pathogenic qi,orifices closed and spirit hidden,with pathological factors including phlegm,fire,and blood stasis.Wind movement and water retention may also be present,and often leading to deficiency syndrome due to the exhaustion of qi,blood,yin,and yang at later stages.Treatment chooses Shexiang(Moschus)as the chief medicinal,emphasizing combination of medicinals and urgency of medication administration;the key therapeutic method is to open the orifices,with focuses on expelling pathogens and reinforcing healthy qi.For patients with severe phlegm or fire,use Xiaochengqi Decoction(小承气汤)to open the lower orifices,discharge heat and unblock the bowels,combined with Shexiang(Moschus)and Niuhuang(Bovis Calculus)to open the upper orifices,awaken the spirit and guide qi.For patients with turbid phlegm as the predominant,temporarily replace Shexiang(Moschus)with Baizhi(Angelicae dahuricae radix),using Ditan Decoction(涤痰汤)to eliminate phlegm to open the orifices,when turbid phlegm gradually subsided,Shexiang(Moschus)could be added.For patients with blood stasis as the predominant,Tongqiao Huoxue Decoction(通窍活血汤)will be used to activate blood and open orifice,if the blood circulates,the endogenous wind will be calmed,the water will be induced,the orifices will open and the consciousness will restore.For patients with closed orifices and body deficiency,the treatment should open the orifices and reinforce healthy qi,and consider the root and branch simultaneously;qi deficiency syndrome can be addressed with Buyang Huanwu Decoction(补阳还五汤)to boost qi and reinforce healthy qi;yin deficiency syndrome can be treated with Shaoyao Gancao Decoction(芍药甘草汤)combined with Fengsui Pill(封髓丹)to nourish yin,soften sinews,and secure kidney essence;yang deficiency can be managed by using Dihua

关 键 词：最小意识状态 麝香 意识障碍 醒脑开窍 痰 火 瘀 虚 

分 类 号：R28[医药卫生—中药学]