基于中医五神理论探讨中风后失语的辨治  

Exploration on Syndrome Differentiation and Treatment for Post-stroke Aphasia Under the Guidance of Five-Spirit Theory of Traditional Chinese Medicine

作　　者：林行健 孔贝贝 陈成[2] 唐健[2] 周文娟[2] 娄必丹[2] 卫然 LIN Xingjian;KONG Beibei;CHEN Cheng;TANG Jian;ZHOU Wenjuan;LOU Bidan;WEI Ran(The First Clinical College of Traditional Chinese Medicine,Hunan University of Chinese Medicine,Changsha 410007 Hunan,China;The First Hospital of Hunan University of Chinese Medicine,Changsha 410007 Hunan,China)

机构地区：[1]湖南中医药大学第一中医临床学院,湖南长沙410007 [2]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《广州中医药大学学报》2025年第3期761-767,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：湖南省卫生健康委科研计划课题(编号:D202319016142);湖南省中医药科研计划项目(编号:D2022008,D2022021,D2022056);湖南中医药大学第一附属医院中医药人才培养重点学科(针灸科)开放基金(编号:ZJ202206);湖南中医药大学科研基金与联合基金计划项目(编号:2021XJJJ048)。

摘　　要：五神理论是中医揭示人类精神、心理活动的重要学说,具有现代认知心理学的雏形。语言是认知活动的重要组成部分。该文基于中医五神理论,结合现代认知心理学研究成果,初步构建中医五神理论指导下的语言加工模型,提出心神、脾意、肾志、肝魂共同参与了语言的形成。并从五神视角探讨中风后失语(PSA)的发病机制,认为PSA为“形神共病”,其发病与五神要素紊乱相关。根据PSA的临床表现,提出心神失养、意志不足可能是PSA患者听理解、阅读障碍的发病机理,而肝魂失用与自发言语、命名障碍紧密相关;治疗以养血安神、增意强志、潜肝定魂为法,方药可选平补镇心丹、智意汤合定志丸、定魂汤等加减,针灸治疗可分别选取心经、心包经、脾经、肾经、肝经等的穴位,从而形成基于五神理论的针药结合辨治PSA体系,弥补了传统脏腑辨证偏重辨“形”而忽视“神”要素的不足,拓展了针对PSA的早期中医药干预及改善康复预后的思路。The theory of five spirits(mind,eternal soul,corporeal soul,consciousness and will)is an important part of traditional Chinese medicine(TCM)theory,which reveals the human mental and psychological activities.Five-spirit theory takes the shape of modern cognitive psychology.Language is an important part of cognitive activities.Under the guidance of the five-spirit theory of TCM,and by combining the research results of modern cognitive psychology,this paper initially constructs a language processing model,and proposes that heart-mind,spleen-consciousness,kidney-will,and liver-soul are all involved in the formation of language.Moreover,the pathogenesis of post-stroke aphasia(PSA)is explored from the perspective of the five spirits.It is proposed that PSA refers to the comorbidity of body and spirit,and its pathogenesis is related to the disorders of the five spirits.After analyzing the clinical manifestations of PSA,it is suggested that malnutrition of heart-mind and insufficient kidney-will contribute to the pathogenesis of auditory comprehension and reading obstacles in patients with PSA,and the deactivation of liver-soul is closely related to spontaneous speech and naming obstacles.The treatment of PSA should be focused on nourishing blood and tranquilizing mind,enhancing consciousness and strengthening will,and suppressing liver to tranquilize soul.And the prescriptions of Pingbu Zhenxin Pills,Zhiyi Decoction plus Dingzhi Pills,and Dinghun Decoction can be chosen for modified use.The acupuncture and moxibustion can also be used for PSA,by performance mainly on the acupoints of heart meridians,pericardial meridians,spleen meridians,kidney meridians and liver meridians.The syndrome differentiation and treatment system for PSA with the combination of Chinese medicine and acupuncture based on the five-spirit theory makes up for the shortcomings of stress on the physique while ignorance of the spirit in the conventional zang-fu organ syndrome differentiation,and expands the methods for early intervention of PSA with T

关 键 词：中风后失语 中医五神理论 现代认知心理学 语言加工模型 平补镇心丹 智意汤 定志丸 定魂汤 针药结合 

分 类 号：R255.2[医药卫生—中医内科学]