基于“上实下虚”理论探讨脑卒中的病机及治疗思路  

To Explore the Pathogenesis and Treatment of Stroke based on the Theory of"Upper Reality and Lower Deficiency"

作　　者：李朝阳 王鹏琴[2] LI Zhaoyang;WANG Pengqin(Liaoning Traditional Chinese Medicine,Liaoning Shenyang 110847,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Liaoning Shenyang 110032,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110033

出　　处：《中医药临床杂志》2025年第3期408-413,共6页Clinical Journal of Traditional Chinese Medicine

摘　　要：文章详细论述了“上实下虚”理论,认为脑卒中的形成特点与“上实下虚”理论相似。肾精亏虚,肾气固摄失司,阴阳失衡,形成“下虚”之势。肾气不固,气血逆乱。肾阳亏虚或脾气虚弱,津液运化失常,泛液成痰。肾阴不足,津亏液乏,不能充盈脉络,血行不畅,瘀血内生。日久痰瘀化热成毒,气血挟热毒,痰毒、瘀毒上逆直冲脑腑,损伤脑神。形成“上实”之态,急性起病。以“上实下虚”的角度论治脑卒中,可分为补髓填精,滋阴补肾;重镇降逆,引气血下行;祛痰化瘀解毒通络,同时在治疗过程中尤应注意虫类药的使用。从“上实下虚”理论新视角出发,有利于从整体上把握脑卒中病病因病机的变化过程,为脑卒中病的治疗提供更多的临床思路。This article discusses the theory of“excessiveness above and emptiness below”in detail,and believes that the formation characteristics of stroke are similar to the theory of“excessiveness above and emptiness below”.Kidney essence deficiency,kidney Qi retention dysfunction,yin and yang imbalance,forming a“empty below”trend.Kidney Qi is not solid,Qi and blood are disordered.Kidney yang deficiency or spleen deficiency,abnormal fluid trans-portation,and fluid overflow into phlegm.Kidney yin deficiency,lack of fluid,can not fill the veins,blood circulation is not smooth,and blood stasis is generated.Over time,phlegm and blood stasis turn into heat and become toxic,Qi and blood carry heat and toxicity,phlegm and blood stasis go up and rush directly to the brain,damaging the brain nerves.The formation of“excessiveness above”and acute onset.From the perspective of“excessiveness above and emptiness below”,the treatment of stroke can be divided into tonifying marrow and essence,nourishing Yin and tonifying kidney;heavy sedation and descending,leading Qi and blood downward;removing phlegm,removing blood stasis,detoxifying and unblocking the meridians.At the same time,special attention should be paid to the use of insect drugs during the treatment process.Starting from the new perspective of the“upper fullness and lower emptiness”theory,it is helpful to grasp the changing process of the etiology and pathogenesis of stroke from a holistic perspective and provide more clinical ideas for the treatment of stroke.

关 键 词：上实下虚 脑卒中 病机 论治 

分 类 号：R271.9[医药卫生—中西医结合]