侯氏黑散组方原则及治疗中风病的机制探究  

Formulation principles of Houshiheisan and its mechanism in treating stroke

作　　者：张秋霞[1,2] 赵晖 ZHANG Qiuxia;ZHAO Hui(School of Traditional Chinese Medicine,Capital Medical University,Beijing 100069,China;Beijing Key Laboratory of Traditional Chinese Medicine Collateral Disease Theory Research,Beijing 100069,China)

机构地区：[1]首都医科大学中医药学院,北京100069 [2]中医络病研究北京市重点实验室

出　　处：《北京中医药大学学报》2025年第2期154-160,共7页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(No.82274402);第五批全国优秀中医临床人才研修项目(国中医药人教发[2022]239号)。

摘　　要：侯氏黑散出自《金匮要略·中风历节病脉证并治第五》,被称为治疗中风的“第一方”,其治疗中风体现了“补不足,损有余”的治疗原则。基础研究结果表明,侯氏黑散全方可改善血液流变学、抗氧化损伤、保护脑缺血损伤后的神经血管单元、促进新生血管成熟、维持脑血管内皮屏障完整等。依据“内虚邪中”中风病机理论对侯氏黑散进行拆方研究,即把方中的药物分为菊花、防风、桂枝等风药组和人参、当归、白术等补虚药组,发现风药主要通过下调凋亡蛋白Caspase-3的表达而补虚药则主要通过上调DNA修复蛋白多聚ADP核糖聚合酶(PARP)的表达而减少脑缺血损伤;风药可明显下调缺血6 h侧脑室水通道蛋白4(AQP4)表达,但其作用时间窗较短,补虚药调控侧脑室AQP4的时间窗较风药明显滞后,这种时间依赖性效应反映了其祛风补虚的双重作用。侯氏黑散祛风通络、化痰活血的功效,与脑小血管病早期风痰瘀阻脑络的病机十分吻合,并且可通过降压、降脂,改善患者的血液流变学,减轻血管内皮细胞的病理损伤和功能障碍,无疑是一首预防和治疗早期脑小血管病的安全有效的经方,未来可以侧重探究其治疗脑小血管疾病的分子机制。Houshiheisan,a classic prescription for stroke treatment,originates from Chapter 5 on Pulse Syndrome Complex and Treatment of Apoplexy and Acute Arthritis of Synopsis of Golden Chamber,which discusses pulse syndrome complex and apoplexy and acute arthritis treatment.Renowned as a primary prescription for stroke,it exemplifies the therapeutic principle of tonifying deficiencies while reducing excesses.This study showed that Houshiheisan improves hemorheology,reduces oxidative damage,protects neurovascular units after cerebral ischemic injury,promotes neovascularization maturation,and maintains cerebrovascular endothelial barrier integrity.Based on the pathogenesis theory of stroke,which is the cause of internal deficiency and pathogenic factor invasion,studies on Houshiheisan disassembling were conducted.The herbs in the prescription were divided into wind-dispelling herbs such as Flos Chrysanthemi,Radix Saposhnikoviae,and Ramulus Cinnamomi and deficiency-tonifying herbs such as Radix Ginseng,Radix Angelicae Sinensis,and Rhizoma Atractylodis Macrocephalae.Wind-dispelling herbs primarily reduced cerebral ischemia injury by downregulating Caspase-3 expression,an apoptotic protein,and deficiency-tonifying herbs reduced cerebral ischemia by upregulating poly ADP-ribose polymerase expression,a DNA repair protein.Wind-dispelling herbs exhibited a rapid yet short-lived effect by significantly downregulating aquaporin-4(AQP4)expression in the lateral ventricle six hours after cerebral ischemia.In contrast,deficiency-tonifying herbs showed a delayed but sustained regulatory impact on AQP4 expression.These complementary time-dependent effects reflect the dual function of the prescription of dispelling wind and tonifying deficiencies,aligning well with the early pathogenesis of cerebral small vessel disease,which is characterized by wind-phlegm and blood stasis obstructing the brain collaterals.Additionally,Houshiheisan reduces blood pressure and blood lipids,improves patients′hemorheology,and alleviates vascular endotheli

关 键 词：侯氏黑散 风药 补虚药 脑小血管疾病 

分 类 号：R222.3[医药卫生—中医基础理论]