基于玄府-气液-络脉理论探析缺血性脑卒中合并2 型糖尿病的病机演变与辨治思路

Exploration on the Pathogenesis Evolution and Differentiation-Treatment Approach for Ischemic Stroke Complicated by Type 2 Diabetes Mellitus Based on the Theory of Sweat Pores，Qi-Fluid，and Collateral Vessels

摘要:

缺血性脑卒中合并2型糖尿病的核心病机与“玄府-气液-络脉”理论密切相关，不同于“痰瘀互结”或“肝肾阴虚”等病机理论，笔者尝试建构从微观通道郁闭到宏观脉络损伤的连贯性病机框架，系统阐述二者合病的动态演变过程，其病机演变规律可概括为：初期玄府郁闭、开阖失司；中期气液失宣，痰瘀搏结；后期毒损络脉，脑窍失养。治疗上应分期论治，初期开通玄府，辛散宣通；中期逐瘀化痰，流行气液；后期解毒补虚，以荣络脉，可为缺血性脑卒中合并2型糖尿病的中医辨治提供新的思路。

Abstract:

Abstract：The core pathogenesis of ischemic stroke complicated by type 2 diabetes mellitus （T2DM） is closely related to the theory of "sweat pores，qi-fluid，and collateral vessels" in traditional Chinese medicine. Different from pathogenesis theories such as "phlegm blended with blood stasis" or "liver-kidney yin deficiency，" the authors attempt to construct a coherent pathogenetic framework that ranges from the stagnation and obstruction of microscopic channels （sweat pores） to the damage of macroscopic collateral vessels， systematically elucidating the dynamic evolution of this comorbidity. The evolutionary pattern of the comorbid pathogenesis can be summarized into three stages： at the early stage，stagnation and obstruction of the sweat pores，leading to the disorder of opening and closing function； at the middle stage，failure of qi and fluid to disperse ，resulting in phlegm blended with blood stasis；at the late stage， toxin damaging the collateral vessels， leading to malnutrition of cerebral orifices. Stage-specific treatment should be adopted accordingly：at the early stage，open the sweat pores to ventilate and unblock the lung with acrid-dispersive medicinals；at the middle stage，eliminate stasis and resolve phlegm to promote the free flow of qi and fluid；at the late stage，remove toxins and tonify deficiency to nourish the collateral vessels. This study aims to provide new insights for the traditional Chinese medicine differentiation and treatment of ischemic stroke complicated by T2DM.