基于脑脉微型癥瘕理论探讨缺血性中风分期辨治

Exploration on Stage-Based Syndrome Differentiation and Treatment for Ischemic Stroke Based on the Theory of Micro Zhengjia of Cerebral Vessels

摘要:

缺血性中风多因脑脉内有形病理产物形成而发。脑脉内有形病理产物可归属于脑脉微型癥瘕范畴，根据脑脉微型癥瘕形成、闭阻发作及毒损脑络的动态演变特点，可将本病病机分为：先兆期气虚痰瘀、积聚成癥；发作期癥阻络闭、神机失用；进展期毒损脑络、腑气不通。本病当分期论治，先兆期以益气行血、化痰软坚、消积防闭为主；发作期以豁痰开窍、活血通络、急则中西并治为要；进展期以通腑泄热、解毒醒神、兼顾脑肠同治为法。本文基于脑脉微型癥瘕理论，探讨缺血性中风的阶段性病机特点及治法治则，为临床实施分期辨治及中医药干预提供理论参考。

Abstract:

Abstract：Ischemic stroke mostly occurs due to the formation of tangible pathological products in cerebral vessels， which can be categorized under the concept of micro zhengjia of cerebral vessels. According to the dynamic features of the formation， occlusive onset， and toxin-induced injury to the cerebral collaterals of micro zhengjia of cerebral vessels， its pathogenesis can be divided into three stages： the precursor stage， characterized by qi deficiency with phlegm and blood stasis， leading to accumulation and zhengjia； the onset stage， characterized by zhengjia blocking and occluding the collaterals， resulting in sudden deactivation of the vital activity； and the progression stage， characterized by toxin-induced injury to cerebra collaterals and obstruction of fu-organ qi. Treatment should be implemented by stages according to the disease course. In the precursor stage， the treatment should focus on replenishing qi to activate blood， resolving phlegm to soften hardness， and eliminating stagnation to prevent obstruction. In the onset stage， it prioritizes resolving phlegm for opening the orifices， activating blood to unblock collaterals，and integrating traditional Chinese and western medicine in urgent conditions. In the progression stage，the therapy adopts purgation to clear heat， removing toxins for resuscitation， and concurrently regulates the brain and intestine. Based on the theory of micro zhengjia of cerebral vessels， this article explores the stage-based pathogenesis characteristics and treatment principles of ischemic stroke， aiming to provide theoretical reference for implementing clinical stage-based syndrome differentiation and treatment and traditional Chinese medicine intervention.