摘要
中医诊治疾病的核心在于辨证论治,八纲辨证是中医辨证的纲领,虚实辨证作为八纲辨证之一,是八纲辨证最基本、最关键的方法。缺血性中风是目前危害我国居民健康的首位原因,对其病因病机的认识历经多次演变,从最早的“外风”致病,到后来的“内风”理论,再到现代新提出的“毒损脑络”等学说,虽立论不同,但均认为该病为本虚标实之证。由既往研究可知,中风病虽病机错综复杂,证候动态演变迅速,但核心病机演变具有一定的规律性,即由实渐虚。该文分析了中风病因病机及辨证分型方案的历史沿革,且立足于中风辨证分型版本众多,临床应用不易的实际情况,从中风病核心病机演变规律出发,提出了以虚实为纲分期序贯治疗缺血性中风的新思路。此团队还对新思路进行了初步验证,以100例缺血性中风患者为对象进行随机对照研究,结果发现以虚实为纲分期序贯治疗缺血性中风临床疗效显著。该文还结合团队前期研究基础及既往其他学者的研究,探讨了中风证候与部分生物标志物的关系,以期为精准掌握病机演变规律寻求可靠客观的科学依据。综上,在临床实践中,针对缺血性中风核心病机由实渐虚的演变规律,以虚实为纲分期辨治缺血性中风,执简驭繁,可以更加精准地实现快速干预,提高缺血性中风的临床疗效。
The core of diagnosing and treating diseases in traditional Chinese medicine lies in syndrome differentiation.The eight principles of syndrome differentiation serve as guidance for syndrome differentiation.As one of the eight principles of syndrome differentiation,the differentiation of deficiency and excess is the basic and critical method.Ischemic stroke is currently the leading cause harming the health of Chinese residents.Although the hypotheses about the cause of ischemic stroke have evolved from external wind to the later internal wind and to the modern theory of toxin damaging the brain collaterals,they all believe that this disease is rooted in internal deficiency and external excess.According to available studies,although stroke is characterized by complex pathogenesis and rapid progression of syndromes,the key cause evolution has a regularity,that is,from excess to deficiency.This article analyzes the historical evolution of the etiology,pathogenesis,and syndrome differentiation schemes of stroke.There are diverse schemes for the syndrome differentiation of stroke,which make it difficult to choose in clinical practice.In view of this problem,this paper puts forward a new approach of staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess according to the evolution law of the key cause of stroke.Furthermore,we conducted a randomized controlled study on 100 patients with ischemic stroke to evaluate this new approach.The results showed that the staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess demonstrated definite clinical efficacy.In addition,this article reviews the previous research results of our team and the research achievements of other teams to preliminarily explore the relationship between stroke syndromes and biomarkers,aiming to provide an objective basis for unveiling the pathogenesis of stroke.In summary,according to the key cause evolution(from excess to deficiency),the treatment of ischemic stroke by stages based on differentiation of deficiency and excess can facilitate the rapid intervention and improve the clinical efficacy on ischemic stroke.
作者
刘向哲
宋艳芳
冉春龙
张道培
王新志
LIU Xiangzhe;SONG Yanfang;RAN Chunlong;ZHANG Daopei;WANG Xinzhi(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Pingdingshan Traditional Chinese Medicine Hospital,Pingdingshan 467000,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2024年第9期186-192,共7页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家重点研发计划项目(2018YFC1705002)
2023年度河南省“双一流”创建学科中医学科研专项(HSRP-DFCTCM-2023-2-18)
河南省中医药学科领军人才项目(豫卫中医函[2021]8号)
河南省中医药科研专项(2023ZXZX1077)。
关键词
缺血性中风
虚实辨证
分期序贯治疗
理论探讨
ischemic stroke
syndrome differentiation of deficiency and excess
staging sequential treatment
theoretical discussion
