首页|基于病络学说分期论治脑小血管病

基于病络学说分期论治脑小血管病

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  • 国家科技期刊平台
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  • NSTL
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脑小血管病(CSVD)是由脑微小血管及血管神经单元的结构和功能紊乱引起的一种缓慢进展的脑血管疾病，CSVD影像标志物可能是脑衰老的表现之一。在临床上，CSVD发病不局限于中老年人群，部分没有典型血管危险因素的年轻患者亦可见扩大的血管周围间隙和脑白质高信号等影像学特征，这部分患者的诊治同样需要重视。相较于西医学，中医药对CSVD患者的情绪、睡眠、认知等相关症状的治疗有一定优势。在疾病认识方面，中医学理论中玄府和脑络与CSVD解剖结构在生理功能和发病机制方面有一定共性。基于此，本文在病络学说指导下结合玄府理论，将CSVD发病过程分为3 个临床阶段，早期玄府失司、气络郁阻;中期毒邪内生、损伤血络;晚期肾虚髓减、毒损脑络;并针对不同发病阶段进行分期论治，早期宣畅气机、宁神通络，中期祛邪通络，晚期补肾填髓、解毒通络，为中医药防治CSVD提供新的诊治思路。
Differentiation and treatment by stages of cerebral small vessel disease based on abnormal collateral theory
Cerebral small vessel disease(CSVD)is a slowly progressive cerebrovascular disease caused by structural and functional disorders of small vessels and vascular neural units in the brain,and CSVD imaging markers may be evidence as manifestations of brain aging.Clinically,the onset of CSVD is not limited to individuals in middle-to-old age.Young patients without typical vascular risk factors may also have imaging markers,such as enlarged perivascular space and white matter hyperintensity.The diagnosis and treatment of these cases must be approached seriously.Compared with Western medicine,traditional Chinese medicine(TCM)has an advantage in treating disorders related to emotions,sleep,and cognition in patients with CSVD.Regarding CSVD,there are commonalities between anatomical structures,physiological functions,pathogenic mechanisms,and xuanfu and collateral theories in TCM.We combined the xuanfu and abnormal collateral theory and classified CSVD into three clinical stages:early-stage,dysfunction in xuanfu and stagnation in the qi collaterals;middle-stage,endogenous toxins and damage to the blood vessels;and late-stage,kidney and marrow deficiency and toxins damaging the brain collaterals.Different treatment strategies,such as promoting qi circulation,calming the mind,and dredging collaterals in the early stage;dispelling pathogenic factors and promoting blood circulation in the middle stage;tonifying the kidney and replenishing the marrow and removing toxins from collaterals in the late stage,are applied at different stages to offer novel perspectives on TCM treatment for CSVD.

cerebral small vessel diseaseabnormal collateral theoryxuanfusyndrome differentiation and treatmentstaged therapy

乔天慈、韩燕、王永炎

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上海中医药大学附属岳阳中西医结合医院 上海 200080

上海中医药大学

中国中医科学院

脑小血管病 病络学说 玄府 辨证论治 分期治疗

国家重点研发计划国家自然科学基金上海申康医院发展中心三年行动计划上海市卫生健康委领军人才项目

2019YFC171160382274304SHDC2020CR2046B2022LJ010

2024

10.3969/j.issn.1006-2157.2024.05.001

北京中医药大学学报
北京中医药大学

北京中医药大学学报

CSTPCD北大核心
影响因子：1.568
ISSN：1006-2157
年,卷(期)：2024.47(5)