基于少阳为枢理论探析颈椎病的病机与治则

Analysis of the Pathogenesis and Treatment of Cervical Spondylosis Based on the Theory of “Shaoyang as the Pivot”

摘要: 颈椎病是因颈椎间盘退变等原因，导致颈神经根、脊髓等受压或刺激，从而引发颈肩痛、肢体麻木等症状的退行性疾病。颈椎病属于中医“痹证”“痿证”等范畴，因其病机复杂致使存在临床疗效欠佳以及副作用较大的问题。少阳主骨、少阳主筋之病及少阳经络循行过颈侧及肩部，提示少阳参与颈椎病的发生、发展及转归。本文以少阳主枢理论为核心，阐明少阳枢机不利引起的经气阻滞、阳气升降失常以及相火妄动等是颈椎病的重要病机。基本治则为和解少阳，调畅枢机。临床从通经活络、升清降浊、枢转气机、清泄相火着手，灵活运用针灸及柴胡汤类方化裁治疗颈椎病，获得较好疗效，可为临床治疗颈椎病提供新的理论指导和诊疗思路。

Abstract: Cervical spondylosis is a degenerative disease in which the cervical nerve roots, spinal cord, etc. are compressed or stimulated due to cervical disc degeneration and other causes, thus triggering symptoms such as neck and shoulder pain and numbness of the limbs. It belongs to the categories of traditional Chinese medicine “bi syndrome” and “impotence syndrome”. Its complex pathogenesis has led modern medical treatments to face the problem of limited efficacy and side effects. Shaoyang governs the bones, Shaoyang governs the tendons, and Shaoyang meridians circulate through the neck and shoulders, suggesting that Shaoyang is involved in the occurrence, development, and outcome of cervical spondylosis. With Shaoyang’s main pivot theory as its core, this paper clarifies that menstrual qi blockage, abnormal rise and fall of yang qi, and facies fire motion caused by Shaoyang’s unfavorable heart are important pathogenesis of cervical spondylosis. The basic rule is to reconcile Shaoyang and unblock the cardinals. Clinically, starting from the aspects of unblocking meridians and activating collaterals, raising clearness and lowering turbidity, pivoting qi, and clearing and relieving internal heat, we can flexibly use acupuncture and Bupleurum decoction to treat cervical spondylosis, and obtain good curative effects, which can provide new theoretical guidance and diagnosis and treatment ideas for the clinical treatment of cervical spondylosis.