从“络病理论”探寻缺血性卒中的诊治研究及思考

Exploration and Reflection on the Diagnosis and Treatment of Ischemic Stroke from the “Collateral Disease Theory”

摘要: 缺血性脑卒中是因脑部血液循环障碍导致的局限性脑组织缺血性坏死，属中医“中风”范畴，病机以阴阳失调、气血逆乱、脑络受损为核心。我国缺血性脑卒中发病率居高不下，西医治疗以再灌注、抗血小板聚集等为主，但致残率及致死率仍较高。络脉作为经脉的微细分支，具有渗灌气血、沟通表里的生理功能，其病理特点为“易滞易瘀、易入难出”。脑为元神之府，脑络损伤可致气血输布异常，引发瘀、痰、浊、毒等病理产物堆积，进而导致各种功能障碍。治疗上遵循“络以通为用”原则，以中药及针刺治疗为主：中药治疗多选辛香通络药及虫蚁剔络药；针刺治疗选取调和营卫、化瘀通络的穴位，以益脑窍，配合其他疗法如艾灸等干预手段治疗缺血性卒中。

Abstract: Ischemic stroke, which falls under the category of “Zhong Feng” (stroke) in Traditional Chinese Medicine (TCM), is characterized by localized ischemic necrosis of brain tissue due to cerebral circulation disorders. Its pathogenesis centers on the imbalance of Yin and Yang, disruption of Qi and Blood flow, and damage to the brain’s collateral vessels. In China, the incidence of ischemic stroke remains high. While Western medical treatments primarily focus on reperfusion and antiplatelet aggregation, the rates of disability and mortality associated with the condition are still significant. Collateral vessels, as the fine branches of the main meridians, possess the physiological functions of infusing Qi and Blood throughout the body and connecting the interior with the exterior. Their pathological characteristics are described as being “prone to stagnation and stasis, and susceptible to the ingress of pathogens that are difficult to expel”. The brain is considered the “residence of the original spirit”. Damage to the brain’s collaterals can lead to abnormal distribution of Qi and Blood, resulting in the accumulation of pathological products, such as blood stasis, phlegm, turbidity, and toxins, which in turn cause various functional impairments. The treatment principle follows the tenet that “collaterals should be kept free for proper function”. Therapeutic approaches primarily involve Chinese herbal medicine and acupuncture. Herbal treatment often utilizes acrid and aromatic herbs to unblock collaterals, as well as insect-based medicines to scour and remove obstructions from the collaterals. Acupuncture treatment selects acupoints that harmonize the Nutritive and Defensive Qi, resolve stasis, and unblock the collaterals, thereby benefiting the brain orifices. These are often combined with other interventions such as moxibustion for the treatment of ischemic stroke.