祝美珍从“虚气留滞”辨治血管性痴呆 经验介绍

An Introduction to the Experience of Treating Vascular Dementia from the Perspective of “Stagnation of Qi” by Zhu Meizhen

摘要: 血管性痴呆是在脑血管疾病所致脑损害基础上形成的一种渐进性、获得性认知功能障碍综合征。吾师祝美珍教授认为VD多发于高年正虚、脏气失调之人，或因虚则津血留滞而脑脉痹阻，或因滞则气血不畅而清空失养，或因虚则津气不足而脑络失滋，更可因痰瘀留滞而蕴毒伤髓，众因叠加而致脑髓失滋受损，日渐脑减髓消，神机失用而发为呆病，提出气虚不足易致津血留滞，气血不畅易致清空失养，痰瘀蕴毒易致脑髓受损为VD的重要病理机转。祝老师基于中医整体观，强调虚气为本，留滞为标，因虚而滞，因滞而损，“虚气留滞”为VD的病机关键，从虚气留滞辨治VD，提出补虚以通滞，通滞以养正为治则，以调脏补气、祛滞通脉、化毒养脑为法，虚实并用、通补兼施、心脑同治、血脉同调，以期恢复脑髓神机，俾使呆气渐轻呆病渐愈，每获良效。

Abstract: Vascular dementia is a progressive and acquired cognitive dysfunction syndrome that arises from brain damage caused by cerebrovascular diseases. Professor Zhu Meizhen believes that vascular dementia (VD) frequently occurs in elderly individuals with deficiency of Yang Qi and internal organ dysfunction. This can be due to deficiency leading to stagnation of fluids and blood, which causes obstruction of the cerebral vessels; or due to stagnation leading to impaired circulation of Qi and blood, resulting in loss of nourishment to the brain; or due to deficiency causing insufficient fluid and Qi, leading to loss of nourishment to the cerebral networks. Furthermore, the accumulation of phlegm and blood stasis can generate toxins that damage the brain marrow. These factors combined cause progressive damage to the brain’s nourishment, leading to cerebral atrophy and impaired cognitive function, manifesting as dementia. The Professor asserts that Qi deficiency is a primary cause that easily leads to the stagnation of fluids and blood, while poor circulation of Qi and blood can result in loss of nourishment. Toxins from phlegm and blood stasis can significantly damage brain marrow, posing crucial pathological mechanisms for VD. Based on Traditional Chinese Medicine’s holistic perspective, Professor Zhu emphasizes that deficiency of Qi is fundamental, while stagnation is symptomatic. The condition progresses from deficiency to stagnation, leading to damage. Hence, the “stagnation due to Qi deficiency” is the key pathogenesis of VD. The treatment approach outlines nourishing deficiency to relieve stagnation and promoting circulation to restore balance, advocating for tonifying Yang Qi, alleviating stagnation, dispelling toxins, and nourishing the brain. A combination of deficiency and excess treatment, along with simultaneous care for both heart and brain, as well as harmonizing the blood circulation, is aimed at restoring the brain’s function and gradually alleviating dementia, achieving positive therapeutic outcomes.