基于“阳化气，阴形成”理论探讨缺血性脑卒中的病机与治疗

Exploring the Pathogenesis and Treatment of Ischemic Stroke Based on the Theory of “Yang Transforming Qi and Yin Constituting Form”

摘要: 缺血性脑卒中是指各种脑血管病变所致脑血管循环障碍，导致脑组织缺血、缺氧性死亡，进而出现神经功能损伤的一类临床疾病。具有高发病率、高死亡率特点，核心临床表现为猝然昏倒、口眼歪斜、偏身瘫痪等症状。近年来，随着缺血性脑卒中发病率逐年攀升，严重影响患者生活质量，还会有损患者身心健康，诱发焦虑、抑郁等不良情绪，一直以来都是临床研究的重点难题。本文基于《黄帝内经》中“阳化气，阴成形”理论，结合缺血性脑卒中的临床特征与病理推演，提出其病机核心在于“阳化气，阴成形”功能性失衡，营卫不和，气血失调，最终导致脑卒中。其中阳化气不及与阴成形太过导致的清阳不升，痰瘀阻窍是疾病发病主要原因。从中医学角度讲，以平衡为核心，协调阴阳，促使气化与成形恢复正常，作为根本治疗原则。并提出温阳通络，调畅气机，祛痰利湿，消散阴凝之法，恢复阴平阳秘，实现升清阳、消阴霾、祛痰浊、复阴液，最终使气血复通，神机得用。

Abstract: Ischemic stroke is a clinical condition in which various cerebrovascular lesions impair cerebral circulation, leading to ischemic and hypoxic death of brain tissue and subsequent neurological impairment. It is characterized by high incidence and mortality rates, with major clinical manifestations including sudden collapse with loss of consciousness, deviation of the mouth and eyes, and hemiplegia. In recent years, the incidence of ischemic stroke has increased annually. The disease severely compromises patients’ quality of life, damages their physical and mental health, and induces adverse emotional states such as anxiety and depression, remaining a major challenge in clinical research. Based on the theory of “yang transforming qi and yin constituting form” in the Huangdi Neijing (The Yellow Emperor’s Inner Classic), this article integrates the clinical characteristics of ischemic stroke with reasoning about its pathological mechanisms. It proposes that the core pathogenesis involves a functional imbalance between yang transforming qi and yin constituting form, disharmony between nutritive and defensive qi, and dysregulation of qi and blood, ultimately leading to stroke. Specifically, insufficient transformation of qi by yang and excessive constitution of form by yin result in failure of clear yang to ascend and obstruction of the orifices by phlegm and blood stasis, which are the principal mechanisms underlying disease onset. From the perspective of traditional Chinese medicine, the fundamental treatment principle centers on restoring balance by harmonizing yin and yang and normalizing qi transformation and form constitution. The proposed therapeutic methods include warming yang and unblocking the collaterals, regulating qi movement, resolving phlegm and draining dampness, and dispersing congealed yin. These methods aim to restore the equilibrium of yin and yang by promoting the ascent of clear yang, dispelling yin obscuration, eliminating turbid phlegm, and replenishing yin fluids, ultimately restoring the free flow of qi and blood and the normal functioning of the spirit.