基于“病机结合病理,药性结合药理”临证模式的柴胡加龙骨牡蛎汤防治缺血性脑卒中思路探讨

Analysis of protective effects of Chaihu Jia Longgu Muli Tang against ischemic stroke by combining traditional Chinese medicine pathogenesis and efficacy with modern pathology and pharmacology

柴胡加龙骨牡蛎汤是《伤寒论》中治疗少阳阳明合病的经典名方,现代常用于治疗精神神志及神经系统、妇科、男科、心血管系统等疾病,然而其治疗缺血性脑卒中的研究尚不多见。笔者在临床实践中发现,该方治疗缺血性脑卒中疗效显著,能缩短病程,并能显著减少复发。柴胡加龙骨牡蛎汤方证特征包括：邪在少阳证、精神神经症状、水饮上冲证以及热结胃肠证。＂病机结合病理,药性结合药理＂是现代中医临床的重要思维模式。据此原则,该文认为中风病机以火热亢盛为主,兼夹痰瘀水饮,与柴胡加龙骨牡蛎汤方证中对应的缺血病灶周围的应激性脑水肿带,颅内压升高、交感神经神经兴奋,单胺类神经递质大量释放、中风后自主神经功能减退,胃肠道应激反应等病理过程契合。同时,柴胡加龙骨牡蛎汤的药理学研究表明,其作用靶标集中在以HPA轴为中心的神经内分泌学系统,参与神经元再生与凋亡、氧化应激、交感神经亢进、炎症反应等过程,这与缺血性脑卒中发生后的病理改变具有一致性。因此,柴胡加龙骨牡蛎汤是防治缺血性脑卒中的关键方剂。

Chaihu Jia Longgu Muli Tang is a classical Chinese formulas treating Shaoyang syndrome complicated with Yangming syndrome according to Treatise on Febrile Diseases. This formula is used in mental disorder,nervous system,gynecologic,andrologic,and cardiovascular disease. However,its therapeutic effect on ischemia stroke and its mechanism is far from clear. In clinical practice,we have found that this formula is effective in treating ischemic stroke,which can shorten the course of the disease and reduce recurrence. The characteristics of this formula include： Shaoyang cardinal disadvantageous syndrome,mental and nervous symptoms,retained fluid punched upward syndrome and accumulation of heat in the stomach and intestines. By combining traditional Chinese medicine（ TCM） pathogenesis and efficacy with modern pathology and pharmacology,we proposed that the TCM pathogenesis of stroke,which is characterized by hyperactivity of heat combining with phlegm,stasis and water drink,is consistent with syndromes and corresponding pathology targeted by Chaihu Jia Longgu Muli Tang,including the stress brain edema zone around the ischemic lesion,the increase of intracranial pressure,the excitement of sympathetic nerve,the release of monoamine neurotransmitter,the hypofunction of autonomic nervous system after stroke,and gastrointestinal stress response. Furthermore,the pharmacological mechanism of Chaihu Jia Longgu Muli Tang is concentrated on regulation the neuroendocrinology system centered by hypothalamic-pituitary-adrenal axis（ HPA）,participating in the process of neuron regeneration and apoptosis,oxidative stress,hyperactivity of sympathetic nerve,and inflammatory reaction. These pathological processes are consistent with the pathological changes after ischemic stroke. Therefore,Chaihu Jia Longgu Muli Tang is a key formula for treating ischemic stroke.