温胆汤及其类方在中风中的应用

Application of Gallbladder-Warming Decoction and Its Associated Formulas in Stroke

从痰论治的中风证型有风痰阻络证、痰湿蒙窍证、痰热(痰火)闭窍证、痰瘀互结证、痰热腑实证、气郁痰阻证、风痰瘀阻证,分别应用导痰汤、涤痰汤、黄连温胆汤、四物温胆汤、硝黄温胆汤、十味温胆汤、桑钩温胆汤治疗。风痰盛者,加半夏、白术化痰熄风;湿痰盛者,加泽泻、桂枝利湿化饮;痰热盛者,加黄连、胆南星、川贝母清热化痰;痰瘀互结者,加桃仁、红花逐瘀行血;痰热腑实者,加生大黄、玄明粉清热通腑导滞。但是目前对于温胆汤及相关类方究竟如何干预血管病的进程,如何有效逆转或延缓血管病相关痴呆的发展等相关方面还缺少深入的研究,因此从具有中医特征性的病理因素"痰"入手,进行温胆汤相关的研究是有必要的。

The syndrome types of stroke treated from phlegm include wind syndrome of phlegm blocking collaterals,syndrome of phlegm dampness blocking orifices,syndrome of phlegm-heat( phlegm-fire) blocking orifices,intermingled phlegm and blood stasis syndrome,phlegm-heat and fu excess syndrome,qi depression and phlegm blocking syndrome,wind phlegm and blood stasis blocking syndrome. They are treated with Phlegm-Expelling Decoction,Phlegm-Flushing Decoction,Coptis and Gallbladder-Warming Decoction,Four Substances and Gallbladder-Warming Decoction,Xiaohuang Gallbladder-Warming Decoction,Ten Substances and Gallbladder-Warming Decoction,Sangteng and Gallbladder-Warming Decoction respectively. For excessive wind and phlegm,Banxia( Rhizoma Pinelliae) and Baizhu( Rhizoma Atractylodis Macrocephalae) can be combined to resolve phlegm and extinguish wind. For excessive phlegm and dampness,Zexie( Rhizoma Alismatis) and Guizhi( Ramulus Cinnamomi) can be combined to remove dampness and transform retention. For excessive phlegm and heat,Huanglian( Rhizoma Coptidis),Dannanxing( Rhizoma Arisaematis cum Bile) and Chuanbeimu( Bulbus Fritillariae Cirrhosae) can be combined to clear heat and resolve phlegm. For intermingled phlegm and blood stasis syndrome,Taoren( Semen Persicae) and Honghua( Flos Carthami) can be combined to activate blood circulation. For phlegm-heat and fu excess syndrome,raw Dahuang( Radix et Rhizoma Rhei) and Xuanmingfen( Natrii Sulfas Exsiccatus) can be combined to clear away heat and dredge viscera and guide stagnation. However,there is still lack of in-depth research on how Gallbladder-Warming Decoction and its associated formulas intervene in the process of vascular disease and how to effectively reverse or delay the development of vascular disease-related dementia. Therefore,it is necessary to study Gallbladder-Warming Decoction from the perspective of phlegm,a pathological factor with TCM characteristics.