武继涛教授治疗中风先兆经验总结

Professor WU Jitao’s Experience on Treating Threatened Apoplexy

中风先兆相当于现代医学的"短暂性脑缺血发作(TIA)",主要表现为一过性昏厥、言语不利或短暂性的肢体无力、麻木,阵发性头晕、视物不明等,其症状多为短暂性或一过性发生,短时间内恢复,并不遗留神经病损症状,可视作中风的早期预警,发展为完全性中风的风险极高。武继涛教授认为本病总属本虚标实之证,肾虚痰瘀是中风先兆的基本病机,发病之本在肾虚,其因在风、痰、瘀邪侵袭所致,三者可相互为患,病位在脑,而与肾、肝、脾等脏密切相关,在治疗上提出分两步治疗,第一步急性期多因长期嗜食酒甘,脾胃受损,运化失司,水湿不化,痰湿内生,遇情志不遂,肝气郁滞,日久化火伤阴,阳亢化风,引动痰湿为患,主要病机为肝肾阴亏,引动肝风,触动痰浊,蒙蔽脑窍为主,故治疗上以化痰通络,重用虫类搜风为主,临床常用自拟方-熄风化痰通络汤为基础方加减;第二步缓解期是在肾虚的基础上,病程日久,脏腑受损,复因他邪诱发,气机逆乱,气血不合而发,主要病因病机为发病日久,正气亏虚,气机逆乱,清浊升降失常为主,故治疗以补肾,升清降浊为法,临床中选升清降浊方加减,分期治疗的理念,体现了"急则治其标,缓则治其本"中医思想,从而控制疾病进展,达到卒中二级预防的目的。

Threatened apoplexy is equivalent to transient ischemic attack (TIA) of modern medicine,which is mainly manifested as transient fainting,speech impairment or transient limb weakness,numbness,paroxysmal dizziness,unclear vision and so on.Most of its symptoms are transient.It recovers in a short period of time and does not leave neurological symptoms.It can be regarded as the early warning of stroke and develops into complete stroke with a high risk.Professor WU Jitao thinks that the disease always belongs to the syndrome of mixed deficiency and excess.Kidney deficiency,phlegm and blood stasis are the basic pathogenesis of stroke omen.The onset pathogenesis of stroke is kidney deficiency,which is caused by the invasion of wind,phlegm and blood stasis.The three diseases can be caused by each other.The disease is located in the brain,which is closely related to the kidney,liver,spleen and other organs.In the treatment,it is proposed to treat stroke omen in two steps.In the acute stage,due to long-term addiction to alcohol,spleen and stomach fail to work normally.The main pathogenesis is Yin deficiency of liver and kidney activating the liver wind and phlegm turbid and the phlegm turbid blinding the brain orifices.Therefore,the treatment is mainly eliminating phlegm and collaterals and using insects drugs to dispel wind,and the self-made clinical formula Xifeng Huatan Tongluo decoction is the basic formula.In the recovery period,long-term kidney deficiency could damage the Zang-fu organs.Combined with the other evils,the Qi and blood are disordered.The main etiology and pathogenesis are long-term deficiency of vital Qi,disorder of Qi and blood,and disorder of ascending and descending of turbidity.Therefore,the treatment is tonifying kidney,ascending clear Qi and descending the turbidity.In clinic,ascending clear Qi and descending the turbidity is basic treatment method,which embodies the concept of treating the root in the acute period and treating the branch causes in the recovery period in order to control the progress of disease and achieve the goal of secondary prevention of stroke.