刘健从“太少两感”辨治急性脊髓炎所致神经源性膀胱

Liu Jian′s Experience of Treating Neurogenic Bladder due to Acute Myelitis Based on"the Greater Yang Meridian and Lesser Yin Meridian Infection"

刘健教授认为,急性脊髓炎病机为体虚内伤,感受外邪,越经而传,直中少阴,以致表里同病,真阳失运,形成"太阳、少阴两感"(简称"太少两感")的病理状态。神经源性膀胱为体虚外感,或寒邪过甚,内舍于太阳经膀胱之腑,少阴经肾阳虚衰,以致太少两感,经气闭塞,膀胱气化无力,水道失司,而成膀胱蓄水之证。刘健教授基于"太少两感"病机,运用麻黄附子细辛汤、真武汤、五苓散等经方组合化裁治疗,获得良效。麻黄附子细辛汤温经散寒,助阳开表,可交通表里,祛邪外出;真武汤温肾阳制寒水,可补阳固本,温暖心脾;五苓散通阳化气,促进膀胱气化,恢复排尿行水机能。同时注意辨别轻重缓急,若阳衰欲脱,当急救其里,纵有表证,亦不可发汗。待病因祛除,病情稳定,以党参、黄芪、山药、山萸肉、薏苡仁、五味子等温养脾肾,益气固本。

Professor Liu Jian believes that the pathogenesis of acute myelitis is deficiency of the body and internal injury attacked by external pathogens passing through the meridians and straight to the lesser yin meridian,resulting in disease involving both exterior and interior,the loss of genuine yang,forming a pathological state of"the greater yang meridian and lesser yin meridian infection".Neurogenic bladder is characterized by body deficiency and external pathogen attack,or excessive cold enclosed in the bladder of the greater yang meridian.In addition,kidney yang of the lesser yin meridian is deficient.As a result,the greater yang meridian and lesser yin meridian are infected at the same time,with obstruction of meridian qi,weakness of bladder qi transformation,and dysfunction of water channels,resulting in bladder fluid retention syndrome.Based on the above pathogenesis,Professor Liu often uses some classical formulas such as Ephedra and Aconite and Asarum Decoction,True Warrior Decoction,Five Substances Powder with Poria,etc.and has always achieved good effects.Ephedra and Aconite and Asarum Decoction can warm the meridians and disperse cold,help yang to open the exterior and dispel external pathogens,and connect exterior with interior.True Warrior Decoction can warm kidney yang and restrict cold fluid,tonify yang and consolidate foundation warm the heart and spleen.Five Substances Powder with Poria can activate yang to transform qi,promote bladder transformation and restore urination and water circulation function.At the same time,he pays attention to distinguish the priorities.If yang is weak and tends to collapse,he often gives first aid to treating interior syndrom.Even if there is evidence on the surface,he never uses sweating.When the cause of the disease is removed and the condition is stable,he uses Dangshen(Radix Codonopsis),Huangqi(Radix Astragali),Shanyao(Rhizoma Dioscoreae),Shanyurou(Fructus Corni),Yiyiren(Semen Coicis),Wuweizi(Fructus Schisandrae Chinensis),etc.to warm the spleen and kidney,replenish qi and consolidate the foundation.