基于“脉定律”探讨急性缺血性卒中的中西医诊治

Discussion on Diagnosis and Treatment of Acute Ischemic Stroke with Chinese Medicine and Western Medicine Based on the Theory of “Pulse Law”

基于现代医学脑保护原则及脑血流动力学特点,并结合中医对急性缺血性卒中(中风)的认识,采用传统医学表述方式提出现代临床诊治急性缺血性脑卒中的"脉定律"理念,即认为急性缺血性卒中的核心病机在于各种原因导致的脑脉缺血;"气血津液"与脑脉血供呈正相关关系,"痰瘀"是引起疾患或使之加重的病理因素,"气血津液"与"痰瘀"决定了血脉(血流)的充盈或不足。对于急性缺血性中风的临床治疗,益气活血、补液生津、化痰祛瘀为其基本治则。基于"脉定律"理念对急性缺血性脑卒中进行防治的"益气"原则主要体现为保持呼吸气道通畅、血氧供应及提高机体免疫能力,"活血"治疗原则主要体现为调整血压和改善血容量,"补液生津"治疗原则主要体现在维持正常血容量,"化痰"治疗原则主要体现在降脂稳斑与清理痰液以保持气道通畅,"祛瘀"治疗原则主要体现在溶栓、抗凝与预防静脉血栓事件以及改善微循环。

By following the principle of cerebral protection and according to the characteristics of the cerebral hemodynamics in the field of modern medicine,together by combining the acquaintance of stroke in the field of traditional Chinese medicine, the concept of "pulse law" for the modern clinical diagnosis and treatment of acute ischemic stroke with traditional Chinese medicine terminology was put forward. In the theory of "pulse law",the core pathogenesis for acute ischemic stroke is due to the ischemia of brain vessels induced by various etiological factors, qi, blood and body fluid are positively correlated with acute ischemic stroke, phlegm and blood stasis are the pathological factors which cause or aggravate the disease, and qi,blood and body fluids as well as phlegm and blood stasis are the decisive factors for the abundance or insufficiency of pulse(blood flow). For the treatment of acute ischemia stroke,the therapeutic principles consist of the methods of replenishing qi and activating blood, supplementing and producing body fluids, resolving phlegm and removing blood stasis.Following the "pulse law" for the prevention and treatment of acute ischemia stroke,method of replenishing qi can be achieved by keeping the airway unobstructed, ensuring blood oxygen supply, and enhancing the immunity;method of activating blood can be achieved by improving blood pressure and blood volume;method of supplementing and producing body fluids can be achieved by maintaining normal blood volume;method of resolving phlegm can be achieved by lowering blood lipid and stabilizing plaque,and clearing the sputum so as to keep the airway unobstructed;method of removing blood stasis can be achieved by thrombolytic treatment,anticoagulation treatment,prevention of venous thromboembolism event and improvement of microcirculation.