基于玄府理论探析脑出血后脑水肿病机与证治

Exploration of Pathogenesis,Syndrome and Treatment of Encephaledema after Intracerebral Hemorrhage Based on Xuanfu Theory

脑水肿在脑出血后的复杂病理机制中占据着重要地位,是导致患者病情加重甚至死亡的关键因素。然而,囿于望、闻、问、切诊无法观察到颅内水肿这一体征,中医对脑出血后脑水肿病机的重视不足,致使中医治疗水肿所积累的经验极少扩展到中风病证治。从玄府气液理论分析脑出血后的“水毒”病机,认为治疗中风病除了考虑风、火、痰、瘀外,若结合影像学等检测报告,还应考虑脑玄府开阖通利障碍、血不利则为水所致的病理因素——“水毒”病机。在脑出血后脑水肿的治法上,辨证论治结合开玄利水法,能使脑内瘀血、气滞、水毒等因素得以减少,营卫、气血、津液、神机得以畅达,血管新生、神经康复能力得以提高。

Encephaledema,also known as brain edema,plays an important role in the complex pathological mechanism after intracerebral hemorrhage,which is the key factor leading to the deterioration of the disease and even the death of the patients.However,due to the difficulties in observing the pathogenesis of encephaledema after intracerebral hemorrhage by the four diagnosis methods in TCM,the accumulated experience of TCM treatment for edema is rarely extended to the treatment for stroke.According to Xuanfu and gas-liquid theory,the pathogenesis of‘water poison’after intracerebral hemorrhage was analyzed in this study.It concluded that besides wind,fire,phlegm and blood stasis,the pathological factors of‘water poison’,which caused by the disorder of opening and closing of Xuanfu,should be considered combined with imaging report and other detection reports.In terms of the treatment for encephaledema after intracerebral hemorrhage,treatment based on syndrome differentiation combined with Kaixuan Lishui method can reduce the influence of the pathogenic factors,such as blood stasis,Qi stagnation and water poison,then the ability of angiogenesis and nerve rehabilitation can be improved.