基于络病理论探讨脑小血管病的病机与治疗

Discussion on Pathogenesis and Treatment of Cerebrovascular Disease Based on Collateral Disease Theory

络病既包括络脉功能障碍及结构损伤的自身病变,也涵盖了因络脉病变引起的继发性脏腑组织病理变化。络病与脑小血管病共同具有病位迂曲、易于阻滞,病机复杂、难以治愈,症状多样、难以辨识等特点。"初为气结在经,久则血伤入络"是络病理论的重要组成部分,也是脑小血管病的病变过程。脑小血管病初起在气,脑络郁滞;久病在血,虚瘀互结。治疗脑小血管病应在病变初期理气通络,在药物选择上宜重视辛味药的应用;久病则应通补兼施、虚实兼顾,在补气养血、荣养络脉的基础上可适当应用虫类药及解毒药。

Collateral diseases include not only the self pathological changes of collateral dysfunction and structural damage, but also the secondary visceral histopathological changes caused by collateral diseases.Collateral disease and cerebrovascular disease have the characteristics of tortuous location, easy block, complex pathogenesis, difficult to cure, diverse symptoms and difficult to identify. "Qi stagnation in the meridian at the beginning, blood injury into the collaterals after a long time" is not only an important part of the collateral disease theory, but also the pathological process of cerebrovascular disease.Small cerebrovascular disease starts from Qifen and stagnation of brain collaterals;long illness are in Xuefen, which causes intermin-gled phlegm and blood stasis.In the treatment of small cerebrovascular disease, we should regulate qi and dredge collaterals in the early stage of disease, and pay attention to the application of pungent medicine in medicine selection.If the patients are ill for a long time, they should be treated by both tonifying deficiency and removing stasis, giving consideration to both deficiency and excess.Insect medicine and detoxication medicine can be properly used on the basis of tonifying qi and nourishing blood and enriching collaterals.