脑-肠互动理论下应用“益髓醒神调枢”法治疗卒中后失语的机理探讨

Exploration on the mechanism of ‘arousing brain and nourishing marrow by modulating pivot method’ for post-stroke aphasia based on the theory of brain-gut interaction

脑-肠轴是中枢神经系统与胃肠道功能相互作用的双向调节轴,反映神经、内分泌、免疫不同层次的交互作用网络。脑卒中发生多伴随胃肠功能紊乱,提示"脑-肠互动异常"。文章在"益髓醒神调枢"理论指导下,针对卒中后最常见的并发症——卒中后失语,阐述该疾病发病与治疗中的形与神,以及益髓、醒神、调枢的关系,强调语言功能障碍源于脑髓败坏、气机逆乱,并结合现代医学的认识,提出通过脑-肠-菌群轴可以改善卒中后失语患者的认知功能,进而促进语言功能的恢复,并从"补虚泻实,填精养神""斡旋升降,调气醒神"两个方面阐释"调枢"之法的具体应用,论述了"益髓醒神调枢"治法的理论基础与临床应用,并探讨其实践意义,以期为卒中后失语的临床治疗提供新视角。

The brain-gut axis is the bidirectional regulating axis of the interaction between the central nervous system and gastrointestinal function, which reflects the difference levels of neuro-endocrine-immune interaction network. The occurrence of stroke often accompanies by gastrointestinal dysfunction, which is defined as ‘disorders of gut-brain interaction’. This paper discusses the body and spirit in the pathogenesis and treatment of post-stroke aphaisa(PSA), the most common complication after stroke, under the guidance of the theory of ‘arousing brain and nourishing marrow by modulating pivot method’. Then, the relationship between ‘nourishing marrow’ ‘arousing brain’ and ‘modulating pivot method’ is explored. We also emphasize that language dysfunction is the result of brain marrow damage, and the main contradiction of it is the loss of the brain marrow and the disturbance of qi-movement. Combining with the understanding of modern researches on PSA, we thought that brain-gut-flora axis might improve the recognition function of patients with aphasia to promote the recovery of language function. Furthermore,we also discuss the concrete application of the method of modulating pivot method from two aspects: One is to achieve the goal of replenishing essence to nourish the spirit through the application of treating asthenia and reducing sthenia, another one is to arouse the function of the spirit by regulating the ascending and descending of qi activity. By summarizing the theoretical basis and clinical application of the treatment of ‘arousing brain and nourishing marrow by modulating pivot method’ and probes into its practical significance, hoping to provide a new perspective on the treatment of PSA.