从下丘脑—垂体—肾上腺轴角度探讨中医“脑—肾—髓”理论指导下卒中后失语神经机制

From the perspective of hypothalamic-pituitary-adrenal axis to explore the neural mechanism of post-stroke aphasia under the guidance of TCM“brain-kidney-sui”theory

卒中后失语(post-stroke aphasia,PSA)“脑—肾—髓”理论从“形”(结构)“神”(功能)的损伤阐释本病的发生发展,认为肾精亏虚,脑髓败坏,脑神失养为其关键病机。基于此病机理论,笔者从结构与功能探讨了神经可塑性与中医“髓”“神”的共通点,提出神经可塑性可能为卒中后失语“髓”“神”损伤与恢复的现代机制基础,并结合神经内分泌学,阐述下丘脑—垂体—肾上腺轴(hypothalamic-Pituitary-Adrenal Axis,HPA)功能紊乱作为中医学肾虚本质的科学依据。基于以上理论探索,进一步以肾精亏虚,髓减神消的病机变化为核心,阐述了“肾精—脑髓—脑神”与“HPA轴—脑源性神经营养因子—神经可塑性”之间的相关性,以期为系统探索卒中后失语中医理论的现代医学内涵奠定基础。此外,结合“脑—肾—髓”理论指导下的病机特点与临证经验,本课题组优化形成了疗效确切的“益髓醒神”针刺方案,并利用功能磁共振技术发现了该方案具有调控卒中后失语脑功能与结构的作用,然而如何整合分子生物学与神经影像学技术,围绕HPA轴调控的神经可塑性机制,更全面、客观地揭示符合中医理论特色的“益髓醒神”针刺方案疗效机制,有待进一步探索。

The“brain-kidney-sui”theory in post-stroke aphasia explains the occurrence and development of the disease from the damage of“Xing”(structure)and“Shen”(function).It is believed that the deficiency of kidney essence,the deterioration of“Sui”,and the dysfunction of“Shen”are the key pathogenesis.Based on this pathogenesis theory,the author explored the common points among neuroplasticity,the“Sui”and“Shen”of TCM from the structure and function,and proposed that the modern mechanism basis for the damage and recovery of aphasia“Sui”and“Shen”after stroke may be neuroplasticity.Combined with the understanding of modern neuroendocrinology,this paper discussed the hypothalamic-pituitary-adrenal axis dysfunction as the scientific basis for the essence of kidney deficiency in TCM.Based on the above theoretical exploration,the author further focused on the pathogenesis changes of kidney essence deficiency and Sui reduction as the core,and elaborated the similarities between“Kidney essence-Sui-Shen”and“HPA axis-BDNF-neuroplasticity”,expecting to lay the foundation for the systematic exploration of the modern medical connotation of the TCM theory of aphasia after stroke.In addition,combined with the pathogenesis characteristics and clinical experience under the guidance of the“brain-kidney-sui”theory,this research group optimized and formed a“Yi Sui Xing Shen”acupuncture program with definite curative effect,and found that the program had the effects of regulating the function and structure of brain in post-stroke aphasia by using functional magnetic resonance technology.However,how to integrate molecular biology and neuroimaging technology,centering on the neural plasticity mechanism regulated by the HPA axis,and more comprehensively and objectively reveal the curative effect mechanism of the“Yi Sui Xing Shen”acupuncture program that conforms to the characteristics of TCM theory,remains to be further explored.