从“肝郁”理论探讨LAA型脑中风的因机治法

Exploring the Mechanism and Treatment of LAA Type Stroke from the Theory of "Liver and Stagnation"

肝郁是临床上常见的致病因素之一,其致病多以气滞表现为主,肝郁的发生与长期的情绪异常有关。LAA(Large artery atherosclerosis,LAA)型脑中风主要是因颅脑大动脉发生粥样硬化而狭窄、闭塞导致脑组织缺血缺氧最终出现意识障碍、肢体偏瘫、偏身感觉障碍、面瘫、偏盲、失语等主要表现的临床综合征。LAA型脑中风的中医致病因素主要以火、痰、瘀、虚为主,从气为津之帅、气为血之帅、气有余便是火而论,火、痰、瘀的形成与气滞关系密切。肝郁气滞、气滞化火、火邪腐蚀血肉脑脉,肝郁气滞、气滞则津血不行结为痰瘀、痰瘀凝滞脉络,损伤血脉,心神、肢体失养出现肢体偏废、肌肤不仁、口舌歪斜、言语不利。中风后期,正气亏虚则需气血津液濡养机体以助其恢复,邪气未尽需气血津液运行驱除邪气,肝郁则气血津液难以运行而气滞血瘀,瘀血不去则新血不生,气滞血瘀影响气血的生成。所以肝郁作为始动及影响因素参与了脑中风的发生发展全过程。基于以上,该文从肝郁理论深入探析脑中风的因机治法,以期为临床辨治提供理论依据。

Liver depression is one of the common pathogenic factors in clinical practice,and its pathogenic effects are mainly caused by the manifestation of Qi stagnation,and the occurrence of liver depression is related to long-term emotional abnormality.LAA type stroke is mainly a clinical syndrome characterized by the occurrence of major manifestations such as impaired consciousness,limb hemiplegia,facial palsy,aphasia due to stenosis and occlusion of large cerebral arteries leading to cerebral ischemia and hypoxia.The traditional Chinese medicine pathogenic factors of LAA type cerebral stroke are mainly fire,phlegm,stasis and deficiency,which is from Qi being Body Fluid General,Qi being blood General and Qi having Stasis is the theory of fire,and the formation of fire,phlegm and stasis is closely related to Qi stagnation.stagnation of Qi due to depression of the liver,Qi stagnation and chemical fire,fire evil corrodes blood flesh brain veins,stagnation of Qi due to depression of the liver,Qi stagnation then Body Fluid blood does not knot into phlegm stasis,phlegm stasis and stagnation choroid,damage blood veins,heart God,limb dystrophy appears limb disuse,skin irregularity,mouth and tongue skewing,and unfavorable speech.In the late stage of stroke,deficiency of Qi due to Qi deficiency needs to nourish the body to aid in its recovery,pathogenic factor is not necessary to remove pathogenic factor Qi by the operation of Qi and blood flow,while on liver depression it is difficult to run Qi and stagnation blood stasis,as said when stasis is not removed new blood does not occur,Qi stagnation and blood stasis affect the production of Qi and blood.So liver depression as a initiating factor is involved in the occurrence and development of cerebral stroke recovery process.Based on the above,the article deeply explores the mechanism and treatment of cerebral stroke from the theory of liver depression,in order to provide a theoretical basis for clinical differentiation.