基于脑玄府理论探讨中药引经及配伍思路

Based on The Theory of Naoxuanfu to Explore Thinking of Chinese Medicine Introduction And Compatibility

自刘河间提出玄微之府的概念后,玄府理论得到加速发展,尤其随着现代人体解剖生理的微观认识,对于玄府的微观解剖更偏向于细胞间隙、离子通道等具有腔隙性、孔、门等的通道结构,发挥其血管内外液体、信息、能量交换、排出代谢废物及维持器官正常运转的功能。玄府是气机运转的结构基础,也是体内气液交换的中心环节。而脑作为元神之府,总领五脏之神,脑玄府开阖功能正常是脑内气血津液流通的中心环节,也是大脑发挥正常生理功能的结构基础,若脑玄府开阖不利、气机不畅,则气血津液的输布异常,影响正常的气-液等物质信息的交换,使元神失养,神机失用,最终导致神志、情感等方面的异常。治疗时应注重开通脑玄府,通畅玄府内外气液交换,恢复玄府气机,从而达到治疗脑病的效果。现阶段西药治疗诸多脑病亟需解决血脑屏障对药物外排的问题、提高药物入脑的有效浓度。脑玄府的结构与功能类似于血脑屏障,中医药的芳香开窍药和风药能归经入脑开通脑玄府,作为脑引经药与他药配伍时,能引领药物入脑恢复脑玄府气机、增强药物对脑病的治疗作用。平肝息风药、虫类药、补益药、清热解毒药、利水渗湿药能对证治疗风、痰、瘀、虚、毒、湿等病理因素,与脑引经药配伍使用,能随引药开玄入脑,增强治疗的有效浓度,从而增强药效,治疗脑病。

Since LIU Hejian proposed the concept of sweat pore,the theory of sweat pore has experienced accelerated development.Especially with the advances in modern human anatomy and physiology,the microscopic anatomy of sweat pore begins to focus on the intercellular space,ion channels and other membranous space with channels,pores,doors,etc.,which exert the functions of exchanging fluid,information,and energy inside and outside blood vessels and discharging metabolic wastes so as to maintain the normal operation of organs.Therefore,sweat pore is the structural basis for the movement of Qi and the central link of Qi-fluid exchange in the body.The brain,as the house of original spirit,is in charge of the spirit of five Zang-organs.The brain sweat pore is pivotal for the circulation of Qi,blood,and fluid in the brain,and it is the structural basis for the normal physiological functions of the brain.The dysfunction of the brain sweat pore will cause the stagnation of Qi and the abnormal transport of blood and fluid.It will cause the abnormal exchange of Qi,liquid and other material and information,which fail to nourish the original spirt and cause the loss of vital activity,eventually leading to consciousness and emotion disorders.The treatment should focus on opening the brain sweat pore,smoothing the exchange of Qi and fluid inside and outside the pore,and restoring the Qi movement,so as to cure encephalopathy.At present,western medicine treatment of encephalopathy needs to solve the problem of drug efflux from the blood-brain barrier and improve the effective concentration of drugs into the brain.The structure and function of brain sweat pore is similar to those of the blood-brain barrier.The aromatic resuscitative medicines and wind-extinguishing medicines can open the brain sweat pore.When being combined with other medicines,they can lead the medicine to enter the brain to restore the Qi movement of the brain sweat pore and enhance the therapeutic effect.Liver-pacifying wind-extinguishing medicines,insect medicines,tonifying medicines,heat-clearing toxin-removing medicines,and damp-draining medicines can treat pathological factors such as wind,phlegm,stasis,deficiency,toxin,and dampness,respectively.These medicines,combined with the medicines with the tropism to brain meridians,can open the brain sweat pore and guide the medicine into the brain to enhance the effective concentration of the medicine,thereby enhancing the efficacy against encephalopathy.