如何准确把握祛邪与扶正在中风治疗中的应用

Application of Eliminating Pathogen and Reinforcing Healthy Qi in the Treatment of Stroke

中风发病急、病情重、变化快、症状多样化,乃多种因素夹杂而致,其发病过程有虚有实,实乃毒邪损伤脑络,虚乃气虚脑髓失养,其治疗不外乎祛邪与扶正。如何正确处理祛邪与扶正,如何恰当运用到中风治疗中是提高临床疗效的关键。中风始发痰瘀生毒、毒损脑络,毒邪炽盛,应先予以祛邪,解毒通络,结合不同证候要素或清热化痰、或化痰通腑;并提出将补气扶正治疗时点前移,以助祛邪;另不容忽视的是中风始发即出现正虚之象,治疗先补气扶正,后再兼祛邪;溶栓后破血耗气致气虚络脉瘀阻及气虚不能摄血而出血,治疗应益气化瘀通络和补气摄血护络;中风恢复期肾虚不容忽视,主要病机是络损髓伤,治疗需要重视补肾益髓护脑,改善中风后神经功能障碍。

Stroke characterized by acute onset,severe illness,rapid changes,and diverse symptoms is caused by a combination of diverse factors.According to the theory of traditional Chinese medicine,this disease is caused by brain collateral injury by toxin or failure of nourishment in the brain and marrow because of qi deficiency.Accordingly,the treatment methods include eliminating pathogen and reinforcing healthy qi.The key to improving clinical efficacy lies in how to properly eliminate pathogen and reinforce healthy qi in the treatment of stroke.At the beginning of a stroke,phlegm and stasis generate toxins,causing damage to the brain collaterals and exuberance of toxin and pathogen.Therefore,it is necessary to first eliminate the pathogen,detoxify,and dredge the collaterals.Considering different syndrome elements,the method of clearing heat to resolve phlegm or resolving phlegm to relax bowls can be adopted.Moreover,we suggest the early application of tonifying qi and reinforcing healthy qi to eliminate pathogen.Since the onset of stroke is a sign of healthy qi deficiency,the treatment should first replenish qi and reinforce healthy qi,and then eliminate pathogen.After thrombolysis,the consumption of blood and qi results in qi deficiency and collateral obstruction by stasis and sometimes bleeding caused by the failure of qi to control blood due to qi deficiency.Accordingly,the treatment should replenish qi and resolve stasis to dredge collaterals and tonify qi to control blood and protect collaterals.In the recovery phase,kidney deficiency caused by collateral and marrow injury should be treated by tonifying kidney,nourishing marrow,and protecting the brain,which can alleviate the neurological dysfunction after stroke.