基于“热毒理论”探讨“血热”“热毒”病机在中风急性期的演变规律

Exploration of the Evolution of the Pathogenesis of“Blood Heat”and“Heat-Toxin”in the Acute Stage of Stroke Based on the“Heat-Toxin Theory”

梳理中风病机的发展过程,历代医家从外风、内风、内伤积损角度整体把握中风病机,近代以来随着王永炎院士提出“毒损脑络”概念,将中风的病机直指“毒”对脑血管的损伤,越来越多的学者开始注意到非风病机对大脑造成的器质性损伤。中风本质在于脑血管损伤,血热证亦是中医卫气营血辨证论治体系下的血分病变,所以文章试从“血热”“热毒”这一非风角度着手,梳理血热、热毒病机在中风急性期的演变规律,探究中风急性期脑血管器质性损伤的发生发展机制与中医“热毒理论”的潜在关联。西医对中风的研究围绕炎症反应、动脉粥样硬化斑块、神经元及内皮细胞损伤等方面展开微体研究,现代病理学中各种病理机制最终产生的细胞毒性、神经毒性的结局与中医血热、热毒的病机发展之间具有共通性。另外具有清热解毒功效的中药制剂如安宫牛黄丸、清开灵注射液、醒脑静注射液在临床运用广泛,也证实基于“热毒理论”的清热解毒法对于中风急性期大脑微环境的改善具有积极作用。

To sort out the development process of the pathogenesis of stroke,physicians of the past dynasties have grasped the pathogenesis of stroke from the perspective of external wind,internal wind,and internal injury accumulation.More and more scholars have begun to pay attention to the organic damage to the brain caused by non-wind pathogens.The essence of stroke is cerebrovascular injury,and blood heat syndrome is also a blood disorder under the TCM system of syndrome differentiation and treatment of Wei,Qi,Ying and Blood.Therefore,this article attempts to sort out blood heat and heat toxicity from the nonwind perspective of“blood heat”and“heat toxicity”.The pathogenesis in the acute phase of stroke,and the potential relationship between the occurrence and development mechanism of cerebrovascular organic damage in the acute phase of stroke and the“heat-toxin theory”of traditional Chinese medicine.The research on stroke in Western medicine focuses on micro-body research on inflammatory response,atherosclerotic plaque,neuron and endothelial cell damage,etc.The results of cytotoxicity and neurotoxicity ultimately produced by various pathological mechanisms in modern pathology are related to the pathogenesis and development of blood heat and heat-toxin in traditional Chinese medicine.In addition,traditional Chinese medicine preparations with heat-clearing and detoxifying effects,such as Angong Niuhuang Pills(安宫牛黄丸),Qingkailing Injection(清开灵注射液),and Xingnaojing Injection(醒脑静注射液),are widely used in clinical practice.It is confirmed that the heat-clearing and detoxifying treatment based on the“heat-toxin theory”has a positive effect on the improvement of the brain microenvironment in the acute stage of stroke.