基于“火与元气不两立”论治缺血性中风

Treatment of ischemic stroke based on "fire and original qi incompatibility"

李东垣在《脾胃论》中提出“火与元气不两立”理论,阐述了阴火与元气相互克伐、一胜一负的关系。元气与阴火的盛衰变化在缺血性中风的发生、发展过程中具有重要意义。机体元气亏虚,阴火炽盛于内,致内风旋动,直冲犯脑而发为中风,故阴火内盛为缺血性中风急性期的病机关键,该时期的阴火主要以火热、痰瘀等实火为表现形式;随着疾病进一步发展,阴火之势渐颓,实火渐消,虚火渐显,虽标实之证未尽,然而,元气亏虚才是中风恢复期及后遗症期病机的重中之重。基于此,提出泻阴火、补元气的治疗原则,根据不同时期病机的不同侧重点,选择相应的治疗方法。急性期重在泻阴火之实,阴火泻除则元气得护;恢复期及后遗症期当首补元气,补肾以充元气,元气充盈则阴火自敛。同时,还应通过辨证论治佐以其他治法提高疗效。本文基于“火与元气不两立”理论对缺血性中风的病机及治法进行相关探讨,以期为缺血性中风的临床治疗提供新思路。

Li Dongyuan proposed the theory of"fire and original qi incompatibility"in his book Piwei Lun,expounding the incompatible relationship between yin fire and original qi.They restrain and overcome each other.The rise and fall of original qi and yin fire is of great significance in the occurrence and development of ischemic stroke.When the original qi of the body is deficient and the yin fire is blazing in the interior,the internal wind moves and rushes straight to the brain to cause stroke.The key pathogenesis of ischemic stroke in the acute period is the excessive internal accumulation of yin fire,which is primarily manifested as fire-heat,phlegm stasis,and other excess syndromes during this period.As the disease progresses,the trend of yin fire gradually declines,the excess fire dies down,and deficiency fire gradually appears.Although the syndrome of excess has not disappeared,the deficiency of original qi is the most important pathogenesis in the recovery period and sequelae phase after ischemic stroke.Based on this,our team proposed the therapeutic principle of purging yin fire and tonifying original qi.According to the different pathogenesis focuses in different periods,the appropriate treatment method should be selected.In the acute period of ischemic stroke,the emphasis is on purging the excess yin fire,and the original qi will be protected when the yin fire is purged.In the recovery and sequelae periods,the original qi should be mainly tonified,and the kidney should be replenished to tonify the original qi.When original qi is abundant,yin fire will be restrained.At the same time,other treatment method should also be combined according to the syndrome differentiation to improve the therapeutic effect.This article explores the pathogenesis and treatment of ischemic stroke based on the theory of"fire and original qi incompatibility",with the aim of providing new ideas for the clinical treatment of ischemic stroke.