基于“火与元气不两立”辨证论治脑卒中后疲劳

Treatment based on syndrome differentiation of post-stroke fatigue based on“fire and primordial qi incompatibility”

脑卒中后疲劳是脑卒中常见并发症,患者持续性主观疲惫感影响康复训练进程,导致整体康复疗效不佳,严重影响恢复期患者的日常生活能力和生活质量。脑卒中后疲劳在中医属于虚劳范畴,“火与元气不两立”与脑卒中后疲劳的反复发作和加重关系密切。李东垣认为脾胃为元气之本,脾胃元气亏虚为其病机之本,阴火独胜为其致病关键,脑卒中后疲劳患者脾胃元气亏虚、阴火内生,临床表现为整体虚劳。以补益脾胃元气、升举阳气和泻除阴火为治则,选用补脾胃泻阴火升阳汤、升阳散火汤和补中益气汤等治疗脑卒中后疲劳,可降低患者复发率,利于其完成康复训练,并提高生活质量。

Post-stroke fatigue is common complication of stroke,and persistent subjective fatigue in patients affects rehabilitation training process,leading to poor overall rehabilitation efficacy and seriously affecting daily living ability and quality of life of patients in recovery period.Post-stroke fatigue belongs to category of deficiency and fatigue in traditional Chinese medicine,“fire and primordial qi incompatibility”is closely related to repeated attacks and aggravation of post-stroke fatigue.Li Dongyuan believes that spleen and stomach are the foundation of vital energy,the deficiency of vital energy of spleen and stomach is the foundation of its pathogenesis,and the dominance of yin and fire is the key to its pathogenesis.Patients with post-stroke fatigue suffer from spleen and stomach qi deficiency and internal yin fire generation,clinically manifested as overall deficiency and fatigue.Based on the principles of nourishing spleen and stomach,promoting yang qi and eliminating yin fire,the use of Bupiwei Xieyinhuo Shengyang Decoction,Shengyang Sanhuo Decoction,and Buzhong Yiqi Decoction can reduce recurrence rate of post-stroke fatigue,facilitate the completion of rehabilitation training,and improve quality of life.