基于固本培元论治小儿癫痫认知障碍

Treating Cognitive Impairment of Children with Epilepsy Based on Consolidating Basis and Cultivating Primordial Qi

'固本培元'理论中'固本'指通过采用益气健脾、补肾益精之法来兼顾先后天;'培元'指以培补人体元气为目的,通过激发人体各组织器官生理功能发挥抵御病邪的作用。癫痫患儿先天脾肾之精气禀赋不足,后天久病不愈、诸虚劳损,致使脾肾后天之精气亏损,精气未充则难以化生和充养脑髓,加之久病脾肾亏虚脏腑功能失调,风、惊、痰、瘀相互为患,最终导致脑髓受损,神机失用,发为认知障碍。从小儿癫痫认知障碍的中医病因病机入手,探讨固本培元理论论治小儿癫痫认知障碍的中医思路,即补肾以固先天之本、健脾以固后天之本,补脾益气、以固卫外,补肾益精、以充脑髓。具体治疗总以固本培元为主、以化痰祛瘀熄风为辅,常选黄芪、党参、熟地黄等培补脾肾,薏苡仁、茯苓、石菖蒲等祛痰,桃仁、红花、赤芍等化瘀,天麻、钩藤等熄风,并配合灵动性猛之虫药以平熄肝风、驱风定痫。

In the theory of'consolidating basis and cultivating primordial qi','consolidating basis'refers to the use of the method of benefiting qi and strengthening the spleen and replenishing the kidney and replenishing essence to take care of the innate and acquired essence;'cultivating primordial qi'refers to the purpose of cultivating and supplementing the body’s primordial qi by stimulating the physiological functions of organs of human body,so as to play a role in resisting disease and evil.In children with epilepsy,the innate spleen and kidney essence qi is not rich,and the acquired long-term illness is unhealed with the deficiency and fatigue,which leads to insufficient and damage of acquired essence qi of the spleen and kidney.The essence of the spleen and kidney is not enough to metabolize and replenish the brain and marrow,and the long-term illness causes depletion and deficiency of the spleen and kidney,and dysfunction of the zang-fu viscera.The wind,frighten,phlegm,and stasis are mutually inflicted,eventually leading to damage to the brain marrow,dysfunction of spiritual mechanism and become cognitive disorders.Starting from the pathogenesis of pediatric epilepsy cognitive impairment,this paper explored the traditional Chinese medicine thinking of consolidating basis and cultivating primordial qi theory in the treatment of cognitive impairment in children with epilepsy,that is,tonifying the kidney to consolidate the innate origin,and invigorating the spleen to consolidate the acquired origin,tonifying the spleen and benefiting qi to consolidate defensive qi,tonifying the spleen and benefiting essence to fill brain marrow.The specific treatment is mainly based on consolidating basis and cultivating primordial qi,supplemented by resolving phlegm,eliminating stasis and extinguish wind,and often chooses Huangqi(Radix Astragali seu Hedysari),Dangshen(Radix Codonopsis),Shudihuang(Radix Rehmanniae Preparata),etc.to cultivate and tonify the spleen and kidney,Yiyiren(Semen Coicis),Fuling(Poria),Shichangpu(Rhizoma Acori Tatarinowii),etc.to eliminate phlegm,Taoren(Semen Persicae),Honghua(Flos Carthami),Chishao(Radix Paeoniae Rubra),etc.to resolve the stasis,Tianma(Rhizoma Gastrodiae),Gouteng(Ramulus Uncariae Cum Uncis),etc.to extinguish the wind,and cooperate with insect medicinals with flexible and fierce nature to pacify the liver,extinguish wind,and drive the wind to relieve epilepsy.