经筋病中医病理机制理论探讨

目的:探讨中医经筋病理机制并探究外周经筋病理三期针刺方法。方法:从现代文献、《内经》结合临床实践进行研究。文献方面,从经筋理论临床运用、经筋理论病理研究、经筋实质等进行研究;在上述研究基础上,结合《内经》相关条文,提出对经筋实质指向与模型建构、经筋病理过程假说(分外周经筋病理与中枢经筋病理两大部分),并结合临床实践,对上述病理过程进行验证。结果:经筋临床运用方面主要集中在筋肉系统与神经系统,对经筋病理研究方面十分薄弱,经筋实质主要集中在筋肉系统学说、神经学说、神经筋肉统一学说等方面;而笔者提出的经筋实质:中枢经筋(手阳明经筋头部相交与足少阳经筋维筋相交)在脑内,为中枢神经系统的重要组成部分;外周经筋主要为筋肉系统;外周经筋病理三期过程即"瘀沫期""筋膜拘挛期""筋结病灶形成期"等假说,经临床验证有其合理性。对外周经筋病进行三期分治(瘀沫期采用毫针温针经脉压痛点针刺法、筋膜拘挛期采用小针刀与刺络放血减张法、筋结病灶形成期采用粗银质针温通"解结"法治疗)提高了临床疗效;中风病"中枢经筋"病理过程早期为"热毒水瘀"的"级联形成"与中后期"痰瘀水"胶结;中风病痉挛性运动障碍从经筋病理角度进行治疗主要有4个方面:①益气血、生髓充脑、温通经络;②通调跷脉;③温通督脉;④调理经筋——温通解结与神经干刺激法。结论:笔者提出的经筋实质假说与外周经筋病三期病理过程假说具有理论意义与临床现实意义,值得观注与进一步研究。

Investigation on Pathological Mechanism of Meridian Sinew Disease Theory of TCM

Objective ： To investigate the pathological mechanism of meridian sinew theory of TCM and the acupuncture treatment for the three phases of the pathology of external meridian sinew disease. Method： We studied the modern literature, Neijing and also combined clinical practice research. The article was about the clinical practice, the theoretical pathological studies and the studies of the essence of meridian sinew. We proposed the hypothesis about the essence of meridian sinew guidance, the model construction and the pathological process of meridian sinew on the basis of the studies above and the relevant provisions in Neijing which was divided into two parts： peripheral and central ones. And then we verified the pathological process combined with the clinical practice. Results ： The clinical applications of meridian sinew are mainly concentrated in the muscular system and nervous system. Researches on the meridian sinew pathology are quite limited. There were several major aspects about the essence of meridian sinew： the muscular system theory, the nervous system theory, the nervous-muscle theory. The theory of the essence of meridian sinew, the author theorized, is that the central nervous- meridian sinew system is in the brain （ the meridian sinew of hand yangming intercrossed on the head, the meridian sinew of foot shaoyang intercrossed in Weijing ）, which is an important part of the central nervous system. External meridian sinew mainly is the the muscular system. The three phases of the pathology of external meridian sinew disease is the hypothesis of blood stasis-mo period, spasm of the fascia period, formation period of Tendon junction lesion and it is proved by the clinical practice. It can improve the therapeutic effect through the three phases of the pathology of external meridian sinew disease （ during the blood stasis-mo period, we use warm acupuncture to treat tenderness point ; during the spasm of the fascia period, we use acupotomology combined with stabbed collaterals bloodletting reduction; and it is treated by warm thick silver needle during the formation period of Tendon junction lesion ）. The early pathological process of stroke about the central nervous system is the formation of toxic heat and water stasis and phlegm, stasis and water twisted together in the late. There are four trentment methords about the spastic movement disorders of stroke from the perspective of the pathological mechanism of meridian sinew： （1）Tonify qi and blood, generate raw to fill brain, warming meridian and collateral; （2）Drain heel vessel; （3）Warming the governor vessel; （4）Regulate meridian regions warming and dismiss the stasis and nerve trunk stimulation. Conclusion ： The essence of meridian sinew hypothesis and the three phases of pathological process of peripheral meridian sinew are both with theoretical significance and clinical practical significance, and we could conduct further studies on this subject.