脑卒中的中医传统病机分析

脑卒中(缺血及出血)归属于中医中风范畴,迄今认为"风、火、痰、气、瘀、虚"为其病因病机,其中"风、火"是发病的关键始动因素。通过按时相次序及因果关系分析,笔者发现:卒中发病在先,是因;"风、火"出现在后,是果。与其他脏器的血栓栓塞性、出血性疾病的平行比较,提示脑卒中后之所以出现"风"证候是由其自身生理特点所决定。根据《内经》,提出脑卒中的病理是:脏腑经遂(脉)受病,"痰瘀故邪"或血内溢(瘀血),耗损脏腑气血,损伤脏神;肝神损伤致半身不遂、口眼歪斜等卒中症状,肝血、阴损伤或心包使道为故邪所闭而致火郁则导致"风、火"证候。

Analyzing the Chinese Medicine Pathogenesis of Stroke

Both ischemic and hemorrhage stroke pertain to the category of wind stroke in Chinese medicine(CM).Up to date,it is deemed that the etiology and pathogenesis of wind stroke are wind,fire,sputum,qi,stasis,and deficiency.Among them,it is regarded that wind and fire are the key factors triggering wind stroke.By analyzing the time order and causality,it is found that wind stroke is prior to the onset of wind and fire,wind and fire are the secondary outcomes of wind stroke.By parallel comparing stroke with thromboembolism and hemorrhagic diseases in other Zang-organs,it can be comprehended that the reason why wind symptoms appear in stroke is due to its physiological feature of brain itself.Based on Neijing,the pathogenesis of wind stroke is proposed as follows.Tunnels of viscera(vessels) get lesions.The old pathogenic factors of sputum and stasis or the stasis formed by bleeding inside viscera consume qi,and blood of viscera and damage the spirits hidden in them.The damage of Gan-spirit causes symptoms of stroke,such as hemiplegia,deviation of eyes and mouth,and so on.Wind and fire symptoms are caused by the injury of Gan blood and yin,and/or the stagnation of fire in pericardium(the pathway organ) due to obstruction by old pathogenic factors and stasis(formed by bleeding).