| 引用本文: |
于子如, 张鹏, 王琪, 许军峰.基于“精成髓，髓充神”理论探讨血管性帕金森综合征认知功能障碍的核心病机和辨治思路[J].湖南中医药大学学报,2026,46(3):541-547[点击复制] |
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| 基于“精成髓，髓充神”理论探讨血管性帕金森综合征认知功能障碍的核心病机和辨治思路 |
| 于子如,张鹏,王琪,许军峰 |
| (天津中医药大学第一附属医院, 中国 天津 300381;中医国家临床医学研究中心, 中国 天津 300381;天津中医药大学, 中国 天津 301617) |
| 摘要: |
| 血管性帕金森综合征（VP）是由脑血管病变引发的继发性帕金森综合征，其中，认知功能障碍（CI）是VP的常见非运动症状。本文从“精”“髓”“神”的中医经典论述出发，概括出“精成髓，髓充神”的理论框架，并据此阐释了肾精化生脑髓，髓海充盈则元神得养、神机聪慧，反之则精亏髓减，髓海空虚而神衰智昏的生理病理关系。通过分析该理论与血管性帕金森综合征认知功能障碍（VP-CI）的关系，提出“精亏髓减，痰瘀阻窍，神机失用”为其核心病机，治疗以“填精益髓以固本、祛瘀化痰以畅枢、调和阴阳以复衡”为原则，旨在恢复髓海充养、神机清明。该理论框架为深化中医对VP-CI病机认识及优化临床诊疗策略提供依据。 |
| 关键词: 血管性帕金森综合征 认知功能障碍 精成髓 髓充神 理论框架 辨证论治 |
| DOI：10.3969/j.issn.1674-070X.2026.03.014 |
| 投稿时间：2025-09-23 |
| 基金项目:国家自然科学基金项目（82104995）；天津市教委科研计划项目（2022ZD045）；河北省中医药管理局科研计划项目（T2025091）；国家中医针灸临床医学研究中心开放课题（NCRCOP2024017）。 |
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| Core pathogenesis of cognitive impairment in vascular Parkinsonism and the differentiating and treating ideas: a perspective based on the theory of "essence generates marrow, marrow nourishes spirit" |
| YU Ziru, ZHANG Peng, WANG Qi, XU Junfeng |
| (First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China;National Clinical Research Center for Chinese Medicine, Tianjin 300381, China;Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China) |
| Abstract: |
| Vascular Parkinsonism (VP) is a secondary Parkinsonian syndrome caused by cerebrovascular lesions, among which cognitive impairment represents one of the most prevalent non-motor symptoms. Based on the classical TCM discussions on the essence, marrow, and spirit, this article synthesizes these insights into the theoretical framework of "essence generates marrow, marrow nourishes spirit." It further elaborates on the physiological and pathological relationships whereby kidney essence generates brain marrow: an abundant sea of marrow nourishes the primordial spirit and maintains mental clarity, whereas deficiency of essence leads to marrow depletion, resulting in an empty sea of marrow, decline of spirit, and cognitive deterioration. By analyzing the correlation between this theory and cognitive impairment in vascular Parkinsonism (VP-CI), this article proposes that its core pathogenesis lies in "essence deficiency and marrow depletion, phlegm-stasis obstruction of the orifices, and dysfunction of mental activity". Accordingly, the therapeutic principles should include tonifying essence and replenishing marrow to strengthen the root, removing stasis and resolving phlegm to unblock the pivotal pathways, and harmonizing yin and yang to restore equilibrium, aiming to restore the nourishment of the sea of marrow and the clarity of mental activity. This theoretical framework provides a basis for deepening the understanding of the TCM pathogenesis of VP-CI and for optimizing clinical diagnosis and treatment strategies. |
| Key words: vascular Parkinsonism cognitive impairment essence generates marrow marrow nourishes spirit theoretical framework treatment based on pattern identification |
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