| 引用本文: |
黄赫, 高晓峰.从“阳虚三夺统于脾”理论探析缺血性中风的中医诊治策略[J].湖南中医药大学学报,2026,46(8):1699-1705[点击复制] |
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| 从“阳虚三夺统于脾”理论探析缺血性中风的中医诊治策略 |
| 黄赫,高晓峰 |
| (湖南中医药大学第一附属医院, 湖南 长沙 410007;湖南中医药大学, 湖南 长沙 410208) |
| 摘要: |
| 缺血性中风（IS）是临床常见的神经系统疾病，近年来其发病率逐年上升，且预后较差。明代医家汪绮石在《理虚元鉴·阳虚三夺统于脾》中提出“阳虚三夺统于脾”的理论，从脾虚所致的夺气、夺精、夺火切入，阐释中风由气、精、火演变的病机过程，指出“脾虚夺气为发病证机肇始”“脾虚夺精为发病病进之源”“脾虚夺火为发病终末环节”，并认为“浊邪内伏、脑络失畅为病情迁延之变”。针对上述病机，确立相应治则：若见夺气之证，则当“健脾益气，升清举陷，培正虚之基”；若见夺精之证，则当“脾肾兼济，固精培元，截传变之势”；若见夺火之证，则当“温煦脾肾，散寒通阳，疗阳虚之本”。此外，针对津血运行失衡引发的浊邪积聚之证，当“理脾泻浊，柔筋通络，除痼疾之标”。上述治法应用于临床诊疗实践，以期为IS的防治拓宽思路。 |
| 关键词: 缺血性中风|阳虚三夺统于脾|夺精|夺气|夺火|健脾|温阳 |
| DOI：10.3969/j.issn.1674-070X.2026.08.024 |
| 投稿时间：2026-04-22 |
| 基金项目:湖南省自然科学基金项目（2025JJ80981）；湖南中医药大学校院联合基金项目（2024XYLH358）。 |
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| TCM diagnosis and treatment strategies for ischemic stroke based on the theory of “yang deficiency with three depletions governed by the spleen” |
| HUANG He, GAO Xiaofeng |
| (The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China;Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| Ischemic stroke (IS) is a common neurological disease in clinical practice, with an increasing incidence and a generally poor prognosis in recent years. In Li Xu Yuan Jian (Primary Mirror of Rectifying Deficiency), WANG Qishi, a physician of the Ming Dynasty, proposed the theory of “yang deficiency with three depletions governed by the spleen" (Yang Xu San Duo Tong Yu Pi). From the perspective that the three depletions of qi, essence, and fire are all governed by the spleen, this theory was adopted to interpret the pathogenesis of stroke as a progressive process involving qi, essence, and fire. It points out that "qi depletion due to spleen deficiency is the initiation of the pathogenic mechanism", "essence depletion due to spleen deficiency is the source of disease progression", and "fire depletion due to spleen deficiency is the terminal stage of disease development", and further holds that "the internal retention of turbid pathogenic factors and impaired circulation in the cerebral collaterals contribute to the persistence and prolonged course of the disease". Corresponding therapeutic principles were established based on the above pathogenesis. For qi depletion, treatment should focus on "strengthening the spleen and tonifying qi, elevating clear yang and uplifting sunken qi, and strengthening the foundation of healthy qi". For essence depletion, treatment should aim to "regulate and supplement the spleen and kidney, strengthen the body's foundation and replenish its vital energy, and prevent further disease transmission and progression". For fire depletion, treatment should involve "warming and nourishing the spleen and kidney, dissipating cold and promoting the circulation of yang qi, and addressing the root of yang deficiency". In addition, for the pattern characterized by the accumulation of turbid pathogenic factors induced by disordered circulation of body fluids and blood, therapy should focus on "regulating the spleen and purging turbidity, softening sinews and unblocking collaterals, and eliminating the manifestations of this persistent disease". These therapeutic methods have been applied in clinical diagnosis and treatment, with the aim of providing new ideas for the prevention and treatment of IS. |
| Key words: ischemic stroke|yang deficiency with three depletions governed by the spleen|essence depletion|qi depletion|fire depletion|strengthening the spleen|warming yang |
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