| 引用本文: |
吴艳萍, 彭思杰, 廖星雨, 廖君鹏, 汪锦燕, 石星宇, 邓方方, 杨沛群.从“久病入络”理论探讨虫类药治疗顽固性三叉神经痛[J].湖南中医药大学学报,2026,46(9):1872-1878[点击复制] |
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| 从“久病入络”理论探讨虫类药治疗顽固性三叉神经痛 |
| 吴艳萍,彭思杰,廖星雨,廖君鹏,汪锦燕,石星宇,邓方方,杨沛群 |
| (广州中医药大学, 广东 广州 510006;广州市中西医结合医院, 广东 广州 510800) |
| 摘要: |
| 顽固性三叉神经痛（TN）病程迁延、反复发作，部分患者存在药物疗效不稳定、长期用药耐受性差或病情复发等问题。清代医家叶天士提出的“久病入络”理论，为认识本病迁延难愈的病机演变提供了理论依据。本文梳理该理论源流与内涵，结合TN疼痛剧烈、触发敏感、反复发作的临床特点，提出“风、痰、瘀互结，络脉痹阻”为其顽固性阶段的核心病机，正虚邪恋为迁延难愈的重要转归，形成“不通则痛”与“不荣则痛”并见的病机特点，并概括为“风邪袭络→痰瘀互结→络脉痹阻→正虚邪恋”的演进规律。在此基础上，归纳前贤运用虫类药治疗TN的经验，阐释其走窜搜剔、通络止痛的传统功用；结合现代药理研究，分析虫类药镇痛、抗炎、改善微循环及神经调节效应与神经病理性疼痛机制的潜在关联；围绕辨证要点、分期论治及虫类药配伍原则，依据病程、证候组合、疼痛性质、触发特点、舌脉变化及既往治疗反应，构建“初期阶段-发展阶段-顽固性阶段”三期辨治框架。附验案一则，以佐证上述辨治思路。 |
| 关键词: 顽固性三叉神经痛|久病入络|虫类药|通络止痛|风痰瘀互结|分期辨治 |
| DOI：10.3969/j.issn.1674-070X.2026.09.017 |
| 投稿时间：2026-04-18 |
| 基金项目:国家中医药管理局全国基层名老中医药专家传承工作室建设项目(国中医药人教函[2024]256号);广东省中医药局科研项目(20251295)。 |
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| Treatment of refractory trigeminal neuralgia with insect-based medicines based on the theory of “long-term illness entering collaterals” |
| WU Yanping, PENG Sijie, LIAO Xingyu, LIAO Junpeng, WANG Jinyan, SHI Xingyu, DENG Fangfang, YANG Peiqun |
| (Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China;Guangzhou Hospital of Integrated Chinese and Western Medicine, Guangzhou, Guangdong 510800, China) |
| Abstract: |
| Refractory trigeminal neuralgia (TN) is characterized by a prolonged disease course and recurrent attacks. Some patients experience unstable therapeutic efficacy, poor tolerance to long-term medication, or disease recurrence. The theory of "long-term illness entering collaterals" proposed by the Qing Dynasty physician YE Tianshi provides a theoretical basis for understanding the evolution of the pathogenesis of this prolonged and refractory disease. This paper reviews the origin, development, and connotation of this theory. Combining the clinical characteristics of TN, including severe pain, hypersensitivity to triggers, and recurrent attacks, it proposes that the core pathogenesis in its refractory stage involves "the intertwining of wind, phlegm, and blood stasis, leading to obstruction of the collaterals", while healthy qi deficiency with lingering pathogenic factors constitutes an important mechanism underlying its chronic and refractory course. Thus, both "pain due to obstruction" and "pain due to malnourishment" coexist in the pathogenesis, which can be summarized as the evolutionary pattern of "wind pathogen attacking collaterals→intertwining of phlegm and blood stasis→obstruction and stagnation of collaterals→healthy qi deficiency with lingering pathogenic factors." Based on this, the experience of previous physicians in using insect-based medicines for TN is summarized, with emphasis on their traditional functions of penetrating and unblocking collaterals, searching out and eliminating pathological obstructions, and relieving pain. Combined with modern pharmacological studies, potential associations between the analgesic, anti-inflammatory, microcirculation-improving, and neuromodulatory effects of these drugs and the mechanisms underlying neuropathic pain are analyzed. Centering on key points of pattern identification, staged treatment, and compatibility principles of insect-based medicines, a three-stage framework for differentiating and treatment, comprising the "initial stage, development stage, and refractory stage" is established based on disease duration, pattern combinations, pain characteristics, trigger features, tongue and pulse conditions, and previous treatment responses. A verified medical record is presented to support the proposed diagnostic and therapeutic approach. |
| Key words: refractory trigeminal neuralgia|long-term illness entering collaterals|insect-based medicines|unblocking collaterals to relieve pain|intertwining of wind,phlegm,and blood stasis|stage-based differentiation and treatment |
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