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田好雨, 韩燕.构建脑小血管病“络脉-玄府-脑髓”分期辨治体系[J].湖南中医药大学学报英文版,2025,45(12):2401-2406.[Click to copy
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| 构建脑小血管病“络脉-玄府-脑髓”分期辨治体系 |
| 田好雨,韩燕 |
| (上海中医药大学附属岳阳中西医结合医院, 上海 200437) |
| 摘要: |
| 随着疾病谱的变化，以脑小血管病（CSVD）为代表的衰老性疾病日益影响公众健康，亟须吸纳新的辨治体系优化中医治疗策略。本文通过梳理中医微观辨证的核心内容，并借鉴循证医学证据和影像学指征，构建了具有分期治疗和中西医结合特色的“络脉-玄府-脑髓”辨治体系，并提出多维疾病认识论。该体系以“双玄失司，络伤髓损”为核心病机，将病程分为“气络受损，玄府郁闭”“双玄失司，血络不畅”“玄府不固，脑髓失用”三期，相应确立“理燮玄府，开阖得当”“气血分治，攻补兼施”的治疗大法，并对应采取“理气开玄”“和血通府”“填髓培元”的治则。本研究融合微观思路与整体辨治观，为中医药治疗CSVD提供了新视角。 |
| 关键词: 脑小血管病 络脉 玄府 脑髓 中西医结合 |
| DOI：10.3969/j.issn.1674-070X.2025.12.023 |
| Received:June 21, 2025 |
| 基金项目:国家自然科学基金项目（82274304），国家重点研发计划项目（2019YFC1711603），上海申康医院发展中心三年行动计划项目（SHDC2020CR2046B）。 |
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| Construction of a staged differentiation and treatment system for cerebral small vessel disease based on the theory of "collaterals-mysterious mansion-brain marrow" |
| TIAN Haoyu, HAN Yan |
| (Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China) |
| Abstract: |
| As the disease spectrum evolves, aging-related diseases, represented by cerebral small vessel disease (CSVD), are increasingly affecting public health, making it urgent to incorporate new differentiation and treatment systems to optimize TCM therapeutic strategies. This paper, by reviewing the core elements of TCM micro-pattern differentiation and incorporating evidence-based medical findings and imaging indicators, constructs a "collaterals-mysterious mansion-brain marrow" differentiation and treatment system characterized by staged therapy and integrated Chinese-Western medicine approaches. It also proposes a multidimensional disease epistemology. This system identifies "dual-mysterious mansion dysfunction and collateral injury with marrow damage" as its core pathogenesis, dividing the disease course into three stages, namely, "qi-collateral impairment with mysterious mansion obstruction," "dual-mysterious mansion dysfunction with blood-collateral obstruction," and "mysterious mansion instability with brain marrow dysfunction." Correspondingly, therapeutic methods of "regulating mysterious mansion to restore proper opening-closing balance," and "treating qi and blood separately with a combination of tonifying and dispersing" are established, with specific treatment principles including "regulating qi to open mysterious mansion," "harmonizing blood to unblock mysterious mansion," and "replenishing marrow and reinforcing yuan-primordial qi." This study integrates micro-level analysis with holistic TCM pattern differentiation, offering a novel perspective for TCM treatment of CSVD. |
| Key words: cerebral small vessel disease collaterals mysterious mansion brain marrow integrated Chinese and Western medicine |
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