张伯礼教授“以平为期”辨治烟雾病临证思路

Professor ZHANG Boli’s clinical thinking in treating moyamoya disease based on the theory of “aim for balance”

关键词:  烟雾病  以平为期  名医经验  张伯礼

Key words:  moyamoya disease  aim for balance  famous physician’s experience  ZHANG Boli

摘要:

张伯礼教授基于烟雾病脑底代偿血管网脆弱且易破裂出血的疾病特点，将“以平为期”思想贯穿治疗始终，择药以“平和”为善，组方以“中和”为贵。辨治法效中风，重视“瘀、痰、亢、虚”之四端，其虽会随病程阶段的不同而各有侧重，但总体病机演变本于正虚不足，重于痰瘀胶结，危于肝阳暴亢。临证擅于气血合治，以益气活血、理气行血为先，慎用破血逐瘀之品；治痰重在辨舌，以把握用药层次、分度，因势利导以分消其势；若久病入络、窠囊难除，酌以虫类之品通达络脉；在重镇潜阳的同时，兼顾疏、柔两法，形神并调，遂肝性而不悖；先后天以涵养、颐养为主，固护胃气以助药力发挥。

Abstract:

Moyamoya disease(MMD) is characterized by the fragile compensatory collateral circulation of the skull base that is prone to rupture and hemorrhage. Under the guidance of the theory of "aim for balance",herbs with mild properties are the preferred choice. Through the proper compatibility between herbs,a tendency towards balance of the overall effect of the decoction is equally expected. By analogy with stroke,the four syndrome elements of phlegm,blood stasis,liver-yang hyperthyroidism and deficiency are important in syndrome differentiation and treatment. Although the above syndrome elements may have different emphasis with the different stages of the disease,the overall pathogenesis of traditional Chinese medicine follows the following rules:the deficiency syndrome is the basis,the mutual accumulation of phlegm and blood stasis leads to the progress,and the hyperthyroidism of liver-yang leads to the critical condition. The treatment should take into account both qi and blood,such as tonifying qi and activating blood circulation,regulating qi and promoting blood circulation,but herbs with strong activity of activating blood circulation and removing blood stasis should be used with caution. For the treatment of phlegm syndrome,tongue diagnosis is helpful to use herbs accurately according to the development trend of the disease. When the chronic course causes the pathogenic factors to enter the collaterals,the appropriate application of medicinal insects can dredge the collaterals. In the treatment of suppressing the hyperthyroidism of liver-yang,the method of soothing should also be considered,and it is expected to comply with the physiological characteristics of the liver by regulating the body and spirit. While supplementing the congenital and acquired foundation,it is also necessary to protect the stomach qi to enhance the therapeutic effect.