基于開闔樞理論辨治自主神經(jīng)疾病

周德生　譚惠中

〔摘要〕 開闔樞理論是中醫(yī)基礎理論的組成部分。以三陰三陽分開闔樞，自主神經(jīng)功能與經(jīng)脈臟腑氣化的開闔樞功能表現(xiàn)類似。開闔樞理論總結了疾病特殊的傳變規(guī)律，可以指導自主神經(jīng)疾病的臨床辨治。通過神經(jīng)源性體位性低血壓、頭部多汗癥、自主神經(jīng)功能不全、術后自主神經(jīng)功能障礙、交感神經(jīng)型頸椎病5個醫(yī)案，闡述自主神經(jīng)疾病的病機特征為樞機障礙，神機失用;開闔樞同病，而表現(xiàn)為偏于開折、闔折、樞折狀態(tài)。治療上必須著眼氣化，整體燮理，邪正兼顧;調(diào)理法包括身心調(diào)理、飲食調(diào)理、方藥調(diào)理之類，并加強及時有效的對癥治療。方藥調(diào)理治療的關鍵點在于養(yǎng)神安神、疏通經(jīng)隧、雙向調(diào)節(jié)、整體燮理，才能樞轉(zhuǎn)神機。

〔關鍵詞〕 自主神經(jīng)疾病;自主神經(jīng)功能障礙;開闔樞理論;樞轉(zhuǎn)神機

〔中圖分類號〕R259;R74? ? ? ?〔文獻標志碼〕A? ? ? ?〔文章編號〕doi：10.3969/j.issn.1674-070X.2019.09.001

Diagnosis and Treatment of Autonomic Nervous Diseases Based on Kaiheshu Theory and Encephalopathy in Traditional Chinese Medicine and Clinical Empirical Study （IX）

ZHOU Desheng1， TAN Huizhong2*

（1. Department of Neurology， The First Hospital of Hunan University of Chinese Medicine， Changsha， Hunan 410007， China;

2. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China）

〔Abstract〕 Kaiheshu theory is an integral part of the basic theory of traditional Chinese medicine. Classify the Kaiheshu according to three Yin and three Yang. The function of autonomic nervous function is similar to that of the Kaiheshu in Qi transformation of meridians and viscera. The Kaiheshu theory summarizes special laws of disease transmission and can guide clinical diagnosis and treatment of autonomic nervous diseases. This paper describes characteristics of pathogenesis in autonomic nervous diseases through 5 cases of neurogenic orthostatic hypotension， head hyperhidrosis， autonomic dysfunction， postoperative autonomic dysfunction， and sympathetic cervical spondylosis. The characteristics are pivot mechanism disorder and spiritual mechanism dysfunction; and if disease involves Kaiheshu， the manifestation tends to the state of Kaizhe， Hezhe， or Shuzhe. The treatment must focus on Qi transformation， overall treatment， and taking both evil and healthy qi into consideration. The methods include physical and mental regulation， diet regulation， prescription regulation， and strengthening timely and effective symptomatic treatment. The key point of prescription regulation is nourishing the spirit and tranquilization， dredging channels， two-way adjustment， and overall treatment， in order to pivot spiritual mechanism.

〔Keywords〕 autonomic nervous disease; autonomic dysfunction; Kaiheshu theory; pivoting spiritual mechanism

自主神經(jīng)系統(tǒng)由交感神經(jīng)系統(tǒng)和副交感神經(jīng)系統(tǒng)組成，既拮抗又協(xié)調(diào)的調(diào)節(jié)內(nèi)臟和血管平滑肌、心肌和腺體的機能活動，在維持機體內(nèi)穩(wěn)態(tài)及保持緊張性效應、應激反應、情緒調(diào)控等方面起主要作用。自主神經(jīng)系統(tǒng)幾乎參與所有疾病的發(fā)生、發(fā)展、表現(xiàn)，各系統(tǒng)疾病或多或少伴有自主神經(jīng)功能障礙。自主神經(jīng)疾病以自主神經(jīng)受累為主，主要包括自主神經(jīng)功能不全、暈厥、反射性軀體神經(jīng)病、雷諾病、原發(fā)性直立性低血壓、神經(jīng)血管性水腫、出汗異常、紅斑性肢痛癥、內(nèi)臟疼痛、偏側萎縮癥、交感神經(jīng)鏈綜合征、間腦疾病等等[1]。……