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基于《伤寒论》“阳微结”理论阐述的“阳虚、阳郁、阴结、阳亢”病机，提出耐药性癫痫以阳气虚损为发病基础，阳气郁滞是其发展的关键病机，阳亢风动导致其反复发作，阳虚阴结则形成其病理产物。据此提出调阳法为核心辨治思路，癫痫发作期治以潜阳熄风、平肝抑阳；癫痫发作间期治以通阳化浊、和解开郁；同时将固护阳气、温阳化气、燮理阴阳贯穿全程治疗，为临床治疗耐药性癫痫提供思路。
Abstract：Based on the pathogenesis of "yang deficiency, yang stagnation, yin obstruction, and yang hyperactivity" elaborated in the concept of "Yang Wei Jie(mild yang stagnation)" from the Treatise on Cold Damage Diseases （《伤寒论》）, this paper proposed that for drug-resistant epilepsy, deficiency of yang-qi is the pathological basis of its onset; stagnation of yang-qi is the key pathogenesis of its progression; yang hyperactivity leading to wind stirring causes its recurrent attacks; and yang deficiency with yin obstruction forms its pathological factors. Accordingly, the yang-regulating method was put forward as the core thought for syndrome differentiation and treatment. During the seizure phase of epilepsy, the treatment focuses on subduing yang and extinguishing wind, and calm the liver to suppress yang; during the interictal phase, the treatment emphasizes activating yang to resolve turbidity, and harmonizing to dissipate stagnancy. Meanwhile, protecting yang-qi, warming yang to transform qi, and regulating yin-yang are integrated throughout the entire treatment process, providing a reference for the clinical treatment of drug-resistant epilepsy.
[1]FISHER RS, ACEVEDO C, ARZIMANOGLOU A, et al.ILAE official report:a practical clinical definition of epilepsy[J]. Epilepsia, 2014, 55(4):475-482.
[2]KWAN P, ARZIMANOGLOU A, BERG AT, et al. Definition of drug resistant epilepsy:consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies[J]. Epilepsia, 2010, 51(6):1069-1077.
[3]AUVIN S, GALANOPOULOU AS, MOSHéSL, et al.Revisiting the concept of drug-resistant epilepsy:a TASK1report of the ILAE/AES Joint Translational Task Force[J].Epilepsia, 2023, 64(11):2891-2908.
[4]中华医学会神经病学分会，中华医学会神经病学分会脑电图与癫痫学组.抗癫痫发作药物联合使用中国专家共识[J].中华神经科杂志，2024, 57(2):108-117.
[5]付伶俐，惠波波，张晓乐，等.中医药治疗难治性癫痫研究进展[J].河北中医，2023,45(7):1227-1232.
[6]聂莉媛，王潇慧，张青，等.柴贝止痫汤加减联合抗癫痫药物治疗难治性癫痫痰气郁滞证70例对照研究[J].中医杂志，2019,60(18):1572-1577.
[7]KOTHUR K, BANDODKAR S, WIENHOLT L, et al.Etiology is the key determinant of neuroinflammation in epilepsy:elevation of cerebrospinal fluid cytokines and chemokines in febrile infection-related epilepsy syndrome and febrile status epilepticus[J]. Epilepsia, 2019, 60(8):1678-1688.
[8]PORTER BE. Neurogenesis and epilepsy in the developing brain[J]. Epilepsia, 2008, 49(Suppl 5):50-54.
[9]李静波.白金丸治疗多药耐药难治性癫痫的基础与临床研究[D].南京：南京中医药大学，2024.
[10]PERUCCA E, PERUCCA P, WHITE HS, et al. Drug resistance in epilepsy[J]. Lancet Neurol, 2023, 22(8):723-734.
[11]SILLS GJ, ROGAWSKI MA. Mechanisms of action of currently used antiseizure drugs[J]. Neuropharmacology,2020, 168:107966. doi:10. 1016/j. neuropharm. 2020.107966.
[12]ABOU KAOUD M, NISSAN R, SEGEV A, et al. Levetiracetam interaction with direct oral anticoagulants:a pharmacovigilance study[J]. CNS drugs, 2023,37(12):1111-1121.
[13]HUANG N, HUANG Y, DENG Z, et al. Blood-brain barrier dysfunction in epilepsy:mechanisms, therapeutic strategies and future orientation[J]. Int J Mol Med,2025,56(3):136.
[14]田雨沐，潘菊华.基于脑玄府理论探讨中药引经及配伍思路[J].中国实验方剂学杂志，2023,29(14):204-214.
[15]中国抗癫痫协会.临床诊疗指南癫痫病分册（2023修订版）[M].北京：人民卫生出版社，2023:85.
[16]马融，张喜莲.小儿癫痫“痰伏脑络，气逆风动”病机论[J].中医杂志，2020,61(1):79-81.
[17]SHI J, XIE J, LI Z, et al. The role of neuroinflammation and network anomalies in drug-resistant epilepsy[J].Neurosci Bull,2025, 41(5):881-905.
[18]张青，杨洞洞，丁成赟，等.中医体质与癫痫难治性相关性探讨[J].广州中医药大学学报，2022,39(1):7-11.
[19]马融，陈汉江，张喜莲，等.胎痫“禀赋异质，精不化气”病机探析[J].中医杂志，2022,63(11):1009-1012.
[20]尹莲君，薛道金，黄涛，等.难治性癫痫的中医用药规律研究[J].广东药科大学学报，2020,36(3):431-435.
[21]CAO H, WEI P, HUANG Y, et al. The alteration of cortical microstructure similarity in drug-resistant epilepsy correlated with mTOR pathway genes[J]. eBioMedicine,2023,97:104847. doi:10. 1016/j. ebiom. 2023. 104847.
[22]马融.马融论治小儿癫痫[M].北京：中国中医药出版社，2021:44-45.
[23]唐温，马融.马融教授运用柴桂龙牡汤辨治小儿癫痫验案1则[J].吉林中医药，2009,29(8):703-704.
[24]何乾超，苏晗，黄德庆，等.柴胡疏肝汤加味对难治性癫痫的影响及疗效相关因素研究[J].辽宁中医杂志，2016,43(12):2581-2583.
[25]谢炜，史国军，李长征，等.柴胡疏肝汤对难治性癫痫大鼠脑电图及多药耐药蛋白P-糖蛋白表达的影响[J].中国实验方剂学杂志，2011,17(3):128-131.
[26]姚汉云，徐雷，周晓香，等.柴胡加龙骨牡蛎汤作用难治性癫痫多药转运体的机制研究[J].世界科学技术-中医药现代化，2023,25(1):120-127.
[27]张瑾.加味地黄饮子对婴儿痉挛症模型大鼠癫痫发作及脑发育的影响研究[D].天津：天津中医药大学，2022.
[28]韩帅，刘姿瑶，张小倩，等.基于肾藏精理论探讨大补元煎对难治性癫痫患者免疫功能以及认知功能的影响[J].辽宁中医杂志，2023,50(7):94-98.
[29]王星辰，马融.马融从“少火生气”论治婴儿痉挛症经验[J].中华中医药杂志，2021,36(12):7141-7144.
[30]房艳艳，李新民，陈会，等.中药复方对难治性癫痫大鼠多药耐药P-糖蛋白表达的影响[J].四川中医，2017,35(6):45-49.
基本信息:
DOI：10.13288/j.11-2166/r.2025.22.006
中图分类号:R277.7
引用信息:
[1]陈朝远,张喜莲,马融.从“阳微结”探讨耐药性癫痫病机及调阳法辨治思路[J].中医杂志,2025,66(22):2322-2326.DOI:10.13288/j.11-2166/r.2025.22.006.
基金信息:
国家自然科学基金（82174434）; 第五批全国中医临床优秀人才研修项目（国中医药办人教函[2021]271号）; 天津市教委科研计划项目（2024ZD008）