中医杂志

总结凃晋文教授运用补虚解毒通络法治疗颅内动脉粥样硬化性狭窄（ICAS）的临证经验。认为毒损脑络是ICAS的核心病机，提出以补虚解毒通络为核心治法。脑络空虚为发病之源，脾肾亏虚、元气不足者，方选四君子汤合六味地黄丸加减，健脾补肾以充络；浊瘀毒结是病机之要，浊瘀相合、蕴毒结络者，方选桃红四物汤合二陈汤加减，解毒散结以畅络；阴毒伏络是病邪之渐，浊瘀寒化、阴毒伏络者，方选补阳还五汤合涤痰汤加减，搜剔温补以活络；热毒损络是疾病之变，浊瘀热化、毒损脑络者，方选大柴胡汤合黄连解毒汤加减，凉血通腑以清络。

This article summarized Professor TU Jinwen's experience in treatment of intracranial atherosclerotic stenosis(ICAS) with principles of supplementing deficiency, resolving toxins and unblocking Collaterals. He believes that toxin damaging brain collaterals is the core pathogenesis of ICAS, and thereafter proposed supplementing deficiency, resolving toxins, and unblocking collaterals be the basic treatment method. The emptiness of brain collaterals is the source of the disease. For cases where there is spleen kidney depletion and insufficiency of original qi, the modified Sijunzi Decoction and Liuwei Dihuang Pills(四君子汤合六味地黄丸) could be used to fortify the spleen and tonify the kidneys to enrich the collaterals. The accumulation of turbidity stasis toxin in brain collaterals is essential components of the pathogenesis. For cases where turbidity and stasis combine together, inducing toxins and obstructing the collaterals, the modified Taohong Siwu Decoction and Erchen Decoction(桃红四物汤合二陈汤) could be used to eliminate toxins and dispel knots to unblock the collaterals. Yin toxins obstructing the latent collaterals represent the gradual progression of pathogenic factors. For cases where turbid stasis transform into cold and yin toxins hide in the collaterals, the modified Buyang Huanwu Decoction and Ditan Decoction(补阳还五汤合涤痰汤) could be used to remove the toxin, warm and activate the collaterals. Heat toxins damaging the collaterals signify aggravated changes in disease. For cases where turbid stasis transforms into heat and toxins injure the brain collaterals, the modified Dachaihu Decoction and Huanglian Jiedu Decoction(大柴胡汤合黄连解毒汤) could be used to cool blood and dredge the fu viscera to clear collaterals.