"瘀去新生"理论指导下内外合治干预缺血性脑卒中后认知障碍探析OA

Cognitive impairment after ischemic stroke is a highly prevalent and refractory sequela of stroke.Its core pathogenesis involves stasis obstructing the brain collaterals,internal retention of static blood,failure of the clear orifices to receive nourishment,and dysfunction of the spirit.Based on the TCM theory of"removing stasis to promote blood regeneration,"this study explains that"stasis"is the key pathological factor leading to brain collateral obstruction and blockage of the brain orifices,while"regeneration"refers to the repair process in which,after stasis is removed,qi and blood resume normal circulation,the brain collaterals become unobstructed,the sea of marrow receives nourishment,and the function of spirit is restored.The pathogenesis evolution is explored from five aspects:stasis obstructing the brain collaterals,qi stagnation and blood stasis,intermingling of phlegm and stasis,qi deficiency with blood stasis,and stasis entering the collaterals and damaging the brain marrow due to prolonged illness.The internal and external combination therapy approach involves external bloodletting at Jing-well points to remove stasis and open the orifices,and internal administration of Chinese medicines based on pattern differentiation to strengthen the body and eliminate pathogenic factors.Based on this approach,a hierarchical pattern differentiation and treatment system was established,and the synergistic mechanism of acupuncture in unblocking collaterals and removing stasis and herbal decoctions in reinforcing healthy qi and resolving stasis was elucidated.Verified by clinical cases,this internal and external combination therapy can significantly improve patients'cognitive function,neurological deficits,and activities of daily living,effectively regulate oxidative stress and neurotrophic levels,and is safe and feasible.The internal and external combination model based on the theory of"removing stasis to promote blood regeneration"addresses both the root and branch manifestations,removes stasis and promotes blood regeneration,thereby providing a new theoretical basis and clinical practice reference for the standardized TCM diagnosis and treatment of cognitive impairment after ischemic stroke.