基于"风-脑玄-神机"病机传变探讨卒中后失眠治疗思路OA

Post-stroke insomnia(PSI)is a common sequelae of stroke,which seriously affects the recovery of neurological function and quality of life.At present,the clinical treatment of traditional Chinese medicine is mostly based on pathological products such as phlegm and blood stasis,and the potential influence of"wind evil",the root cause of stroke,is relatively neglected.Based on the theory of"wind entering the viscera"in Huangdi Neijing(《黄帝内经》),this paper puts forward that"wind lurking in Zang-Fu(脏腑)organs,stagnation of cerebral orifices,dysfunction of mental vitality"is the core pathogenesis of PSI.It is believed that pathogenic wind lingers after stroke and hides deeply inside the body,triggering the mutual accumulation of phlegm and blood stasis that obstructs the cerebral micropores-the microscopic passages for the circulation of Qi(气),blood,body fluid and mental activities.This results in failure of clear Qi to ascend,insufficient nourishment of the spirit and disturbed sleep-wake cycle.In view of this pathogenesis,we break through the conventional treatment of simple tranquilization,advocate"dispelling wind and dredging Xuan(玄)"as the fundamental rule.Accordingly,Qufeng Tongxuan Fang(祛风通玄方)was developed.Wind-dispelling herbs including Chuanxiong(Chuanxiong Rhizoma),Qianghuo(Notopterygii Rhizoma et Radix),Fangfeng(Saposhnikoviae Radix),and other wind medicines are used as principal medicines to unblock obstructed cerebral micropores.Dangshen(Codonopsis Radix)and Baizhu(Atractylodis Macrocephalae Rhizoma)are supplemented to invigorate the spleen and replenish Qi;Shudihuang(Rehmanniae Radix Praeparata),Wuweizi(Schisandrae Chinensis Fructus)and Shanzhuyu(Corni Fructus)nourish the liver and kidney;Guijia(Testudinis Carapax et Plastrum)and Muli(Ostreae Concha)suppress hyperactive Yang(阳)and calm wind.Concurrent symptoms should be accurately differentiated,and wind herbs such as Mahuang(Ephedrae Herba),Guizhi(Cinnamomi Ramulus),Jingjie(Schizonepetae Herba)and Duhuo(Angelicae Pubescentis Radix)can be flexibly applied.Thereby pathogenic wind is eliminated,micropores unchoked and mental function restored.Acupuncture at three wind points[Fengchi(GB12),Fengfu(GV16),Fengmen(BL12)]and seven Chong(冲)points[Taichong(LR3),Guanchong(SJ1),etc.]is adopted concurrently in treatment to boost healthy Qi.Selecting a smaller number of wind acupoints and applying gentle,steady stimulation are recommended to dispel wind,regulate Qi,unblock micropores and refresh mental faculty.This paper systematically establishes a wind-centered diagnosis and treatment system for post-stroke insomnia covering theoretical interpretation,herbal medication and acupuncture.It provides novel ideas and practical regimens rooted in the original TCM theory of pathogenic wind,aiming to offer targeted therapeutic approaches for the disease.