基于脑窍理论辨治非意识障碍神经病(1)
〔摘要〕 脑窍有广义和狭义之分，化生神机总统众神，调控一身之活动，窍闭乃非意识障碍神经病产生的主要病因病机。本文通过皮层下动脉硬化性脑病假性球麻痹、视神经脊髓炎、混合神经性耳聋、脑外伤后嗅觉味觉障碍、颈椎病舌体感觉异常5个医案，以脑窍理论为基础，认为治疗此类疾病需从病因病机出发，以通为用，开郁宣闭，调神导气，虚实分治，形神窍脏同治，同时配合调治奇经，目的在于恢复脑窍玄府开阖常度，从而使脏腑、形体、官窍、神明调和，神机得使。
〔关键词〕 脑窍;玄府;神机;神经病
〔中图分类号〕R259 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.04.003
Syndrome Differentiation and Treatment of Non-Consciousness Disorder Neuropathy Based on
Brain-Orifices Theory： Traditional Chinese Medicine Theory of Encephalopathy and
Clinical Empirical Study (XV)
ZHOU Desheng1， TAN Huizhong2*
(1. Department of Neurology， The First Affiliated Hospital of Hunan University of Chinese Medicine， Changsha，Hunan 410007， China; 2. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China)
〔Abstract〕 Brain orifices is divided into broad and narrow senses. It transforms and generates vital activity and control every sprit， as well as regulates the activities of whole body. Orifices blockage is the main etiology and pathogenesis of non-consciousness neuropathy. This paper analyzed 5 medical cases of subcortical arteriosclerotic encephalopathy pseudobulbar palsy， optic neuromyelitis， mixed neurological deafness， olfactory and taste disorders after brain trauma， cervical spondylopathy tongue abnormality. Based on the theory of brain orifices theory， it is believed that the treatment of such diseases should start from etiology and pathogenesis. For the purpose of unblocking， expelling depression and ventilating blockage， regulating the spirit and guiding Qi， the deficiency and the excess should be treated separately， and the body， spirt and orifices are treated together. At the same time， regulating extra-channels to restore the regularity of the opening and closing of the brain orifice and fu-viscera of mental activity， so that the zang-fu organs， body， orifices， and spiritual mind are regulated and harmonized.
〔Keywords〕 brain orifice; fu-viscera of mental activity; vital activity; neuropathy
從解剖和生理意义来讲，脑窍属奇恒之府[1]，头面上七窍通于脑系，与脑髓、经脉、脑室、脉络等均可归属脑窍范畴。《医林改错·脑髓说》认为“灵机记性在脑”，有赖“卫总管”和“荣总管”通脊入脑[2]，化而为髓，髓充于内，气液流通，神机由生，主导一身之活动，临床上应用脑窍理论治疗脑病已屡见不鲜，以脑髓神志病变较为多见，对非意识障碍神经病缺乏系统论述，本文探讨基于脑窍理论辨治非意识障碍神经病的临床体会。
1 脑窍理论
《说文解字》中脑有二意，一指脑髓，二指颅腔。窍有孔、隙、穴之义。脑为清空之窍，元神之府，脑窍为神机出入之隙[3]，《灵枢·邪气脏腑病形》曰：“十二经脉，三百六十五络，其血气皆上于面而走空窍。”明确提出了脑窍(空窍)的概念。中医学有“九窍”之说，将耳、目、鼻、口之上七窍归为清窍，属广义脑窍范畴，如《临证指南医案·眩晕门》所言：“头为诸阳之首，耳目口鼻皆系清空之窍。”而狭义脑窍一般指神窍，总统神志、意识、思维等活动，包含脑髓、脑室、脑膜、脑脉、脑络及玄府神窍等内部结构[3]，中空似腑，藏精似脏，属奇恒之腑。根据解剖特点，神窍属内窍，化生神机，为气机升降之所主，官窍为神窍之外显，乃气机升降出入之门户，诸窍皆为脑主司，正如俞琰《周易参同契发挥·鼎器歌》中所言：“脑为上田，乃元神所居之宫。人能握元神，栖于本宫，则真气自升，真息自定，所谓一窍开而百窍齐开，大关通而百关尽通也。”神窍化生之神机，凭借气血津液精髓的升降出入运动，司诸窍之开阖，通过脊髓经脉调控各脏腑官窍生理机能，而临床又可以通过官窍的外显征象来推测神窍的生理病理状态。, 百拇医药(周德生 谭惠中)
〔关键词〕 脑窍;玄府;神机;神经病
〔中图分类号〕R259 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.04.003
Syndrome Differentiation and Treatment of Non-Consciousness Disorder Neuropathy Based on
Brain-Orifices Theory： Traditional Chinese Medicine Theory of Encephalopathy and
Clinical Empirical Study (XV)
ZHOU Desheng1， TAN Huizhong2*
(1. Department of Neurology， The First Affiliated Hospital of Hunan University of Chinese Medicine， Changsha，Hunan 410007， China; 2. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China)
〔Abstract〕 Brain orifices is divided into broad and narrow senses. It transforms and generates vital activity and control every sprit， as well as regulates the activities of whole body. Orifices blockage is the main etiology and pathogenesis of non-consciousness neuropathy. This paper analyzed 5 medical cases of subcortical arteriosclerotic encephalopathy pseudobulbar palsy， optic neuromyelitis， mixed neurological deafness， olfactory and taste disorders after brain trauma， cervical spondylopathy tongue abnormality. Based on the theory of brain orifices theory， it is believed that the treatment of such diseases should start from etiology and pathogenesis. For the purpose of unblocking， expelling depression and ventilating blockage， regulating the spirit and guiding Qi， the deficiency and the excess should be treated separately， and the body， spirt and orifices are treated together. At the same time， regulating extra-channels to restore the regularity of the opening and closing of the brain orifice and fu-viscera of mental activity， so that the zang-fu organs， body， orifices， and spiritual mind are regulated and harmonized.
〔Keywords〕 brain orifice; fu-viscera of mental activity; vital activity; neuropathy
從解剖和生理意义来讲，脑窍属奇恒之府[1]，头面上七窍通于脑系，与脑髓、经脉、脑室、脉络等均可归属脑窍范畴。《医林改错·脑髓说》认为“灵机记性在脑”，有赖“卫总管”和“荣总管”通脊入脑[2]，化而为髓，髓充于内，气液流通，神机由生，主导一身之活动，临床上应用脑窍理论治疗脑病已屡见不鲜，以脑髓神志病变较为多见，对非意识障碍神经病缺乏系统论述，本文探讨基于脑窍理论辨治非意识障碍神经病的临床体会。
1 脑窍理论
《说文解字》中脑有二意，一指脑髓，二指颅腔。窍有孔、隙、穴之义。脑为清空之窍，元神之府，脑窍为神机出入之隙[3]，《灵枢·邪气脏腑病形》曰：“十二经脉，三百六十五络，其血气皆上于面而走空窍。”明确提出了脑窍(空窍)的概念。中医学有“九窍”之说，将耳、目、鼻、口之上七窍归为清窍，属广义脑窍范畴，如《临证指南医案·眩晕门》所言：“头为诸阳之首，耳目口鼻皆系清空之窍。”而狭义脑窍一般指神窍，总统神志、意识、思维等活动，包含脑髓、脑室、脑膜、脑脉、脑络及玄府神窍等内部结构[3]，中空似腑，藏精似脏，属奇恒之腑。根据解剖特点，神窍属内窍，化生神机，为气机升降之所主，官窍为神窍之外显，乃气机升降出入之门户，诸窍皆为脑主司，正如俞琰《周易参同契发挥·鼎器歌》中所言：“脑为上田，乃元神所居之宫。人能握元神，栖于本宫，则真气自升，真息自定，所谓一窍开而百窍齐开，大关通而百关尽通也。”神窍化生之神机，凭借气血津液精髓的升降出入运动，司诸窍之开阖，通过脊髓经脉调控各脏腑官窍生理机能，而临床又可以通过官窍的外显征象来推测神窍的生理病理状态。, 百拇医药(周德生 谭惠中)