人迎脉积病因病机与证治释要

系统阐述人迎脉积(颈动脉粥样硬化斑块)病因病机与证治。卫气失常,火热灼脉,损伤脉络,以致痰瘀结滞于人迎脉,终成斑块,名曰人迎脉积。饮食失节、吸烟饮酒、运动不足、情志失调、烦劳无度、久病损伤血脉,痰浊瘀血遁入血脉,日久成积,为主要病因病机。年老体虚,阳明脉衰,脏腑渐损,气化衰减,卫外不固,营虚瘀积,血脉易损,是人迎脉积发病基础。营卫失常是人迎脉积发病的基本病机,痰瘀遁脉,痹阻人迎脉是发病的核心环节。根据其结块性质,硬斑名癥积,软斑曰痈积。本病发病隐匿,全身正虚为本,局部邪结为标;危害多端,防治皆难。立足整体,着眼局部,干预脉积,预防中风是防治本病的原则与目的。治分标本,治标当祛邪散结,用清火、化痰、活血、散结、消积法;治本需补虚扶正,调和营卫,固护腠理。列举火热灼脉、痰热壅滞、阴虚火灼、瘀阻阳明、卫郁营滞、气虚血瘀、厥阴阴虚证治。

Explanation of Etiology,Pathogenesis,Syndromes and Treatments of Accumulation in Renying Pulse

The etiology,pathogenesis,syndromes and treatments of accumulation in Renying pulse(carotid atherosclerotic plaque) are expounded systematically. Disorders of defensive qi and burns of meridians by heat and fire pathogens can cause the damage of meridians and collaterals,which then lead to phlegm and blood stasis accumulation in Renying pulse and finally form the plaque. This is why the disease is called accumulation in Renying pulse. The etiology and pathogenesis of the disease is complex,which mainly include improper diet,smoking and drinking,insufficient physical activity,emotional disorder,overstrain,damage of blood vessels caused by long illness,and accumulation of phlegm,turbidity and blood stasis in blood vessels. The pathological basis of the disease include being advanced in age and poor in heath,decline of Yangming meridian,injury of zang-fu organs,weakening of qi transformation,insecurity of defensive qi,deficiency of nutrient qi,blood stasis,and vulnerable blood vessels. The disorder of nutrient and defensive qi is the basic pathology of accumulation in Renying pulse,and the obstruction of Renying pulse by phlegm and blood stasis is the core of the disease. According to the property of the plaque,the disease can be divided into two categories. The hard plaque is called mass accumulation,and the soft one is called carbuncle accumulation. The disease is characterized by insidious onset,generalized deficiency of healthy qi and local accumulation of pathogenic qi. With varied hazards,it is difficult to be prevented and treated.Based on the whole body and focused on the local lesion,the principle for prevent the disease is intervening accumulation in pulse,and the aim to treat the disease is preventing stroke. Both principal and secondary aspect of the disease should be treated. For the secondary aspect,the principle of the treatment is removing pathogenic factors and dissipating mass,including the methods of clearing fire,resolving phlegm,promoting blood circulation,dissipating mass,and resolving accumulation. For the principal aspect,the treatment include tonifying deficiency and reinforcing healthy qi,harmonizing nutrient qi and defensive qi,and consolidating striae and interstice. Syndromes of pulse burned by fire and heat,accumulation of phlegm and heat,yin deficiency and fire burning,obstruction of yangming meridian by blood stasis,depression and stagnation of defensive qi and nutrient qi,yin deficiency of reverting yin,and their treatments are listed.