王宝亮 王鑫鑫 郭亚萌 陈媛朋 关运祥

【摘 要】 文章主要介绍在中医病机指导下通过察舌诊脉辨治运动神经元病。根据多年临床经验，总结出运动神经元病7种常见证型：肺热津伤型、脾胃亏虚型、脾肾阳虚型、肝肾阴虚型、络脉瘀滞型、湿热蕴结型、肾阴阳两虚型，临床重视运用中医特色诊法——“舌诊”“脉诊”辨证论治运动神经元病，为临床上中医治疗此病提供思路及借鉴，减轻患者痛苦。

【关键词】 运动神经元病;病机;舌脉;辨证论治

【中图分类号】R744.8   【文献标志码】 A    【文章编号】1007-8517（2021）21-0110-03

Treat the Motor Neuron Disease by Examining Tongue and Pulse From Pathogenesis

WANG Baoliang1 WANG Xinxin2 GUO Yameng2 CHEN Yuanpeng2 GUAN Yunxiang1

1.The 1st Affiliated Hospital of Henan University of Traditional Chinese Medicine，zhengzhou 450000，China;2.The 1st Clinical College of Henan University of Traditional Chinese Medicine，zhengzhou 450000，China

Abstract：Under the guidance of pathogenesis of traditional Chinese medicine， The author's experience in treating motor neuron disease （MND） by observing tongue and pulse was introduced in this article. Based on years of clinical experience， The author has summed up seven common syndromes of motor neuron disease： syndrome of fluid consumption due to lung heat，spleen-stomach weakness， spleen and kidney yang deficiency ，deficiency of liver- kidney yin，qi stagnation and blood stasis of collateral，dampness-heat amassment pattern，dual vacuity of kidney yin and Yang.The author attaches great importance to the application of the characteristic diagnosis method of traditional Chinese Medicine - “tongue diagnosis” and “pulse diagnosis” to treat motor neuron disease，  providing ideas and reference for clinicians to use TCM to treat  this disease， alleviating patients’pain.

Key words：Motor Neuron Disease; Pathogenesis; Tongue and Pulse; Syndrome Differentiation and Treatment

運动神经元病（Motor neuron disease，MND）是一种病因未明、主要累及大脑皮质、脑干和脊髓运动神经元的神经系统变性疾病[1]。据研究[2]表明，MND发病率为1.5/10万，患病率为4/10万，易致患者伤残乃至死亡。利鲁唑可能是延缓疾病进展的唯一药物[3]。笔者从医40余载，在治疗运动神经元病方面颇有见解，临床多从病机入手察舌诊脉辨治此病。

中医学中，《素问玄机原病式·五运主病》中提到“痿，谓手足痿弱，无力运行也”，即手足痿软而无力、百节缓纵而不收。中医将此病归属于“痿证”“痿病”范畴。《内经》将痿证分为皮、脉、筋、骨、肉五痿，结合历代古籍文献及现代医学研究，属“肉痿”和“筋痿”者居多。更有《奇效良方·风门》云：“瘖痱之状，舌瘖不能语 ，足废不为用。”与MND构音障碍、四肢痿废症状较为相似，此外亦有 “痿痉”“痿痹”之说[4]。

1 病因论述

目前MND病因及病理机制尚未明确，可能与遗传、基因缺陷及环境因素有关[5]。笔者认为，疾病病因不外乎阴阳两类，即《素问·调经论》云：“夫邪之生也，或生于阳，或生于阴。……