刘长英 周莉 董兴鲁 刘博文 于姚 张根明

摘要 随着人口老龄化的加剧，脑小血管病发病率越来越高，已成为当前研究的热点及难点。以中医理论为依据，结合现代医学研究，探讨脑小血管病的发病机制，提出气虚血瘀为脑小血管病的基本病机之一，阐述益气活血逐瘀法为脑小血管病病情波动期的主要治法，认为根据疾病特点及其病因病机进行动态管理能及时截断病情进展，减少脑内病灶的产生，防止神经功能受损。益气扶正与活血逐瘀并举，标本兼顾，为脑小血管病的治疗提供新的思路。

关键词 脑小血管病;气虚血瘀;益气活血逐瘀;络病;病因病机

Analysis of the Theory of Treating Cerebral Small Vascular Disease by the Method of Invigorating Qi and Activating Blood Circulation and Removing Blood Stasis

LIU Changying1，ZHOU Li2，DONG Xinglu2，LIU Bowen1，YU Yao1，ZHANG Genming1

（1 Beijing University of Chinese Medicine，Beijing 100029，China; 2 The Second Department of Encephalopathy，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100700，China）

Abstract With the aggravation of population aging，the incidence of cerebral small vessel disease is getting higher and higher，which has become a hot and difficult issue in current research.Based on the theory of traditional Chinese medicine，combined with modern medical research，this paper discusses the pathogenesis of cerebral small vessel disease，puts forward that qi deficiency and blood stasis are one of the basic pathogenesis of cerebral small vessel disease，and expounds that the method of invigorating qi and activating blood circulation and removing blood stasis is the main treatment of cerebral small vessel disease in fluctuating period.Dynamic management based on the characteristics of the disease and its etiology and pathogenesis can cut off the progress of the disease in time，reduce the generation of brain lesions，and prevent damage to nerve function.Replenishing vital energy，promoting blood circulation，eliminating blood stasis simultaneously，taking consideration of specimen，provide new ideas for the treatment of cerebral small vessel disease.

Keywords Cerebral small vessel disease; Qi deficiency and blood stasis; Invigorating Qi and activating blood circulation and removing blood stasis; Collateral disease; Etiology and pathogenesis

中图分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.01.021

随着脑血管疾病发病率的不断攀升和人口老龄化的加剧，脑小血管病（Cerebral Small Vessel Disease，CSVD）已成为当前研究的热点及难点。CSVD起病隐匿，病程较长且呈动态变化，存在突变加重的危险性，患者在疾病过程中突然或反复出现头晕、记忆力下降、肢体乏力等表现，影像学检查并未发现新发脑梗死或脑出血病灶，而脑小血管细小，病灶较小时难以通过影像学显现，此时患者病情出现波动性下滑，也应引起足够的重视，若不及时干预，病灶逐渐累积增多，终致痴呆等不可逆转的疾病。西医治疗主要以抗血小板聚集、降压、降脂等二级预防为主[1]，针对脑小血管病的病因病机，从中医理论出发，中西医综合治疗CSVD，使其治疗更具有针对性，及时截断病情进展，减少脑内病灶的产生，防止神经功能受损。……