雷霆 刘华彤 古诗琴 刘绪银

〔摘要〕 脑瘫全称脑性瘫痪，主要表现为运动障碍，刘绪银主任医师认为脑瘫属中医“脑痿”范畴。由三焦、膜原、腠理、膜络、玄府所构成的膜府系统涩滞则藏腑气化失常，生化不足，血涩为瘀，津停为痰，痰瘀壅塞黏附膜府膜络则膜络涩滞，精气津血输布渗灌障碍，导致上气不足、髓海不充，是脑瘫的重要基础病机。临证分阴虚髓热、气滞痰阻、痰热扰动、脑气郁滞、气虚血瘀、风痰交夹、气血亏虚、肝肾不足、髓海空虚等基本证候，在辨证论治的基础上佐以芳香药、藤枝类药、虫类药，内外合治，以疏达膜府、畅通脑络，促进气血精津上输，以充养脑髓。

〔关键词〕 刘绪银;脑瘫;膜府系统;疏达膜府;十味温胆汤;补阳还五汤;涤痰汤

〔中图分类号〕R259;R742.3       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.04.019

〔Abstract〕 The main manifestation of cerebral palsy is dyskinesia. Chief physician Liu Xuyin believes that the cerebral palsy belongs to the category of "cerebral flaccidity" of traditional Chinese medicine. If the Mo-Fu composed of triple energizers， membrane source， interstices， membrane and meridians， and mysterious mansion is blocked， the qi of internal organs will be abnormal， the engendering transformation will be insufficient， the blood stasis due to blood stagnation and the stagnation of body fluid will turn into phlegm. Phlegm and blood stasis will block and adhere to the Mo-Fu， membrane and meridians， resulting in the astringency of membrane and meridians， obstacles in the distribution and infiltration of essence， qi， fluid and blood， deficiency of ascending qi and insufficiency of sea of marrow， which are the important basic pathogenesis of cerebral palsy. Clinical experiences divided the diseases into different basic syndromes like： Yin deficiency and marrow heat， qi stagnation and phlegm resistance， phlegm heat disturbance， brain qi stagnation， qi deficiency and blood stasis， wind phlegm intersection， qi and blood deficiency， liver and kidney deficiency， sea of marrow empty. On the basis of syndrome differentiation and treatment， he uses aromatic medicine， rattan branch medicine and insect medicine， internal and external treatment， in order to dredge Mo-Fu， smooth brain collaterals， promote qi and blood essence and fluid infusion， to nourish brain marrow.

〔Keywords〕 Liu Xuyin; cerebral palsy; Mo-Fu system; dredge Mo-Fu; Shiwei Wendan Decoction; Buyang Huanwu Decoction; Ditan Decoction

劉绪银主任医师系全国优秀中医临床人才、中华中医药学会公布的脑病专家和首批科学传播专家，师从国医大师路志正、张学文、李今庸等教授，潜心研读中医经典，提出了膜府系统理论[1]，以指导临床实践，主张在辨证论治的基础上佐以疏达膜络，疗效显著。笔者有幸跟师侍诊，现将其以膜府系统理论指导治疗脑瘫的经验介绍如下。

1 脑瘫属中医“脑萎”病

《灵枢·海论》云：“脑为髓海，其输上在于盖，下在风府。”风府在颈部，故脑是指颈以上的髓组织。“脑”字古为“匘”。脑居颅内，颅骨由多块骨骼组成。颅骨未合时，头皮可随气血鼓荡而隆起，故作“囟”字表述。《说文解字》云：“囟……头会匘盖也。”《集韵》：“囟，思忍切，小儿头会也国。