基于脑心与胆相通理论辨治癫痫病——中医脑病理论与临床实证研究(四)

心与胆相通即脑心与胆相通理论，属于脏腑别通之一，是癫痫病脑与胆同治、共治和互治的理论基础。癫痫乃内外合邪为病，病机关键是神机受累、元神失控，多虚实夹杂之证。本文例举重症肺炎并癫痫持续状态、脑外伤后遗症并继发性癫痫、继发性癫痫并早期认识障碍、原发性癫痫等4个医案，说明基于脑心与胆相通理论指导癫痫病辨治，确立癫痫病的治则为疏达元神、枢转神机、和法论治。坚持病证结合，分清标本缓急，以元气亏虚、脑神失养为本，相火与逆气、内风、痰热、瘀血、浊毒等结合为标；癫痫发作期气火、风痰为主；癫痫缓解期痰瘀、浊毒、正虚为主；癫痫持续状态气逆无制、风火煽动、痰浊上涌、脑窍壅闭。从胆治脑，主方用升降温胆汤加减，和解少阳，斡旋气机，枢转神机。

Syndrome Differentiation-Based Treatment of Epilepsy Based on the Theory of Brain Heart and Gallbladder Connection:Traditional Chinese Medicine Theory of Encephalopathy and Clinical Empirical Study (IV)

The heart and gallbladder connection is the theory of brain and heart, which belongs to one of the theory of Zang-Fu viscera connections. It is the theoretical basis of the simultaneous treatment, co-treatment and mutual treatment of brain and gallbladder in the epilepsy. Epilepsy is a disease caused by internal and external pathogen. The key to the pathogenesis is the involvement of the spiritual mechanism, the loss of control of the primordial spirits, and is the syndrome of intermingled deficiency and excess. This paper illustrated four cases of severe pneumonia with persistent epilepsy, sequelae of brain trauma and secondary epilepsy, secondary epilepsy with early cognitive impairment, and primary epilepsy, indicating that syndrome differentiation and treatment of epilepsy is guided by the theory of brain heart and gallbladder connection. The treatment principle of epilepsy is established as soothing primordial spirit, pivoting the spiritual mechanism, and harmonizing method. The combination of disease and syndrome should be adhered to, and the manifestations and root causes, as well as the order of priority should be clarified. The deficiency of primordial Qi, lack of nourishing of brain and spirit are the root causes, and the combination of ministerial fire, adverse wind, internal wind, phlegm heat, blood stasis, turbidity toxin are the manifestations; During the attack stage, epilepsy was mainly caused by climate fire and wind phlegm. During the remission stage, epilepsy was mainly caused by phlegm stasis, turbidity toxin, deficiency of vital Qi. During the persistent state, epilepsy is manifested as unlimited counterflow of Qi, wind and fire inciting, phlegm turbidity up-flowing, brain and orifices stagnation. The treatment of brain diseases from the gallbladder, mainly uses modified Shengjiang Wendan Decoction to reconcile Shaoyang, smooth the Qi movement, and pivot the spiritual mechanism.