〔摘要〕 开阖枢理论是中医基础理论的组成部分。以三阴三阳分开阖枢，自主神经功能与经脉脏腑气化的开阖枢功能表现类似。开阖枢理论总结了疾病特殊的传变规律，可以指导自主神经疾病的临床辨治。通过神经源性体位性低血压、头部多汗症、自主神经功能不全、术后自主神经功能障碍、交感神经型颈椎病5个医案，阐述自主神经疾病的病机特征为枢机障碍，神机失用;开阖枢同病，而表现为偏于开折、阖折、枢折状态。治疗上必须着眼气化，整体燮理，邪正兼顾;调理法包括身心调理、饮食调理、方药调理之类，并加强及时有效的对症治疗。方药调理治疗的关键点在于养神安神、疏通经隧、双向调节、整体燮理，才能枢转神机。
〔关键词〕 自主神经疾病;自主神经功能障碍;开阖枢理论;枢转神机
〔中图分类号〕R259;R74 〔文献标志码〕A 〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.09.001
Diagnosis and Treatment of Autonomic Nervous Diseases Based on Kaiheshu Theory and Encephalopathy in Traditional Chinese Medicine and Clinical Empirical Study （IX）
ZHOU Desheng1， TAN Huizhong2*
（1. Department of Neurology， The First Hospital of Hunan University of Chinese Medicine， Changsha， Hunan 410007， China;
2. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China）
〔Abstract〕 Kaiheshu theory is an integral part of the basic theory of traditional Chinese medicine. Classify the Kaiheshu according to three Yin and three Yang. The function of autonomic nervous function is similar to that of the Kaiheshu in Qi transformation of meridians and viscera. The Kaiheshu theory summarizes special laws of disease transmission and can guide clinical diagnosis and treatment of autonomic nervous diseases. This paper describes characteristics of pathogenesis in autonomic nervous diseases through 5 cases of neurogenic orthostatic hypotension， head hyperhidrosis， autonomic dysfunction， postoperative autonomic dysfunction， and sympathetic cervical spondylosis. The characteristics are pivot mechanism disorder and spiritual mechanism dysfunction; and if disease involves Kaiheshu， the manifestation tends to the state of Kaizhe， Hezhe， or Shuzhe. The treatment must focus on Qi transformation， overall treatment， and taking both evil and healthy qi into consideration. The methods include physical and mental regulation， diet regulation， prescription regulation， and strengthening timely and effective symptomatic treatment. The key point of prescription regulation is nourishing the spirit and tranquilization， dredging channels， two-way adjustment， and overall treatment， in order to pivot spiritual mechanism.
〔Keywords〕 autonomic nervous disease; autonomic dysfunction; Kaiheshu theory; pivoting spiritual mechanism
自主神經系统由交感神经系统和副交感神经系统组成，既拮抗又协调的调节内脏和血管平滑肌、心肌和腺体的机能活动，在维持机体内稳态及保持紧张性效应、应激反应、情绪调控等方面起主要作用。自主神经系统几乎参与所有疾病的发生、发展、表现，各系统疾病或多或少伴有自主神经功能障碍。自主神经疾病以自主神经受累为主，主要包括自主神经功能不全、晕厥、反射性躯体神经病、雷诺病、原发性直立性低血压、神经血管性水肿、出汗异常、红斑性肢痛症、内脏疼痛、偏侧萎缩症、交感神经链综合征、间脑疾病等等[1]。中医在辨治自主神经疾病及自主神经功能障碍并发症方面有丰富的经验，但缺乏深入的规律总结，临床上容易漏诊误诊。《素问·皮部论》以三阴三阳分“开阖枢”，丹波元简《素问识》释义为“不过借以见神机枢转之义”，谓经脉之气环转无端，升降出入以渗于脏腑、募原、五体等，发挥不同的神机功能。中医对自主神经的认识很少。笔者认为神机是阴阳升降、出入、聚散、旋转之机，借鉴陈无咎《内经辨惑提纲》以正负释阴阳奇恒，因此，本文引于开阖枢理论阐释自主神经功能。在象思维的背景下，已有学者[2-4]认识到开阖枢理论与自主神经生理病理作用机制之间的相关性。本文基于开阖枢理论，介绍辨治自主神经疾病的临床体会如下。