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第114章 中医药调理病毒性脑炎后遗症(1 / 1)

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病毒性脑炎后遗症

[病案]阎某,女,19岁。 1978年12月2日就诊。同事发现患者近二天来情况不正常,食欲猛增,由原来每天8两增至2斤,食后即吐。一周后自觉两腿无力,记忆力减退,嗜笑,言不对题,尿失禁。曾于1977年12月31日入院,诊断为“病毒性脑炎”。血常规检查基本正常,腰穿:测得脑积液压力230毫米水柱(正常值为80~180),脑电图:高度弥漫性异常脑电图,两半球基本电活动为d波,以右侧额部明显,曾用地塞米松、强的松、辅酶A等静滴及对症治疗后,症情好转出院。十个月后出现多思多疑,神识模糊,行为怪异,烦躁不安,经常外出狂奔。精神科会诊为,病毒性脑炎后伴发精神症状,服用谷氨酸,健脑片、地巴唑、氯丙嗪等未效。刻下头痛头晕,狂躁不安,胡言乱语,多怒喜吵,持续低热,时欲呕吐,便结数日一行,舌尖红,苔黄腻。

[治则]清肝泻火,涤痰开窍。

[方药]龙胆草10克,生山栀10克,黄芩10克,生大黄10克(后入),制胆星10克,黄连3克,远志10克,郁金10克,石菖蒲30克,山羊角30克,礞石滚痰丸15克(包煎),脾约麻仁丸12克(包煎)。服7剂后,诸恙递减,大便已通,尚有头痛,苔转薄黄,舌尖略红,脉弦细。予原方去龙胆草、制胆星、黄芩,加首乌10克,牛黄清心丸1粒(吞服)。连服14剂后自觉诸症好转,时有脾气急躁,手有拘挛感,头晕嗜睡。此为精气不足,肾阴亏损所致。遂予培补气阴为主,佐以清心:大生地10克,淮山药10克,女贞子10克,枸杞子10克,炙远志10克,制胆星10克,脾约麻仁丸10克,首乌15克,首乌藤30克,山羊角30克,灵磁石30克,牛黄清心丸1粒 (吞服)。又服7剂,予原方去山羊角,灵磁石、制胆星,脾约麻仁丸,牛黄清心丸,加肉苁蓉10克,白蒺藜10克,石菖蒲15克以补肾益髓巩固之。继服7剂,病情日益稳定,即改用六味地黄丸,1980年7月随访,患者已停药一年余,除略有头晕、记忆力稍差外,余皆如常。脑电图复查:与1978年1月相比已明显好转。

[评析]本病属于中医“狂症”的范畴,古代名医张景岳等先贤曾经指出:“狂病的发病原因多与火有关,如肝胆气逆、木火合邪等。因此,在治疗时应首先治火,并根据病情辅以痰或气的治疗。”为了达到良好的治疗效果,治疗狂症应采用大黄、山栀、黄连等清热通腑的药物,同时配合牛黄清心丸等清心药物以达到通腑清心的效果。

此外,为了更好地清除肝胆之火,可以采用龙胆泻肝汤来清肝胆之火,再结合礞石滚痰丸、石菖蒲、制胆星等豁痰开窍的药物。这些药物的运用有助于消除痰火,减轻患者的病情。

在用药得当的情况下,患者的病情会逐渐好转。治疗过程中,还可以逐渐减少潜降化痰的药物,增加补肾益髓的方剂,以期达到更好的治疗效果。同时,可以适当使用补气养血、滋阴润燥等药物来调理患者的整体体质,以提高疗效。

最后,以补肾药物调理善后,以期帮助患者恢复健康。补肾药物可以帮助改善患者的肝肾功能,增强身体的免疫力和抵抗力,预防病情反复。

总之,中医治疗狂症的方法是综合性的,包括清热通腑、清心、豁痰开窍、补肾益髓等多种方法。这些方法相辅相成,通过正确运用这些方法,可以达到较好的治疗效果,帮助患者恢复健康。然而,在实际治疗过程中,医生会根据患者的个体差异和病情进行针对性的治疗,以期取得最佳疗效。

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