多系统萎缩是一组原因未明的神经系统变性疾病,目前西医尚无特异性治疗方法.王宝亮教授认为该病为本虚标实沉疴之疾,本为脏腑亏虚,标为风动、痰瘀、湿热,久之表现为气血、阴阳虚损,主张分期论治.早期以风痰、瘀热为主要病机,责之于少阳,胆气不舒,痰瘀阻络,肝风内动,治当和解少阳、宣畅三焦,予柴胡加龙骨牡蛎汤加减;中期以阴(血)液亏虚为主要病机,责之于肝肾,痰瘀积留,久之伤阴,筋脉失养,肝阳上亢,变生内风,治当滋阴填精、养血活血,予镇肝熄风汤合龟鹿二仙胶加减;后期阴损及阳,阴阳两虚,责之于脾肾,正虚积损,肾之精气不足,阳气难以化生,加之脾胃虚衰,筋骨、肌肉皆无气以生,则形体不足,肌肉萎缩不用,治当健脾补肾、温阳益气,予补中益气汤或地黄饮子加减.
Multiple system atrophy(MSA)is a series of neurodegenerative diseases with unknown causes,and there is no specific treatment by western medicine.Professor WANG Baoliang holds that MSA is of deficient root and excessive branch.The root involves deficiency of zang-fu organs,while the branch involves wind stirring,phlegm and stasis and damp heat.MSA usually manifests as deficiency of qi,blood,yin and yang.He holds that MSA should be treated according to the stages.In the early stage,wind phlegm and stasis heat are the primary disease mechanism,mainly involving shaoyang,unsmooth movement of gallbladder qi,phlegm and stasis blocking collaterals,liver wind stirring up internally,and therefore harmonizing shaoyang,and unblocking triple energizer should be applied,usually with Chaihu Jia Longgu Muli Decoc-tion(柴胡加龙骨牡蛎汤)being applied.In the middle stage,yin(blood)fluids deficiency is the primary disease mechanism,mainly involving liver and kidney,accumulation of phlegm and stasis,injury of yin for a long time,malnutrition of muscle and vessels,up stirring of liver yang,and generation of internal wind,and therefore the treatment should be nourishing yin and supplementing essence,tonifying blood and activating blood,with Zhengan Xifeng Decoction(镇肝熄风汤)plus Guilu Erxianjiao Decoction(龟鹿二仙胶)with modification being applied;in the late stage,yin damage affects yin,resulting into deficiency of both yin and yang,mainly involving spleen and kidney,deficiency of healthy qi and accumulation of damages,deficiency of kidney essence leading to insufficient generation of yang qi,with deficiency of spleen and stomach leading to insufficient generation of tendons,bones and muscles,and insufficient body and weakness of muscle,and therefore invigorating spleen and tonifying kidney,warming yang and benefiting qi should be applied,with Buzhong Yiqi Decoction(补 中 益 气 汤)or Dihuang Yinzi(地黄饮子)with modification being applied.