半身不遂的病因、临床表现与诊断治疗方法有哪些？ 北京中医如何治疗中风?
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半身不遂是指病人左侧或右侧上、下肢先觉麻木，继之不能随意运动，常伴见瘫痪侧面部口眼歪斜，语言謇涩，久则患肢枯瘦，麻木不仁的病证。又名“偏枯”、“偏风”、“偏瘫”。西医的脑溢血、脑梗死、蛛网膜下腔出血等可参考进行辨证治疗。
一、病因病机本病通常为中风后遗症，多由营卫先衰、络脉空虚，风寒湿邪及痰湿乘虚而人；或因气虚、肾虚、精气不足所致。
二、临床表现与诊断
1．临床表现主要表现为半侧肢体功能障碍，不能随意活动，感觉减弱，或伴有口歪眼斜，舌头发硬，语言謇涩等症状。
2．诊断
（1）意识障碍性偏瘫：表现为突然发生意识障碍，并伴有偏瘫，常有头及眼各一侧偏斜。
（2）弛缓性偏瘫：表现为一侧上、下肢随意运动障碍伴有明显的肌张力低下，随意肌麻痹明显而不随意肌则可不出现麻痹，如胃肠运动、膀胱肌等均不发生障碍。
（3）痉挛性偏瘫：一般由弛缓性偏瘫移行而来，其特点是明显的肌张力增高。上肢的伸肌群及下肢的屈肌群瘫痪明显，肌张力显著增高，故上肢表现为屈曲，下肢伸直，手指呈屈曲状态，被动伸直手有僵硬抵抗感。
（4）轻偏瘫：在偏瘫极轻微的情况下，如进行性偏瘫的早期，或一过性发作性偏瘫的发作间隙期，瘫痪轻微。
三、辨证施治
1．风中经络型
【辨证】突然昏仆，半身不遂，肌肤不仁，伴见口眼歪斜，语言不利，或伴有发热恶寒，头痛，骨节痛，肢体拘急。舌苔白腻，脉象浮滑。
【施治】祛风通络，养血和营。
【方药】大秦艽汤：秦艽9g，川芎、独活、当归、白芍、石膏、甘草各6g，羌活、防风、白芷、黄芩、白术、茯苓、生地、熟地各3g，细辛2g，水煎服。
【加减】口眼歪斜甚者加全蝎、僵蚕；筋脉拘挛甚者加木瓜、威灵仙。
2．肝阳化风型
【辨证】头痛眩晕，耳鸣眼花，心烦易怒，面红目赤，遇有激怒则突发半身不遂，舌强语謇，口眼歪斜，甚则呕吐，神志不清。舌质红，脉弦数。
【施治】平肝潜阳，涤痰通络。
【方药】天麻钩藤饮：天麻10g，钩藤12g（后下），石决明18g（先煎），川牛膝12g，栀子、黄芩、杜仲、益母草、桑寄生、夜交藤、茯神各9g。
【加减】有痰者可加川贝10g，胆南星6g；手足发麻者加广地龙10g，豨莶草12g；视物不清者，可加决明子9g，茺蔚子10g；偏于火盛者，可加龙胆草10g，夏枯草15g；偏于风盛者，可加龟版15g，牡蛎25g。
3．痰火内闭型
【辨证】突然昏仆，神识不清，半身不遂，口眼歪斜，两手握固，牙关紧闭，面红目赤，喉中痰呜，喘促躁动。舌质红，苔黄腻，脉弦滑而数。
【施治】芳香开窍，涤痰息风。
【方药】羚角钩藤汤：羚角片（先煎）4．5g，双钩藤（后入）
9g，霜桑叶6g，滁菊花、生白芍各9g，鲜生地15g，川贝母（去心）
12g，淡竹茹（鲜刮）、羚羊角（先煎代水）各15g，茯神木9g，生甘草3g。水煎服。
4．湿痰内闭型
【辨证】卒暴僵仆，半身不遂，嗜睡或昏睡，神识不清，两手握固，痰涎壅盛，颜面虚浮，牙关紧闭，静而不烦，面白唇紫，四肢不温。舌淡苔白滑腻，脉沉滑或缓。
【施治】芳香开窍，涤痰息风。
【方药】导痰汤：半夏10g，橘红、茯苓、制南星、枳实各5g，炙甘草3g，生姜15g，水煎，2次分服。
5．阴脱阳浮型
【辨证】突然半身不遂，昏不识人，口眼歪斜，亦可见目合口开，手撒遗尿，鼻鼾息微，然手足冷而面颧红赤。舌痿而红，脉沉细欲绝。亦可于苏醒后方见半身不遂。
【施治】壮水制火。
【方药】地黄饮：生地黄90g，巴戟天、山茱萸、肉苁蓉、石斛、附子（炮）、茯苓、石菖蒲、远志、肉桂、麦门冬各30g，五味子15g，水煎服。
6．气虚血瘀型
【辨证】半身不遂，面色苍白，形赢自汗，偏身枯瘦，肌肤不仁，或手足肿胀，筋脉拘急，上肢屈曲，下肢伸直，上下肢强制屈伸则疼痛，或有半身刺痛。肌肤甲错。舌淡白，或晦滞有瘀血斑点，脉弦数或涩结。
【施治】补气，活血，化瘀。
【方药】补阳还五汤：黄芪30～120g，当归10～15g，赤芍10～15g，地龙、川芎、桃仁各10g，红花10～15g。水煎服。
7．肝肾亏虚型
【辨证】病人多年高力衰，面色苍白，腰酸腿软，齿摇发脱，耳鸣健忘，眩晕目糊，语言不利，神情呆滞，智能低下，如癫如痴。舌淡白，脉沉细弱。
【施治】滋补肝肾。
【方药】杞菊地黄丸：枸杞子、菊花各4g，熟地黄16g，山茱萸（制）、山药各8g，牡丹皮、茯苓、泽泻各6g，水煎服。
四、辅助治疗
1．成药方人参再造丸、大活络丹、维脑路通丸、愈风宁心片。
2．验方
（1）牛膝70g，牛蒡子（微炒）36g，防风30g，牛蒡根40g，大麻子、晚蚕沙各40g，萆薢、枸杞子、羌活、海桐皮各30g，秦艽20g，黑豆（炒熟）、苍耳子、制附子各30g，五加皮、茄子根各60g，虎胫骨（涂酥炙微黄）30g，好酒2．5kg。将诸药共捣细，以纱袋盛，置于坛内，用酒浸之，密封口，7天后即可取用。每次空心温饮1～2杯，每日午、晚各服1次，随饮随添新酒，味淡即换药。勿食猪、鸡、鱼等黏滑物。
（2）川乌、草乌、附子各100g（皆炮制去毒，俱用生姜煮过），川椒60g，共研末，酒糊为丸，如绿豆大。每服9丸，每日早、午、晚服3次，空腹送下。
（3）五灵脂100g，草乌25g（炮制去毒），共研细末，再用核桃仁100g，去油后与药末混合，醋糊为丸，如梧桐子大，晚用白酒送服；初次服3g，取微汗禁风；次日服4．5g；后增服至6g为止。
（4）独活100g，白酒500ml，煎至一半后，去渣取汁服用。
（5）羌活、独活、升麻、柴胡、秦艽、防风各等份。共研末，每次白酒送服3g，每日3次。
3．针灸疗方刺手足井穴皆出血，再以毫针刺其无病一边之手足1小时，起针后略停片刻，再刺其有病之肩髑、曲池、合谷、环跳、风市、阳陵泉、足三里、绝骨、昆仑、涌泉。头上针百会、风府、哑门、风池、人中、承浆、颊车、地仓、印堂，平捻刺之。人中、哑门对捻，涌泉强刺约1小时。针到行动完全恢复正常止。
五、调护
（1）急性期病人，生活不能自理，应严密观察、精心护理，切不可马虎大意。
（2）保持安静，尽量少搬动病人。患者头偏向一侧，保持呼吸道通畅，更换体位，防止久卧床者发生肺部感染和褥疮。
（3）饮食宜清淡，多食蔬菜水果、豆类食物，酌加瘦肉和鸡蛋，但忌食鸡、牛、羊等肉类。
（4）恢复期的患者应及早下床活动，积极功能锻炼，早日康复。
（5）积极治疗中风先兆症状，控制高血压和动脉硬化。保持精神愉快，避免精神刺激，防止过度劳累。
用食补的方法补肾比较好。可以常食下列食物：肉类骨髓：能润肺补肾，使肌肤润泽，面色红润，适宜肾虚体弱、精血亏损者食用。猪肾：能补肾虚，主治腰酸背痛、遗精、盗汗，用治肾虚导致的耳疾。
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