脑小血管病（CSVD）是一种常见的脑血管疾病，主要表现为认知能力下降和步态不稳等症状，严重影响患者生活质量。 中医认为，CSVD与络病、玄府相关，其病机与络脉瘀阻、玄府闭塞、脑髓失养有关。开玄通络法可作为CSVD的治疗原则， 临证时可分期论治。早期CSVD宜宣畅玄府气机、宁神通络，主要采用辛香类药物；中期CSVD宜化瘀通络，多选用活血类 药物；末期CSVD宜补肾开玄、填髓通络，主要采用补肾类药物。开玄通络法治疗CSVD体现了中医辨证施治的优势，可为 CSVD的临床治疗提供思路。

Cerebral small vessel disease （CSVD） is a common cerebrovascular disorder characterized by decreased cognitive ability，unstable gait，and other symptoms that significantly impair patients’ quality of life. Traditional Chinese medicine （TCM） posits that CSVD is associated with collateral disorders and dysfunction of sweat pore，and its pathogenesis is due to blockage of collaterals by blood stasis，obstruction of sweat pore，and malnourishment of the brain marrow. The therapeutic principle of opening sweat pore and unblocking collaterals can be applied for CSVD through staging treatment. For the treatment of early CSVD， the focus is on regulating qi movement of sweat pore， calming the spirit， and unblocking collaterals， which can be achieved primarily by using aromatic and acrid herbs. For the treatment of CSVD at intermediate stage，the emphasis shifts to resolving stasis to unblock collaterals，which can be achieved usually by blood-activating herbs. For the treatment of late CSVD，treatment aims at tonifying the kidneys to open sweat pore，replenishing marrow to unblock collaterals， which can be achieved mainly by employing kidney-tonifying herbs. The approach of opening sweat pore and unblocking collaterals exemplifies the advantages of TCM’s syndrome differentiation and treatment，offering valuable insights for the clinical management of CSVD.

R277.743

广东省中医药局科研项目（编号：20241354）；中山市中医药传承创新发展科研专项重点项目（编号：2024B3007）