从“心主神明”理论探讨心血管疾病与认知功能障碍的关联  

The association between cardiovascular disease and cognitive impairment based on the theory of “heart governing the spirit light”

作　　者：蒋洋洋 谢颖桢[1] 赵明镜[1] JIANG Yangyang;XIE Yingzhen;ZHAO Mingjing(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《北京中医药大学学报》2022年第4期334-341,共8页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(No.81973787)。

摘　　要：中医理论认为“心主神明”,而心所主之神的功能受损是心系疾病伴发认知障碍的核心发病机制。文章首先从中医学和西医学对心与脑在生理和病理的关联进行总结。其中“元神在脑、识神在心”是对心与脑主宰人的精神思维活动的高度概括,心属五脏,脑为奇恒之腑,故脑神亦要受心神的调控。心脏的泵血和内分泌功能是心对脑功能影响的生理基础,心与脑疾病也有共同的病理基础和危险因素。同时进一步对心力衰竭、房颤、高血压、冠心病等心血管疾病伴发认知功能障碍的中西医发病机制进行了总结。从中医角度来说,“心主神明”失常是其共同的病机。或心气亏虚,心血不足,或阳虚无以温煦,导致心神失于滋养,即形神失调;或有形实邪阻滞,心神被扰,导致认知功能下降。而西医学发现心血管疾病可通过影响脑血流动力学、神经和血管等造成脑组织结构或功能的改变而导致认知功能的下降。心对脑功能的影响为“心主神明”理论提供了科学依据。The theory of traditional Chinese medicine holds that “heart governs the spirit light”. The core pathogenesis of heart diseases with cognitive impairment is the dysfunction of the mentality dominated by the heart. Firstly, this paper summarizes the relationship between heart and brain in physiology and pathology from traditional Chinese medicine and modern medicine. Among them, “the meta-mind is in the brain and the awareness-spirit in the heart” is a highly generalization of heart and brain’s role in controlling people’s spiritual consciousness and thinking activities. The heart belongs to the five viscera, and the brain is an organ of extraordinary fu-viscera, so the spirit light of brain should also be regulated by the spirit light of heart. The blood-pumping and endocrine functions of the heart are the physiological basis of the influence of the heart on brain function, and heart and brain diseases also share common pathological basis and risk factors. Then the etiology and pathogenesis of cognitive impairment associated with heart diseases such as heart failure, atrial fibrillation, hypertension and coronary heart disease are then summarized. From the perspective of traditional Chinese medicine, the disorder of “heart governing the spirit light” is the underlying pathogenesis. Heart qi deficiency, or heart blood deficiency, or yang deficiency without warmth, could result in the loss of nourishment of mind, i.e. the disorder of body and mind;Or substantial pathogenic factors blocking the heart could bring about disturbed mind and impaired cognitive function. Modern medicine finds that cardiovascular diseases can lead to the decline of cognitive function by affecting cerebral hemodynamics, nerves and blood vessels to injure brain tissue structure or function. The influence of heart on brain function provides a scientific basis for the theory of “heart governing the spirit light”.

关 键 词：心主神明 脑为元神之府 心血管疾病 认知功能障碍 心脑相关 

分 类 号：R259.749[医药卫生—中西医结合]