双心疾病之冠心病伴焦虑抑郁“瘀热虚滞”病机探析  

Exploring the pathogenesis of psycho-cardiological disease from “blood stasis, heat, deficiency and stagnation”

作　　者：王昀 王超 丁婉丽 侯季秋 史金玉 王帅 唐卓然[3] 孙怿泽 赵海滨 WANG Yun;WANG Chao;DING Wanli;HOU Jiqiu;SHI Jinyu;WANG Shuai;TANG Zhuoran;SUN Yize;ZHAO Haibin(Shunyi Hospital,Beijing Hospital of Traditional Chinese Medicine,Beijing 101300,China;Dongfang Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100078,China;Beijing University of Traditional Chinese Medicine,Beijing 102488,China;The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医医院顺义医院,北京101300 [2]北京中医药大学东方医院 [3]北京中医药大学 [4]北京中医药大学第三附属医院

出　　处：《北京中医药大学学报》2022年第4期347-352,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：北京市自然科学基金项目(No.7214298,No.7202126);国家自然科学基金项目(No.82174332)。

摘　　要：双心疾病是心内科常见病,临床以冠心病伴焦虑抑郁多见。针对双心疾病,基于中医“心主血脉”“心主神明”的生理功能,结合心身医学“形神同调”思想,我们提出中医学“双心学说”,血脉之心与神明之心生理相依,病理互损,双心为病。结合临床认为“瘀热虚滞”是双心疾病中冠心病伴焦虑抑郁的重要病机,其中瘀为基,热为渐,虚为枢,滞为扰。梳理相关机制研究,发现“瘀热”与炎症通路激活、“虚滞”与“线粒体能量代谢障碍”存在相关性,且炎症通路与线粒体能量代谢障碍存在交叉对话现象。由此从“瘀热虚滞”的病机角度,结合炎症机制和线粒体能量代谢过程,探索性阐释“瘀”“热”“虚”“滞”导致冠心病伴焦虑抑郁的发病内涵,可以为中医药治疗该病提供一定的思路。Psycho-cardiological disease is commonly seen in cardiology as coronary heart disease tends to be accompanied by anxiety and depression in clinic. We put forward the psycho-cardiological theory of traditional Chinese medicine based on the physiological functions of “heart governing blood and vessels” and “heart governing spirit light” in traditional Chinese medicine, combining with the idea of “harmony between body and mind” in psychosomatic medicine. In this theory, the heart of the blood vessels and the heart of the spirit are physiologically dependent, and pathologically correlated, resulting in psycho-cardiological disease. Based on clinical observation, we hold that “blood stasis, heat, deficiency, and stagnation” are the primary pathogenesis of psycho-cardiological disease, in which blood stasis is the foundation, heat aggravates the condition, deficiency is the key, and stagnation is the trigger. After reviewing the relevant mechanism studies, it is concluded that “blood stasis and heat” are correlated with the activation of inflammatory pathways, and “deficiency and stagnation” are correlated with “mitochondrial energy metabolism disorder”. In addition, there is a coincidence between inflammatory pathways and mitochondrial energy metabolism disorder. Therefore, from the perspective of the pathogenesis of “blood stasis, heat, deficiency, stagnation”, we can provide certain perspectives for the treatment of psycho-cardiological disease with traditional Chinese medicine, combining inflammatory mechanisms and mitochondrial energy metabolism processes to further explore the roles of “blood stasis”, “heat”, “deficiency” and “stagnation” in the development of coronary heart disease with anxiety and depression.

关 键 词：双心疾病 冠心病 焦虑抑郁 心主血脉 心主神明 炎症 线粒体 病机 

分 类 号：R259.41[医药卫生—中西医结合]