从“因虚致郁,因郁化毒,因毒损心”探讨冠心病伴发抑郁状态的病机及治疗  

Discussion of the pathogenesis and treatment of patients on coronary heart disease with depression based on the“depression due to deficiency,toxin due to accumulation of depression,and heart damage due to toxin”

作　　者：雷舒扬 王丽颖[2] 朱爱松 LEI Shuyang;WANG Liying;ZHU Aisong(School of Basic Medical Sciences,Zhejiang Chinese Medical University,Hangzhou 310053,China;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]浙江中医药大学基础医学院,杭州310053 [2]中国中医科学院中医临床基础医学研究所

出　　处：《北京中医药大学学报》2023年第11期1605-1610,共6页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(No.81904325);浙江中医药大学校级科研项目人才专项(No.2022RCZXZK15)。

摘　　要：在现代“生物—心理—社会”医学模式下,冠心病伴发抑郁状态的“双心”疾病已成为研究热点,其核心病机要素可以概括为“虚、郁、毒”,即因虚致郁、因郁化毒、因毒损心。其中,“虚”主要责之于心胆气虚,为发病的根本内因;“郁”既包含广义的气机郁滞,又包含狭义的情志三郁(怒郁、思郁、忧郁),为病情进展的关键因素;“毒”为痰饮、瘀血等病理产物蕴久化生的“伏毒”,并在情志之郁的影响下暴发,继而损伤心脉、败坏形质,造成不可逆的心功能损伤,为冠心病伴发抑郁状态的最终结局,并以益气强心、调神壮胆,理气解郁、加强意疗,痰瘀毒同治、透达血脉为主要治法,以期为临床诊治冠心病伴发抑郁状态提供新思路。Under the modern“biology-psychology-society”medical model,coronary heart disease with depression has become a research focus,and its core pathogenesis elements can be summarized as“deficiency,depression,and toxin”,that is,depression due to deficiency,toxin due to accumulation of depression,and heart damage due to toxin.“Deficiency”mainly refers to the qi deficiency of heart and gallbladder,the fundamental internal cause of the disease.“Depression”includes both the broad sense of qi stagnation and the narrow sense of three depression-related emotions(anger,depressive thinking,and anxiety),which are key factors in the progression of the disease.“Toxin”refers to the accumulation and transformation of pathological products,such as phlegm and static blood,into the“latent toxin”.Toxins emerge under the stimulation of emotional depression and damage the heart channels,corrupt the shape,and cause irreversible cardiac functional lesions,the final outcome of coronary heart disease with depression.The main treatment methods include supplementing qi,strengthening heart,regulating the mind and strengthening the gallbladder,regulating qi to relieve depression,strengthening mental therapy,treating phlegm,stasis,and toxins together to smooth the blood vessels.We hope to provide new ideas for the clinical diagnosis and treatment of coronary heart disease with depression.

关 键 词：冠心病伴发抑郁状态 心胆气虚 情志三郁 内生毒邪 毒损心脉 

分 类 号：R259.414[医药卫生—中西医结合]