老年冠心病合并认知障碍时空辨治思路及应用  

Exploring the Spatiotemporal Discrimination Thinking and Application for Cognitive Impairment in Elderly Coronary Heart Disease

作　　者：惠稼祺 漆仲文 张月莹 李彤 徐凤芹[1,2] HUI Jiaqi;QI Zhongwen;ZHANG Yueying;LI Tong;XU Fengqin(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing,100091;Laboratory of Combining Diseases and Evidence to Prevent Vascular Aging,National Administration of Traditional Chinese Medicine;Graduate School of Beijing Uni-versity of Chinese Medicine)

机构地区：[1]中国中医科学院西苑医院,北京市100091 [2]国家中医药管理局病证结合防治血管衰老研究室 [3]北京中医药大学研究生院

出　　处：《中医杂志》2024年第23期2419-2426,共8页Journal of Traditional Chinese Medicine

基　　金：中国中医科学院西苑医院提升中医药临床循证证据级别研究专项揭榜挂帅项目(XYZX0204-04);中国博士后科学基金项目(2023M733915);国家中医药管理局中医药传承与创新“百千万”人才工程(岐黄工程)岐黄学者项目(02045006)。

摘　　要：认为“心脑环路”为老年冠心病合并认知障碍共病基础。在心脑同治指导下,基于老年冠心病合并认知障碍“虚-瘀-毒”病机演变的时间序贯特点,从病机时相性和心脑同治空间多维性视角构建“病-证-期”的治疗策略。前期以肾虚脑空为本,发作期以浊瘀脑伤为要,进展期以毒邪脑损为变,临床可通过补虚益肾以复络脉畅通,祛瘀化浊以促血脉充沛,解毒清心以安神益脑,初步构建以空间维度辨病位、时间维度定病期的老年冠心病合并认知障碍的时空辨治思路,以期为心脑共病的中医时空辨证论治提供理论基础。With increasing aging,cognitive impairment in elderly coronary heart disease is a"disease group"with high morbidity and mortality in the senior population,which seriously affects the health and quality of life of the elderly.This paper takes the"cardio-cerebral circuit"as the basis of co-morbidity,and under the guidance of the cardio-cerebral homoeopathy,based on the temporal sequential characteristics of the evolution of the disease mecha⁃nism of cognitive impairment in elderly coronary heart disease,we construct a“disease-syndrome-phase”prevention and treatment strategy based on the time-sequential characteristics of the pathogenesis of the disease mechanism of"deficiency-blood stasis-toxicity",from the perspective of pathogenicity of the disease mechanism in time-phase and the spatial multidimensionality of cardio-cerebral homoeopathy.The prevention and treatment strategy of the"diseasesyndrome-phase"is constructed from the perspective of the temporal phase of the disease mechanism and the multidi⁃mensionality of the space of cardio-cerebral homoeopathy.In the earlier stage,"kidney deficiency and brain empti⁃ness are the foundation",in the attack stage,"turbid stasis and brain injury are the key",and in the progression stage,"toxicity and brain damage are the changes".It is emphasized that replenishing the deficiency and benefiting the kidneys to restore the smooth flow of collaterals,eliminating blood stasis and removing turbidity to promote the enrichment of blood,and detoxifying and clearing the heart to tranquilize the spirit and benefit the brain,the spatio⁃temporal thinking of cognitive impairment of coronary heart disease in the elderly is initially constructed with the spa⁃tial dimension to identify the location of the disease,and the temporal dimension to determine the stage of the disease,which will provide a theoretical basis for the spatiotemporal diagnostic and treatments for the heart and brain comorbidities of TCM.

关 键 词：冠心病 认知障碍 老年人 心脑同治 

分 类 号：R259[医药卫生—中西医结合] R277.7[医药卫生—中医内科学]