基于心主神明论治冠状动脉微循环障碍  

On Treating Coronary Microvascular Dysfunction Based on the Theory of the Heart Controlling Spiritual and Mental Activities

作　　者：朱永锋 唐可清[2] ZHU Yongfeng;TANG Keqing(Shandong University of Traditional Chinese Medicine,Jinan,Shandong,China,250000;Weifang Traditional Chinese Hospital,Weifang,Shandong,China,261000)

机构地区：[1]山东中医药大学,山东济南250000 [2]潍坊市中医院,山东潍坊261000

出　　处：《河南中医》2025年第4期514-518,共5页Henan Traditional Chinese Medicine

摘　　要：人之心脏连脉,心是脉的中心,脉的功能活动正常全赖于心的健全。血液的正常流动,除了依赖心气的推动,也赖于血脉的通利。心主脉,心气既推动血液运行,也维持脉道通利。心主神明,总辖一切,血脉与心体相连,直接受心神的调控和支配,同时,心神又有赖于血的濡养,心主神明与心主血脉,生理互用。冠状动脉作为直接为心脏本体提供营养物质的血脉系统,不但负责存养心神,更是濡养心脏本体的关键。冠状动脉微循环作为冠状动脉的远端微细结构,可以视为心脉之孙络。气行则血行,气滞则血瘀,且气滞引起的浊聚、痰凝,均可阻滞脉络,所谓不通则痛,因此有益气、养血、行气、活血、化痰、祛浊、通络等治法。心不静,则神不明,神不明,则使道闭塞,形体乃伤。血脉和利,神有归养,心神爽明,又能调气和脉。宁神致远汤以酸枣仁为君,人参、川芎、丹参为臣,瓜蒌、薤白、琥珀为佐,甘草为使,诸药共用,宁神以使神明,神明而使令慧,令慧而气血脉各安其职,血脉和利。The human heart is interconnected with blood vessels,serving as the core of the vascular system.Normal vascular function relies entirely on the integrity of the heart.Proper blood circulation depends not only on the propulsion of heart qi but also on the unobstructed flow within the vessels.The heart controls blood circulation,with heart qi both driving blood circulation and maintaining vascular patency.The heart also controls spiritual and mental activities,overseeing all physiological functions.Blood vessels are directly connected to the heart and regulated by mental activities.Conversely,mental activities depend on nourishment by blood.Thus,the heart′s roles in governing spiritual and mental activities and blood circulation are physiologically interdependent.The coronary arteries,as the blood vessel system directly providing nutrients to the heart,not only nourish the heart spirit,but also are crucial for nourishing the heart itself.The coronary microcirculation,as the distal fine structure of the coronary arteries,can be regarded as the tertiary collateral vesselof the heart meridian.When qi flows,blood flows;when qi stagnates,blood stasis occurs.Moreover,the turbidity accumulation and phlegm coagulation caused by qi stagnation can all obstruct the vessels.As the saying goes,"Where there is no smooth flow,there is pain." Therefore,therapeutic methods such as tonifying qi,nourishing blood,moving qi,activating blood circulation,resolving phlegm,eliminating turbidity,and unblocking the vessels are adopted.Restlessness of the heart disrupts mental clarity,leading to blocked pathways and physical damage.Harmonized blood vessels and stabilized mental activities ensure proper nourishment of the heart and balanced qi-blood dynamics.Mind-Calming and Clarity-Promoting Decoction uses Suanzaoren(Semen Ziziphi Spinosae) as the sovereign herb,Renshen(Ginseng),Chuanxiong(Rhizoma Chuanxiong),and Danshen(Radix Salviae Miltiorrhizae) as ministers,Gualou(Fructus Trichosanthis),Xiebai(Bulbus Allii Macrostemi) and Hupo(Succinum

关 键 词：冠状动脉微循环障碍 心主神明 心主血脉 宁神致远汤 

分 类 号：R259.414[医药卫生—中西医结合]