摘要
冠状动脉粥样硬化性心脏病合并焦虑抑郁临床上通常被称为“双心疾病”,符合我国现代生物-心理-社会模式。目前研究表明下丘脑-垂体-肾上腺(HPA)轴可能是冠心病合并焦虑或抑郁的发病机制和治疗中的潜在靶点。团队基于络病理论,总结出“畅络调神”思想以论治双心疾病,临床上颇有成效,从“络不畅、神不安”辨治冠心病合并焦虑抑郁,“络不畅”易致冠心病患者出现炎症反应、氧化应激损伤从而影响HPA轴水平,产生焦虑或抑郁。“神不安”主要表现在血小板活化聚集、肠道菌群紊乱等易引起焦虑或抑郁症状的发生,与HPA轴水平亢进密切相关,HPA轴亢进反过来亦致冠心病。HPA轴被认为是冠心病合并焦虑或抑郁潜在的治疗靶点之一,有助于调节炎症介质水平、减轻氧化应激损伤、促进血小板活化、稳定肠道菌群,以发挥神经保护、心脏保护作用。故从HPA轴角度阐述络病理论之“畅络调神”思想论治冠心病合并焦虑或抑郁的理论内涵,为冠心病合并焦虑或抑郁中医辨治提供崭新视角。
Coronary atherosclerotic heart disease(CHD) complicated by anxiety/depression is commonly referred to in clinical practice as “psychocardiological disease”,aligning with the modern Chinese medical paradigm of the biopsychosocial model.Current research suggests that the hypothalamic-pituitary-adrenal(HPA) axis may serve as a potential pathogenic mechanism and therapeutic target in CHD accompanied by anxiety/depression.Based on the theory of collateral disease,this research group has proposed the therapeutic principle of “unblocking collaterals to calm the mind” for the treatment of psychocardiological disease,with promising clinical outcomes.Syndrome differentiation and treatment of CHD accompanied by anxiety/depression from “obstructed collaterals and restless mind” suggests that “obstructed collaterals” may lead to inflammatory responses and oxidative stress injury in CHD patients,thereby affecting the HPA axis and resulting in anxiety or depression.Meanwhile,“restless mind” manifests in platelet activation and aggregation and gut microbiota dysbiosis,both of which contribute to symptoms of anxiety and depression and are closely associated with HPA axis hyperactivity,which in turn exacerbates CHD.The HPA axis is thus considered a key potential therapeutic target for CHD accompanied by anxiety/depression,which helps regulate inflammatory mediators,reduce oxidative damage,promote platelet activation,and stabilize gut microbiota,offering neuroprotective and cardioprotective benefits.Therefore,this paper elaborates on the theoretical connotation of the collateral disease concept of “unblocking collaterals and calming the mind” in the treatment of CHD with anxiety/depression from the perspective of HPA axis regulation,providing a novel insight into syndrome differentiation and treatment in TCM for CHD with anxiety/depression.
作者
冯兰栓
王一鸣
宁博
余湖斌
李世淋
王宇婷
赵明君
FENG Lanshuan;WANG Yiming;NING Bo;YU Hubin;LI Shilin;WANG Yuting;ZHAO Mingjun(Shaanxi University of Chinese Medicine,Xianyang 712046,China;Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)
出处
《世界中医药》
北大核心
2025年第6期984-988,993,共6页
World Chinese Medicine
基金
国家重点研发计划-中医药现代化研究重点专项项目(2018YFC1704204)
陕西省重点研发计划-重点产业创新链(群)项目(2024SF-ZDCYL-03-21)
陕西省省级院士工作站建设项目-吴以岭院士工作站项目(陕组通字[2019]49号-30)
陕西省名中医赵明君传承工作室建设项目(2019007)
陕西省教育厅重点实验室项目(22JS005)
陕西省中医药管理局中医药科研项目(SZY-KJCYC-2023-009)。
关键词
冠心病合并焦虑或抑郁
下丘脑-垂体-肾上腺轴
畅络调神
理论内涵
双心疾病
络病理论
络不畅
神不安
Coronary heart disease combined with anxiety/depression
Hypothalamic-pituitary-adrenal axis
Unblocking collaterals and calming the mind
Theoretical connotation
Psychocardiological disease
Collateral disease theory
Collateral blockage
Restless mind
