[1]胡冉冉,赵海滨,赵维哲,等.基于“气-血-络-神”一体观探析“辛”法辨治冠心病合并焦虑抑郁[J].陕西中医,2025,46(11):1514-1519.[doi:DOI:10.3969/j.issn.1000-7369.2025.11.013]
　HU Ranran,ZHAO Haibin,ZHAO Weizhe,et al.Analysis of syndrome differentiation and treatment of coronary heart disease complicated with anxiety and depression by the Pungent method based on Qi-Blood-Collateral-Spirit[J].,2025,46(11):1514-1519.[doi:DOI:10.3969/j.issn.1000-7369.2025.11.013]
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基于“气-血-络-神”一体观探析“辛”法辨治冠心病合并焦虑抑郁
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《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
46
期数:
2025年11期
页码:
1514-1519
栏目:
学术探讨
出版日期:
2025-11-05

文章信息/Info

Title:
Analysis of syndrome differentiation and treatment of coronary heart disease complicated with anxiety and depression by the Pungent method based on Qi-Blood-Collateral-Spirit
作者:
胡冉冉; 赵海滨; 赵维哲; 孙治琪
（北京中医药大学东方医院，北京 100078)
Author(s):
HU Ranran; ZHAO Haibin; ZHAO Weizhe; SUN Zhiqi
(Dongfang Hospital，Beijing University of Chinese Medicine，Beijing 100078，China)
关键词:
冠心病; 焦虑; 抑郁; 气-血-络-神; 辛法
Keywords:
Coronary heart disease; Anxiety; Depression; Qi-blood-collateral-spirit; Xin method
分类号:
R 541.4
DOI:
DOI:10.3969/j.issn.1000-7369.2025.11.013
文献标志码:
A
摘要:
冠状动脉粥样硬化性心脏病（CHD）合并焦虑抑郁的发病率持续攀升，严重威胁人民的身心健康。基于“气-血-络-神”一体观，结合叶天士“久病入络”理论，提出本病病理进程中病邪由“湿热”演变为“瘀热”，由气及血、由功能性损伤发展为器质性病变。结合现代医学对CHD合并焦虑抑郁的认识及病理学改变的佐证，认为“湿热瘀滞”导致“久病入络，气血皆窒”，引起“气-血-络-神”失常是核心病机。基于上述理论，提出“络以辛为泄”作为本病的治疗大法，从“辛香流气，畅络怡神”“辛润和血，柔络安神”“辛法立方，祛瘀调神”立法论述。
Abstract:
The incidence of coronary atherosclerotic heart disease (CHD) complicated by anxiety and depression continues to rise,posing a serious threat to the physical and mental health of the population.Based on the integrated concept of “Qi-Blood-Collateral-Spirit” and in combination with YE Tianshi’s theory of “prolonged illness affecting the collaterals”,it is proposed that during the pathological process of this disease,the pathogenic factors evolve from “damp-heat” to “stasis-heat”,progressing from the Qi aspect to the blood aspect and from functional impairment to organic lesions.In light of the modern medical understanding of CHD complicated by anxiety and depression and the evidence of pathological changes,it is believed that “damp-heat stasis” leads to “prolonged illness affecting the collaterals and obstruction of both Qi and blood”,thereby causing the dysfunction of “Qi-Blood-Collateral-Spirit”,which is the core pathogenesis.Based on the above-mentioned theory,the treatment principle of “using pungent herbs to dredge the collaterals” is proposed for this disease,and the treatment methods are expounded from the aspects of regulating Qi with pungent-aromatic herbs to dredge the collaterals and soothe the spirit,nourishing blood with pungent-moistening herbs to soften the collaterals and calm the spirit,and formulating prescriptions with pungent-method herbs to remove stasis and regulate the spirit.

参考文献/References:

[1]中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2022概要[J].中国循环杂志,2023,38(6):583-612.
[2]PALACIOS J,KHONDOKER M,MANN A,et al.Depression and anxiety symptom trajectories in coronary heart disease:Associations with measures of disability and impact on 3-year health care costs[J].J Psychosom Res,2018,104:1-8.
[3]JHA M K,QAMAR A,VADUGANTHAN M,et al.Screening and management of depression in patients with cardiovascular disease:JACC state-of-the-art review[J].J Am Coll Cardiol,2019,73(14):1827-1845.
[4]王帅,赵海滨,肖若然.从“瘀热虚滞”论心肌梗死合并抑郁焦虑[J].辽宁中医杂志,2022,49(5):44-46.
[5]史金玉,王超,黄乐曦,等.CHD合并焦虑抑郁的治疗研究进展[J].世界中医药,2022,17(14):2087-2091.
[6]LI Y,XU W,GUO L.Anxiety is associated with coronary microvascular dysfunction:Results from the CAMADA study[J].Microcirculation，2023，30(4):e12798.
[7]ABBATE A,BIONDF Z,OCCAI G G,et al.Recurrent angina after coronary revascularization: A clinical challenge[J].Eur Heart J,2007,28(9):1057-1065.
[8]刘璐,贾文浩.经皮冠状动脉介入治疗术后再狭窄的中医药防治研究进展[J].基层中医药,2024,3(9):112-118.
[9]LU Y,JIANG Y,GU L.Using path analysis to investigate therelationships between depression anxiety and health-relatedquality of life among patients with coronary artery disease[J].Qual Life Res,2019,28(10):2695-2704.
[10]张国星,宋玲毓,时向民.抗抑郁药物与治疗心血管疾病药物相互作用的研究进展[J].中华老年心脑血管病杂志,2024,26(12):1501-1503.
[11]邢丽君,魏月娟,纪立霞,等.补脾通络方治疗冠心病微血管心绞痛疗效研究[J].陕西中医,2023,44(3):316-319.
[12]曾建勇,王小玲,范小虹,等.复方丹参滴丸联合阿托伐他汀治疗冠心病合并心绞痛疗效及对患者氧化应激指标的影响[J].陕西中医,2023,44(1):55-59.
[13]赵京生.针灸学基本概念术语通典[M].北京:人民卫生出版社,2014:645-645.
[14]常成成,袁国强,魏聪,等.脉络学说营卫理论指导冠心病心绞痛辨证论治[J].疑难病杂志,2019,18(8):837-840,846.
[15]王建枝,吴立玲,陈琪.疾病机制[M].北京:人民卫生出版社,2018:661-661.
[16]WANG H H,GARRUTI G,LIU M,et al.Cholesterol and lipoprotein metabolism and atherosclerosis: Recent advances in reverse cholesterol transport[J].Ann Hepatol,2017,16(l):s27-s42.
[17]马静茹,张强,王吉峰,等.血浆ox-LDL水平与冠状动脉粥样硬化病变程度相关性分析[J].中国实验诊断学,2022,26(1):25-28.
[18]刘继东,张哲,贾连群,等.从现代生物学角度探讨动脉粥样硬化“痰浊-痰结-痰瘀”病机演变规律[J].中华中医药学刊,2021,39(2):109-112.
[19]吴以岭.络病学[M].北京:中国中医药出版社,2017:205-205.
[20]许璐,白春英,陈士萍,等.早发冠心病患者载脂蛋白E基因多态性分析及其与冠状动脉病变严重程度关系研究[J].陕西医学杂志,2022,51(9):1090-1093.
[21]蔡敏一,赵德强,于宏梅,等.老年冠心病患者血清脂联素、生长素释放肽水平与血小板聚集率及主要不良心脏事件相关性分析[J].陕西医学杂志,2024,53(7):931-935.
[22]张景岳.景岳全书[M].北京:中国医药科技出版社,2011:208,229.
[23]赵维哲,贾子昊,刘铸,等.基于“营气痹窒，络脉瘀阻”探讨“辛润通络”法在CHD合并焦虑中的应用[J].世界中医药,2024,19(6):826-829.
[24]杜敏,王怡茹,冯骁腾,等.基于“双心理论”的女性CHD合并精神心理障碍发病机制及临床研究概况[J].山东中医药大学学报,2022,46(6):782-787.
[25]汪思慧,沈雁.从“络以辛为泄”论治冠心病心绞痛研究进展[J].陕西中医,2022,43(12):1822-1824.
[26]顾成娟,朴春丽,吴学敏,等.降香、水蛭、川芎治疗微循环障碍经验——仝小林三味小方撷萃[J].吉林中医药,2019,39(11):1466-1468.
[27]李玉坤,刘大胜,任聪,等.中医芳香疗法的研究进展[J].中国中医急症,2020,29(1):178-181.
[28]黄罗生,顾燕飞,李红.中药挥发油及芳香性药物的研究进展[J].中国中药杂志,2009,34(12):1605-1611.
[29]孙坤坤,王加锋.辛味药药性理论及归经应用[J].山东中医药大学学报,2021,45(4):458-461.
[30]黄熙,赵健蕾,张红敏,等.冠心二号方剂对健康人冠脉血流量的影响以及对大鼠心肌缺血再灌注模型抗心肌细胞凋亡的作用[J].中药药理与临床,2007,22(5):206.
[31]刘保和.《西溪书屋夜话录》讲用与发挥[M].北京:中国中医药出版社,2013:53-53.
[32]王昀,王超,丁婉丽,等.双心疾病之CHD伴焦虑抑郁“瘀热虚滞”病机探析[J].北京中医药大学学报,2022,45(4):347-352.
[33]杨良.药物依赖学[M].北京:人民卫生出版社,2015:66.
[34]李锂,裴丽霞,卡丽比努尔·依马木,等.基于生物-心理-社会医学模式理论探析针灸“调神”[J].实用中医内科杂志,2023,37(2):15-17.
[35]刘祥,侯季秋,赵海滨,等.双心方对经皮冠脉介入术术后合并抑郁状态心血瘀阻证患者的血清成分影响及相关性分析[J].北京中医药大学学报,2023,46(7):913-923.
[36]黄乐曦,杜泓森,靳会会,等.双心方治疗心肌梗死后抑郁的网络药理学研究[J].中医学报,2021,36(9):1985-1991.

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备注/Memo

备注/Memo:
国家自然科学基金资助项目（82174332）；中央高水平中医医院临床科研业务费资助项目（2023-DYXY-010）；首都卫生发展科研专项项目（首发2024-2-4203）
更新日期/Last Update: 2025-11-04