基于浊邪理论述评阿尔茨海默病的中医治疗:聚焦脑胆固醇稳态

Review of Traditional Chinese Medicine Treatment of Alzheimer's Disease Based on Turbidity Theory:Focusing on Brain Cholesterol Homeostasis

阿尔茨海默病(Alzheimer's disease,AD)是痴呆中最常见的进行性神经退行性疾病,也是一种特殊的脂质疾病。从现代医学角度,胆固醇稳态失衡是AD的重要风险因素,淀粉样蛋白-β斑块沉积、神经原纤维缠结、大量脂质颗粒堆积是AD的典型病理特征;从中医学角度,浊邪是AD的发病关键,痰浊、瘀浊、毒浊是浊邪的具体衍化,是AD的发病之标。胆固醇产自水谷精微代谢之膏脂,胆固醇稳态失衡是浊邪内生这一发病机制的典型体现。从中医药调节胆固醇稳态失衡的角度入手可能是未来治疗AD的新方向。本文聚焦胆固醇稳态的现代研究,以中医浊邪理论为切入点,分析浊邪理论内涵与胆固醇稳态失衡的相关性以及致病机制,并从痰浊、瘀浊、毒浊3方面探讨在治疗AD中的临床应用成果,使之更好指导临床和科研。

Alzheimer′s disease(AD),the most common progressive neurodegenerative disease in dementia,is also a special lipid disease.From the perspective of modern medicine,cholesterol homeostasis is an important risk factor for AD.Amyloid-beta plaque deposition,neurofibrillary tangles,and large amount of lipid granule accumulation are typical pathological features of AD.From the perspective of TCM,turbidity is the key to the pathogenesis of AD.Phlegm turbid,stasis turbid and turbid toxin are the concrete derivation of turbidity,which are the standard of AD.Cholesterol is the greasy lipid which is produced from of the essence of water and food,the disturbance of cholesterol homeostasis is a typical embodiment of the pathogenesis mechanism of endogenous turbidity.Regulating cholesterol homeostasis by traditional Chinese medicine may be a new direction for the treatment of AD in the future.Focusing on the modern research of cholesterol homeostasis,taking the theory of turbidity as the starting point,this paper analyzed the correlation between the connotation of turbidity theory and the imbalance of cholesterol homeostasis as well as the pathogenesis mechanism,and further elucidated the clinical application results in the treatment of AD from the aspects of phlegm turbid,stasis turbid and turbid toxin,so as to better guide clinical practice and scientific research.