从肝论治“双心疾病”的理论渊源及临床病例剖析

Theoretical Origin and Case Analysis of Treating"Double Heart Disease"from Liver

随着人们生活水平的提高及生活压力的加剧,全球冠状动脉粥样硬化性心脏病(简称冠心病)发病率高达33%,已成为我国人民致死的重要病原,动脉粥样硬化是以动脉退行性和增生性改变为特征的血管性病变,主要表现为管壁增厚变硬、失去弹性和管腔狭窄,病变多起始于内膜,表现为糖类和脂类在血管壁局部聚集,继而动脉层逐渐出现退行性改变,甚至产生继发性病变,其中不稳定斑块的破裂、出血、脱落是造成动脉粥样硬化相关并发症的主要机制。通过大量临床观察及研究表明,冠状动脉粥样硬化性心脏病患者普遍存在明显的焦虑、抑郁等负性情绪,并且焦虑和抑郁会使冠状动脉粥样硬化性心脏病发病率和心源性死亡的风险显著增加。现代医学将心血管疾病与焦虑、抑郁等负性情绪的心理疾病同时存在一个机体时称为“双心疾病”。在新的生物-心理-社会医学模式下,心血管疾病合并焦虑抑郁等负性情绪的“双心疾病”受到极大重视。中医学认为焦虑、抑郁的发病责之于肝,且肝主疏泄的功能与血脂异常有密切关系,故从心肝阴阳相关、五行共济、经脉络属、气血互调、七情相系等方面论述,指出从肝论治冠心病合并焦虑的重要性。并提出疏肝理气法、清肝泻火法、疏肝化痰、清肝活血等基本治法,为冠心病合并焦虑提供新的思路及治疗方案。

With the improvement of people's living standard and the aggravation of living pressure,the incidence of coronary heart disease is as high as 33%in the world,which has become an important cause of death in our country.Atherosclerosis is a vascular disease characterized by degenerative and proliferative changes of the arteries,mainly manifested as thickening and hardening of the wall,loss of elasticity and stenosis of the lumen.The lesions mostly originate from the inner membrane,which is characterized by the presence of sugars and lipids.The main mechanism of atherosclerotic complications is the rupture,hemorrhage and abscission of unstable plaque.Through a large number of clinical observations and researches,it has been found that patients with coronary atherosclerotic heart disease generally have negative emotions such as anxiety and depression,and anxiety and depression can significantly increase the incidence of coronary atherosclerotic heart disease and the risk of cardiac death.In modern medicine,cardiovascular disease is called"double heart disease"when there is a body at the same time with psychological diseases with negative emotions such as anxiety and depression.Under the new bio-psycho-social medical model,cardiovascular disease combined with negative emotions such as anxiety and depression has attracted great attention.Traditional Chinese medicine holds that the pathogenesis of anxiety and depression lies in the liver,and the function of liver controlling and relieving is closely related to the abnormality of blood lipid.Therefore,this paper discussed the relationship between heart and liver,Yin and Yang,the five elements,the meridians and collaterals,the mutual regulation of Qi and blood,and the seven emotions,and pointed out the importance of treating coronary heart disease with anxiety from the perspective of liver.And it put forward the basic treatment methods,such as the method of soothing liver and regulating Qi,the method of clearing liver and reducing fire,the method of soothing liver and resolving phlegm,the method of clearing liver and promoting blood circulation to provide new ideas and treatment plans for coronary heart disease combined with anxiety.