基于“血-脉-心-神”一体观辨治冠心病血运重建后心境障碍

Treatment of Mood Disorders after Coronary Revascularization under the Concept of“Blood-pulse-heart-spirit”Holism

“血-脉-心-神”一体观蕴含的时空整体性、形神一体观等核心内涵与冠心病血运重建后心境障碍患者心体受损、神机失调、血失稳态特征高度契合。提出从血脉失和、心体失养、神不安位角度认识术后心境障碍病机变化。倡导从术后依据心境障碍发生前、发生时、稳定后三个阶段进行序贯辨治。第一阶段,在血运重建后以心体受损为主,运用清心宁心方药干预,起预防作用;第二阶段,即心境障碍发生阶段,以神机失调为主,运用五神安位汤并加重行气活血药物以调神安神;第三阶段,即心境障碍稳定阶段,以血失稳态久存,运用育心宁心方药配合血脉宁共同干预,起改善预后的作用。临诊时抓住疾病当前主要矛盾,依据病情发展序贯施治,则疗效显著。

The concept of“blood-pulse-heart-spirit”holism reflects the core of time and space unity and spirit and form unity,which is highly consistent with the characteristics of mood disorders after coronary revascularization such as heart and body damage,vital activity disorder,and blood homeostasis loss.The pathogenesis of mood disorders after coronary revascularization can be understood from the perspectives of blood and vessels disharmony,failure to nourish the heart and body,and spirit dislocation.Sequential treatment based on syndrome differentiation is suggested,and the three stages are before,during and after stabilization of mood disorders.In the first stage when heart damage is mostly common after revascularization,Qingxin Ningxin Formula(清心宁心方)can be used for prevention.In the second stage when the mood disorder occurs,vital activity disorder is mainly involved,and Wushen Anwei Decoction(五神安位汤)with more qi-moving and blood-invigorating herbs are suggested to regulate and calm the mind.In the third stage when the disease is stable but with persistent blood homeostasis loss,Yuxin Ningxin Formula(育心宁心方)together with Xuemaining(血脉宁)is recommended to improve the prognosis.In clinical practice,the doctors should focus on the main pathogenesis of the mood disorder after coronary revascularization,and then perform sequential treatment based on syndrome differentiation to obtain remarkable therapeutic effect.