心脑同治及其中药转化研究:历史、现状与思考

Simultaneous Treatment of Heart and Brain and Its Transformation of Chinese Medicine:History,Present Situation and Thinking

心脑血管疾病的高致残率、高致死率严重危害人类健康,影响生存质量,增加疾病负担。心脑之间的相互关系受到越来越多的关注,“心脑同治”是中医“异病同治”理论的不断深化与发展,探究二者的关系及中医药治疗现状对建立心脑血管疾病的中西医结合诊疗方案具有重要临床意义。该文通过对“心脑同治”进行较为系统的理论溯源,认为心脑血管疾病异病同源,心脑以血为基、神明相统;并阐述了心脑同治的现代生物学基础,心脑血管疾病致病因素相同、共患疾病夹杂,而神经体液反射失调、内分泌及免疫调节紊乱等可影响彼此功能。同时探讨了心脑同治中药的临床应用现状及对心脑血管疾病的干预效应,发现此类中药能够通过多靶点、多途径、多环节的调控起到心脑血管保护作用。结合目前研究所存在的问题对中医药心脑同治心脑血管疾病的实践策略做出思考与展望,从关注重点人群、聚焦优势病种、发挥中医药价值、科学阐释心脑同治的内涵等方面进行探讨,以期为转化应用研究提供思路。

The high morbidity and fatality rates of cardiovascular and cerebrovascular diseases seriously harm human health,greatly affect the quality of life and increase the burden of disease.Thus,more and more attention has been paid to the relationship between heart and brain."Simultaneous treatment of heart and brain" is the continuous deepening and development of the theory of "simultaneous treatment of different diseases" in traditional Chinese medicine(TCM),and exploring the relationship between heart and brain as well as the current situation of Chinese medicine treatment has important clinical significance for the establishment of integrated traditional Chinese and western medicine diagnosis and treatment programs of cardiovascular and cerebrovascular diseases.Through a systematic theoretical tracing of the "simultaneous treatment of heart and brain",the authors held that cardiovascular and cerebrovascular diseases had the same origin,and that heart and brain took blood as the material basis and governed mind jointly.They also expounded the modern biological relationship of the simultaneous treatment of heart and brain.In other words,the pathogenic factors of cardiovascular and cerebrovascular diseases were the same,with complicated comorbidities,and the disorders of neurohumoral reflex and endocrine system and immune system regulation could affect each other’s function.Additionally,the present situation of clinical application of Chinese medicine for simultaneous treatment of heart and brain and its intervention effect on cardiovascular and cerebrovascular diseases were discussed.It was found that these Chinese medicines could protect cardiovascular and cerebrovascular diseases through multi-target,multi-pathway and multi-link regulation.Combined with the existing problems in the current research,the authors thought and looked forward to the practical strategies of treating cardiovascular and cerebrovascular diseases with Chinese medicine by paying attention to key groups,focusing on dominant diseases,giving full play to the value of Chinese medicine,and scientifically explaining the connotation of simultaneous treatment of heart and brain,in order to provide ideas and reference for the follow-up transformation application research and better guidance of clinical practice.