血运重建后双心病当代中医认识思路初探

Preliminary Study on Contemporary Chinese Medicine Understanding of Double Heart Disease after Revascularization

冠心病患者合并心理精神障碍属心脏心理病(简称“双心病”),冠状动脉血运重建术是除药物治疗冠心病以外的有效方法,目前已广泛应用于临床。近年来研究发现,术后患者伴随焦虑、抑郁等负性心理问题的发病率越来越高,严重危害患者预后。单纯西医治疗不良反应大且存在耐药性和成瘾性的危害,而中医药干预手段验之有效,并能减轻和避免西药治疗的不良反应。近现代中医学者研习经典,从“血脉,神明之心”认识双心病,以五神论五脏梳理致病机制,以“七郁”划分疾病分期,在临床实践中观察疾病特征,总结辨治思路,身心同治、内外齐下、中西结合全面干预双心疾病,改善冠状动脉血运重建患者的预后,该文通过梳理前辈对双心病的辨思经验,初步认识该病证治的核心规律、特征证素,以期为临床干预血运重建后双心病提供有效方案,为中医药研究思路提供方向。

Patients with coronary heart disease complicated with mental disorder belong to cardiac psychological disease(referred to as“double heart disease”). Coronary revascularization is an effective treatment besides pharmacotherapy,which has been widely used in clinical practice. In recent years,studies have found that the incidence of postoperative patients with anxiety,depression and other negative psychological problems is increasing,which seriously harm the prognosis of patients. Simple Western medicine treatment has great side effects,and there is the harm of drug resistance and addiction,while traditional Chinese medicine(TCM)intervention proved effective and can reduce and avoid the adverse reactions of Western medicine treatment. Modern scholars study of the traditional Chinese medicine classics,understand double heart disease from“the heart dominating the blood vessels and the the spirit”,analyze the pathogenic mechanism of the five Zang based on the five spirits theory,divide the disease stages by the“seven constraints”,observe the characteristics of the disease in clinical practice,summarize the ideas of differentiation and treatment,simultaneouly treat the body and the mind,combine the internal and external therapy,integrate Chinese and Western medicine,comprehensively intervene in double heart disease,improve the prognosis of patients with coronary artery revascularization. In this paper,through sorting out the treatment experience of predecessors in the double heart disease,the core law and the characteristics of TCM syndrome elements of the disease have been preliminarily summarized,in order to provide an effective plan for clinical intervention of double heart disease after revascularization,and provide a direction for the research of traditional Chinese medicine.