基于“畅络调神”思想辨治经皮冠状动脉介入治疗术后焦虑抑郁

Differentiation and Treatment of Anxiety and Depression after Percutaneous Coronary Intervention Based on the Idea of“Smoothing Collaterals and Calming the Spirit”

经皮冠状动脉介入治疗(PCI)术后焦虑抑郁是指发生心血管急性事件而行PCI术后继发情志障碍的一类疾病,西医治疗以精神类药物联合心血管类药物为主,但患者接受度不高。本文以“承制调平”理论为指导,结合心主神明、形神一体等总结出“畅络调神”既是双心疾病治疗的指导思想,又是其核心治法,气络、脉络通畅,心神、肝魂安定则双心之病可去。从“畅络调神”角度分析PCI术后焦虑抑郁病因病机为络虚瘀滞、心神失养,络气郁滞、肝魂不宁;围绕“畅络调神”的核心治法,制定其基本治则为益气畅络、调心安神,流气畅络、调肝定魂;总结出临床验方益气通络调心方、畅络调肝定魂方,为PCI术后焦虑抑郁的中医药诊治及双心疾病的络病证治提供理论基础。

Percutaneous coronary intervention(PCI)postoperative anxiety depression refers to a kind of disease with secondary emotional disorder after coronary intervention after acute cardiovascular events.Western medicine treatment is mainly psychotropic drugs combined with cardiovascular drugs,but the acceptance of patients is not high.Under the guidance of“Cheng Zhi Tiao Ping”theory,combined with“heart controlling the mental activity”and“unity of the physique and mental state”,this article summarized“smoothing collaterals and calming the spirit”,which is the guidance idea for bilateral cardiac disease,as well as the core treatment method.Smoothing qi collateral and meridians,and calming spirit and soul of liver can remove the bilateral cardiac diseases.Analyzed from the aspect of“smoothing collaterals and calming the spirit”,the etiology and pathogenesis of PCI is collaterals deficiency and stasis and stagnation,leading to loss of nutrients for heart and spirit;and collaterals qi stagnation,leading to restless soul of liver.Around the core treatment of“smoothing collaterals and calming the spirit”,this article proposed the basic treatment principles as tonifying qi and soothing collaterals to calm heart and spirit,and regulating qi and soothing collaterals to calm soul of liver;summarized the clinical experienced prescriptions of Yiqi Tongluo Tiaoxin Prescription and Changluo Tiaogan Dinghun Prescription,which provided a theoretical basis for the TCM diagnosis and treatment of anxiety and depression after PCI and the syndrome treatment of bilateral cardiac diseases.