基于“气-血-神”病机演变探讨中医药对心脏神经官能症治疗

Discussion on the Treatment of Cardiac Neurosis by Traditional Chinese Medicine Based on the Evolution of“Qi-Blood-Spirit”Pathogenesis

心脏神经官能症(cardiac neurasthenia,CN)是由于心脏自主神经兴奋而引起的心血管功能紊乱综合征。其发病多是由过度焦虑、紧张、惊吓或者精神创伤等因素对中枢神经兴奋和抑制功能的影响所引起。CN患者不仅因为心血管症状与神经功能失调引起的不良情绪并存导致生活质量严重降低,而且长期CN还能通过影响肿瘤坏死因子(TNF-α)和超敏C反应蛋白(hs-CRP)等炎症因子引起血管内皮功能紊乱从而增加心血管疾病的风险。由于CN的病因众多,机制复杂,目前现代医学对CN的治疗多采用对症治疗;中医对CN的治疗还未形成较系统的诊疗体系。中医的“气-血-神”的病机演变理论与CN的病理过程不谋而合,启示在临床上辨证论治,调气、行血、安神均不可偏废。据此,该文从“气-血-神”病机演变切入,将CN的病机分为气郁化邪则神扰、气血不行则神乱、气血无源则神散以探讨CN的病机演变规律,引申和梳理了气血失和影响心神而诱发CN的病理过程。文中根据气、血、神三者之间的联系,从理气解郁以安神、调气化瘀以宁神、益气养血以养神3个方面阐述中医药治疗CN的诊疗思路,为中医药治疗CN提供更系统的理论支持,亦为其丰富了的诊疗方向,同时还归纳并总结了调气、治血、安神之类中医方药治疗CN的临床研究,以期进一步证实中医药的科学性并挖掘其优势,拓宽用药思路,为CN诊疗提供进一步的启示和指导,更好地改善患者病情和预后。

Cardiac neurosis(CN)is a syndrome of cardiovascular dysfunction due to cardiac autonomic excitation.Its onset is mostly caused by the effects of factors such as excessive anxiety,tension,shock or trauma on the excitatory and inhibitory functions of the central nervous system.Patients with CN not only have a severely reduced quality of life due to the coexistence of cardiovascular symptoms and dysphoria caused by neurological dysfunction,but also long-term CN can cause vascular endothelial dysfunction by affecting inflammatory factors such as TNF-αand hs-CRP,thereby increasing the risk of cardiovascular disease.Due to the numerous etiologic factors and complex mechanisms of CN,the treatment of CN in modern medicine is mostly symptomatic;the treatment of CN in TCM has not yet formed a more systematic diagnosis and treatment system.The TCM theory of“Qi-blood-spirit”coincides with the pathological process of CN,which reveals that in clinical diagnosis and treatment,regulating Qi,promoting blood circulation and tranquilizing spirit should not be neglected.Accordingly,this article starts from the evolution of“Qi-blood-spirit”,divides the pathomechanism of CN into Qi depression and evil transformation into spirit disturbance,Qi and blood failure into spirit chaos,and Qi and blood sourcelessness into spirit dispersion in order to explore the law of evolution of the pathomechanism of CN,and derives and combs out the pathological process of CN triggered by the influence of Qi and blood disorder on the heart and spirit.According to the connection between Qi,blood and spirit,the article elaborates the diagnostic and therapeutic ideas of Chinese medicine in treating CN from three aspects:regulating Qi and relieving depression to calm the spirit,regulating Qi and eliminating blood stasis to tranquilize the spirit,and benefiting Qi and blood to nourish the spirit,so as to provide a more systematic theoretical support for the treatment of CN in Chinese medicine and enrich the direction of diagnosis and therapy,and at the same time,it also generalizes and concludes the clinical studies on the treatment of CN with Chinese herbal prescriptions for regulating Qi,regulating blood,and calming the spirit in order to further confirm the scientific nature of Chinese medicine and to tap into its strengths,to broaden the ideas of medicine,and to provide further revelations and guidelines for the diagnosis and treatment of CN and to improve the patient's condition and prognosis better.