基于“心脾相关,调气为先”探讨双心病中医治疗

Based on“heart-spleen correlation,regulating Qi first”to explore Chinese medicine treatment of double heart disease

双心病是机体心脏与精神心理共同致病。随着社会生活压力不断增加,心血管疾病合并焦虑/抑郁的患病率也逐年上涨。双心病主要临床表现为胸痛、胸闷、心慌、抑郁善忧、心惊胆怯、精神紧张等。根据双心病临床症状特征,可归属于中医学“胸痹”“郁证”范畴。胸痹与郁证合而为病与目前西医提出的双心病相似,为“心主血脉”与“心主神明”共病体现的一类疾病,故“心身同治”“心神同调”成为目前治疗本病的关键。根据“五脏相关理论”,心脾两脏存在母子相生、经络相贯、阴阳相承、气血相济、神志相合的生理学关系。而情志失畅为双心病重要危险因素,与肝脏密切相关。同时肝木与脾土间存在五行相克的关系。温胆汤作为化痰经典方,具有健脾化痰、理气解郁之功效;小柴胡汤具有疏解少阳枢机的功效,二者联用加强畅达气机之效。试从“心脾相关,调气为先”理论出发,探讨温胆汤联合小柴胡治疗双心病。

“Double heart disease”is condition caused by combined pathology of physical heart and psychological mind.With the continuous increase in social life stress.Prevalence of cardiovascular diseases accompanied by anxiety/depression has also risen year by year.“Double heart disease”primarily presents with clinical symptoms such as chest pain,chest tightness,palpitations,depression with tendency to worry,timidity,and mental tension.Based on clinical symptoms of“Double heart disease”,it can be categorized under traditional Chinese medicine concepts of“Xiongbi”and“Yu syndrome”.The combination of“Xiongbi”and“Yu syndrome”as disease is similar to“Double heart disease”proposed by modern western medicine,representing type of disease where the“heart governing blood vessels”and the“heart governing spirit”were both affected.Therefore,the key to treating this disease lies in“treating the body and mind together”and“regulating the heart and spirit together”.According to the“theory of five viscera interconnection,”the heart and spleen have physiological relationship of mother-child generation,meridian penetration,Yinyang inheritance,Qi-blood mutual aid,and spirit-integration.Emotional distress is significant risk factor for“Double heart disease”and is closely related to the liver.There was relationship of mutual restraint between the liver(wood)and the spleen(earth)in the five elements theory.Wendan prescription,classic phlegm-resolving formula,has effect of strengthening the spleen and resolving phlegm,as well as regulating Qi and relieving depression.Xiaochaihu prescription has effect of dispersing pivot of the Shaoyang.The combined use of these two enhances effect of unblocking the flow of Qi.Exploring the treatment of“Double heart disease”with Wendan prescription combined with Xiaochaihu prescription from the perspective of“heart-spleen interconnection,prioritizing the regulation of Qi.”