从“有故无殒”探讨黄连解毒汤治疗阿尔茨海默病的用药思路

Exploration on the idea of using Huanglian Jiedu Decoction in the treatment of Alzheimer disease based on the principle that if there is enough reason

阿尔茨海默病(AD)是老年期最常见的神经变性病,发病机制尚未明确,临床治疗以改善症状为主。面对靶向药物研发不断受挫,单靶点药物研发方向饱受质疑。中医药多靶点、多途径、多环节作用特点比单一靶点更具潜力及优势,中医经典名方黄连解毒汤治疗AD疗效确切,但药物均为苦寒之品,不少医家考虑老年脏腑渐衰、阴阳渐虚的生理特点,唯恐清热解毒治法损伤中阳,临床难以推广应用。文章从“有故无殒”角度,针对AD“毒损脑络”的核心病机,探讨黄连解毒汤治疗AD的用药思路,有助于确保苦寒类中药的临床安全使用,以期为AD等神经退行性疾病的中医药治疗提供新思路。

Alzheimer disease(AD)is the most common neurodegenerative disease in the elderly,and the pathogenesis has not been cleared,the clinical treatment is mainly improving symptoms.In the face of continuous setback of research on targeted drug,the research direction of single-target drug is questioned.The multi-target,multi-path and multi-link action characteristics of traditional Chinese medicine(TCM)have more potential and advantages than single target,and the classical TCM formula,Huanglian Jiedu Decoction is effective in treating AD,but bitter and cold in taste.Many doctors consider the physiological characteristics of Zang-fu weak and yin-yang deficiency gradually in the erderly,and are afraid of the method of clearing heat and detoxication hurting middle yang,so it is hard to be promoted and applied in clinic.Therefore,in this paper,we will try to discuss the role of Huanglian Jiedu Decoction in AD from the perspective of‘the principle that if there is enough reason’,which will help to promote the safe use of bitter-cold TCM drugs,in view of the core pathogenesis of AD,which is‘toxin damaging brain collaterals’.It will help to promote the safe use of bitter-cold TCM drugs and establish a new thinking for the TCM treatment of neurodegenerative diseases such as AD.