摘要
从“因郁致病”“因病致郁”角度探析冠心病与抑郁症的共病机制,认为“因郁致病”与“因病致郁”之间的纽带是“郁”,气机阻滞是关键。中医学的心藏象涵盖了循环系统、精神神经系统的多数生理过程及部分内分泌系统功能,心脑血管疾病和心理疾病与心藏象密切相关。基于中医学认识提出,心阳郁阻导致“阳微”是冠心病即中医学胸痹的病机所在,情志拂郁导致阳气结聚不得发越则胸痹加重,反映了“因病致郁”过程;随着疾病发展,出现痰、瘀病邪,可进一步加重病情,反映了“因郁致病”过程。基于现代医学认识提出脂质、血小板、氧化产物、细胞因子等的异常聚集即“郁”的一种形式,也是冠心病与抑郁症双心共病的物质基础,这些物质促使情绪和认知区域的神经元损伤或凋亡,诱导抑郁症的发病,反映了“因病致郁”过程;而不良情绪导致交感神经兴奋,产生儿茶酚胺,促进血小板聚集,炎症标志物水平升高,增加了冠心病的致病风险,反映了“因病致郁”过程。
This study explored the comorbidity mechanisms of coronary heart disease and depression from the perspectives of"constraint causing disease"and"disease causing constraint",for which"constraint"is the link,and the key lies in the stagnation of qi.The heart storing manifestations in traditional Chinese medicine(TCM)encom⁃passes most physiological processes of the circulatory system,the mental nervous system,and some functions of the endocrine system,and cardiovascular diseases and psychological disorders are closely related to it.In TCM,it is pro⁃posed that the stagnation of heart yang leading to"yang deficiency"is the pathogenesis of chest tightness,and emo⁃tional disturbance leading to the stagnation of yang qi aggravates the chest tightness,reflecting the process of"disease causing constraint".As the disease progresses,the appearance of phlegm and stasis further worsens the condition,re⁃flecting the process of"constraint causing disease".Based on modern medical understanding,the abnormal accumula⁃tion of lipids,platelets,oxidative products,cytokines,and other substances constitute a form of"constraint",which is also the material basis for the comorbidity of coronary heart disease and depression.These substances promote neu⁃ronal damage or apoptosis in the emotional and cognitive regions,inducing the onset of depression,reflecting the pro⁃cess of"disease causing constraint".Meanwhile,adverse emotions lead to sympathetic nerve excitement,resulting in the production of catecholamines,promoting platelet aggregation,elevating levels of inflammatory markers,and increasing the risk of coronary heart disease,reflecting the process of"disease causing constraint".
作者
韩慧莹
刘寨华
张华敏
曹洪欣
HAN Huiying;LIU Zhaihua;ZHANG Huamin;CAO Hongxin(Institute of Basic Theory of Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing.100700)
出处
《中医杂志》
CSCD
北大核心
2024年第8期858-861,共4页
Journal of Traditional Chinese Medicine
基金
北京市中医基础理论重点学科建设项目(KJX202201)
中央科研院所基本科研业务费专项资金(YZX-202326)。
关键词
冠心病
抑郁症
双心疾病
因郁致病
因病致郁
coronary heart disease
depression
psycho-cardiological disease
constraint causing disease
disease causing constraint
