冠心病“双心”异常的诊疗进展及中医药防治探讨(1)
[摘要]文章探讨冠心病“双心”异常的内涵、病因病机、治法方药，并结合现代医学诊疗进展，笔者认为冠心病“双心”异常与冠心病合并焦虑、抑郁、失眠等精神心理应激密切相关，病因多与情志内伤有关，病位在心，涉及肝脾肾，病机为心肝火旺、心肾阴虚、心脾两虚等。充分认识冠心病“双心”异常的内涵和病机，运用中医病证结合的优势进行治疗，对于减少精神心理应激等冠心病的危险因素，防治冠心病并改善预后有重要价值。
[关键词]胸痹;心神;精神心理应激;抑郁;治法方药
[收稿日期]2014-06-28
[基金项目]国家“重大新药创制”科技重大专项(2012ZX09102-201-006)
[通信作者]*王阶，主任医师，Tel：(010)88001817，E-mail：wangjie0103@126.com
, http://www.100md.com
[作者简介]袁蓉，研究方向为心血管，Tel：15210854880，E-mail：yuanrong427@163.comAdvance in diagnosis and treatment of psycho-cardiological abnormality of
patients with coronary heart disease with traditional Chinese medicines
YUAN Rong1，2， WANG Jie1*， LIU Wei1，2
(1. Department of Cardiology， Guang′anmen Hospital， China Academy of Chinese Medical Sciences， Beijing 100053， China;
, 百拇医药 2. Beijing University of Chinese Medicine， Beijing 100029， China)
[Abstract]To discuss the etiology， pathogenesis， therapies and prescriptions of psycho-cardiological abnormality of patients with coronary heart disease. According to the advance in modern diagnosis and treatment， the authors believed that psycho-cardiological abnormality of patients with coronary heart disease is closely related with mental stresses， like anxiety， depression and insomnia. It is mostly caused by emotional injury and expressed in heart， liver， spleen and kidney. The pathogenesis is heart-liver hyperactivity， yin deficiency in heart and kidney， and insufficiency in heart and spleen. The full recognition of etiology and pathogenesis of psycho-cardiological abnormality of patients with coronary heart disease and the combined treatment of disease and syndromes are of great significance to reduce mental stress and other risk factors， prevent and treat coronary heart disease and improve prognosis.
, http://www.100md.com
[Key word]thoracic obstruction; heart and mind; mental stress; depression; therapy and formula of traditional Chinese medicine
doi：10.4268/cjcmm20150336
冠心病现已成为WHO公认的首位死亡原因[1]，目前，介入治疗的应用在冠心病心绞痛、心肌梗塞的治疗方面取得了突破性进展[2]。然而，临床诊疗过程中医生对精神心理障碍的忽视和诊断不明确，患者对疾病的恐惧程度高，依从性低等综合因素导致冠心病合并焦虑、抑郁、烦躁、失眠等现象屡见不鲜，心脏和心理的“双心”异常日渐突出，显著影响着冠心病的发病率和死亡率[3]。现阶段单纯的西药治疗已远不能满足患者需求，难以达到生物-心理-社会医学模式的要求。中医“形神合一”双调“心神”的理念在冠心病“双心”异常中有独特优势和地位，因此，探求中医药防治思路，对于提高临床疗效有重要意义。
1冠心病“双心”异常的诊疗进展
冠心病“双心”异常已成为全球关注和急需解决的重点问题。WHO预测[4]，到2030年冠心病和抑郁将排在全球负担疾病的前3位。近期流行病学发现[5]心绞痛频繁发作的患者合并抑郁达64%，合并焦虑达44%，且冠心病患者焦虑、抑郁易独立引起频繁的心绞痛。有研究证实患者精神压力引起的心肌缺血发生率达到40%[6]，焦虑抑郁与美国老年男性冠心病的发病率呈线性正相关[7]。因此，“双心”问题显著，其临床表现除胸闷胸痛，心悸气短外，还伴有脾气急躁，惊悸胆怯或情绪低落，悲伤欲哭，失眠多梦等，可单一出现或同时并存。, 百拇医药(袁蓉 王阶 刘巍)
[关键词]胸痹;心神;精神心理应激;抑郁;治法方药
[收稿日期]2014-06-28
[基金项目]国家“重大新药创制”科技重大专项(2012ZX09102-201-006)
[通信作者]*王阶，主任医师，Tel：(010)88001817，E-mail：wangjie0103@126.com
, http://www.100md.com
[作者简介]袁蓉，研究方向为心血管，Tel：15210854880，E-mail：yuanrong427@163.comAdvance in diagnosis and treatment of psycho-cardiological abnormality of
patients with coronary heart disease with traditional Chinese medicines
YUAN Rong1，2， WANG Jie1*， LIU Wei1，2
(1. Department of Cardiology， Guang′anmen Hospital， China Academy of Chinese Medical Sciences， Beijing 100053， China;
, 百拇医药 2. Beijing University of Chinese Medicine， Beijing 100029， China)
[Abstract]To discuss the etiology， pathogenesis， therapies and prescriptions of psycho-cardiological abnormality of patients with coronary heart disease. According to the advance in modern diagnosis and treatment， the authors believed that psycho-cardiological abnormality of patients with coronary heart disease is closely related with mental stresses， like anxiety， depression and insomnia. It is mostly caused by emotional injury and expressed in heart， liver， spleen and kidney. The pathogenesis is heart-liver hyperactivity， yin deficiency in heart and kidney， and insufficiency in heart and spleen. The full recognition of etiology and pathogenesis of psycho-cardiological abnormality of patients with coronary heart disease and the combined treatment of disease and syndromes are of great significance to reduce mental stress and other risk factors， prevent and treat coronary heart disease and improve prognosis.
, http://www.100md.com
[Key word]thoracic obstruction; heart and mind; mental stress; depression; therapy and formula of traditional Chinese medicine
doi：10.4268/cjcmm20150336
冠心病现已成为WHO公认的首位死亡原因[1]，目前，介入治疗的应用在冠心病心绞痛、心肌梗塞的治疗方面取得了突破性进展[2]。然而，临床诊疗过程中医生对精神心理障碍的忽视和诊断不明确，患者对疾病的恐惧程度高，依从性低等综合因素导致冠心病合并焦虑、抑郁、烦躁、失眠等现象屡见不鲜，心脏和心理的“双心”异常日渐突出，显著影响着冠心病的发病率和死亡率[3]。现阶段单纯的西药治疗已远不能满足患者需求，难以达到生物-心理-社会医学模式的要求。中医“形神合一”双调“心神”的理念在冠心病“双心”异常中有独特优势和地位，因此，探求中医药防治思路，对于提高临床疗效有重要意义。
1冠心病“双心”异常的诊疗进展
冠心病“双心”异常已成为全球关注和急需解决的重点问题。WHO预测[4]，到2030年冠心病和抑郁将排在全球负担疾病的前3位。近期流行病学发现[5]心绞痛频繁发作的患者合并抑郁达64%，合并焦虑达44%，且冠心病患者焦虑、抑郁易独立引起频繁的心绞痛。有研究证实患者精神压力引起的心肌缺血发生率达到40%[6]，焦虑抑郁与美国老年男性冠心病的发病率呈线性正相关[7]。因此，“双心”问题显著，其临床表现除胸闷胸痛，心悸气短外，还伴有脾气急躁，惊悸胆怯或情绪低落，悲伤欲哭，失眠多梦等，可单一出现或同时并存。, 百拇医药(袁蓉 王阶 刘巍)