| 引用本文: |
李若涵, 吴圣贤, 李纳川, 杜雅薇.从“因加而发，心脑合病”探讨冠心病继发认知障碍的辨治[J].湖南中医药大学学报,2026,46(9):1847-1853[点击复制] |
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| 从“因加而发，心脑合病”探讨冠心病继发认知障碍的辨治 |
| 李若涵,吴圣贤,李纳川,杜雅薇 |
| (北京中医药大学东直门医院, 北京 100700) |
| 摘要: |
| 冠状动脉粥样硬化性心脏病（以下简称“冠心病”）可通过多重病理机制介导脑损伤，进而导致认知障碍。冠心病继发认知障碍符合中医学“心脑合病”概念。本文从“因加而发，心脑合病”出发，认为冠心病继发认知障碍的核心病机在于“心脑合病”，发病机制为“因加而发”，以痰瘀伏络为“故”，以情志刺激、外感邪毒、医源损伤为“加”，以浊蒙清窍为“发”。治疗上，提出“心脑同治”的治疗原则，并主张分期辨治：故邪伏络期，浊毒未成，先其时而治，方选内消软脉汤2号；新邪诱导期，浊毒氤氲，治病于未盛，方选补阳还五汤合黄连温胆汤加减；新故相加期，浊毒已成，治病于已发，方选黄连解毒汤合通窍活血汤化裁。 |
| 关键词: 冠心病|认知障碍|因加而发|心脑合病|分期辨治 |
| DOI：10.3969/j.issn.1674-070X.2026.09.013 |
| 投稿时间：2026-01-19 |
| 基金项目:国家自然科学基金面上项目(82174339)。 |
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| Differentiating and treating cognitive impairment secondary to coronary heart disease from the perspective of “onset triggered by pathogenic superimposition and heart-brain comorbidity” |
| LI Ruohan, WU Shengxian, LI Nachuan, DU Yawei |
| (Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China) |
| Abstract: |
| Coronary atherosclerotic heart disease (hereinafter referred to as "coronary heart disease", CHD) can mediate brain injury through multiple pathological mechanisms, thereby leading to cognitive impairment. Cognitive impairment secondary to CHD conforms to the concept of "heart-brain comorbidity" in Chinese medicine. Starting from the perspective of "onset triggered by pathogenic superimposition and heart-brain comorbidity", this paper holds that the core pathogenesis of cognitive impairment secondary to CHD lies in "heart-brain comorbidity", and its pathogenic mechanism is "onset triggered by pathogenic superimposition", with phlegm and blood stasis lurking in the collaterals as the "underlying factor," emotional stimuli, exogenous pathogenic toxins, and iatrogenic injury as the "triggering factors," and turbidity clouding the clear orifices as the "onset." In terms of treatment, the therapeutic principle of "simultaneous treatment of the heart and brain" is proposed, and stage-based differentiation and treatment is advocated: in the stage of underlying pathogens lurking in the collaterals, before turbid toxin has formed, treatment should be given prior to its onset, with Neixiao Ruanmai Decoction No. 2 selected; in the stage of induction by new pathogens, when turbid toxin is gathering, treatment should be given before it becomes predominant, with modified Buyang Huanwu Decoction combined with Huanglian Wendan Decoction selected; in the stage of superimposition of new and underlying pathogens, when turbid toxin has already formed, treatment should be given after its onset, with modified Huanglian Jiedu Decoction combined with Tongqiao Huoxue Decoction selected. |
| Key words: coronary heart disease|cognitive impairment|onset triggered by pathogenic superimposition|heart-brain comorbidity|stage-based differntiation and treatment |
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