双心诊疗干预心肌梗死后抑郁理论探源

心肌梗死后合并抑郁属于“双心疾病”范畴,抑郁作为一种常见的精神障碍性疾病持续存在,可增加冠心病的复发或影响心肌梗死预后。中医的“双心学说”认为心为“君主之官”主血脉、神志,按照功用之异,分为“血脉之心”“神明之心”,双心一体,生理相依,病理互损。心肌梗死后抑郁的核心病机为“心脉瘀阻,心神失养”所致神明失守,抑郁由生。结合“双心学说”、心梗后抑郁的启动环节与其核心病机,本课题组主张“双心同治”,予祛瘀养心治法为基础,“祛瘀”以祛除心肌梗死(真心痛)之瘀血内停,“养心”以调节抑郁(郁病)之心神失养。

Theoretical origin of depression after myocardial infarction intervened with double heart therapy

Depression after myocardial infarction belongs to the category of‘double heart’.depression,as a common mental disorder,can increase the recurrence of coronary heart disease or affect the prognosis of myocardial infarction.The‘double heart theory’of traditional Chinese medicine holds that the heart is‘official of monarchy’,‘heart governing blood and vessels’and‘heart governing mind’.According to different functions,it can be divided into‘heart of blood and vessels’and‘heart of mind’,double heart integrated into one,physiologically mutually dependent and pathologically mutually damaged.The core pathogenesis of depression after myocardial infarction is‘blockade of heart vessel and malnutrition of heart spirit’,resulting in the loss of mind and spirit and depression.Combining with the theory of‘double heart’,the initiation link and core pathogenesis of depression after myocardial infarction adhere to‘double heart treated simultaneously’,based on the method of removing blood stasis and nourishing heart,‘removing blood stasis’in order to removing blood stasis of myocardial infarction(real heart pain),‘nourishing heart’in order to regulating malnutrition of heart spirit of depression(depression syndrome).