阿尔茨海默病脾虚痰饮病机探析

张静远; 赵娟; 虞鹤鸣; 徐后喜; 周春祥

doi:10.14148/j.issn.1672-0482.2023.1174

阿尔茨海默病脾虚痰饮病机探析

doi: 10.14148/j.issn.1672-0482.2023.1174

1.
南京中医药大学中医学院，江苏南京 210023
2.
南京秦虹社区卫生服务中心，江苏南京 210006
3.
南京中医药大学附属南京中医院，江苏南京 210022

基金项目:

国家自然科学基金面上项目 8177140780

江苏省学位委员会项目 KYCX21_1643

江苏省高校哲学社会科学研究项目 2022SJYB0331

江苏省高校哲学社会科学研究项目 2022SJYB0333

虞鹤鸣名中医工作室基层工作站 YHM-2021-SJJCGZZ

详细信息

作者简介:
张静远，男，讲师，E-mail：zyw6002@126.com

通讯作者:
周春祥，男，教授，博士生导师，主要从事经方抗炎、抗肿瘤及其作用机制的研究，E-mail：chunxiangzhou@njucm.edu.cn

中图分类号: R259.41
计量
- 文章访问数: 190
- HTML全文浏览量: 33
- PDF下载量: 39
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-19
- 网络出版日期: 2023-12-20
- 发布日期: 2023-12-10

Exploration of the Pathogenesis of Spleen Deficiency and Phlegm Fluid in Alzheimer's Disease

1.
School of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
2.
Nanjing Qinhong Community Health Service Center, Nanjing 210006, China
3.
Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 210022, China

摘要

摘要: 脾虚痰饮是阿尔茨海默病(Alzheimer's disease, AD)的病机特征。根据AD患者不同年龄阶段机能衰退及其记忆、思维与认知障碍，与脾土功能之间的关系，结合历代医家对该病认识，提出脾虚是AD发病的始动原因, 痰饮内生、神机失用是AD进展的重要环节，健脾化痰/饮是AD的基本治法，苓桂术甘汤为干预AD的代表方剂。
- 阿尔茨海默病 /
- 脾虚痰饮 /
- 病机
Abstract: Spleen deficiency and phlegm fluid are the pathological characteristics of Alzheimer's disease (AD). Based on the functional decline and memory, thinking, and cognitive impairments of AD patients at different age stages, as well as the relationship with spleen soil function, combined with the understanding of previous medical experts on this disease, it is proposed that spleen deficiency is the initial cause of AD, the endogenous production of phlegm fluid and the loss of spiritual transformation activity are important links in the progression of AD. Strengthening the spleen and resolving phlegm fluid are the basic treatment methods for AD, and Linggui Zhugan Decoction is a representative formula for intervening AD.
- Alzheimer's disease /
- spleen deficiency and phlegm fluid /
- pathogenesis

HTML全文

参考文献(37)

[1]	NGANDU T, MANGIALASCHE F, KIVIPELTO M. The Epidemiology and Prevention of Alzheimer's Disease and Projected Burden of Disease[M]//Global Clinical Trials for Alzheimer's Disease. Amsterdam: Elsevier, 2014: 3-20.
[2]	CHAN KY, WANG W, WU JJ, et al. Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990-2010: A systematic review and analysis[J]. Lancet, 2013, 381(9882): 2016-2023. doi: 10.1016/S0140-6736(13)60221-4
[3]	JESSEN F, WOLFSGRUBER S, WIESE B, et al. AD dementia risk in late MCI, in early MCI, and in subjective memory impairment[J]. Alzheimers Dement, 2014, 10(1): 76-83. doi: 10.1016/j.jalz.2012.09.017
[4]	PALMQVIST S, JANELIDZE S, QUIROZ YT, et al. Discriminative accuracy of plasma phospho-tau217 for Alzheimer disease vs other neurodegenerative disorders[J]. JAMA, 2020, 324(8): 772-781. doi: 10.1001/jama.2020.12134
[5]	SPERLING RA, AISEN PS, BECKETT LA, et al. Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease[J]. Alzheimers Dement, 2011, 7(3): 280-292. doi: 10.1016/j.jalz.2011.03.003
[6]	黄帝内经[M]. 北京: 中华书局, 2010. The Yellow Emperor's Inner Classic[M]. Beijing: Zhonghua book company, 2010.
[7]	孙思邈. 千金翼方[M]. 影印本. 天津: 天津古籍出版社, 2009: 346-347. SUN SM. Supplement to Important Formulas Worth a Thousand Gold Pieces[M]. Photocopy. Tianjin: Tianjin ancient books publishing house, 2009: 346-347.
[8]	叶天士. 临证指南医案[M]. 北京: 人民卫生出版社, 2006: 398-399. YE TS. Case Records as a Guide to Clinical Practice[M]. Beijing: People's medical publishing house, 2006: 398-399.
[9]	刘晓岚. 中医"脾主智"的理论探讨及强脾益智法对AD大鼠行为学影响的实验研究[D]. 福州: 福建中医学院, 2007. LIU XL. Theory of spleen governing intelligence and experimental study on the effects of ethology of AD rats' treated with invigorating spleen and reinforcing mental activities[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2007.
[10]	吴凤芝, 宁艳哲, 贾竑晓. 脾虚证患者认知功能的临床特征[J]. 首都医科大学学报, 2020, 41(1): 55-58. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYD202001011.htm WU FZ, NING YZ, JIA HX. Clinical changes of cognitive function patients with spleen deficiency[J]. J Cap Med Univ, 2020, 41(1): 55-58. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYD202001011.htm
[11]	凌耀星. 难经校注[M]. 北京: 人民卫生出版社, 1991: 93. LING YX. Annotation of The Classic of Difficult Issues[M]. Beijing: People's medical publishing house, 1991: 93.
[12]	严用和. 重辑严氏济生方[M]. 北京: 中国中医药出版社, 2007: 152. YAN YH. Re-compilation of Yan's Formulas to Aid the Living[M]. Beijing: China press of traditional Chinese medicine, 2007: 152.
[13]	朱震亨. 丹溪心法[M]. 北京: 人民卫生出版社, 2005: 208. ZHU ZH. Teachings of[Zhu] Dan-xi[M]. Beijing: People's medical publishing house, 2005: 208.
[14]	张介宾. 景岳全书[M]. 北京: 中医古籍出版社, 2021: 779. ZHANG JB. The Complete Works of[Zhang] Jing-yue[M]. Beijing: Traditional Chinese medicine ancient books publishing house, 2021: 779.
[15]	方隅. 医林绳墨: 八卷[M]. 上海: 商务印书馆, 1957: 53. FANG Y. Thread Ink of Medical Circle: Eight Volumes[M]. Beijing: The commercial press, 1957: 53.
[16]	唐容川. 血证论[M]. 上海: 上海人民出版社, 1977: 98. TANG RC. Theory of Blood Syndrome[M]. Shanghai: Shanghai people's publishing house, 1977: 98.
[17]	陈士铎. 辨证录[M]. 北京: 人民卫生出版社, 1989: 223-227. CHEN SD. Dialectical Records[M]. Beijing: People's medical publishing house, 1989: 223-227.
[18]	陈士铎. 石室秘录[M]. 北京: 人民卫生出版社, 2006: 319. CHEN SD. The Secret Record of the Stone Chamber[M]. Beijing: People's medical publishing house, 2006: 319.
[19]	徐瑞英, 李勇. 老年人的科学饮食与健康长寿[J]. 中国现代药物应用, 2013, 7(18): 248-249. doi: 10.3969/j.issn.1673-9523.2013.18.209 XU RY, LI Y. Scientific diet and health and longevity of the elderly[J]. Chin J Mod Drug Appl, 2013, 7(18): 248-249. doi: 10.3969/j.issn.1673-9523.2013.18.209
[20]	邓娟. 吸烟、饮酒与老年性痴呆关系的研究[D]. 重庆: 第三军医大学, 2006. DENG J. Study of the relationship between cigarette smoking, alcohol drinking and risk of dementia[D]. Chongqing: Third Military Medical University, 2006.
[21]	翟德华, 陶立群. 高龄老人性格心理特征、饮食习惯与健康长寿关系研究[J]. 中国人口科学, 2004(增1): 83-87, 177. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKRK2004S1013.htm ZHAI DH, TAO LQ. The relationship between psychological features, diet habits and healthy longevity of Chinese oldest-old[J]. Popul Sci China, 2004(Supp1): 83-87, 177. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKRK2004S1013.htm
[22]	于明秀, 孙西庆. 从阳明病变论述老年呆病的发病机制[J]. 新中医, 2009, 41(10): 1-2, 8. https://www.cnki.com.cn/Article/CJFDTOTAL-REND200910003.htm YU MX, SUN XQ. Discussion on pathogenesis of senile dementia with the theory of Yangming disease[J]. J N Chin Med, 2009, 41(10): 1-2, 8. https://www.cnki.com.cn/Article/CJFDTOTAL-REND200910003.htm
[23]	王清峰, 张丹, 李柱. 健脾化痰法治疗老年性痴呆痰浊阻窍证的疗效及机制研究[J]. 中医临床研究, 2013, 5(2): 12-13. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY201302011.htm WANG QF, ZHANG D, LI Z. Efficacy and mechanism research on treating phlegm blocking orifices symptoms from senile dementia by Jianpi Huatan therapy[J]. Clin J Chin Med, 2013, 5(2): 12-13. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY201302011.htm
[24]	桑锋, 谢中尧, 刘成全, 等. 通窍化痰汤治疗阿尔茨海默病30例[J]. 辽宁中医杂志, 2011, 38(1): 95-96. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY201101049.htm SANG F, XIE ZY, LIU CQ, et al. The therapeutic effect of Tongqiao Huatan Decoction(THD) on thirty cases of Alzheimer's disease[J]. Liaoning J Tradit Chin Med, 2011, 38(1): 95-96. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY201101049.htm
[25]	林祖辉. 裘昌林从痰论治老年痴呆经验[J]. 中医杂志, 2006, 47(11): 826-827. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ200611015.htm LIN ZH. Qiu Changlin's experience in treating Alzheimer's disease from phlegm[J]. J Tradit Chin Med, 2006, 47(11): 826-827. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ200611015.htm
[26]	杨惠丹. 加味温脾通络开窍方治疗脾虚痰阻型阿尔茨海默病的临床疗效观察[D]. 南宁: 广西中医药大学, 2017. YANG HD. The clinical observation on Alzheimer's disease of spleen deficiency and sputum resistance type with modified Wenpi Tongluo Kaiqiao Decoction[D]. Nanning: Guangxi University of Chinese Medicine, 2017.
[27]	刘艳菊. 补脾益智法对AD大鼠学习记忆能力及NGF、BDNF、NT-3表达的影响[D]. 福州: 福建中医药大学, 2011. LIU YJ. The effect of Bupi Yizhi method on the ability of learning and memory and the expression of NGF, BDNF, NT-3 in rats with Alzheimer's disease[D]. Fuzhou: Fujian University of Traditional Chinese Medicine, 2011.
[28]	YU BB, ZHOU CX, ZHANG JY, et al. Latest study on the relationship between pathological process of inflammatory injury and the syndrome of spleen deficiency and fluid retention in Alzheimer's disease[J]. Evid Based Complement Alternat Med, 2014, 2014: 743541.
[29]	郑英宇. 健脾祛痰化瘀法干预冠状动脉粥样硬化小型猪脑Aβ的实验研究[D]. 沈阳: 辽宁中医药大学, 2016. ZHENG YY. Experimental study on the intervention of invigorating spleen, eliminating phlegm and removing blood stasis on brain Aβ in miniature pigs with coronary atherosclerosis[D]. Shenyang: Liaoning University of Traditional Chinese Medicine, 2016.
[30]	XIONG S, SHI YJ, LIU JG, et al. Linggui qihua decoction inhibits atrial fibrosis by regulating TGF- β 1/Smad2/3 signal pathway[J]. Evid Based Complement Alternat Med, 2023, 2023: 3764316.
[31]	于蓓蓓. 基于苓桂术甘汤干预Aβ致炎症损伤研究探讨阿尔茨海默病与脾虚饮停关联[D]. 南京: 南京中医药大学, 2015. YU BB. Study on the relationship between Alzheimer's disease and the syndrome of spleen deficiency and fluid retention based on lingguizhugantang's intervention of Aβ-induced inflammatory injury[D]. Nanjing: Nanjing University of Chinese Medicine, 2015.
[32]	ZHANG JY, YANG DQ, ZHAO JA, et al. Ling-Gui-Zhu-Gan Decoction alleviates cognitive deficits in Alzheimer's disease by activating the nuclear factor-erythroid factor 2-related factor 2/the antioxidant responsive element signaling pathway[J]. Curr Top Nutraceutical Res, 2023, 21(1): 1-9.
[33]	XI FF, SANG F, ZHOU CX, et al. Protective effects of Lingguizhugan Decoction on amyloid-beta peptide (25-35)-induced cell injury: Anti-inflammatory effects[J]. Neural Regen Res, 2012, 7(36): 2867-2873.
[34]	周西彬. 苓桂术甘汤调控阿尔兹海默病病理进程中中枢神经元自噬的生物学机制研究[D]. 南京: 南京中医药大学, 2021. ZHOU XB. Research on the biological mechanism of Linggui Zhugan Decoction in regulating autophagy of central neurons in the pathological process of Alzheimer's disease[D]. Nanjing: Nanjing University of Chinese Medicine, 2021.
[35]	陈君媚. 苓桂术甘汤改善脑淋巴炎症保护神经元损伤作用机制研究[D]. 南京: 南京中医药大学, 2020. CHEN JM. Study on the protective mechanism of Linggui Zhugan Decoction on neuronal injury induced by cerebral lymphatic inflammation[D]. Nanjing: Nanjing University of Chinese Medicine, 2020.
[36]	胡谦锋. 从苓桂术甘汤干预Aβ转运、沉积、致损伤研究探讨温脾化饮治疗AD生物学机制[D]. 南京: 南京中医药大学, 2018. HU QF. A research on the biological mechanism of the theory of warming spleen to resolve fluid retention in treating AD by intervention of Aβ transporter, sedimentation and damage[D]. Nanjing: Nanjing University of Chinese Medicine, 2018.
[37]	王莉兰, 周春祥. 苓桂术甘汤运化并举干预β淀粉样蛋白代谢研究思路刍议[J]. 南京中医药大学学报, 2022, 38(9): 790-796. doi: 10.14148/j.issn.1672-0482.2022.0790 WANG LL, ZHOU CX. Discussion on research ideas of intervention of β-amyloid metabolism with Linggui Zhugan decoction to regulate spleen's governing transportation and transformation[J]. Nanjing Univ Tradit Chin Med, 2022, 38(9): 790-796. doi: 10.14148/j.issn.1672-0482.2022.0790