-
活血化瘀法是指使用具有活血祛瘀作用的方药,消散瘀滞,促进瘀血吸收的治法。活血化瘀类药物在我国的应用已有千年历史,比如最具代表性的药物之一的丹参,在《神农本草经》中便有记载:“味苦,微寒。治心腹邪气,肠鸣幽幽如走水,寒热积聚,破癥除瘕,止烦满,益气。”
血管性痴呆是脑血管病变后所引起的认知功能障碍,发病机制源于血管系统损害引起低脑血流灌注、氧化应激等一系列病理过程[1]。中医认为,该病的发生与肝郁以及瘀血密切相关,肝气郁结造成气机逆乱,肝不藏血,脑髓失养,从而发病为痴呆,所以肝气郁结,瘀血阻窍,致使脑失所养,灵机皆失为血管性痴呆的核心病机[2]。笔者对相关的文献进行综合分析,对活血化瘀法及具有活血化瘀功效的药物治疗血管性痴呆的研究进展进行归纳总结。
Research progress on the treatment of vascular dementia by promoting blood circulation and removing blood stasis
-
摘要: 活血化瘀法,是指使用具有消散作用能祛除体内瘀血的中药治疗瘀血病证的方法;具有畅通血脉、消散瘀滞、调经止痛的作用;广泛应用于瘀血导致的胸痹心痛、痴呆、月经不调等病症;常用药物有丹参、三七、川芎、郁金等。活血化瘀类药物普遍具有改善微循环、舒张血管、抑制血栓素形成、抑制血小板聚集等作用,在治疗冠心病、心绞痛、血管性痴呆等疾病的血瘀证具有较好的疗效。本文通过对活血化瘀类药物治疗血管性痴呆的中医和现代医学研究进展进行综述,以期为临床上应用活血化瘀法治疗血管性痴呆提供参考。Abstract: The method of promoting blood circulation and removing blood stasis refers to the use of traditional Chinese medicine with a dispersing effect that can eliminate blood stasis in the body to treat the syndrome of blood stasis; It has the effects of unblocking blood vessels, dissipating stasis, regulating menstruation and relieving pain; Widely used for conditions such as chest tightness, heartache, dementia, menstrual disorders caused by blood stasis. Common medicines include Salvia miltiorrhiza Bunge; Panax notoginseng (Burkill); Ligusticum chuanxiong Hort; Radix Curcumae, etc. Blood activating and stasis removing drugs generally have the effects of improving microcirculation, relaxing blood vessels, inhibiting thromboxane formation, and inhibiting platelet aggregation. They have good therapeutic effects on blood stasis syndrome in diseases such as coronary heart disease, angina pectoris, and vascular dementia. The research progress on traditional Chinese medicine and modern medicine on the treatment of vascular dementia with blood activating and stasis removing drugs were reviewed, in order to provide reference for the clinical application of blood activating and stasis removing methods in the treatment of vascular dementia.
-
[1] 陆佳婧, 侯瑜超, 黄思维, 等. 从发病机制概述针刺治疗血管性痴呆的研究进展[J]. 世界中医药, : 2023 , 18(17): 2556-2559+2564. [2] 陈维, 刘福友, 呼兴华, 等. 从肝郁血瘀论治血管性痴呆[J]. 辽宁中医杂志, 2010, 37(8):1462-1463. [3] 杨展. 血管性痴呆中西医治疗研究进展[J]. 继续医学教育, 2023, 37(6):165-168. [4] 向岁, 王平, 石和元. 血管性痴呆的中西医研究进展[J]. 中西医结合心脑血管病杂志, 2022, 20(18):3352-3356. [5] 姜雄, 况时祥. 益气升阳活血法治疗血管性痴呆早期机理探讨[J]. 时珍国医国药, 2015, 26(8):1967-1968. [6] 邓秋媚, 胡跃强, 潘能珍, 等. 补肾活血法治疗血管性痴呆研究进展[J]. 辽宁中医药大学学报, 2020, 22(11):100-105. [7] 谢虹亭, 孙权, 林松俊. 从痰、瘀、肾虚论治血管性痴呆研究进展[J]. 湖北中医杂志, 2021, 7(5):60-64. [8] 董风林. 通窍活血汤治疗血管性痴呆的疗效及对血脂与同型半胱氨酸的影响[J]. 长春中医药大学学报, 2020, 36(2):309-311. [9] 万改生, 杨耀凯. 通窍活血汤联合石杉碱甲治疗脑梗死后血管性痴呆的临床疗[J]. 深圳中西医结合杂志, 2023, 33(12):32-35. [10] BIR S C, KHAN M W, JAVALKAR V, et al. Emerging concepts in vascular dementia: a review[J]. J Stroke Cerebrovasc Dis, 2021, 30(8):105864. doi: 10.1016/j.jstrokecerebrovasdis.2021.105864 [11] ZHU H Y, HONG F F, YANG S L. The roles of nitric oxide synthase/nitric oxide pathway in the pathology of vascular dementia and related therapeutic approaches[J]. Int J Mol Sci, 2021, 22(9):4540. doi: 10.3390/ijms22094540 [12] Wang X X, Zhang B, Xia R, et al. Inflammation, apoptosis and autophagy as critical players in vascular dementia[J]. European Review for Medical & Pharmacological Sciences, 2020, 24(18):9601-9614. [13] 余文骁, 王延江. 亚洲血管性认知损害的流行病学现状和发展趋势[J]. 中国医学前沿杂志(电子版), 2020, 12(10):前插1,1-前插1,7. [14] T O'Brien J, Thomas A. Vascular dementia[J]. The Lancet, 2015, 386(10004):1698-1706. doi: 10.1016/S0140-6736(15)00463-8 [15] ZHANG Y Y, ZHANG X J, YANG J, et al. Effects of huayu tongluo moxibustion on learning and memory ability and the hippocampal BDNF/TrkB expressions in the rats of vascular dementia[J]. Chin Acupunct Moxibustion, 2019, 39(1):65-71. [16] LEE E S, YOON J H, CHOI J, et al. A mouse model of subcortical vascular dementia reflecting degeneration of cerebral white matter and microcirculation[J]. J Cereb Blood Flow Metab, 2019, 39(1):44-57. doi: 10.1177/0271678X17736963 [17] IADECOLA C. The pathobiology of vascular dementia[J]. Neuron, 2013, 80(4):844-866. doi: 10.1016/j.neuron.2013.10.008 [18] SHRIVASTAVA S K, DALKO E, DELCROIX-GENETE D, et al. Uptake of parasite-derived vesicles by astrocytes and microglial phagocytosis of infected erythrocytes may drive neuroinflammation in cerebral malaria[J]. Glia, 2017, 65. [19] BLASZKIEWICZ M, WOOD E, KOIZAR S, et al. The involvement of neuroimmune cells in adipose innervation[J]. Mol Med, 2020, 26(1):126. doi: 10.1186/s10020-020-00254-3 [20] 张喜武, 刘安然, 窦金金. 基于中西医结合的血管性痴呆发病机制及治疗的研究进展[J]. 中国实验方剂学杂志, 2023, 29(4):202-211. [21] 陈昭, 吴林, 蓝雪琳, 等. 血管性痴呆发病机制中西医研究进展[J]. 辽宁中医药大学学报, 2022, 8(1):40-44. [22] LIU J L, LI Q, PENG T, et al. Assessment of four serum biochemical markers in elderly patients with vascular dementia after cerebral infarction and their response to donepezil and idebenone[J]. J Neurol Surg B Skull Base, 2022, 84(6):629-636. [23] Shenkin S D, Hewitt J, Quinn T J. Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: a network meta‐analysis[J]. Cochrane Database of Systematic Reviews, 2021(2):1210-1217. [24] 陈希西, 韩嵩, 樊根豪, 等. 活血化瘀类中药现代药理学研究进展[J]. 天津中医药, 2023, 40(2):250-257. [25] 中药学(第十一版)[S], 北京: 中国中医药出版社, 2023, 267, 200, 261, 262. [26] 单晓晓, 洪帮振, 刘洁, 等. 丹参化学成分、药理作用、临床应用的研究进展及质量标志物的预测分析[J]. 中国中药杂志, 2021, 46(21):5496-5511. [27] 何德全. 丹参酮ⅡA通过调控Hippo-YAP信号通路改善动脉粥样硬化炎症反应[D]. 广州: 南方医科大学, 2023. [28] YANG Y, SHAO M Y, CHENG W K, et al. A pharmacological review of tanshinones, naturally occurring monomers from Salvia miltiorrhiza for the treatment of cardiovascular diseases[J]. Oxid Med Cell Longev, 2023, 2023:3801908. [29] 胡琼. 丹参酮ⅡA对静脉血栓栓塞症治疗的研究进展[J]. 贵州医药, 2023, 47(10):1526-1528. [30] HAN J Y, FAN J Y, HORIE Y, et al. Ameliorating effects of compounds derived from Salvia miltiorrhiza root extract on microcirculatory disturbance and target organ injury by ischemia and reperfusion[J]. Pharmacol Ther, 2008, 117(2):280-295. doi: 10.1016/j.pharmthera.2007.09.008 [31] WU Y, XU S, TIAN X Y. The effect of salvianolic acid on vascular protection and possible mechanisms[J]. Oxid Med Cell Longev, 2020, 2020:5472096. [32] YU L, WAN H F, JIN W F, et al. Protective effects of effective ingredients of Danshen(Radix Salviae Miltiorrhizae)and Honghua(Flos Carthami)compatibility after rat hippocampal neurons induced by hypoxia injury[J]. J Tradit Chin Med, 2018, 38(5):685-697. doi: 10.1016/S0254-6272(18)30907-5 [33] HE G N, CHEN G F, LIU W D, et al. Salvianolic acid B: a review of pharmacological effects, safety, combination therapy, new dosage forms, and novel drug delivery routes[J]. Pharmaceutics, 2023, 15(9):2235. doi: 10.3390/pharmaceutics15092235 [34] LI X, DU J R, ZHANG R, et al. The experimental study of the effect of tanshinone on artery restenosis in mouse[J]. Zhongguo Zhong Yao Za Zhi, 2004, 29(3):255-258. [35] LIANG R, BRUNS H, KINCIUS M, et al. Danshen protects liver grafts from ischemia/reperfusion injury in experimental liver transplantation in rats[J]. Transpl Int, 2009, 22(11):1100-1109. doi: 10.1111/j.1432-2277.2009.00925.x [36] BEZHAEVA T, KARPER J, QUAX P H A, et al. The intriguing role of TLR accessory molecules in cardiovascular health and disease[J]. Front Cardiovasc Med, 2022, 9:820962. doi: 10.3389/fcvm.2022.820962 [37] PENA E, BRITO J, EL ALAM S, et al. Oxidative stress, kinase activity and inflammatory implications in right ventricular hypertrophy and heart failure under hypobaric hypoxia[J]. Int J Mol Sci, 2020, 21(17):E6421. doi: 10.3390/ijms21176421 [38] LU J S, ZHANG H B, PAN J Y, et al. Fargesin ameliorates osteoarthritis via macrophage reprogramming by downregulating MAPK and NF-κB pathways[J]. Arthritis Res Ther, 2021, 23(1):142. doi: 10.1186/s13075-021-02512-z [39] 曹博雅, 陈家黎, 石晓溪, 等. 复方丹参滴丸调控LOX-NF-κB炎症途径治疗心肌缺血的机制研究[J]. 中草药, 2023, 54(1):151-159. [40] 庞振阳. 血管性痴呆的危险因素及发病机制的研究进展[J]. 吉林医学, 2019, 40(12):2890-2892. [41] 叶明灯, 汪晶莹, 周源, 等. 丹参酮B调控LRP6/Wnt1/β-catenin通路对血管性痴呆性小鼠认知功能的影响[J]. 中国药理学通报, 2022, 38(2):255-260. [42] 梁春晓, 王珊珊, 陈淑静, 等. 虎杖化学成分及药理活性研究进展[J]. 中草药, 2022, 53(4):1264-1276. [43] 林思, 秦慧真, 邓玲玉, 等. 虎杖苷药理作用及机制研究进展[J]. 中国实验方剂学杂志, 2021, 27(22):241-250. [44] 叶根亿, 姜旭, 王振兴. 虎杖苷抗动脉粥样硬化机制研究进展[J]. 医学综述, 2022, 28(7):1302-1307. [45] LI R P, WANG Z Z, SUN M X, et al. Polydatin protects learning and memory impairments in a rat model of vascular dementia[J]. Phytomedicine, 2012, 19(8-9):677-681. doi: 10.1016/j.phymed.2012.03.002 [46] SUN J, QU Y, HE H, et al. Protective effect of polydatin on learning and memory impairments in neonatal rats with hypoxic-ischemic brain injury by up-regulating brain-derived neurotrophic factor[J]. Mol Med Rep, 2014, 10(6):3047-3051. doi: 10.3892/mmr.2014.2577 [47] ZHANG Y Q, LI Y W, WANG Y X, et al. Effects of resveratrol on learning and memory in rats with vascular dementia[J]. Mol Med Rep, 2019, 20(5):4587-4593. [48] WANG Q, YU Q, WU M. Antioxidant and neuroprotective actions of resveratrol in cerebrovascular diseases[J]. Front Pharmacol, 2022, 13:948889. doi: 10.3389/fphar.2022.948889 [49] Ma X, Sun Z, Liu Y, et al. Resveratrol improves cognition and reduces oxidative stress in rats with vascular dementia[J]. Neural regeneration research, 2013, 8(22):2050-2059. [50] 梁旗, 张来宾, 吕洁丽. 川芎的化学成分和药理作用研究进展[J]. 新乡医学院学报, 2024, 41(3):275-285. doi: 10.7683/xxyxyxb.2024.03.015 [51] LU L Z, LU T T, WU Y J, et al. Research on the effectiveness and material basis of Ligusticum chuanxiong in alleviating acute liver injury[J]. J Ethnopharmacol, 2023, 314:116643. doi: 10.1016/j.jep.2023.116643 [52] QIN Y H, CHEN F F, TANG Z Z, et al. Ligusticum chuanxiong Hort as a medicinal and edible plant foods: Antioxidant, anti-aging and neuroprotective properties in Caenorhabditis elegans[J]. Front Pharmacol, 2022, 13:1049890. doi: 10.3389/fphar.2022.1049890 [53] YAN H L, ZHOU Y L, TANG F, et al. A comprehensive investigation on the chemical diversity and efficacy of different parts of Ligusticum chuanxiong[J]. Food Funct, 2022, 13(3):1092-1107. doi: 10.1039/D1FO02811A [54] LUO Y Y, LI X Q, LIU T W, et al. Senkyunolide H protects against MPP+-induced apoptosis via the ROS-mediated mitogen-activated protein kinase pathway in PC12 cells[J]. Environ Toxicol Pharmacol, 2019, 65:73-81. doi: 10.1016/j.etap.2018.12.007 [55] JIANG Y Y, LUO Y Y, CHEN X Y, et al. Senkyunolide H protects PC12 cells from OGD/R-induced injury via cAMP-PI3K/AKT signaling pathway[J]. J Ethnopharmacol, 2022, 282:114659. doi: 10.1016/j.jep.2021.114659 [56] 陈应奇, 刘英莲, 梁薇, 等. 丹参-川芎药对干预大鼠血管性痴呆作用机制[J]. 陕西中医, 2024, 45(3):297-301. doi: 10.3969/j.issn.1000-7369.2024.03.002 [57] 严强东, 彭蓓, 马岱朝, 等. 石菖蒲-川芎药对改善血管性痴呆机制研究进. 辽宁中医药大学学报, 2024, 1–9. [58] 李华露, 贾昌平, 闵春艳, 等. 基于UPLC-Q-TOF/MS的不同基原郁金中化学成分分. 中药材, 2022, 45(11): 2648–2655. [59] 李星辰, 尹丽燕, 蔡红, 等. 温郁金化学成分、药理作用、临床应用的研究进展及其质量标志物的预测分. 中国中药杂志, 2023, 48(20): 5419–5437. [60] CHO W, NAM J W, KANG H J, et al. Zedoarondiol isolated from the rhizoma of Curcuma heyneana is involved in the inhibition of iNOS, COX-2 and pro-inflammatory cytokines via the downregulation of NF-kappaB pathway in LPS-stimulated murine macrophages[J]. Int Immunopharmacol, 2009, 9(9):1049-1057. doi: 10.1016/j.intimp.2009.04.012 [61] 何洁英, 王汝上, 何洁宝, 等. 郁金醇提取物对过氧化氢诱导的人脐静脉内皮细胞氧化应激损伤的保护作用[J]. 中国实验方剂学杂志, 2013, 19(3):223-225. [62] 吴东雪, 候宁, 李晶, 等. 基于药性组合的姜黄、郁金、莪术的性效关系研究[J]. 中国中药杂志, 2019, 44(2):229-234. [63] LIN W W, TU H F, ZHU Y, et al. Curcumolide, a unique sesquiterpenoid from Curcuma wenyujin displays anti-angiogenic activity and attenuates ischemia-induced retinal neovascularization[J]. Phytomedicine, 2019, 64:152923. doi: 10.1016/j.phymed.2019.152923 [64] THOTA R N, ROSATO J I, DIAS C B, et al. Dietary supplementation with curcumin reduce circulating levels of glycogen synthase kinase-3β and islet amyloid polypeptide in adults with high risk of type 2 diabetes and Alzheimer’s disease[J]. Nutrients, 2020, 12(4):E1032. doi: 10.3390/nu12041032 [65] KIM Y, CLIFTON P. Curcumin, cardiometabolic health and dementia[J]. Int J Environ Res Public Health, 2018, 15(10):2093. doi: 10.3390/ijerph15102093
计量
- 文章访问数: 126
- HTML全文浏览量: 90
- PDF下载量: 0
- 被引次数: 0