三阳经辨证论治PCI术后抑郁症的理论探讨

Theoretical Discussion on Syndrome Differentiation and Treatment of Post-PCI Depression Based on the Three Yang Meridians

摘要: 经皮冠状动脉介入术(PCI)后抑郁症的高发极大影响着患者康复速度及生活质量。本文基于《伤寒论》六经辨证理论，详细探讨了太阳、少阳、阳明三条经与PCI术后抑郁症之间的病理关系及病机变化。研究发现：太阳病营卫失调可致心神失养，少阳病枢机不利能引发气机郁滞，阳明病痰热内扰可致痰热蒙窍。经过对《伤寒论》中经典方剂的分析(如桂枝汤、小柴胡汤、栀子豉汤等)，发现了其通过多个细胞因子通路调控神经递质的代谢、抑制炎症反应、营养周围神经等改善抑郁及其伴随症状。三阳经治以“调和气血、疏导气机”为主，与PCI术后“本虚标实”的特点不谋而合，为中西医联合治疗提供了新的角度。

Abstract: Depression following percutaneous coronary intervention (PCI) demonstrates high prevalence and substantially impedes patient recovery and quality of life. Guided by the Six-Meridian Syndrome Differentiation theory from the Treatise on Cold Pathogenic Diseases, this study systematically investigates the pathological correlations and disease mechanisms of the Taiyang, Shaoyang, and Yangming meridians in post-PCI depression. The findings indicate that Taiyang disease characterized by disharmony between nutrient qi and defensive qi may induce mental malnourishment; Shaoyang disease with compromised pivot mechanism can lead to qi stagnation; while Yangming disease accompanied by internal phlegm-heat may result in orifices clouding. Pharmacological analysis of classical formulations from the Treatise on Cold Pathogenic Diseases, including Guizhi Decoction, Xiaochaihu Decoction, and Zhizichi Decoction, reveals their multimodal antidepressant effects through regulating neurotransmitter metabolism via cytokine pathways, suppressing neuroinflammatory responses, and enhancing neural trophism. Therapeutic strategies targeting these Three Yang meridians, emphasizing harmonization of qi and blood and regulation of qi dynamics, correspond precisely with the fundamental deficiency-excess complex observed in post-PCI conditions, thereby providing an integrative framework for combining traditional Chinese medicine with contemporary cardiology.