基于开阖枢理论探讨冠心病伴焦虑抑郁诊治思路*

作者：呼晓婷1，董增浩1，冯利民2,3

单位：1.天津中医药大学，天津 301617； 2.天津市滨海新区中医院，天津 300450； 3.天津中医药大学第二附属医院，天津 300250

引用：引用：呼晓婷，董增浩，冯利民.基于开阖枢理论探讨冠心病伴焦虑抑郁诊治思路[J].中医药导报,2025,31(10):189-194.

DOI：10.13862/j.cn43-1446/r.2025.10.034

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摘要：

冠心病伴焦虑抑郁病因复杂，目前中西医结合治疗尚缺乏分阶段辨证思路。本文基于《黄帝内经》开阖枢理论，分三阶段探讨其病机与治法：发病初期以太阳开机不畅、营卫失和，太阴脾虚、痰瘀阻脉为主，治以桂枝类方调和营卫，理中丸温补太阴，截断痰瘀之源；枢机不利期，少阳胆郁痰热、少阴心肾不交，治以小柴胡汤合温胆汤和解少阳，四逆汤振奋少阴阳气，黄连阿胶汤交通心肾；阖机失司期，厥阴失阖、阳明不降，治以乌梅丸调和寒热，半夏泻心汤通降阳明。

关键词：冠心病；焦虑抑郁；开阖枢；双心疾病

Abstract：

Coronary heart disease (CHD) accompanied by anxiety and depression has a complex etiology, and current integrated Chinese-Western medicine approaches lack a staged syndrome differentiation framework. Based on the Opening-Closing-Pivot theory from Huangdi Neijing, this article discusses its pathogenesis and treatment strategies in three stages. In the initial stage, characterized by impaired Taiyang opening, Nutritive and Defensive Qi disharmony, Taiyin spleen deficiency, and Phlegm-Stasis obstructing the vessels, treatment involves Guizhi-based formulas to harmonize Nutritive and Defensive Qi, and Lizhong Wan (理中丸) to warm and supplement Taiyin, thereby cutting off the source of phlegm and stasis. In the pivoting disorder stage, marked by Shaoyang gallbladder depression with phlegm-heat and Shaoyin heart-kidney non-interaction, treatment employs Xiaochaihu Tang (小柴胡汤) combined with Wendan Tang (温胆汤) to harmonize Shaoyang, Sini Tang (四逆汤) to invigorate Shaoyin Yangqi, and Huanglian Ejiao Tang (黄连阿胶汤) to restore heart-kidney communication. In the closing disorder stage, featuring Jueyin closing failure and Yangming failure to descend, treatment uses Wumei Wan (乌梅丸) to regulate cold-heat imbalance and Banxia Xiexin Tang (半夏泻心汤) to unblock and descend Yangming.

Key words：coronary heart disease; anxiety and depression; opening-closing-pivot theory; psycho-cardiological disease

发布时间：2026-01-08

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