【摘要】 基于《黄帝内经》“精神”体用关系可从两方面认识阿尔茨海默病(Alzheimer′s disease, AD)的病因病机。首先从五神脏理论出发，认知功能障碍属于中医“神明异常”范畴，其不同临床阶段，认知功能障碍表现不同，所对应的脏腑功能损伤也不同。AD临床前期多起于脾虚，继而出现心神受损，中期可出现肾、肝受损，晚期五脏皆衰。其次从精与神为体用关系出发，神以精为物质基础，脑中的精是核心物质，肾、脾、心等脏腑功能异常可通过精、气、血、津液等病变，最终导致脑中精的亏虚，逐渐演变为脑络受损、髓减脑消。因此，针对AD复杂多变的病因病机，辨治应围绕五脏功能，“精神”并重，以神为主。AD病初应重视脾脏功能，病情发展过程中重视脾、心、肾等多脏腑功能，晚期尤其要顾护脾肾先后天之本。更多还原

【Abstract】 Based on the relationship between "spirit" and "body" in Huang Di Nei Jing,the etiology and pathogenesis of Alzheimer′s disease(AD) can be recognized from two aspects.Firstly, from the theory of the Five Shen Zang, cognitive impairment belongs to the category of abnormalities of the gods in Chinese medicine, and at different clinical stages, cognitive impairment manifests itself in different ways, corresponding to different damage to the functions of the internal organs.In the early clinical stage of AD,most of the cognitive disorders start with Spleen deficiency, followed by damage to the Heart and spirit; in the middle stage, damage to the Kidney and Liver may occur; in the late stage, all the functions of the Five Zang are in decline.Secondly, from the relationship between Essence and spirit, spirit takes essence as the material basis and essence in the brain is the core material.Abnormalities in the functions of the internal organs, such as Kidney, Spleen and Heart can lead to the deficiency of Essence in the brain through the lesions of essence, Qi, blood, and Fluid, which will gradually evolve into the damage of the brain complex and the reduction of the medulla oblongata.Therefore, according to the complex and changing etiology and pathogenesis of AD,the treatment should be centered on the function of the Five Zang, with "Essence" and "spirit" being focused on and with "spirit" being the most critical aspect.Therefore, the focus of the AD disease is to pay attention to the function of the Spleen at the beginning of the disease, the functions of the Spleen, Heart, Kidney and other Zang and Fu in the development of the disease, and the Spleen and Kidney functions in the late stage of the disease.更多还原