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血管性痴呆（VD）的发生发展与慢性神经炎症密切相关，小胶质细胞过度活化及促炎因子（如IL-1β、IL-6、TNF-α）释放是其关键病理环节。VD具有“血管-炎症-神经退行性”交互作用的复杂病理网络，而现代医学单一靶点干预策略常显局限。中医药基于“本虚标实”病机理论，认为肾精亏虚为神经炎症失衡的内在基础，痰浊、瘀血等病理产物则与脂质代谢紊乱、缺血缺氧及继发性炎症损伤相应，为从炎症角度干预VD提供了理论依据。本文系统综述了中医药通过调控神经炎症干预VD的研究进展，涵盖中药复方、中药单体（含活性成分）及非药物疗法三类。研究表明，补肾益精类（如地黄饮子）、活血化瘀类（如通窍活血汤）、化痰开窍类（如黄连温胆汤）等经典复方可通过抑制NF-κB、NLRP3等炎症信号通路，调节小胶质细胞M1/M2极化，降低海马等脑区促炎因子水平，进而改善认知功能。单味药方面，川芎嗪、丹酚酸、小檗碱、人参皂苷等活性成分通过作用于PI3K/Akt、MAPK、TLR4/MyD88等多条信号通路，发挥抗炎、抗氧化及神经保护协同效应。非药物疗法中，针灸（取穴百会、风池、足三里等）可通过调节胆碱能抗炎通路及抑制中枢TLR4/NF-κB通路发挥作用；艾灸、推拿及导引术则通过调畅气血、改善免疫微环境产生系统性抗炎效应。中医药具有多成分、多靶点、多通路的整体调节特点，在调控神经炎症以干预VD方面展现出良好的应用前景。未来研究应借助系统生物学方法，开展设计严谨的临床试验，深入阐明"证-炎-效"内在关联，以推动中医药在VD防治中的精准化应用与临床转化。
Abstract：The onset and progression of vascular dementia (VD) are closely associated with chronic neuroinflammation， with key pathological mechanisms involving excessive microglial activation and the release of pro-inflammatory factors such as IL-1β， IL-6， and TNF-α. VD exhibits a complex pathological network of ‘vascular-inflammatory-neurodegenerative’ interactions， rendering modern medicine's single-target intervention strategies frequently inadequate. Traditional Chinese Medicine (TCM)， grounded in the ‘root deficiency and branch excess’ pathogenesis theory， posits that deficiency of kidney essence constitutes the intrinsic foundation for neuroinflammatory imbalance. Pathological products such as phlegm-dampness and blood stasis correspond to lipid metabolism disorders， ischaemia-hypoxia， and secondary inflammatory damage， thereby providing theoretical support for inflammation-targeted interventions in VD. This systematic review examines TCM's progress in regulating neuroinflammation to intervene in VD， encompassing three categories: compound formulas， single herbal constituents (including active components)， and non-pharmacological therapies. Research indicates that classical formulas such as kidney-tonifying and essence-nourishing preparations (e.g.， Rehmannia Decoction)， blood-activating and stasis-resolving formulas (e.g.， Tongqiao Huoxue Decoction)， and phlegm-resolving and orifice-opening formulas (e.g.， Huanglian Wendan Decoction) can improve cognitive function by inhibiting inflammatory signalling pathways (e.g.， NF-κB， NLRP3)， modulating M1/M2 polarisation of microglia， and reducing pro-inflammatory factor levels in brain regions including the hippocampus. Regarding single herbs， active constituents such as chuanxiongzine， danfen acid， berberine， and ginsenosides exert synergistic anti-inflammatory， antioxidant， and neuroprotective effects by modulating multiple signalling pathways including PI3K/Akt， MAPK， and TLR4/MyD88. Among non-pharmacological therapies， acupuncture (targeting points such as Baihui， Fengchi， and Zusanli) exerts effects by modulating cholinergic anti-inflammatory pathways and inhibiting central TLR4/NF-κB pathways. Moxibustion， massage， and qigong techniques produce systemic anti-inflammatory effects by regulating qi and blood circulation and improving the immune microenvironment. Traditional Chinese Medicine possesses holistic regulatory characteristics involving multiple components， targets， and pathways， demonstrating promising prospects for regulating neuroinflammation to intervene in VD. Future research should employ systems biology approaches to conduct rigorously designed clinical trials， elucidating the intrinsic relationship between syndrome patterns， inflammation， and efficacy to advance the precision application and clinical translation of Traditional Chinese Medicine in VD prevention and treatment.
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基本信息:
中图分类号:R277.7
引用信息:
[1]张荣,罗琪,曾碧雨,等.中医药调控炎症因子干预血管性痴呆的研究进展[J].辽宁中医药大学学报().
基金信息:
国家岐黄学者培养项目（中医药领军人才培养项目）(国中医药人教函[2025]182号); 国家重点研发计划（2024YFC3506700）; 中药壮瑶药创新药物教育部工程研究中心经费资助（ZYZYY2025031）; 广西中医药大学引进博士科研启动基金项目（2024BS037）; 广西道地药材资源开发与利用人才小高地（第十批广西人才小高地）; 姚春桂派中医大师传承工作室（GZY2024002）; 国家中医药管理局高水平中医药重点学科建设项目-中医内科学（zyyzdxk-2023166）
2026-05-19
2026-05-19
2026-05-19