阿尔茨海默病（Alzheimer’s disease，AD）是一种以进行性认知衰退为特征的神经退行性疾病，其病理机制复杂，涉及β-淀粉样蛋白（β-amyloid protein，Aβ）沉积、Tau蛋白过度磷酸化、神经炎症及突触功能障碍等多个关键环节。中医学将其归属于“痴呆”“健忘”等范畴，病机核心为“本虚标实”，即以肾精亏虚为本，痰浊、瘀血蒙蔽清窍为标。芳香开窍药作为中医药特色疗法，凭借其辛香走窜、透达经络之性，秉承“开窍醒神、化痰辟秽”之则，在AD防治中展现出独特优势，代表性药物如石菖蒲、远志、麝香、冰片等。现代药理研究揭示其具有多靶点干预潜力，能够抑制Aβ生成与聚集、减轻Tau蛋白磷酸化、抗神经炎症、抗氧化应激，并调节神经递质与促进神经发生。临床常用具有芳香开窍功效的复方如安宫牛黄丸、苏合香丸、菖蒲郁金汤等，通过配伍协同，在改善患者认知功能、记忆力和日常生活能力方面显示出良好疗效。系统综述了芳香开窍药在AD防治中的研究及应用现状，以期为芳香开窍类中药干预AD提供理论依据与实践参考。

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by progressive cognitive decline. Its pathological mechanisms are complex, involving multiple key links such as beta-amyloid protein (Aβ) deposition, excessive phosphorylation of Tau protein, neuroinflammation and synaptic dysfunction. Traditional Chinese medicine (TCM) categorizes AD under conditions like “dementia” and “forgetfulness”, with the core pathogenesis being “deficiency at the root and excess at the surface”, where kidney essence deficiency is the root cause and phlegm turbidity and blood stasis obscuring the orifices are the surface manifestations. As a distinctive TCM therapy, aromatic orifice-opening drugs, with their pungent, fragrant and penetrating nature that can reach and regulate meridians, follow the principle of “awakening the orifices and refreshing the mind, resolving phlegm and dispelling foulness”, demonstrating unique advantages in the prevention and treatment of AD. Representative drugs include Shichɑngpu (Acori Tatarinowii Rhizoma), Yuanzhi (Polygalae Radix), Shexiang (Moschus), Bingpiɑn (Borneolum Syntheticum), etc. Modern pharmacological research has revealed their multi-target intervention potential, including inhibiting Aβ generation and aggregation, reducing Tau protein phosphorylation, anti-neuroinflammation, anti-oxidative stress, and regulating neurotransmitters and promoting neurogenesis. Commonly used TCM formulas with the effect of aromatic orifice-opening such as Angong Niuhuang Pill (安宫牛黄丸), Suhexiang Pill (苏合香丸) and Changpu Yujin Decoction (菖蒲郁金汤) have shown good efficacy in improving patients’ cognitive function, memory, and daily living abilities through compatibility and synergy. This review systematically summarizes the research and application status of aromatic orifice-opening drugs in the prevention and treatment of AD, providing theoretical basis and practical references for the intervention of AD by aromatic orifice-opening TCMs.

R285

贵州省高等学校中药（民族药）药性与效应研究重点实验室项目（黔教技[2023] 018号）；贵州省科技计划项目（黔科合基础-ZK [2022]一般471）