基于“调和脾胃,心无凝滞”理论探讨“健脾祛痰化瘀”法治疗冠心病的疗效机制

Mechanism of Strengthening Spleen and Removing Phlegm and Blood Stasis for Coronary Heart Disease Based on Theory of Reconciling Spleen and Stomach System to Remove Stagnation from Heart

《脾胃论》“调和脾胃,心无凝滞”提出了防治冠心病的关键在调和脾胃。在冠心病的发生发展过程中“脾虚生痰,因痰致瘀,痰瘀互结”是心脉痹阻的关键因素。深入探究以“调和脾胃,心无凝滞”理论为中心治疗冠心病的疗效机制对于中西医结合防治心血管疾病尤为关键,有助于进一步丰富中医脾脏象理论的科学内涵。基于课题组前期研究进展及其他相关研究对其进行简要论述发现:冠心病脾虚痰瘀互结的现代生物学基础可能与氧化应激、炎症反应、微循环障碍、细胞凋亡、坏死、自噬等过程有关;健脾祛痰化瘀法可能通过抑制动脉局部的免疫反应、改善动脉弹性、促进心肌血管新生、改善内皮细胞与心肌细胞的活性等方面发挥作用。未来需要从基因、蛋白直至关键病理环节的成链式的、系统式的研究冠心病痰瘀互结及健脾祛痰化瘀法的机理机制,并经高质量的循证医学证据进一步支持。

The theory reconciling spleen and stomach system may remove stagnation from heart from Treatise on Spleen and Stomach puts forward that the key to preventing and treating coronary heart disease is to reconcile the spleen and stomach.In the occurrence and development of coronary heart disease,“spleen deficiency produces phlegm turbidity,and then phlegm turbidity leads to blood stasis,and finally phlegm turbidity and blood stasis intersect each other”are the key factors.The in-depth exploration of the therapeutic mechanism of coronary heart disease centered on the theory of“reconciling spleen and stomach system may remove stagnation from heart”is particularly important for the integrated medicine treatment of coronary heart disease,thereby may further enriching the scientific connotation of the theory of spleen in traditional Chinese medicine.We briefly discussed the theory based on our team research progress and other related studies as follows.The modern biological basis of coronary heart disease with“spleen deficiency and phlegm and blood stasis”syndrome may be related to the processes as oxidative stress,inflammatory response,microcirculation disorder,cell apoptosis,cell necrosis and autophagy.The method of“strengthening spleen and resolving phlegm and blood stasis”may play a role in inhibiting the local immune response of coronary artery,improving coronary artery elasticity,promoting myocardial angiogenesis,and improving the activity of endothelial cells and cardiomyocytes.In the future,chained and systematic studies which concern about coronary heart disease with spleen deficiency and phlegm and blood stasis syndrome and the method of strengthening spleen phlegm and blood stasis should be conducted from genes to proteins and to key pathological links,and should further be supported by high-quality evidence-based evidence.