基于“五脏痰瘀”理论探讨冠心病的证治

Discussion on Syndromes and Treatment of Coronary Heart Disease Based on Theory of “Phlegm and Blood Stasis in Five Zang-Organs”

目前冠心病已成为全球范围内人类最常见的死亡原因之一,众多研究表明中医药治疗冠心病疗效较为突出。从中医角度而言,痰瘀互结是冠心病发病的重要病理因素,冠心病痰瘀互结证为目前较常见且病变程度较严重的证型。冠心病具有动脉粥样硬化和心肌缺血的双重病理特征,诸多医家将中医理论与现代医学有机结合,认为动脉粥样硬化和脂质代谢紊乱与中医"痰"相关,心肌缺血和凝血功能异常、炎症反应与中医"瘀"相关。周仲瑛教授的"五脏痰瘀"理论认为:人以五脏为中心,气血津液运行失常皆为其病变的结果,五脏皆可生痰生瘀,所谓"肺为贮痰之器","脾为生痰之源","肾为痰之本",肺、脾、肾痰瘀多以痰为主;所谓"恶血必归于肝","瘀血不离乎心",心、肝痰瘀多以瘀为主。该文从该理论出发,认为痰瘀同病与五脏密切相关,治痰重在肺脾肾,治瘀重在心肝,因而论治冠心病应重视调节五脏机能、痰瘀同治来改善多种病理变化,最终达到改善临床症状及客观指标的双赢效果。

At present,coronary heart disease has become one of the most common causes of death in the world.Many studies have shown that traditional Chinese medicine treatment of coronary heart disease is more prominent.From the perspective of traditional Chinese medicine,phlegm-blood stasis cementation is an important pathological factor in the pathogenesis of coronary heart disease.The syndrome of phlegm and blood stasis in coronary heart disease is a common and serious disease type.Coronary heart disease has the dual pathological characteristics of atherosclerosis and myocardial ischemia.Many doctors combine the theory of traditional Chinese medicine with modern medicine,and think that atherosclerosis and lipid metabolism disorder are related to“phlegm”of traditional Chinese medicine,myocardial ischemia,abnormal coagulation function and inflammatory reaction are related to“blood stasis”of traditional Chinese medicine.Professor ZHOU Zhongying′s theory of“phlegm and blood stasis in Five Zang-organs”holds that the five Zang-organs are the center of human beings.Pathological changes of five organs lead to abnormal movement of Qi,blood and body fluid.All five organs can produce phlegm and blood stasis.The so-called“lung is the organ for storing phlegm”,“spleen is the source of producing phlegm”and“kidney is the root of phlegm”,phlegm and blood stasis in lung,spleen and kidney are mainly phlegm.The so-called“evil blood must be attributed to the liver”and“blood stasis is inseparable from the heart”,while phlegm and blood stasis in heart and liver are mainly blood stasis.Based on this theory,this paper holds that the same disease of phlegm and blood stasis is closely related to the five Zang-organs.The treatment of phlegm focuses on the lung,spleen and kidney,while the treatment of blood stasis focuses on the heart and liver.As a result,in the treatment of coronary heart disease,the attention should be paid to regulating the function of five Zang-organs and treating phlegm and blood stasis simultaneously to improve various pathological changes,so as to achieve a win-win effect of improving clinical symptoms and objective indicators.