基于血管稳态的动脉粥样硬化病-证-时分期防治思路

Staging Prevention and Treatment of Disease-Syndrome-Time of Atherosclerosis:Based on Vessel Homeostasis

提出动脉粥样硬化的病理演变实质是血管由稳态走向失稳态的过程,其发生是动态的、长程的、血-脉-心-神功能异常共同参与的系统性改变。以血管稳态与失稳态为时间轴上的切入点,以显性可见的斑块形成-易损-破裂演变轨迹作为阐述载体,结合各阶段血、脉、心、神关联病变的主次、缓急,总结基于"病-证-时"的动脉粥样硬化三期分治规律,即血管失稳态早期——斑块形成阶段,以血液-血管功能失衡为主,病变在血、在脉,治以益肾健脾、涤痰散结、调气和血;血管失稳态中期——斑块易损阶段,以血管结构失衡为主,病变主要在脉、在神,治以滋阴解毒、调和营卫、通脉调神;血管失稳态后期——斑块破裂阶段,以血管结构破坏为主,病变在血、在心,治以理气活血、益气保心。

This paper put forward the essence of pathological evolution of atherosclerosis is the process of blood vessels from homeostasis to dyshomeostasis. Its occurrence is a systematic change jointly involving dynamic,longterm,and blood-vessel-heart-spirit functional abnormality. This paper took the homeostasis of vessel as the entry point,the development track of plaque forming-vulnerability-rupture as elaboration carrier,combined with the primary and secondary,degree of urgency of blood,vessel,heart and spirit associated diseases in each stage,ultimately summarized the treatment rules of three stages of atherosclerosis based on disease-syndrome-time,which was early stage of vascular dyshomeostasis-plaque formation,characterized by blood-vessel function imbalance. The disease was in blood and vessel,and should be treated by tonifying the kidney and fortifying the spleen,resolving phlegm and dissipating masses,and regulating and harmonizing qi and blood; medium stage of vascular dyshomeostasis-plaque vulnerable,characterized by vascular structure imbalance. The disease was located in vessel and spirit,and should be treated by nourishing yin and detoxifying,regulating and harmonizing ying and wei,unblocking vessels and regulating spirit; late stage of vascular dyshomeostasis-plaque disruption,characterized by vascular structure damage. The disease was located in blood and heart,and should be treated in regulating qi and activating blood,tonifying qi and safeguarding the heart.