从“阳微阴弦”论治胸痹研究进展

Research Progress on the Treatment of Chest Bi from"Yangwei Yinxian"

心肌缺血再灌注损伤(myocardial ischemia-reperfusion injury,MIRI)归属于中医学"胸痹"的范畴,"阳微阴弦"为胸痹心痛的总病机,揭示了疾病的本质。中医学对胸痹的认识以"阳微阴弦"为着眼点,将其分为虚和虚实夹杂两类:阴阳不调为虚类,主要由于年事过高,饮食情志,劳倦内伤导致五脏气血阴阳虚衰引起的气阴两虚;阳微甚于阴弦、阴弦甚于阳虚为虚实夹杂类。前者以虚为主,治则为温补脾肾,通阳利水;后者以实为主,治则为宽胸理气,温阳化痰。虽然中医药防治MIRI有诸多优势,但仍有以下问题亟待解决:①研究多集中于动物实验,理论研究相对较少;②研究多结合西医机制进行,对中医理论机制的探讨不足,缺少中医药特色,对发展中医药理论意义不大;③临床研究的地域和研究中心单一,缺乏多中心联合的大样本、大规模临床研究,难以避免因地域、年龄、性别等因素导致的误差。在今后的临床实践中,应遵循"阳微阴弦"之理,抓住病机本质,辨清虚实之轻重及标实本虚之主次,灵活配伍,酌情变化,更好地发挥中医在胸痹诊治中的优势。

Myocardial ischemia-reperfusion injury(MIRI)belongs to the category of"chest bi"in Chinese medicine,and"yangwei yinxian"is the total pathogenesis of chest bi with heart pain,which reveals the nature of the disease.Chinese medicine regards"yangwei yinxian"as the point of view,and divides chest bi into two types:deficiency syndrome,mixed syndrome of deficiency and excess:The disharmony of yin and yang is a kind of deficiency,which is mainly caused by the deficiency of qi and yin in the five zang organs due to the high age,eating emotion,and fatigue and internal injury;yangwei exceeding yinxian,yinxian exceeding yang deficiency belong to the category of mixed syndrome of deficiency and excess.The former is mainly based on deficiency syndrome,while the treatment is to warm the spleen and kidney,dredge yang and promote diuresis;the latter is mainly based on excess syndrome,and the treatment is to broaden the chest and regulate qi,warm yang and dissipate phlegm.Although Chinese medicine has many advantages in the prevention and treatment of MIRI,there are still the following problems to be solved:①Research is mainly focused on animal experiments,and theoretical research is relatively less.②The research is mostly combined with western medicine mechanism,and the discussion on the theoretical mechanism of Chinese medicine is insufficient,lacking the characteristics of Chinese medicine,which is of little significance to the development of Chinese medicine theory.③The region and research center of clinical research are single,lack of large-scale clinical research with multi centers,and it is difficult to avoid errors caused by regional,age,gender and other factors.In clinical practice,we should follow the principle of"yangwei yinxian",grasp the essence of pathogenesis,distinguish the severity of deficiency and excess,and the primary and secondary of standard and actual deficiency,mix flexibly and change according to circumstances,so as to better play the advantages of Chinese medicine in the diagnosis and treatment of chest bi.