张军平基于“血-脉-心-神”一体观辨治冠状动脉粥样硬化性心脏病临证思路

Clinical experience of ZHANG Jun-ping in treating coronary heart disease from ‘blood-pulse-heart-spirit’ integral view

冠状动脉粥样硬化性心脏病(简称冠心病)治、效矛盾临床屡见不鲜,给医患双方带来了诸多困惑。究其原因,可能与过分关注"血液-血管"等理化、解剖层面的病理改变在发病和疗效评估中的作用,而忽略了血、脉、心、神各自功能层面的隐匿性调控机制,进而造成中医整体思维在冠心病治疗中体现不彻底有关。借鉴现代医学对缺血性心脏病认识观的变革--"心肌-太阳系"学说,着重从内皮功能、血管痉挛、血小板聚集、心肌缺氧耐受、微循环障碍等多角度阐释心肌缺血病机的复杂性,张军平团队首次提出以"血-脉-心-神"一体观来重新认识和干预缺血性心脏病,临床疗效卓然。略列举验案一二,分别从"血-心""心-神"功能层面的统一性上来解析"血-脉-心-神"四维一体的科学内涵。

The conflict between treatment and curative effect of coronary heart disease is common in the clinic,which brings much confusion to both doctors and patients.The reason may be related to the actuality that too much attention has been paid to the role of anatomical pathological changes such as ‘blood-vessel’ in the pathogenesis and efficacy evaluation,while the hidden regulatory mechanisms of blood,pulse,heart,and spirit at the functional level have been neglected.The holistic thinking of TCM can not be fully reflected.Referring to the understanding of ischemic heart disease (IHD) ‘cardiomyo-solar system’ theory,the complexity of pathogenesis has been explained from multiple perspectives,such as endothelial function,vasospasm,platelet aggregation,myocardial hypoxia-tolerance,and microcirculation disorder.ZHANG Jun-ping’s team proposed to re-recognize and intervene IHD with the concept of ‘blood-pulse-heart-spirit’,and has achieved remarkable clinical results.This article analyzed the scientific connotation of ‘blood-pulse-heart-spirit’ integral view from the functional unity of ‘blood-heart’ or ‘heart-spirit’ levels respectively from clinical case.