基于“四位一体”探析炙甘草汤治疗冠心病机制

Mechanism of Zhigancao Tang Against Coronary Heart Disease:An Exploration Based on Thought of "Four in One"

"四位一体"是基于"性、位、势、证"四维角度辨识经方的研究思路,可通过多维度、立体化地分析经方,探讨炙甘草汤治疗冠心病的机制,更好地领会仲景的辨证论治思想。冠心病发病以虚为本,炙甘草汤通过"性、位、势、证"四位发挥治疗冠心病的作用:方性为辛甘而温,甘可补虚,辛以宣阳化阴散余邪,温以行阳气、补血液、鼓动脉行;方位为脉,可恢复血液在脉道的正常运行,改善冠状动脉狭窄及缺血缺氧状态;方势为向内向上,润补与温散并行,大补脏腑之虚,增津液益营血,且散寒凝,合之以疗胸痹;方证为津枯血燥、阴阳气血虚损证,初为"脉结代、心动悸"而立,现已被广泛运用于十大系统,70多种中西医病种,尤以心血管疾病为多。炙甘草汤"一体"是由多药组成,又发挥着部分之和大于整体的作用;"一体"治疗冠心病的药理机制包括抗炎、保护缺血再灌注损伤、调节心肌细胞膜离子通道、参与心房结构重构、造血等,其治疗冠心病的机制与临床疗效得到了临床和实验的验证。使用"四位一体"思想分析经方,使方证结合,对临床应用及经方的现代化发展具有重要意义。

"Four in one" is a research idea of identifying the classic prescriptions from the following four dimensions: "nature,location,tendency,and syndrome". The multi-dimensional analysis of the mechanism of classic prescription Zhigancao Tang in treating coronary heart disease helps to understand the syndrome differentiation and treatment thoughts of ZHANG Zhong-jing. The coronary heart disease results from deficiency.The efficacy of Zhigancao Tang in treating coronary heart disease can be elucidated from the "nature,location,tendency,and syndrome". In terms of nature,Zhigancao Tang is pungent and sweet in flavor and warm in property,with the sweet responsible for tonifying deficiency,the pungent for dispersing Yang,resolving Yin,and eliminating surplus pathogen,and the warm for moving Yangqi,nourishing blood,and promoting blood circulation. In terms of location,Zhigancao Tang mainly acts on vessels for restoring the normal circulation of blood in the vessels and improving coronary artery stenosis and the resulting ischemia and anoxia. In terms of tendency,Zhigancao Tang tends to affect the upper and inner parts of the body to tonify deficiency in Zangfu organs,promote fluid production,nourish nutrient blood,and dissipate cold simultaneously,thus alleviating chest impediment. In terms of syndrome,Zhigancao Tang is applicable to fluid exhaustion with blood dryness and Yin-yang-qi-blood deficiency syndrome,manifested as regularly or irregularly intermittent pulse and severe palpitation. Zhigancao Tang has been widely used for the treatment of over 70 diseases classified into 10 systems, especially the cardiovascular diseases, in traditional Chinese medicine(TCM) and western medicine. As the“one”of“four in one”,Zhigancao Tang is composed of multiple Chinese herbs and its therapeutic effect is superior to the sum of its parts. It ameliorates the coronary heart disease by resisting inflammation,protecting against ischemia-reperfusion injury,adjusting the ion channels of myocardial cells,and participating in atrial remodeling and hematopoiesis. Its mechanism and clinical efficacy in the treatment of coronary heart disease have been verified by clinical and experimental studies. The utilization of the thought of "four in one" to analyze classical prescriptions enables the combination of prescriptions with syndromes,which is of great significance to the clinical application and modern development of classical prescriptions.