基于“肝心同病”探析代谢相关脂肪性肝病合并动脉粥样硬化的病机与治疗思路

Pathogenesis and treatment of metabolic⁃associated fatty liver disease combined with atherosclerosis based on“disease involving liver and heart”

通过探析中医“肝-血-心-脉”“肝心和合”的生理特点,可知临床“肝心同病”较为多见,是防治代谢相关脂肪性肝病与动脉粥样硬化的核心病机基础。“肝心郁滞、心脉不通”“肝心虚损、痰瘀互结”“肝心失和、毒损脉络”是代谢相关脂肪性肝病合并动脉粥样硬化的核心病机演变规律,体现“郁→虚→毒”的病邪转化过程。结合胆固醇代谢紊乱、线粒体功能障碍的病变特点及两者交叉转化的因果联系,管窥“肝心同病”在防治代谢相关脂肪性肝病合并动脉粥样硬化过程中的微观辨证价值,采用疏肝理气、通心和脉,养肝护心、化痰祛瘀,保肝育心、解毒通络等分期治疗策略,以期为临床辨治代谢相关脂肪性肝病合并动脉粥样硬化提供有益参考。

By analyzing the physiological characteristics of“liver⁃blood⁃heart⁃vessel”and“liver heart harmony”in traditional Chinese medicine,it can be seen that“disease involving liver and heart”is more common in clinic,which is the core pathogenesis basis for the clinical prevention and treatment of metabolic⁃associated fatty liver disease(MAFLD)and atherosclerosis(AS).“Stagnation of liver and heart,obstruction of heart vessel”,“deficiency of liver and heart,intermingled phlegm and blood stasis”,and“disharmony of liver and heart,toxin damaging vessels and collaterals”are the core pathogenesis evolution rules of MAFLD combined with AS,reflecting the transformation process of“stagnation→deficiency→toxin”.Combined with the pathological characteristics of cholesterol metabolism disorder and mitochondrial dysfunction and the causal relationship of their cross transformation,the microscopic syndrome differentiation value of the“disease involving liver and heart”in the prevention and treatment of MAFLD combined with AS is observed.The stage⁃tailored treatment strategies are adopted,such as smoothing liver and regulating qi,regulating heart harmonizing vessel;nourishing liver and protecting heart,resolving phlegm and removing blood stasis;protecting liver and nourishing heart,removing toxicity and dredging collaterals,in order to provide a useful reference for Journal of Beijing University of Traditional Chinese Medicine clinical differentiation and treatment of MAFLD combined with AS.