基于毒邪学说探讨冠心病血管内皮损伤的病机与治法

Exploring the pathogenesis and treatment of vascular endothelial injury in coronary heart disease based on the toxic pathogen theory

多种危险因素导致的血管内皮损伤状态是冠心病发生发展的病理基础,持续存在于疾病的全过程。毒邪学说立足毒邪的致病特性,结合冠心病病理演变规律,认为毒邪为血管内皮损伤的关键因素,其中又蕴含着从潜毒至显毒的状态演变,是以心脉为病位的复杂动态过程。慢性稳定期以潜毒伏脉为核心病机,毒之因素逐渐积聚并潜藏于脉内,与危险因素及相关病理因子的异常表达相对应,慢性隐匿损伤血管内皮是疾病的启动因素;急性发作期以显毒损脉为核心病机,毒邪顽恶难解、腐脉伤络,代表以易损斑块为病理基础的发作性心血管事件,血管内皮急性损伤是疾病的恶化标志。依据毒邪的显现发作与否,冠心病不同阶段应侧重不同治法。冠心病稳定期治以扶正祛邪,清除血脉中的病理因子,消除毒邪形成之源;冠心病不稳定期治以攻邪解毒,祛除有形病邪,缓解病理实体对血脉的实质损伤。研究发现,毒邪学说指导下的中药治疗,展现出良好的血管内皮保护功效,从而改善冠心病相关症状。

The state of vascular endothelial damage caused by multiple risk factors is the pathological basis for the development of coronary heart disease(CHD).It persists throughout the course of disease.Toxic pathogen theory,which is based on the pathogenic characteristics of toxic pathogen,combined with the pathological progress of CHD,states that toxic pathogen is the key factor of vascular endothelial injury,ranging from potential toxic pathogens to apparent toxic pathogens.This is a complex dynamic process in which the heart vessel is the location of disease.In the chronic stable phase,“potential toxic pathogen hiding in the blood vessel”is the core pathogenic factor.Specifically,toxic factors gradually accumulate and hide in the blood vessel,corresponding to the abnormal expression of risk factors and related pathological factors,which chronically and insidiously damage the vascular endothelium and are the initiating factors of the disease.In the acute attack phase,apparent toxic pathogen damaging the blood vessel is the core pathogenesis factor.Specifically,the toxic pathogen is persistent and difficult to resolve and will damage the blood vessel,representing an episodic cardiovascular event based on the pathology of vulnerable plaques,and acute toxic pathogen can damage the vascular endothelium,which is a sign of deterioration of the disease.According to the appearance of toxic pathogen,different treatments should be given in different stages of CHD.The treatment of CHD in the stable stage focuses on reinforcing healthy qi to eliminate pathogenic factors to help to eliminate the pathological factors in the blood vessels and eliminate the source of the formation of toxic pathogen.The treatment of CHD in the unstable stage focuses on attacking and removing toxins to eliminate the tangible pathological evil and relieve the substantial damage to the blood vessels by the pathological entity.It has been found that herbal treatments under the guidance of toxic pathogen theory have shown great endothelial protective effects,thus improving CHD.