基于“血-脉-心络”共病理论探讨虫类药在冠状动脉微血管功能障碍的应用

Application of Insect Medicines in Treatment of Coronary Microvascular Dysfunction Based on Comorbidity Theory of"Blood-Vessel-Cardiac Collaterals"

冠状动脉微血管功能障碍(CMD)是导致心肌缺血和非阻塞性冠状动脉缺血症状的重要原因之一,然而目前对CMD尚缺乏有效的检查手段和靶向性的治疗策略。中医的“血-脉-心络”共病理论贯穿于CMD的发展全过程,启示在其临床诊疗中,治血、治脉和治心络均不可偏废,而虫类药以化瘀通络、搜风解痉等功效见长,具有治疗CMD的潜在价值。但目前未见对虫类药治疗CMD的研究与总结,据此,该文以中医“血-脉-心络”共病理论为切入点,将CMD病机演变分为5个环节,即病起在血(血液成分、血液流变学改变)、病进在脉(粥样斑块形成;粥样斑块不稳定)、病发在心络(微血管内皮损伤;微血管收缩、痉挛)、病末在心络(微血管重塑)、能量代谢障碍贯穿全程,以探讨CMD的发病机制及其演变规律。同时,结合虫类药的现代药理研究,从祛痰化瘀以通络、搜风解痉以止痛、以毒攻毒以散结、通补心络以荣心等4个方面阐述虫类药在CMD临床治疗中的应用,以期为中医药治疗CMD提供理论依据,拓宽用药思路,更好地提高临床疗效。

Coronary microvascular dysfunction(CMD)is one of the important causes of myocardial ischemia and non-obstructive coronary artery ischemic symptoms.However,effective diagnostic methods and targeted treatment strategies for CMD are currently lacking.According to traditional Chinese medicine(TCM),the comorbidity theory of"blood-vessel-cardiac collaterals"plays a central role throughout the entire development process of CMD.It suggests that in the clinical diagnosis and treatment of CMD,the treatment of blood,vessels,and cardiac collaterals should not be neglected.In light of this,insect medicines,known for their efficacy in promoting blood circulation,resolving stasis,and alleviating spasms,hold promise as a potential treatment for CMD.However,there is currently no research or summary on the use of insect medicines for the treatment of CMD.Therefore,this article took the comorbidity theory of"blood-vessel-cardiac collaterals" as the starting point and divided the pathogenesis of CMD into five evolution stages: Beginning in the blood (changes in blood components and hemorheology), progressing in the vessels (atheromatous plaque formation and unstable plaques), occurring in the cardiac collaterals (microvascular endothelial damage and microvascular constriction and spasms), ending in the cardiac collaterals (microvascular remodeling), and resulting in energy metabolism disorders throughout the process, so as to explore the pathogenesis and evolution of CMD. In addition, based on the modern pharmacological research on insect medicines, this article discussed the clinical application of insect medicines in the treatment of CMD from four aspects: Promoting blood circulation and removing blood stasis to relieve vessels' obstruction, relieving spasms to alleviate pain,combating poison with poison to disperse stagnation, and tonifying cardiac collaterals to nourish the heart,which aims to provide a theoretical basis for the use of TCM in treating CMD, broaden the scope of medication,and improve clinical efficacy.