基于“瘀毒”理论探讨难治性心绞痛发病机制及中医药防治策略

Pathogenesis and Traditional Chinese Medicine Prevention and Treatment Strategy of Refractory Angina Based on Theory of Stasis and Toxin

难治性心绞痛以持续时间不少于3个月的反复、持久的心绞痛为主要症状,与冠脉狭窄、阻塞等引起的可逆性缺血、缺氧有关,主要涉及阻塞性冠状动脉疾病和以冠脉痉挛、冠脉微循环功能障碍为主的非阻塞性冠状动脉疾病。“瘀毒”在心血管疾病的发病机制中占重要地位,“瘀毒”致病秽浊顽固、缓积急发、变化迅速,与难治性心绞痛复杂多变、迁延难愈的疾病特点不谋而合。难治性心绞痛的病机本质是本虚标实,“瘀毒”贯穿其始末,是其重要的病理因素。基于“活血解毒”的整体思路,结合不同类型的本虚机制,并辅以益气温阳、补肾健脾、清热化痰等治法,在中医药领域运用抗炎、调节脂质代谢、抑制氧化应激和血栓形成、保护血管内皮功能,以及建立侧支循环等手段来预防和治疗难治性心绞痛。故该文从“瘀毒”理论出发,结合中医理论及现代医学研究,探讨难治性心绞痛的发病机制及中医药防治策略,阐明难治性心绞痛难以治愈的原因及与普通心绞痛、冠脉微循环功能障碍、冠脉痉挛和阻塞性冠状动脉疾病之间的关系,为中医药防治难治性心绞痛提供一定的理论依据和临床思路。

Refractory angina is characterized by recurrent and persistent angina with a duration of not less than three months,which is related to reversible ischemia and hypoxia caused by coronary stenosis and obstruction.It mainly involves obstructive coronary artery disease and non-obstructive coronary artery disease with coronary artery spasm and coronary microvascular dysfunction.“Stasis and toxin” play an important role in the pathogenesis of cardiovascular diseases.The pathogenesis of stasis and toxin is stubborn filthy turbidity featured by slow accumulation and sudden onset,and rapid changes,which coincides with the characteristics of refractory angina which is complex and changeable,prolonged and difficult to cure.The pathogenesis of refractory angina involves a combination of underlying deficiency and excessive manifestation,with "stasis and toxin" playing a crucial role as an important pathological factor in the whole process of refractory angina.Traditional Chinese medicine(TCM) employs a holistic approach known as "activating blood circulation and removing toxins",which is supplemented by various methods to tonify Qi and warm Yang,nourish the kidneys and invigorate the spleen,clear heat and transform phlegm.This approach applies anti-inflammatory measures,regulates lipid metabolism,inhibits oxidative stress and thrombus formation,protects endothelial function in blood vessels,as well as establishes collateral circulation for the prevention and treatment of refractory angina.Therefore,based on the theory of "stasis and toxin",combined with TCM theory and modern medical research,this paper discusses the pathogenesis of refractory angina and the prevention and treatment strategy of TCM,and elucidates the reasons for the difficulty in curing refractory angina and the relationship between refractory angina and common angina pectoris,coronary microvascular dysfunction,coronary artery spasm and obstructive coronary artery disease,hoping to provide certain theoretical basis and clinical ideas for the prevention and treatment of refractory angina with TCM.