从气、血、痰论治冠状动脉粥样硬化性心脏病的理论探索及临床应用

Theoretical exploration and clinical application of treating coronary heart disease from Qi,blood and phlegm

冠状动脉粥样硬化性心脏病(简称冠心病)与中医学胸痹心痛病联系密切,作为临床常见的心血管疾病目前已成为严重威胁中老年人生命健康的多发病、常见病。因此,寻找有效的冠心病防治方法已成为迫切需要。近些年来,在冠心病的治疗方式上,传统中医治疗手段已经逐渐步入主流,无论从预防、治疗及预后的任何角度,中医都有着不能替代的优势与作用。中医学在整体观的指导下,基于辨证论治的治疗思路对疾病进行干预。基于古典医籍和丰富的各家学说,并结合中医临床流行病学调查,冠心病中医证候以“阳微阴弦”即“本虚标实”为基本病机,本虚以气虚为主,标实以血瘀、痰浊为主,其中气虚、血瘀、痰浊三者关系密切。故文章以此为切入点,探究历代胸痹心痛病相关著作中关于气虚、血瘀、痰浊的致病机制及三者之间相互依存、互为因果的理论基础,从而以病机言治则,将“益气温阳”“活血化瘀”“化痰逐饮”三法作为中医治疗胸痹的大方向,三法结合,灵活辨证,既重视阴弦之标,又兼顾阳微之本。同时与现代医学相结合,述析“益气、活血、化痰”的现代医学本质,发现其与现代医学所提出的通过正性肌力、抗凝、调脂、稳定斑块等手段抑制动脉粥样硬化形成的理念不谋而合,为临床中西医结合治疗冠心病提供理论基础。通过案例介绍现代医家从气、血、痰论治冠心病的经验,以期为临床提供新思路、新方法。

Coronary atherosclerotic heart disease is closely related to chest impediment and pain in traditional Chinese medicine.As a common clinical cardiovascular disease,it has become a frequent and common disease that seriously threatens the life and health of middle-aged and elderly people.Therefore,to find effective prevention and treatment of coronary heart disease has become an urgent need.In recent years,in the treatment of coronary heart disease,traditional Chinese medicine treatment has gradually entered the mainstream,and it has irreplaceable advantages and roles either from the prevention,or treatment and prognosis,or any other perspective.Under the guidance of the holistic view,traditional Chinese medicine intervenes in the disease based on the treatment idea of syndrome differentiation.Based on the classical medical books and various theories of different schools,combined with the clinical epidemiological investigation of traditional Chinese medicine,it is shown that the basic pathogenesis of traditional Chinese medicine syndrome of coronary heart disease is“weak pulse at Yang(阳)and wiry pulse at Yin(阴)”,that is,the basic pathogenesis of this disease is deficiency in origin and excess in superficiality.Deficiency in origin is the primary deficiency of Qi(气),and excess in superficiality is mainly blood stasis and phlegm turbidness,and the three are closely related.Therefore,this article takes this as a starting point to explore the pathogenic mechanism of Qi deficiency,blood stasis and phlegm turidity in the relevant works of chest impediment and pain in the past and the theoretical basis of mutual dependence and mutual causation among the three, so as to take the principle of pathogenesis and treatment. The three methods of “benefiting Qi and warming Yang”, “promoting blood circulation and removing blood stasis” and “resolving phlegm and expelling fluids” are taken as the general direction of TCM treatment of chest impediment, in combination of the three methods and flexible syndrome differentiation, which pays attention to both wiry pulse at Yin and weak pulse at Yang. At the same time, it is combined with modern medicine to analyze the essence of modern medicine of “supplementing Qi, promoting blood circulation and eliminating phlegm”, and finds that it coincides with the concept of inhibiting the formation of atherosclerosis by means of positive muscle strength, anticoagulation, lipid regulation and plaque stabilization proposed by modern medicine, which provides a theoretical basis for the clinical treatment of coronary heart disease in the integrative medicine. This paper introduces the experience of modern doctors in treating coronary heart disease from Qi, blood and phlegm through listing cases, in order to provide new ideas and new methods for clinical practice.