基于“三因四证”调整免疫炎症状态的中医药治疗心血管疾病研究述评

Aresearch review on characteristics of TCM modulating inflammatory immune state in cardiovascular diseases based on three causes and four syndromes

动脉粥样硬化是心血管疾病发生发展的重要病理基础,物质代谢异常和免疫炎症反应是其发生发展的重要原因,由此导致的免疫炎症状态贯穿其病理始终。本文以“病”(心力衰竭)为切入点,结合心脉相关理论,总结气、血、水“三因”病机与免疫炎症状态的相关性。心气、心血、心水异常可出现在心力衰竭的不同阶段,持续的免疫炎症状态贯穿心力衰竭始终。同时,岭南地区常年湿热的气候环境因素及人群气虚、阳虚和湿热体质与免疫炎症状态发生密切相关,“积湿生热”及“湿自热生”的湿热相互转化机制使得岭南地区心血管疾病的病机以气虚痰浊夹瘀多见。在此基础上,痰、瘀、湿、热等伏匿机体的多种病理产物在疾病发展过程中累积,久酿而成内生伏毒,由此总结性归纳将痰、瘀、湿、毒“四证”与免疫炎症状态紧密联系。本文用“病—证—治”关联视角探讨中医药防治心血管疾病,融合治未病思想,从理论到应用,从基础到临床,以期为进一步制定和实施中医药诊疗方案提供理论指导。

Atherosclerosis(AS)is an important pathological basis for the occurrence and development of cardiovascular diseases,and abnormal substance metabolism and immune inflammatory response are important reasons for the occurrence and development of AS,inflammatory immune state runs through the pathology of cardiovascular diseases.Taking‘disease’(heart failure)as the starting point,combined with the theory of heart-pulse correlation,we summarized the correlation between the pathogenesis of the‘three etiological categories’of qi,blood and water and the immune inflammatory state.The unusual qi,blood,and water of heart often appear in different stages,and the continuous inflammatory immune state runs through heart failure.At the same time,the climatic and environmental factors of perennial dampness and heat in Lingnan area,as well as the people’s qi deficiency,yang deficiency and damp-heat constitution are closely related to the occurrence of immune inflammatory state.A variety of pathological products of the body,such as phlegm,stasis,dampness,and heat,accumulate in the process of disease development,and become endogenous poison for a long time,so the‘four syndromes’of phlegm,stasis and dampness had a close relationship with immune inflammatory state,which was summarized.We discussed the prevention and treatment of cardiovascular diseases with traditional Chinese medicine from the perspective of‘disease-syndrome-treatment’,and integrates the idea of preventive treatment,from theory to application,from basic to clinical,in order to provide theoretical guidance for the further formulation and implementation of traditional Chinese medicine diagnosis and treatment programs.