基于“阳微阴弦”理论探讨虚、痰、瘀与心肌纤维化的关系

Discussion on the relationship between deficiency, phlegm, blood stasis, and myocardial fibrosis based on the theory of “weak pulse at yang and wiry pulse at yin”

心血管疾病已成为中国居民死亡的首要原因,且其患病率和死亡率持续上升,心肌纤维化(MF)是多种心血管疾病共同的特征性病理变化。MF是由心肌成纤维细胞的过度增殖,心肌细胞外基质中胶原纤维过量聚集所致。中医根据临床症状,将MF归入“胸痹”“心悸”“心胀”等范畴,“阳微阴弦”是对胸痹病机的高度概括,提出胸中阳微不运,气化不利聚而生痰;血液不运,渐而阻滞脉道,导致疾病发生,病变之本为阳微则胸阳不振,病变之势为阴弦则痰瘀渐生。可见“阳微阴弦”与虚、痰、瘀三者关系密切,在MF的病理演变过程中有重要作用。本文基于“阳微阴弦”理论,从中西医结合角度阐明虚、痰、瘀与MF的关系,并根据急则治其标,缓则治其本的治疗思路,提出急性期以“祛痰化瘀阻其变佐以补益”,缓解期以“益气温阳治其本兼以祛邪”,遵循病机变化特点调整用药方案,探讨和分析能否有效延缓或改善MF的病理改变,为中西医结合防治MF提供新思路。

Cardiovascular disease has become the leading cause of death in China,and its prevalence and mortality rate continue to rise,myocardial fibrosis(MF)is a common characteristic pathological change of many cardiovascular diseases.MF is caused by the excessive proliferation of myocardial fibroblasts and the excessive aggregation of collagen fibers in extracellular matrix of myocardium.According to clinical symptoms,Chinese medicine puts MF into the categories of“chest paralysis”,“palpitation”,and“heart distension”,etc.“Weak pulse at yang and wiry pulse at yin”is a high degree of gener-alization of the pathogenesis of chest paralysis,which puts forward that weak pulse at yang in chest does not transport,qi and digestion are not favorable,and phlegm is generated.The lack of transportation of blood leads to blockage of veins,resulting in the occurrence of the disease;weak pulse at yang is the cause of the lack of vibration in chest,and wiry pulse at yin is the cause of phlegm and blood stasis.It can be seen that the relationship between“weak pulse at yang and wiry pulse at yin”and deficiency,phlegm,and blood stasis is close,and plays an important role in pathological evolution of MF.Based on the theory of“weak pulse at yang and wiry pulse at yin”,this paper elucidates the relationship between deficiency,phlegm,blood stasis and MF from the perspective of combine traditional Chinese and western medicine.According to treatment strategy of treating the target in case of urgency and treating the root cause in case of delay,it proposes that“expelling phlegm and resolving blood stasis to block its changes and supplementing with tonic benefits”during acute stage, and “tonifying qi, warming yang, treating the root and dispelling the evil spirits” during remission stage, adjust medication plan according to characteristics of pathological changes, explore and analyze whether it can effectively delay or improve pathological changes of MF, and provide new ideas for the prevention and treatment of MF with combination of traditional Chinese and western medicine.