基于“阳化气,阴成形”与心外膜脂肪组织的相关性探讨心房颤动的中医药防治策略

Based on the correlation between"yang transforming qi,yin shaping up the body"and epicardial adipose tissue,discussing the prevention and treatment strategies of atrial fibrillation by traditional Chinese medicine

心外膜脂肪组织是紧贴心肌与脏层心包的脂肪库,具有特殊的解剖和生理特点,其体积大小及沉积部位与心房颤动的发生、发展关系紧密。本文基于中医学理论“阳化气,阴成形”的内涵,认为机体阳化气不足、阴成形太过是心外膜脂肪组织异常蓄积的本质,阴邪渐积,局部阴阳失衡,出现分泌异常,邪郁日久,其内蕴之阳热相伴而生,且日渐亢盛,最终阴难制阳,造成心外膜脂肪组织浸润正常组织,诱发心房颤动。在该理论的指导下,当明辨机体与心外膜脂肪组织中阴阳的多寡,考虑整体和局部“阳化气”与“阴成形”的能力,合理选用扶阳与消阴之法。疾病之初以复“阳化气”为主,在避免阴邪蓄积的同时,消散已成之阴体;病进则以祛邪为要,针对病机辅以燥湿、行气、活血等不同治法。此外,整个疾病进程中当顾护患者虚损之体,注意时时扶阳补正,适时消阴祛邪,从而提高中医药治疗心房颤动的临床疗效。

Epicardial adipose tissue(EAT)is a fat reservoir close to the myocardium and visceral pericardium.It has special anatomical and physiological characteristics.The volume and deposition site of EAT are closely related to the occurrence and development of atrial fibrillation(AF).This article discusses the connotation of the traditional Chinese medicine theory,"yang transforming qi and yin shaping up the body",and holds that the essence of abnormal accumulation of EAT is"yang transforming qi deficiency and yin constituting form too much".Yin pathogen gradually accumulates,local yin and yang imbalance occurs,and abnormal secretion occurs.With the extension of time,the intrinsic yang heat is accompanied and becomes increasingly exuberant.Finally,yin is difficult to control yang,resulting in EAT infiltrating normal tissues,inducing and promoting the occurrence and progression of AF.Under the guidance of this theory,when distinguishing the amount of yin and yang between the body and EAT,considering the ability of"yang transforming qi"and"yin constituting form"in the whole and part,the method of supporting yang and eliminating yin should be reasonably selected.At the beginning of the disease,it is mainly to restore"yang transforming qi".By avoiding the accumulation of evil from the yin,it dissipates the body of the yin that has become.When the disease progresses,it is necessary to"eliminate pathogenic factor",supplemented by different treatment methods such as eliminating dampness,activating qi,and promoting blood circulation.Furthermore,the whole course of the disease should take care of the patient′s deficiency,pay attention to strengthening yang and tonifying the healthy qi,and eliminate yin and evil promptly to improve clinical efficacy.