从“脉生痰核”论治动脉粥样硬化

Treating Atherosclerosis from Perspective of "Meridian Phlegm Node"

动脉粥样硬化病理变化过程中'痰'贯穿始终,以'痰核'为特点,而其核心病机为宿痰失道,脉生痰核。因此需着眼于'痰核',当以化痰散结作为大法,兼顾健脾、行气、化瘀、清热、解毒。在'脉生痰核'理论指导下将动脉粥样硬化分为6期:①痰核始生期(内中膜增厚期):病机为宿痰失道,此时'痰核'始结脉壁,给予顺气匀血汤加减治疗,以期气血顺畅,气机条达,化湿消痰;②痰核已成期(稳定斑块期):病机为宿痰失道,兼有血瘀,此时痰瘀互结,给予内消软脉汤加减,以期斑块消退,遏制病情发展;③痰核坚化期(斑块钙化期):病机为宿痰失道,兼有瘀热,此时积病已久,郁而化热,伤津耗气,痰核坚化,斑块钙化形成,给予内金钙化散加减,清痰散结、化石消癥;④痰核腐化期(易损斑块期):病机为宿痰失道,毒聚不散,气血衰败,易损斑块形成,给予托里稳斑汤加减,解毒为先,补气治本;⑤痰核溃破期(斑块溃破期):病机为瘀毒壅盛,化腐成脓,斑块破溃,给予四妙勇安汤加减,解毒祛腐,活血通脉;⑥痰核复生期(再狭窄期):病机为外伤血瘀,给予加味复原汤为主,后用内消软脉汤治疗。

During the process of the pathological changes of atherosclerosis,the evil factor of Phlegm always exists.The core pathogenesis of the disease is abnormal condition of the Phlegm.Therefore,it is necessary to focus on the'Phlegm Node',and take'resolving Phlegm and Stagnation'as the main principle,taking tonifying Spleen,activating Qi,solving Phlegm,clearing Heat and detoxification into account.Under the guidance of the theory of'Meridian Phlegm Node',atherosclerosis is divided into 6 stages:(1)Period of Phlegm Node formation(inner membranous thickening period):the pathogenesis is the stagnation of Phlegm on the wall of the vein and Shunqiyunxue Decoction is used in treatment in order to smooth the movement of the blood and Qi and to eliminate the Dampness and Phlegm;(2)The stage of developed Phlegm Node(stable plaque stage):the pathogenesis is blood stasis an Phlegm and modified Neixiao Ruanmai Decoction is used in order to eliminate the plaque and curb the development of the disease.(3)Phlegm Node hardening period(plaque calcification period):the pathogenesis is the stagnation and heat,the injury of body fluid and Qi,and plaque calcification exists.In treatment,modified Neijin Gaihua Powder is used to clear and eliminate the evil factors;(4)Phlegm Node decay period(vulnerable plaque stage):the pathogenesis is a decay condition of the blood and Qi with ulnerable plaque formation.In treatment,modified Tuoli Wenbian Decoction is used to detoxification first and tonify Qi at the same time;(5)Phlegm Node rupture period(plaque rupture period):the pathogenesis is the stronger condition of stasis and toxin,which causes the rotton and broken of the plaque.In treatment,Simiao Yongan Decoction is used to achieve detoxification and phlegm resolving,and then to promote blood circulation;(6)the Phlegm Node rejuvenation period(restenosis period):the pathogenesis is traumatic blood stasis.After the modified Fuyuan Decoction being used,Neixiao Ruanmai Decoction is used then in treatment.