基于脉络营卫理论探讨冠状动脉微循环障碍的中医诊疗思路  

Coronary Microvascular Dysfunction and Its Diagnosis and Treatment in Traditional Chinese Medicine Based on Theory of Collaterals and Ying and Wei

作　　者：胡岚清 李晓雅 于宗良 陈纪烨 刘龙涛[1,2] HU Lanqing;LI Xiaoya;YU Zongliang;CHEN Jiye;LIU Longtao(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;National Clinical Research Center for Chinese Medicine Cardiology,Beijing 100091,China)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]国家中医心血管病临床医学研究中心,北京100091

出　　处：《辽宁中医药大学学报》2023年第11期83-87,共5页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81973689,82074254);北京市自然科学基金项目(7202176)。

摘　　要：冠状动脉微循环障碍(coronary microvascular dysfunction,CMD)是指冠状动脉微血管结构和/或功能受损,导致心肌血流灌注下降。目前国际指南尚未明确其诊断标准,治疗方案建立在抗动脉粥样硬化、抗缺血基础上。循环系统逐级分布,微循环为最末层分支,脉络系统中孙络与其形态相似。孙络主渗灌气血,交互营卫,与微循环维持血供、物质交换的基本生理功能相通。此外,络脉与微循环均在疾病初期受累,病变表现不典型,且多轻微缓和、隐匿迁延。综上,基于孙络与微循环在形态、生理、病理层面的相似性,认为CMD病位在孙络。营卫借孙络交互生化,营卫病变内涵可从中医角度阐释CMD现代医学病理机制,故认为CMD病机属营卫失调。初步提出中医药治疗CMD应通络联合调和营卫,灵活使用虫蚁类及风药以搜剔络脉,并重视以桂枝汤为代表的调和营卫类方的运用。Coronary microvascular dysfunction(CMD)refers to the impairment of the structure and/or function of coronary microcirculation,resulting in the decrease of myocardial blood flow perfusion.The diagnostic criteria have not been clarified at present and the treatment is based on anti-atherosclerosis and anti-ischemia.Microcirculation is the minimum branch of the circulatory system.Collaterals are the last branches of the meridian and are similar to microcirculation in the structure.Collaterals infiltrate Qi and blood to interact with Ying and Wei,and its basic physiological function mainly equals to microcirculation,which is used to maintain sufficient blood supply and realize material exchange.In addition,collaterals and microcirculation are involved in the early stage of the disease,and the clinic symptoms are mild,inapparent,long-lasting and not typical.Thus,based on the similarity of structure,physiology and pathology between collaterals and microcirculation,it is believed that CMD is located in collaterals.Ying and Wei interact with each other in collaterals and the pathogenesis of CMD can be explained from the perspective of Ying and Wei in traditional Chinese medicine,thus our group believe that CMD is caused by the disorder of Ying and Wei.It is preliminarily proposed that traditional Chinese medicine should be used to treat CMD by dredging collaterals and harmonizing Ying and Wei.It is important to use insect drugs and wind herbs flexibly to dredge collaterals,and apply Guizhi Decoction(桂枝汤)and its similar prescriptions to harmonize Ying and Wei.

关 键 词：冠状动脉微循环障碍 中医药 孙络 营卫 诊疗思路 

分 类 号：R259[医药卫生—中西医结合]