急性冠脉综合征“寒热”的研究进展  

Cold and Heat in Acute Coronary Syndrome:A Review

作　　者：王雪娇 邵祯 孟超 姜春云 陈恒文[1] 李军[1] WANG Xuejiao;SHAO Zhen;MENG Chao;JIANG Chunyun;CHEN Hengwen;LI Jun(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]北京中医药大学,北京100029

出　　处：《中国实验方剂学杂志》2024年第6期246-252,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金面上项目(81973836);中国中医科学院科技创新工程项目(CI2021A00902)。

摘　　要：寒热是中医八纲辨证的一对纲领,可以反映疾病中机体阴阳的盛衰、病邪性质的属阴属阳。目前中医对于急性冠脉综合征寒热的认识尚不统一,对于寒热病邪的强调有所偏颇,量表中寒热证候要素体现不全面等。鉴于此,该文通过文献研究从病因病机、证候要素及以药测证等角度对其寒热进行梳理。总结为从病因角度分析外感寒邪、热邪均可增加急性冠脉综合征的发病风险,既往多认为急性冠脉综合征在冬春等寒冷季节时高发,在此认识基础上,补充炎热天气也会诱发急性冠脉综合征,并且不同温度对不同年龄段、不同基础疾病患者影响不同。并强调了新时代下人为“寒邪”如过食生冷、制冷空调等作为新的致病因素;从病机角度梳理提出,在传统“阳微阴弦”“痰瘀虚滞”认识基础上,阴寒、火热病机均可以引发心脉痹阻、不通则痛,以及当急性冠脉综合征表现为“啖蒜状”的热郁寒束病机时需与胃食管反流疾病相鉴别。并且区别了阴寒凝结和脉滞风阻病机,二者病因病性不同。且急性冠脉综合征符合风性“善行而数变”的特点,可以用风药协助治疗;从证候要素角度梳理寒凝、热蕴、毒等证候要素,基础证候要素及其单元组合形式的使用更便于临床和科研的交流使用;并且以药测证可知,急性冠脉综合征处方用药的寒热属性可从温度敏感相关的瞬时受体电位(TRP)离子通道角度得以阐释,进而反证其寒热病机。Cold and heat belong to the eight-principal syndrome differentiation of traditional Chinese medicine,which can reflect the rise and fall of Yin and Yang in the body and the Yin and Yang nature of the disease.At present,traditional Chinese medicine has an inconsistent understanding of cold and heat in acute coronary syndrome.The emphasis on pathogenic factors of cold and heat is biased,and the elements of cold and heat syndrome are not fully reflected in the scale.Therefore,the literature has been reviewed from the perspectives of etiology,pathogenesis,symptom elements,and test signs with drugs.From the perspective of etiology,both cold evil and heat evil can increase the risk of acute coronary syndrome.It was previously believed that acute coronary syndrome occurs frequently in cold climates such as winter and spring.Based on this understanding,hot weather can also induce acute coronary syndrome,and different temperatures have different effects on patients of different ages and with different underlying diseases.In addition,artificial pathogenic factors such as excessive consumption of cold food and refrigeration air conditioners were added.From the perspective of pathogenesis,on the basis of the traditional''asthenia in origin and asthenia in superficiality''and''phlegm stagnation'',it is found that Yin-cold and fire-heat can both cause paralysis of the heart chakra and pain induced by the blockage.The pathogenesis of acute coronary syndrome characterized by heat stagnation and coldness featuring heartburn should be distinguished from gastroesophageal reflux disease.Moreover,the pathogenesis of Yin cold coagulation and pulse stagnation and wind obstruction are different.The acute coronary syndrome is in line with the wind characteristics of frequent changes and can be treated with wind medicine.From the perspective of syndrome elements,the syndrome elements such as cold condensation,heat accumulation,and toxicity are analyzed,and the use of basic syndrome elements and their combination forms facilitates clinical

关 键 词：急性冠脉综合症 寒热 病因病机 证候要素 瞬时受体电位(TRP)离子通道 

分 类 号：R2-0[医药卫生—中医学] R22R242R2-031R287