基于心脾相关理论探讨中医治疗冠状动脉粥样硬化性心脏病思路  

An analysis of treating coronary heart disease in TCM based on the theory of heart and spleen correlation

作　　者：岳哲宇 郑娴[2] YUE Zheyu

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《中医临床研究》2024年第20期76-80,共5页Clinical Journal Of Chinese Medicine

基　　金：辽宁中医药大学校级自然科学类重点项目(2021LZY053)。

摘　　要：冠状动脉粥样硬化性心脏病(简称冠心病)是我国发生率最高的疾病之一,中医在以“痰浊-痰结-痰瘀”为整体病机演变的基础上,依据心脾相关理论提出了冠心病虽病位在心,但其形成与脾密切相关的观点。心与脾经脉相连、五行相生、气血生化互相依存,一方功能异常常会引起另一方的异常。因此,中医治疗冠心病不仅从心本身脏腑出发,还从脾论治。从脾论治冠心病主要是根据脾主运化及脾主统血两个方面:脾主运化功能主要通过影响血脂、血糖水平等诱发动脉粥样硬化,从而导致冠心病的发生与发展。老年人脾气不足、痰浊内生,用益气健脾、祛痰化浊之法治疗,如四君子汤,方中人参可以降血糖、降血脂、抗心肌缺血,茯苓具有增强心肌收缩力、降低血糖的作用,白术和甘草分别能够降血糖和降血脂;而脾主统血功能则通过影响D-二聚体、纤维蛋白原等凝血因子水平来影响冠心病的心血管事件发生率。痰浊日久影响血液运行,形成痰浊和瘀血并存的痰瘀,采取健脾祛痰化瘀的治法,如瓜蒌薤白半夏汤合二陈汤,前者可以有效改善心肌微循环状态。中医依据心脾相关理论,从脾主运化及脾主统血两个方面来治疗冠心病,在一定程度上能够有效改善患者临床症状以及生活质量,延缓冠心病的发展。Coronary heart disease is one of the diseases with the highest incidence rate in China.Based on the overall Cpathogenesis of phlegm turbidity-phlegm coagulation-phlegm stasis and the theory of heart and spleen correlation,traditional Chinese medicine proposes that although coronary heart disease is located in the heart,its formation is closely related to the spleen.The heart is connected to the spleen meridians,the five elements are interdependent,and Qi(气)and blood biochemistry are interdependent.Abnormal function of one side often leads to abnormalities in the other.Therefore,traditional Chinese medicine treatment of coronary heart disease often starts not only from the heart,but also from the spleen.The treatment of coronary heart disease from the spleen is mainly based on the two aspects of spleen governing transportation and transformation and spleen governing blood circulation.The function of spleen governing transportation and transformation mainly induces the occurrence of atherosclerosis by affecting blood lipids,blood glucose levels,etc.,thus leading to the occurrence and development of coronary heart disease.Elderly people with insufficient spleen Qi and endogenous phlegm turbidity can be treated by methods such as nourishing Qi and strengthening the spleen,dispelling phlegm and resolving turbidity.For example,in the Sijunzi decoction(四君子汤),Renshen(Radix Ginseng)can lower blood spleen Qi,blood lipids,and resist myocardial ischemia,Fuling(Poria)can enhance myocardial contraction and lower blood spleen Qi,while Baizhu(Rhizoma Atractylodis Macrocephalae)and Gancao(Radix Glycyrrhizae)can lower blood spleen Qi and blood lipids,respectively.The spleen’s function of regulating blood flow affects the incidence of cardiovascular events in coronary heart disease by affecting the levels of coagulation factors such as D-dimer and Fibrinogen.Phlegm turbidity for a long time affects blood circulation,resulting in phlegm and blood stasis coexisting.Treatment methods such as strengthening the spleen,removi

关 键 词：心脾相关理论 冠状动脉粥样硬化性心脏病 中医 

分 类 号：R256.2[医药卫生—中医内科学]