基于“阳化气,阴成形”理论探析心肌梗死后心室重构的病机与治疗  

Discussion on the Pathogenic Mechanism and Treatment of Post-Myocardial Infarction Ventricular Remodeling Based on the Theory of"Yang Transforms into Qi,While Yin Constitutes Form"

作　　者：陈一帆 姜众会 王柳丁 马丹 高铸烨[1] CHEN Yifan;JIANG Zhonghui;WANG Liuding;MA Dan;GAO Zhuye(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing,10009l;Suzhou Hospital Branch of Xiyuan Hospital,China Academy of Chinese Meddcal Sciences)

机构地区：[1]中国中医科学院西苑医院,北京市海淀区100091 [2]中国中医科学院西苑医院苏州医院

出　　处：《中医杂志》2024年第17期1762-1768,共7页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82274508);中国中医科学院科技创新工程重大攻关项目(CI2021A00920)。

摘　　要：心室重构是心肌梗死预后与转归的关键病理环节。以《黄帝内经》“阳化气,阴成形”理论为指导,结合心室重构的病理特点及表现,认为“阳化气”不足与“阴成形”太过导致的心阳不振、浊阴痹阻是心肌梗死后心室重构的基本病机,“阴成形”不足与“阳化气”太过导致的心络失养、变证丛生是疾病发展与转归的关键病机。结合临床实践,主张调和阴阳以维持“阳化气”与“阴成形”动态平衡,提出温通并用、调和气化以助阳运,化痰除湿、活血解毒以散阴积,清热熄风、滋阴通络以改善预后,以期为中医药防治心肌梗死后心室重构提供思路。Ventricular remodeling is a crucial pathological process in the prognosis and regression of myocardial infarction.Guided by the theory of“yang transforms into qi,while yin constitutes form"of The Inner Canon of Yellow Emperor(《黄帝内经》),combined with the pathological characteristics and manifestations of ventricular remodelling,it is believed that insufficient"yang transforms into qi"and excess"yin constitutes form"resulting to heart yang deficiency and turbid pathogen obstruction are the basic pathomechanism of ventricular remodelling after myocardial infarction;insufficient"yin constitutes form"and excess"yang transforms into qi"resulting to inadequate nourishment of the heart meridians and the emergence of various pathological changes are the key pathomechanism of prognosis and regression.Combined with clinical practice,we advocated that harmonizing yin and yang to maintain the dynamic balance of"yang transforms into qi"and"yin constitutes form".We also proposed the use of warming and tonifying to harmonise qi and transform it to help yang transport;resolving phlegm and removing dampness,invigorating blood and resolving toxins to disperse yin accumulation;clearing heat and extinguishing wind,and nourishing yin and channels to improve the prognosis.All these findings and summary could provide ideas on traditional Chinese medicine for prevention and treatment of ventricular remodelling after myocardial infarction.

关 键 词：心肌梗死 心室重构 阳化气 阴成形 胸痹 调和阴阳 

分 类 号：R259[医药卫生—中西医结合]