从“血络失和、气化失司”探析冠状动脉微血管疾病的辨治  

Diagnostic and Treatment Approach to Coronary Microvascular Disease from the Perspective of "Disharmony of Blood Collaterals and Dysfunction of Qi Transformation"

作　　者：张笑霄 林建国 孙晓宁 孙梓宜 仝彤 左文茜 王泽祺 姚魁武[1,3] ZHANG Xiaoxiao;LIN Jianguo;SUN Xiaoning;SUN Ziyi;TONG Tong;ZUO Wenqian;WANG Zeqi;YAO Kuiwu(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing,100053;Beijing University of Chinese Medicine;China Academy of Chinese Medical Sciences)

机构地区：[1]中国中医科学院广安门医院,北京市100053 [2]北京中医药大学 [3]中国中医科学院

出　　处：《中医杂志》2025年第7期755-759,共5页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81873173);北京市自然科学基金(7232324);北京中医药薪火传承“新3+3”工程室站建设项目(2023-SZ-H-13);中国中医科学院科技创新工程项目(CI2021B004);中国中医科学院眼科医院中央高水平中医医院项目(GSP2-02);中国中医科学院眼科医院中央高水平中医医院项目(GSP3-08)。

摘　　要：从“血络失和、气化失司”探析冠状动脉微血管疾病(CMVD)的中医辨治思路,认为此病核心病机为血络失和、气化失司。从中西医结合角度分别论述CMVD不同类型所对应的具体病机,结合临床提炼出“温、通、补、动”四法进行针对性论治。动脉粥样硬化因素导致的CMVD主要与心肌缺血、心肌梗死、冠状动脉血运重建相关,相应病机分别为伏邪痹阻、蕴毒入络、正虚络瘀。病机演变具有相关性、阶段性、转化性特点,分别以温助气化、通痹泄浊,动散毒滞、开玄活络,补正消瘀、行血养络进行辨治。对于非动脉粥样硬化因素相关的CMVD,需关注原发病,分析血、络失和的主要证候,强调病证结合、调血和络辨治。The study explores the traditional Chinese medicine(TCM)diagnostic and treatment approach to coronary microvascular disease(CMVD)from the perspective of"disharmony of blood collaterals and dysfunction of qi transformation".It is proposed that the core pathogenesis of CMVD lies in these two mechanisms.From an integrative medicine perspective,different CMVD types are analyzed based on their specific pathogenesis.Through clinical practice,four targeted treatment methods,i.e.warming,unblocking,tonifying,and activating,are formulated.CMVD caused by atherosclerosis is primarily associated with myocardial ischemia,myocardial infarction,and coronary revascularization,with corresponding pathological mechanisms of latent pathogenic obstruction,toxic accumulation in the collaterals,and deficiency with collateral stasis.The disease progression exhibits characteristics of correlation,staging,and transformation.Accordingly,treatment principles include warming to assist qi transformation,unblocking obstruction and dispelling turbidity,activating to disperse toxic stasis and invigorate collaterals,and tonifying to eliminate stasis and nourish collaterals.For CMVD unrelated to atherosclerosis,attention should be paid to the underlying disease,analyzing the main syndromes of blood and collateral disharmony.An approach combining disease-syndrome differentiation with blood and collateral regulation is emphasized for precise treatment.

关 键 词：冠状动脉微血管疾病 血络失和 气化失司 温法 通法 补法 动法 

分 类 号：R259[医药卫生—中西医结合]