脉络学说营卫理论指导血管病变防治研究
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摘要
继承发展血脉理论,结合中医气血相关理论特色,汲取主持承担的2项国家973计划项目研究成果,系统构建指导血管病变防治的脉络学说,把中医络病学学科的学术发展从"络病证治"推向"脉络学说"研究的历史新阶段。系统研究脉络病变发病规律、基本病机、临床证候及辨证治疗,提出脉络学说核心内容——营卫理论,建立"脉络-血管系统病"辨证诊断标准,完善发展了中医血脉理论。深化发展脉络学说营卫理论,提出营卫交感和营卫"由络以通、交会生化"理论指导血管病变防治研究,以"孙络-微血管"为研究切入点,提出四类微观病理特征,证实通络保护"孙络-微血管"是治疗心、脑和(糖)肾重大疾病共性关键机制——保护微血管、改善血流灌注、保护组织细胞、改善脏器功能,通络保护微血管内皮细胞是治疗"孙络-微血管"病变核心机制,提出保护微血管内皮细胞是解决微血管病变难题的新策略。历经十余年,完成4项循证医学研究解决急性心梗无再流临床难题,为心功能不全伴室性早搏国际医学界难题提供新药物,填补窦缓伴早搏快慢兼治、整合调律的药物治疗空白,明显提高慢性心力衰竭临床治疗效果,取得中医药治疗微血管病变重大突破,受到国内外医学界的充分认可和高度评价,推动了脉络学说营卫理论指导下的专科平台建设和学科学会发展,以及脉络病变辨证诊疗方法和药物的临床应用,具有显著的社会效益和经济效益。
The blood-vein theory is inherited and developed. Combined with the related theory features of Qi and blood of traditional Chinese medicine(TCM),the progress results in two national 973 plan projects undertaken are learned from,the vessel-collateral theory guiding the prevention and treatment of vascular lesions is systematically built,the academic development of TCM collateral disease discipline is pushed from " treatment of symptoms of collateral disease " to study on " vessel-collateral theory ", a new stage in the history. The pathogenesis,basic pathogenesis,clinical syndrome and syndrome differentiation therapy of vessel-collateral lesions are systematically studied,Yingwei theory,the core content of vessel-collateral theory,is proposed,the syndrome differential diagnosis standard of " vessel-collateral-vascular system disease" is established,and the blood-vessel theory of TCM is improved. The development of Yingwei theory of vessel-collateral theory is deepened. The theory of Yingwei sympathia and Yingwei's " opening by collaterals,intersecting and generating" are proposed to guide the study on prevention and control of vascular lesions. With tertiary collaterals-microvessel as a breakthrough point of research,four types of microscopic pathological features of microvessels are proposed. It is confirmed that dredging collaterals and protecting tertiary collaterals-microvessel is the common key mechanism for the treatment of major diseases of heart,brain and kidney(sugar). It protects microvessels,improves blood flow perfusion,protects tissue cells,and improves the viscera function. Dredging collaterals and protecting microvascular endothelial cells is the core mechanism of treating tertiary collaterals-microvessel lesions. It is proposed that protection of microvascular endothelial cells is a new strategy to solve the problem of microvascular lesions. After more than ten years,four studies of evidence-based medicine have been completed to solve the clinical problem of acute myocardial infarction without reflow. New drugs are provided to the international medical problem of cardiac insufficiency with premature ventricular contraction. The gap of fast and slow treatment,integration and rhythm adjustment of sinus bradycardia with premature ventricular contraction is filled. The clinical treatment effect of chronic heart failure is significantly improved,a major breakthrough in the treatment of microvascular lesions by TCM is achieved,and it is fully recognized and highly evaluated by the medical profession at home and abroad. It promotes the specialized subject platform construction and society development under the guidance of Yingwei theory of vessel-collateral theory,as well as the clinical application of syndrome differentiation diagnosis and treatment method and drugs of vessel-collateral lesions,and has significant social and economic benefits.
The blood-vein theory is inherited and developed. Combined with the related theory features of Qi and blood of traditional Chinese medicine(TCM),the progress results in two national 973 plan projects undertaken are learned from,the vessel-collateral theory guiding the prevention and treatment of vascular lesions is systematically built,the academic development of TCM collateral disease discipline is pushed from " treatment of symptoms of collateral disease " to study on " vessel-collateral theory ", a new stage in the history. The pathogenesis,basic pathogenesis,clinical syndrome and syndrome differentiation therapy of vessel-collateral lesions are systematically studied,Yingwei theory,the core content of vessel-collateral theory,is proposed,the syndrome differential diagnosis standard of " vessel-collateral-vascular system disease" is established,and the blood-vessel theory of TCM is improved. The development of Yingwei theory of vessel-collateral theory is deepened. The theory of Yingwei sympathia and Yingwei's " opening by collaterals,intersecting and generating" are proposed to guide the study on prevention and control of vascular lesions. With tertiary collaterals-microvessel as a breakthrough point of research,four types of microscopic pathological features of microvessels are proposed. It is confirmed that dredging collaterals and protecting tertiary collaterals-microvessel is the common key mechanism for the treatment of major diseases of heart,brain and kidney(sugar). It protects microvessels,improves blood flow perfusion,protects tissue cells,and improves the viscera function. Dredging collaterals and protecting microvascular endothelial cells is the core mechanism of treating tertiary collaterals-microvessel lesions. It is proposed that protection of microvascular endothelial cells is a new strategy to solve the problem of microvascular lesions. After more than ten years,four studies of evidence-based medicine have been completed to solve the clinical problem of acute myocardial infarction without reflow. New drugs are provided to the international medical problem of cardiac insufficiency with premature ventricular contraction. The gap of fast and slow treatment,integration and rhythm adjustment of sinus bradycardia with premature ventricular contraction is filled. The clinical treatment effect of chronic heart failure is significantly improved,a major breakthrough in the treatment of microvascular lesions by TCM is achieved,and it is fully recognized and highly evaluated by the medical profession at home and abroad. It promotes the specialized subject platform construction and society development under the guidance of Yingwei theory of vessel-collateral theory,as well as the clinical application of syndrome differentiation diagnosis and treatment method and drugs of vessel-collateral lesions,and has significant social and economic benefits.
引文
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[2]吴以岭.“脉络-血管系统”相关性探讨[J].中医杂志,2007,48(1):5-8.
[3]吴以岭.络病理论体系的构建[J].疑难病杂志,2005,4(6):349-350.
[4]吴以岭.络病理论体系构建及其学科价值[J].前沿科学,2007(2):40-46.
[5] WU Y L. Collateral theory and vascular lesion treatment[J]. Am J Chinese Med,2009,37(2):241-252.
[6] WU Y L. Construction of the vessel-collateral theory and its guidance for prevention and treatment of vasculopathy[J]. Front Med-Prc,2011,5(2):118-122.
[7]吴以岭,袁国强,贾振华,等.脉络学说的学术地位及其应用价值[J].中医杂志,2012,53(1):3-7.
[8]吴以岭,魏聪,贾振华,等.脉络学说的核心理论——营卫承制调平[J].中医杂志,2013,54(1):3-7.
[9]贾振华,吴以岭,高怀林,等.“脉络-血管系统病”辨证诊断标准[J].中医杂志,2007,48(11):1027-1032.
[10]贾振华,高怀林,谷春华,等.基于3469例血管病变患者证候分布规律的脉络病变共性探讨[J].中医杂志2009,50(10):920-924.
[11]吴相君,常成成.基于脉络学说分析通心络胶囊对临床心血管疾病的系统干预价值[J].中国实验方剂学杂志,2018,24(8):7-11.
[12]尹玉洁,张倩,贾振华,等.通心络对高脂血症兔血管内皮功能的保护作用及机制研究[J].中国中西医结合杂志,2018,38(3):325-330.
[13] GAO Y,YANG Y,GUAN Q G,et al. IL-1βmodulate the Ca2+-activated big-conductance K channels(BK)via reactive oxygen species in cultured rat aorta smooth muscle cells[J]. Mol Cell Biochem,2010,338(1/2):59-68.
[14] GUAN Q G,LIU M J,LIU R H,et al. Tongxinluo induces n NOS expression through ERK activation:possible contribution to the effects of Tongxinluo to attenuate vasoconstriction[J]. J Cardiovasc Pharm,2015,66(1):9-15.
[15]吴以岭.通络治疗血管病变的效应规律——承制调平与系统效应[J].疑难病杂志,2007,6(3):129-132.
[16]常成成,魏聪,吴以岭.脉络学说“孙络-微血管”概念及其临床指导意义[J].中医杂志,2016,57(1):7-11.
[17]王朋,杨明会,李绍旦,等.孙络与微血管相关性探析[J].环球中医药,2012,5(10):736-738.
[18]常成成,李红蓉,刘红利,等.脉络学说营卫交会生化理论探讨[J].中医杂志,2017,58(1):2-5.
[19]郭鹞,任东青.微循环学基础与实验方法[M].西安:第四军医大学出版社,2005:16-55.
[20]常丽萍,李禄金,魏聪,等.基于主成分分析方法的“孙络-微血管”病变数学模型构建及通络干预研究[J].疑难病杂志,2018,17(7):649-666.
[21]张鑫月,贾振华,常丽萍.甲襞微循环与颈动脉病变程度相关性研究[J].中国医科大学学报,2014,43(2):127-130.
[22]张鑫月,贾振华,常丽萍,等.糖尿病患者甲襞微循环病变及其与颈动脉内-中膜厚度的相关性[J].中国老年学杂志,2015,35(14):3853-3855.
[23]张俊修,霍旺,王朋,等.心之络病“孙络疏失”模型大鼠心肌组织病理变化研究[J].中国中医急症,2014,23(5):785-787,791.
[24] ZHANG J X,FENG Y,LI S D,et al. Microvascular pathological features and changes in related injury factors in a rat acute blood stasis model[J]. J Tradit Chin Med,2017,37(1):108-115.
[25] QI K,LI L J,LI X D,et al. Cardiac microvascular barrier function mediates the protection of Tongxinluo against myocardial ischemia/reperfusion injury[J]. PLo S One,2015,10(3):e0119846.
[26] LI X D,YANG Y J,GENG Y J,et al. The cardioprotection of simvastatin in reperfused swine hearts relates to the inhibition of myocardial edema by modulating aquaporins via the PKA pathway[J]. Int J Cardiol,2013,167(6):2657-2666.
[27] LI X D,YANG Y J,CHENG Y T,et al. Protein kinase A-mediated cardioprotection of Tongxinluo relates to the inhibition of myocardial inflammation,apoptosis,and edema in reperfused swine hearts[J]. Chinese Med JPeking,2013,126(8):1469-1479.
[28] DANG S,HUANG C X,WANG X,et al. Shensong Yangxin(SSYX)ameliorates disordered excitation transmission by suppressing cardiac collagen hyperplasia in rabbits with chronic myocardial infarction[J]. J Huazhong U Sci-Med,2016,36(2):162-167.
[29] SHI S B,LIANG J J,LIU T,et al. Depression increases sympathetic activity and exacerbates myocardial remodeling after myocardial infarction:evidence from an animal experiment[J]. PLo S One, 2014, 9(7):e101734.
[30] SHEN S T,JIANG H M,BEI Y H,et al. Qiliqiangxin attenuates adverse cardiac remodeling after myocardial infarction in ovariectomized mice via activation of PPARγ[J]. Cell Physiol Biochem,2017,42(3):876-888.
[31] WANG J F,ZHOU J M,DING X F,et al. Qiliqiangxin improves cardiac function and attenuates cardiac remodeling in rats with experimental myocardial infarction[J]. Int J Clin Exp Patho,2015,8(6):6596-6606.
[32] ZHOU J M,HAN X T,WANG S J,et al. Qiliqiangxin protects cardiac myocytes against hypoxia-induced apoptosis via Erb B4/PI3K/Akt pathway[J]. Int J Clin Exp Med,2016,9(6):9152-9160.
[33] CHU H L,HUANG C Y,DING H Y,et al. Aquaporin-4and cerebrovascular diseases[J]. Int J Mol Sci,2016,17(8):1249.
[34] YANG X B,CHU H L,TANG Y P,et al. The role of connexin43 in hemorrhagic transformation after thrombolysis in vivo and in vitro[J]. Neuroscience,2016,doi:10. 1016/j. neuroscience. 2016. 04. 040.
[35] WANG J Y,GAO Y B,ZHANG N,et al. Tongxinluo ameliorates renal structure and function by regulating miR-21-induced epithelial-mesenchymal transition in diabetic nephropathy[J]. Am J Physiol Renal Physiol,2014,306(5):485-495.
[36] ZHANG N,GAO Y B,ZOU D W,et al. Effects of Chinese medicine Tongxinluo on diabetic nephropathy via inhibiting TGF-β1-induced epithelial-to-mesenchymal transition[J]. Evid Based Complement Alternat Med,2014,doi:10. 1155/2014/123497.
[37] CUI F Q,ZOU D W,GAO Y B,et al. Effect of Tongxinluo on nephrin expression via inhibition of Notch1/Snail pathway in diabetic rats[J]. Evid Based Complement Alternat Med,2015, doi:10. 1155/2015/424193.
[38] WU X L,ZHENG B,JIN L S,et al. Chinese medicine Tongxinluo reduces atherosclerotic lesion by attenuating oxidative stress and inflammation in microvascular endothelial cells[J]. Int J Clin Exp Patho,2015,8(6):6323-6333.
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