基于“气血交互于脉”理论探讨益气活血中药防治心肌缺血再灌注损伤的作用机制

Mechanism of Prevention and Treatment of Myocardial Ischemia-reperfusion Injury by Qi-replenishing and Blood-activating Chinese Medicines Based on Theory of Qi and Blood Interacting in Vessels

摘要:

心肌缺血再灌注损伤（MIRI）为缺血性心脏病在治疗过程中的常见损伤，可归属于中医学“胸痹”“心悸”范畴，其发生发展与气血失和导致的血脉损伤相关。气血同病是MIRI发生发展的重要病机，气血辨证是辨证论治的基本方法。“气血交互于脉”由该团队基于“气为血帅，血为气母”的气血理论，结合相关研究而提出，具体内容为“气以脉而帅血，血由脉而载气，气血交互于脉”。MIRI阶段线粒体功能失常、血小板功能异常、血管内皮损伤，线粒体功能障碍与气虚、血小板功能异常与血瘀、血管内皮损伤与脉损具有相关性，线粒体、血小板与血管内皮相互影响引发的结构与功能改变是气虚血瘀脉损导致MIRI发生发展的机制之一。该文通过探讨中医理论“气”与线粒体，“血”与血小板，“脉”与血管的相关性，阐释中医“气血交互于脉”理论的现代科学内涵与MIRI机制。根据核心病机“气血失和于脉”探讨“益气”中药、“活血”中药与“益气活血”复方对MIRI防治的中药药理学机制。结合该团队以“气血交互于脉”理论为指导开展的益气活血中药防治MIRI的相关研究，分析益气活血中药对气血脉的影响，传承和发展气血理论，揭示其防治心血管疾病的理论依据和科学内涵，以期为临床应用中医药防治心血管疾病提供新的思路和参考。

Abstract:

Myocardial ischemia-reperfusion injury （MIRI） is a common injury in the treatment of ischemic heart diseases. MIRI can be categorized as chest impediment and palpitation in traditional Chinese medicine， with the pathogenesis related to Qi and blood disharmony. The simultaneous disorders of Qi and blood are the key mechanism of MIRI， and thus the differentiation of Qi and blood syndromes is the prerequisite for the treatment. The theory of Qi and blood interacting in vessels is proposed by our team based on Qi being the commander of blood and blood being the mother of Qi as well as previous pharmacological studies. Specifically， Qi marshals blood by vessels， and the blood carries Qi by vessels. Accordingly， Qi and blood interact in the vessels. MIRI is accompanied by mitochondrial dysfunction， platelet function abnormality， and vascular endothelial damage， which are correlated with Qi deficiency， blood stasis， and vessel damage， respectively. Mitochondrial， platelet， and vascular endothelial structural and functional changes triggered by their interactions are one of the mechanisms by which Qi deficiency， blood stasis， and vessel damage lead to the occurrence and development of MIRI. By exploring the correlations between Qi and mitochondria， between blood and platelets， and between vessels and blood vessels， we can explain the modern scientific content of the theory of Qi and blood interacting in vessels in traditional Chinese medicine. According to the pathogenesis of Qi and blood disharmony in vessels， we discussed the pharmacological mechanisms of Qi-replenishing medicines， blood-activating medicines， and their combinations in the prevention and treatment of MIRI. On the basis of the research achievements in the prevention and treatment of MIRI by Qi-replenishing and blood-activating Chinese medicines based on the theory of Qi and blood interacting in vessels， we analyzed the effects of these medicines on Qi， blood， and vessels. According to the theory of Qi and blood， this article reveals the theoretical basis and scientific connotations of the prevention and treatment of cardiovascular diseases， with the aim of providing new ideas and references for the clinical application of traditional Chinese medicine in the prevention and treatment of cardiovascular diseases.