基于“肝心同病”探析代谢相关脂肪性肝病合并动脉粥样硬化的病机与治疗思路

张伟; 卢秉久; 张艳

doi:10.3969/j.issn.1006-2157.2023.05.016

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基于“肝心同病”探析代谢相关脂肪性肝病合并动脉粥样硬化的病机与治疗思路

思路与方法 | 更新时间：2023-06-05

- 基于“肝心同病”探析代谢相关脂肪性肝病合并动脉粥样硬化的病机与治疗思路
- Pathogenesis and treatment of metabolic-associated fatty liver disease combined with atherosclerosis based on "disease involving liver and heart"
- 北京中医药大学学报 2023年46卷第5期页码：697-704
- 作者机构：
  
  1.辽宁中医药大学　沈阳　110847
  2.辽宁中医药大学附属医院
- 作者简介：
  
  张伟，女，博士，助理研究员
  # 卢秉久，男，主任医师，博士生导师，主要研究方向：中西医结合治疗肝脏疾病，E-mail：lubingjiu@163.com
- 基金信息：
  
  国家重点研发计划“中医药现代化研究”重点专项(2019YFC1708703);国家自然科学基金项目(81774157;82174241);全国名老中医药专家传承工作室建设项目(2022-304);辽宁省科技厅项目(L201903)
- DOI：10.3969/j.issn.1006-2157.2023.05.016
  中图分类号： R259
- 纸质出版日期：2023-05-30，
  
  网络出版日期：2023-03-03，
  
  收稿日期：2022-12-03，
- 稿件说明：
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张伟, 卢秉久, 张艳. 基于“肝心同病”探析代谢相关脂肪性肝病合并动脉粥样硬化的病机与治疗思路[J]. 北京中医药大学学报, 2023,46(5):697-704.

ZHANG Wei, LU Bingjiu, ZHANG Yan. Pathogenesis and treatment of metabolic-associated fatty liver disease combined with atherosclerosis based on "disease involving liver and heart"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(5):697-704.
张伟, 卢秉久, 张艳. 基于“肝心同病”探析代谢相关脂肪性肝病合并动脉粥样硬化的病机与治疗思路[J]. 北京中医药大学学报, 2023,46(5):697-704. DOI： 10.3969/j.issn.1006-2157.2023.05.016.

ZHANG Wei, LU Bingjiu, ZHANG Yan. Pathogenesis and treatment of metabolic-associated fatty liver disease combined with atherosclerosis based on "disease involving liver and heart"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(5):697-704. DOI： 10.3969/j.issn.1006-2157.2023.05.016.

摘要

通过探析中医“肝－血－心－脉”“肝心和合”的生理特点，可知临床“肝心同病”较为多见，是防治代谢相关脂肪性肝病与动脉粥样硬化的核心病机基础。“肝心郁滞、心脉不通”“肝心虚损、痰瘀互结”“肝心失和、毒损脉络”是代谢相关脂肪性肝病合并动脉粥样硬化的核心病机演变规律，体现“郁→虚→毒”的病邪转化过程。结合胆固醇代谢紊乱、线粒体功能障碍的病变特点及两者交叉转化的因果联系，管窥“肝心同病”在防治代谢相关脂肪性肝病合并动脉粥样硬化过程中的微观辨证价值，采用疏肝理气、通心和脉，养肝护心、化痰祛瘀，保肝育心、解毒通络等分期治疗策略，以期为临床辨治代谢相关脂肪性肝病合并动脉粥样硬化提供有益参考。

Abstract

By analyzing the physiological characteristics of "liver-blood-heart-vessel" and "liver heart harmony" in traditional Chinese medicine

it can be seen that "disease involving liver and heart" is more common in clinic

which is the core pathogenesis basis for the clinical prevention and treatment of metabolic-associated fatty liver disease (MAFLD) and atherosclerosis (AS). "Stagnation of liver and heart

obstruction of heart vessel"

"deficiency of liver and heart

intermingled phlegm and blood stasis"

and "disharmony of liver and heart

toxin damaging vessels and collaterals" are the core pathogenesis evolution rules of MAFLD combined with AS

reflecting the transformation process of "stagnation→deficiency→toxin". Combined with the pathological characteristics of cholesterol metabolism disorder and mitochondrial dysfunction and the causal relationship of their cross transformation

the microscopic syndrome differentiation value of the "disease involving liver and heart" in the prevention and treatment of MAFLD combined with AS is observed. The stage-tailored treatment strategies are adopted

such as smoothing liver and regulating qi

regulating heart harmonizing vessel; nourishing liver and protecting heart

resolving phlegm and removing blood stasis; protecting liver and nourishing heart

removing toxicity and dredging collaterals

in order to provide a useful reference for clinical differentiation and treatment of MAFLD combined with AS.

关键词

肝心同病代谢相关脂肪性肝病动脉粥样硬化病机治疗

Keywords

disease involving liver and heartmetabolic-associated fatty liver diseaseatherosclerosispathogenesistreatment

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