| 引用本文: |
周凯龙, 刘陆阳, 梁帅, 杨漪, 仲伟伟, 孙月, 顾晓通, 孙慧媛.基于“阳化气，阴成形”理论探析低氧性肺动脉高压的病机和辨治[J].湖南中医药大学学报,2025,45(7):1351-1356[点击复制] |
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| 基于“阳化气，阴成形”理论探析低氧性肺动脉高压的病机和辨治 |
| 周凯龙,刘陆阳,梁帅,杨漪,仲伟伟,孙月,顾晓通,孙慧媛 |
| (北京中医药大学第三附属医院, 北京 100029;中国中医药科技发展中心, 北京 100027;北京中医药大学东方医院, 北京 100078) |
| 摘要: |
| 低氧性肺动脉高压（HPH）是一种慢性、进行性心肺血管系统疾病，能够导致慢性肺源性心脏病甚至死亡。肺血管重塑是HPH的关键病理环节。中医药具有标本兼治、疗效确切等优势，对HPH的防治具有重要的临床意义。本文基于《黄帝内经》“阳化气，阴成形”理论，结合HPH的病理特点，解析HPH的核心病机为“阳化气”不足与“阴成形”太过。“阳化气”不足主要责之于肺心阳气亏虚，功能失调，为HPH发病之基；痰瘀互结，浊阴阻滞，致“阴成形”太过，为HPH进展之要。HPH线粒体氧化磷酸化水平降低、肺动脉内皮细胞功能障碍等病理是机体“阳化气”不足的微观表现；肺动脉平滑肌细胞过度增殖、内皮-间质转化致肺血管重塑变厚等病理是机体“阴成形”太过的微观表现。结合临床实践，主张“肺心同治”之法：培补宗气，定“化气”“成形”之基；通补肺心，“助阳”以化气；清心益肺，“化阴”以成形。以期调和阴阳而复“化气”与“成形”之衡，为中医药防治HPH提供思路和借鉴。 |
| 关键词: 低氧性肺动脉高压 肺胀 阳化气 阴成形 肺心同治 本虚标实 |
| DOI：10.3969/j.issn.1674-070X.2025.07.023 |
| 投稿时间：2025-03-07 |
| 基金项目:第七批全国老中医药专家学术经验继承工作项目（国中医药人教函〔2022〕76号）；北京中医药新时代125工程领衔人才项目（京中医药科字〔2025〕2号）；北京中医药大学第三附属医院精诚青年人才项目（2025-QNKY-004）。 |
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| Pathogenesis and differentiation of treatment of hypoxic pulmonary hypertension based on the theory of "yang transforms into qi, while yin constitutes form" |
| ZHOU Kailong, LIU Luyang, LIANG Shuai, YANG Yi, ZHONG Weiwei, SUN Yue, GU Xiaotong, SUN Huiyuan |
| (Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing 100029, China;China Science and Technology Development Center for Chinese Medicine, Beijing 100027, China;Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China) |
| Abstract: |
| Hypoxic pulmonary hypertension (HPH) is a chronic and progressive cardiopulmonary vascular disease that can lead to chronic cor pulmonale and even death. Pulmonary vascular remodeling is a key pathological process in HPH. Chinese medicine offers advantages in addressing both the root cause and symptoms, with confirmed clinical efficacy, and thus has significant clinical value in the prevention and treatment of HPH. Based on the theory of "yang transforms into qi, while yin constitutes form" from The Huangdi's Internal Classics (Huang Di Nei Jing) and in combination with the pathological features oHPH, this paper analyzes the core pathogenesis of HPH as the insufficiency of "yang transforms into qi" and the excess of "yin constitutes form". The deficiency in "yang transforms into qi" is attributed to pulmonary and cardiac yang deficiency and functional imbalance, serving as the basis for HPH onset. Intertwined phlegm and blood stasis and turbid yin obstruction result in excessive "yin constitutes form", which contributes to HPH progression. On a microscopic level, impaired mitochondrial oxidative phosphorylation and pulmonary arterial endothelial dysfunction reflect the insufficiency of "yang transforms into qi"; excessive proliferation of pulmonary artery smooth muscle cells and endothelial-to-mesenchymal transition resulting in pulmonary vascular remodeling and thickening represent the excess of "yin constitutes form". Drawing on clinical experience, this paper advocates the therapeutic principle of "simultaneous treatment of the lung and heart":strengthening pectoral qi to regulate the foundation of qi transformation and form formation; invigorating both the lung and heart to "assist yang" for qi transformation; clearing the heart and benefiting the lung to "transform yin" for form formation. The treatment goal is to harmonize yin and yang and restore the balance between "qi transformation" and "form formation", providing insights and references for the prevention and treatment of HPH with Chinese medicine. |
| Key words: hypoxic pulmonary hypertension lung distention yang transforms into qi yin constitutes form simultaneous treatment of the lung and heart deficiency in root with excess in manifestations |
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