1.中国中医科学院广安门医院,北京市西城区北线阁5号,100053
2.北京中医药大学
yaokuiwu@126.com
收稿:2025-08-16,
修回:2025-12-16,
纸质出版:2026-04-02
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张笑霄,王泽祺,黄梦文等.从“三焦寒郁”探析微血管疾病的辨治思路[J].中医杂志,2026,67(07):741-746.
ZHANG Xiaoxiao,WANG Zeqi,HUANG Mengwen,et al.Differentiation and Treatment of Microvascular Diseases from the Perspective of "Cold Constraint in Sanjiao (三焦)"[J].Journal of Traditional Chinese Medicine,2026,67(07):741-746.
张笑霄,王泽祺,黄梦文等.从“三焦寒郁”探析微血管疾病的辨治思路[J].中医杂志,2026,67(07):741-746. DOI: 10.13288/j.11-2166/r.2026.07.008.
ZHANG Xiaoxiao,WANG Zeqi,HUANG Mengwen,et al.Differentiation and Treatment of Microvascular Diseases from the Perspective of "Cold Constraint in Sanjiao (三焦)"[J].Journal of Traditional Chinese Medicine,2026,67(07):741-746. DOI: 10.13288/j.11-2166/r.2026.07.008.
微血管疾病(MVD)可累及全身多个系统,是心脏、脑血管、肾脏、代谢相关疾病的发生发展及衰老进程的重要影响因素。认为三焦寒郁为MVD的关键病机,基于寒邪理论,结合三焦病位的病机共性与局部特性,提出以活血温通为治则,拟定活血温通方为基础方,分别根据上、中、下焦的病机特点合以不同治法。上焦寒郁关键为清阳失展、气血郁滞,需注重宣通心肺、开郁振阳,常合用升陷汤温散以助宣通,合用桂枝汤类方可和营卫、通腠理,二者均可振奋阳气;中焦寒郁关键为中阳失运、浊邪内生,应采取和调脾胃、温化扶阳之法,合用四逆散、枳实消痞丸、半夏泻心汤恢复气机、纳运、寒热之平衡,升阳益胃汤还可加强升清降浊、散寒除湿之力;下焦寒郁关键为真阳受损、气化失司,需注意培元固本、淡渗通阳,常视虚损程度及水饮内蓄之病位合方以金匮肾气丸、附子汤、真武汤等。从寒郁立论,以活血温通贯穿MVD辨治,进一步结合部位三焦的病机特性,灵活立法遣方,有助于深入认识该病病因病机并拓宽临床诊疗思路。
Microvascular diseases (MVD) can affect multiple systems in the body and are important factors in the occurrence and development of cardiovascular, cerebrovascular, renal, and metabolic diseases, as well as the aging process. It is proposed that
the key pathogenesis of MVD is "cold constraint in
sanjiao
(三焦)". Based on the theory of cold pathogen, and by integrating the common and local pathologies of
sanjiao
, a treatment principle of promoting blood circulation and warming is established. A basic prescription for promoting blood circulation and warming is formulated, with modifications based on the specific pathogenesis of the upper, middle, and lower
jiao
(焦). For the upper
jiao
, cold constraint primarily involves the failure of the clear
yang
to rise and
qi
and blood stagnation, for which treatment should focus on diffusing and unblocking the heart and the lung, opening constraint and vibrating
yang
, commonly adding
Shengxian Decoction
(升陷汤) for warming and dispersing to assist in diffusion and dissipation, and using
Guizhi Decoction
(桂枝汤)-series formulas to harmonize
ying
-
wei
(营卫) and open the striae and interstices; both formulas can invigorate
yang qi
. For the middle
jiao
, cold constraint primarily involves the dysfunction of the central
yang
and internal accumulation of turbid pathogen, for which treatment should focus on harmonizing the spleen and stomach, warming and reinforcing
yang
; formulas such as
Sini Powder
(四逆散),
Zhishi Xiaopi Pill
(枳实消痞丸), and
Banxia Xiexin Decoction
(半夏泻心汤) can be used to restore
qi
flow, promote digestion, and balance cold and heat;
Shengyang Yiwei Decoction
(升阳益胃汤) can further enhance raising the clear and directing the turbid downward, expelling cold and removing dampness. For the lower
jiao
, cold constraint primarily involves damage to the original
yang
and dysfunction of
qi
transformation, for which the treatment should focus on to
nifying original
qi
and reinforcing the foundation, as well as promoting diuresis and supporting
yang
; depending on the degree of deficiency and the presence of internal water accumulation, formulas like
Jingui Shenqi Pill
(金匮肾气丸),
Fuzi Decoction
(附子汤), and
Zhenwu
Decoction
(真武汤) can be used. Based on the theory of cold constraint, the principle of promoting blood circulation and warming method runs through the differentiation and treatment of MVD. By further incorporating the pathological characteristics of
sanjiao
, flexible treatment strategies can be developed, which helps deepen the understanding of the disease's etiology and pathogenesis, while broadening clinical diagnostic and therapeutic approaches.
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