1.浙江中医药大学基础医学院,浙江省杭州市滨江区滨文路548号,310053
2.浙江中医药大学中医“治未病”智慧健康浙江省工程研究中心
3.浙江中医药大学第二临床医学院
通讯作者:liaoningzhongyi@hotmail.com
收稿:2026-01-27,
修回:2026-03-24,
录用:2026-02-14,
纸质出版:2026-06-02
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王瀚峥,刘智慧,陈含璐等.从“郁结-肉腐-脓溃”探讨动脉粥样硬化斑块的病机演变及分期辨治思路[J].中医杂志,2026,67(11):1162-1166.
WANG Hanzheng,LIU Zhihui,CHEN Hanlu,et al.Pathogenesis Evolution and Staged Differentiation and Treatment Strategy of Atherosclerotic Plaques:from the Perspective of "Constraint-Putrefaction-Ulceration"[J].Journal of Traditional Chinese Medicine,2026,67(11):1162-1166.
王瀚峥,刘智慧,陈含璐等.从“郁结-肉腐-脓溃”探讨动脉粥样硬化斑块的病机演变及分期辨治思路[J].中医杂志,2026,67(11):1162-1166. DOI: 10.13288/j.11-2166/r.2026.11.006.
WANG Hanzheng,LIU Zhihui,CHEN Hanlu,et al.Pathogenesis Evolution and Staged Differentiation and Treatment Strategy of Atherosclerotic Plaques:from the Perspective of "Constraint-Putrefaction-Ulceration"[J].Journal of Traditional Chinese Medicine,2026,67(11):1162-1166. DOI: 10.13288/j.11-2166/r.2026.11.006.
认为动脉粥样硬化斑块虽生于脉内,但其形质变化特点同痈疽相类。借鉴痈疽的病机传变规律,构建用于阐释动脉粥样硬化斑块“郁结-肉腐-脓溃”的动态病机。认为动脉粥样硬化斑块始于痰浊壅阻、气血郁滞而成“郁”,继则郁久化热、热灼脉道形成斑块而成“腐”,终致毒势内陷、溃败伤心而成“溃”。据此进行分期辨治,即郁滞期治以达郁通络、清解郁热,方用越鞠丸合丹栀逍遥散加减;肉腐期治以清热消痈、化瘀散结,方用五味消毒饮合血府逐瘀汤加减;溃败期治以托毒涤瘀、益气养阴,方用瓜蒌薤白半夏汤合生脉散加减,以期为动脉粥样硬化斑块的中医辨治提供思路。
Atherosclerotic plaques arise within the vessels, yet their morphological evolution parallels that of carbuncles and abscesses. Drawing on the pathomechanism progression of carbuncles and abscesses, this paper proposes a dynamic pathogenesis model of "constraint-putrefaction-ulceration" for atherosclerotic plaques. The formation of atherosclerotic plaque begins
with phlegm-turbidity obstruction and
qi
-blood stagnation (constraint stage); prolonged constraint transforms into heat that scorches the vessels and forms plaques (putrefaction stage); ultimately, toxin invades inward and ruptures the vessels, injuring the heart (ulceration stage). Accordingly, staged differentiation and treatments are proposed. During the constraint stage, the focus is venting constraint and unblocking collaterals, clearing and relieving constraint-heat, for which
Yue Jyu Pills
(越鞠丸) and
Danzhi Xiaoyao Powder
(丹栀逍遥散) with modifications can be used. During the putrefaction stage, the method is clearing heat and dispelling abscesses, resolving stasis and dissipating knot, with modified
Wuwei Xiaodu Beverage
(五味消毒饮) and
Xuefu Zhuyu Decoction
(血府逐瘀汤). During the ulceration stage, it is suggested to expell toxin and stasis, benefit
qi
and nourish
yin
using modified
Gualou Xiebai Banxia Decoction
(瓜蒌薤白半夏汤) and
Sheng Mai Powder
(生脉散). This framework offers new perspectives for the differentiation and treatment of atherosclerotic plaques in traditional Chinese medicine.
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