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冠状动脉痉挛（CAS）是非阻塞性缺血性心脏病的重要发病机制，是刺激影响下冠状动脉血管及微血管平滑肌敏感性增加导致的一种血管舒缩功能障碍。血管及平滑肌在功能和结构上可以与中医学广义之筋相对应，故可将CAS归于中医学筋病范畴。在肝主筋理论指导下，根据筋的功能状态变化，可将CAS分为“筋急”和“筋痹”两种类型。“筋急”病机有虚、实之分，虚者常见肝阴虚、肝血不足，治疗采用滋阴养肝补血之法，实者多为肝火炽盛、灼烧阴液，治疗需在益阴基础上清肝、镇肝、疏肝，以恢复筋脉之柔。“筋痹”病机多属本虚标实，是在肝脉不足基础上外感风寒湿邪，邪气入里、入脏而见胸痛，预后具有高危特点，治疗以暖肝散结除痹为主。
Abstract：Coronary artery spasm(CAS) is an important pathogenic mechanism of non-obstructive ischemic heart disease. It is a kind of vascular vasomotor dysfunction caused by the increased sensitivity of coronary artery vessels and microvascular smooth muscles under stimulation. Blood vessels and smooth muscles can correspond to the generalized sinews in traditional Chinese medicine in terms of function and structure.Therefore,CAS can be classified into the category of sinew diseases in traditional Chinese medicine. Under the guidance of the theory that the liver governs the sinews,CAS can be divided into two types,namely “sinew spasm” and “sinew impediment” based on the changes in the functional state of the sinews. The pathogenesis of “sinew spasm” can be divided into deficiency and excess. The deficiency types are commonly seen as liver yin deficiency and insufficient liver blood,and treatment adopts the method of nourishing yin,tonifying the liver,and menriching the blood. The excess types are mostly due to exuberant liver fire scorching yin fluid. The treatment requires clearing away the liver-fire,calming the liver,and soothing the liver on the basis of nourishing yin to restore the flexibility of the sinews and vessels. The pathogenesis of “muscular arthralgia” is mostly characterized by underlying deficiency and superficial excess. It is based on the deficiency of the liver meridian and is caused by exogenous wind,cold,and dampness pathogens. The pathogens invade the interior and the viscera,resulting in chest pain. The prognosis is of high-risk characteristics,and the treatment is mainly to warm the liver,resolve masses,and eliminate impediment.
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基本信息:
DOI：10.16295/j.cnki.0257-358x.2025.05.004
中图分类号:R259
引用信息:
[1]马明茹,杨洁.基于肝主筋理论辨治冠状动脉痉挛[J].山东中医杂志,2025,44(05):504-509.DOI:10.16295/j.cnki.0257-358x.2025.05.004.
基金信息:
泰山学者岗位建设项目（编号：tsqn202211352）; 山东省中医药科技项目（编号：M-2023058）
2025-05-05
2025-05-05