从"三焦寒郁"探析微血管疾病的辨治思路OA

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 pro-moting 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 dissipa-tion,and using Guizhi Decoction(桂枝汤)-series formulas to harmonize ying-wei(营卫)and open the striae and inter-stices;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 tonifying original qi and reinforcing the foundation,as well as promoting diuresis and supporting yang;depending on the degree of defi-ciency 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 pro-moting blood circulation and warming method runs through the differentiation and treatment of MVD.By further incor-porating 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.