武跃华

〔摘要〕 病机，是疾病发生、发展与变化的机制。病机学说，以阴阳五行、气血津液、藏象、经络、病因和发病等为基础理论，探讨和阐述疾病发生、发展、变化和结局的本质特点和基本规律。构建符合中医思维特点的病机学说，是中医药防治动脉粥样硬化（Atherosclerosis，AS）的核心问题。文章基于AS组织病理发展过程，充分结合中医学意象思维模式，综合大量现代研究成果，提出AS“痈疽”病机假说，及分期病机特点与防治原则，为AS的防治提供理论参考。

〔关键词〕 动脉粥样硬化;痈疽;病机;营卫;气血

〔中图分类号〕R259;R972+.6       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.01.012

〔Abstract〕 Pathogenesis is the mechanism of disease occurrence， development and change. Pathogenesis theory， based on the basic theories of Yin-Yang， five elements， Qi， blood， body fluid， visceral manifestations， channels and collaterals， etiology and pathogenesis， discussed and expounded the essential characteristics and the basic rules of disease occurrence， development， change and outcome. To establish the pathogenesis theory in line with the thinking characteristics of traditional Chinese medicine （TCM） has become the core issue of TCM in the prevention and treatment of atherosclerosis. Based on the pathological development characteristics of atherosclerosis and the combination of the traditional Chinese medicine image thinking mode with a large number of modern research results， the author creatively proposed the pathogenesis hypothesis of "carbuncle-abscess" and its stage characteristics as well as prevention and treatment principles in atherosclerosis， in hope to provide theoretical references for the prevention and treatment of atherosclerosis.

〔Keywords〕 atherosclerosis; carbuncle-abscess; pathogenesis; nutrient Qi and defensive Qi; Qi blood

動脉粥样硬化（Atherosclerosis，AS）是心脑血管疾病中最常见的疾病，主要累及大、中动脉，如冠状动脉、颈动脉、脑动脉、肾动脉等，是动脉硬化中最常见、最重要的一种。目前，构建符合中医思维特点，对临床理、法、方、药具有指导意义的病机学说，仍然是当今中医药防治AS的核心问题，不仅涉及临床诊治，而且关系到AS的三级预防体系建设。笔者根据AS的病理学特点及《内经》中关于痈疽病机地记载，充分利用中医学的意象思维模式，提出AS的“痈疽”病机假说，及不同分期的病机特点与相关防治策略，以期为AS的防治提供理论参考。

1 AS基本病理过程

AS的基本病变是动脉内膜的脂质沉积，内膜灶状纤维化，粥样斑块形成，至管壁变硬，管腔狭窄。早期不易诊断，随着病理进展，特别是发生在心、脑、肾等重要器官引起缺血性改变，尤其伴有器官明显病变，呈现相关临床症状时，诊断并不困难。……