彭高强 文颖娟 陈茉 王河江 仝武宁

〔摘要〕 高脂血症是诱发心脑血管疾病的主要因素。中医认为痰浊、瘀血是形成高脂血症的主要原因，过食肥甘厚味伤及脾，脾气虚则精气血津液运化失常，凝聚成痰，久则成瘀，痰瘀内生最终形成浊脂。痰浊、瘀血不仅是“壮火”生成的始动因素，还是导致脾气亏虚（“食气”）的加重因素。因此，在“壮火食气”理论指导下，逐渐形成以益气健脾、化痰降浊、活血祛瘀为主要治疗原则。

〔关键词〕 高脂血症;壮火食气;瘀血;痰浊;脾气虚;益气健脾;化痰降浊;活血祛瘀

〔中图分类号〕R259       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.06.029

Relationship Between Phlegm-Stasis-Spleen and Hyperlipidemia Based on

"Vigorous Fire Consumes Qi"

PENG Gaoqiang1， WEN Yingjuan1*， CHEN Mo1， WANG Hejiang1， TONG Wuning2

（1. Shanxi University of Chinese Medicine， Xianyang， Shanxi 712046， China; 2. Affiliated Hospital of Shanxi

University of Chinese Medicine， Xianyang， Shanxi 712000， China）

〔Abstract〕 Hyperlipidemia is the main factor of cardiovascular and cerebrovascular diseases. Traditional Chinese medicine believes the production of phlegm and turbid blood stasis are important causes of hyperlipidemia. Excessive consumption of fat and sweet taste will damage the spleen. Deficiency of spleen Qi will lead to abnormal transportation of essence， Qi， blood and body fluid， which will condense into phlegm. Long time will lead to blood stasis. Phlegm and blood stasis are endogenous and eventually form turbid lipid. Turbid phlegm and blood stasis are not only the initiating factors of "vigorous fire"， but also the aggravating factors of spleen Qi deficiency “consumes Qi”. Therefore， under the guidance of the theory of "vigorous fire consumes Qi"， the main treatment principles are gradually formed， such as supplementing Qi and strengthening spleen， resolving phlegm and turbidity， promoting blood circulation and removing blood stasis.

〔Keywords〕 hyperlipidemia; vigorous fire consumes Qi; blood stasis; phlegm; deficiency of spleen Qi; supplement Qi and strengthen spleen; resolve phlegm and turbidity; promote blood circulation and remove blood stasis

高脂血癥（hyperlipidemia， HLP）通常指体内胆固醇或甘油三酯升高的一种病症[1]。中医古籍虽没有HLP这一名称，却有膏脂描述，如《素问·通评虚实论》云：“凡治消瘅仆击、偏枯痿厥、气满发逆，甘肥贵人，则高梁之疾也”。《脾胃论·卷中·长夏湿热胃困尤甚用清暑益气汤论》云：“清气不升，浊气不降……使周身气血逆行而乱”，说明脾的气机升降失调是血液异常主要原因之一。随着生活节奏加快，饮食起居失常或过食肥甘之品，导致痰湿内蕴、脾失健运、阻碍气血流行造成痰瘀互结，从而导致痰脂膏浊在体内堆积形成高脂血症[2]。中医认为“壮火食气”，不仅仅是“火”与“气”之间关系，更是机体内阴阳平衡调节的一种体现。脾失健运、痰脂瘀血浊邪堆积打破了机体阴阳平衡，因此，“壮火食气”与痰瘀脾三者密切相关。

1 高脂血症是代谢异常类疾病

现代医学认为HLP血清中的总胆固醇（total cholesterol， TC）、甘油