【作者】 李晓亮；

【导师】 张俊龙；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2013， 博士

【摘要】 目的：基于“心主血脉”理论提出动脉硬化闭塞症（ASO）从心论治的认识，并通过动物实验观察养心通脉汤对气虚血瘀型ASO家兔的影响，探讨其防治ASO的有效性和作用机制，为临床从心论治ASO提供科学依据和有效方药，亦为“心主血脉”微观机制的探讨提供科学依据。方法：⑴理论研究：通过梳理古今文献对“心主血脉”理论的认识，在阐明“心”、“血”、“脉”的关系及“心主血脉”生理、病理的基础上，探讨从心论治ASO的科学性、可行性；通过梳理现代医学对ASO发病机制、ASO发病与心脏关系的认识，以期诠释中医“心主血脉”的科学内涵。⑵实验研究：研究选取具有补益心气、养血活血、温经通脉作用的养心通脉汤，采用光电镜、免疫组化法、放免法、酶联免疫法观察其对气虚血瘀型ASO家兔的影响，阐明其治疗ASO的有效性和作用机制，为临床从心论治ASO提供科学依据和有效方药，亦为“心主血脉”科学内涵的诠释提供科学依据。结果：⑴理论研究：基于“心主血脉”理论，认为ASO病变虽在脉管，但其根本在五脏之心，治疗当从心论治。ASO病理状态下会使心脏分泌脑钠素(BNP)含量升高，起到降低ET-1、抑制VSMC增殖等作用，推测心脏分泌的BNP可能为“心主血脉”的物质基础之一。⑵实验研究：养心通脉汤能明显改善气虚血瘀型ASO家兔血管内皮细胞紊乱、血管平滑肌细胞增生、脂质沉积等病理；能显著降低气虚血瘀型ASO家兔血管平滑肌细胞增殖的百分数；能显著降低气虚血瘀型ASO家兔TC、TG、LDL、ET-1、BNP、Hs-CRP的水平；显著升高气虚血瘀型ASO家兔HDL、NO的含量。结论：养心通脉汤能通过调节血管内皮紊乱、抑制血管平滑肌细胞增殖、抗炎、降脂等作用机制有效防治ASO，为从心论治ASO提供了科学依据和有效方药；心脏分泌的BNP为“心主血脉”的物质基础之一，为进一步诠释“心主血脉”的科学内涵提供了科学依据。更多还原

【Abstract】 Objective: The research proposed that arteriosclerosis obliterans (ASO) might betreated from the aspect of "heart" on the basis of theory of "heart governing blood andvessels". How the decoction of Yangxintongmai Decoction acts on the type of qi deficiencyand blood stasis ASO rabit is to be observed. The conclusion may provide scientific basisand effective prescription for ASO from the main theory of the "heart" in clinic andscientific evidence for "heart governing blood and vessels" as well.Method:(1) Theoretical research: A literature review on “heart governs the blood andvessels” was applied to exploring the scientific and feasibility of treating ASO form“heart” on the basis of elucidating relationship among “heart”,“blood”, and “vessels”and the physiology and pathology of "heart governing blood and vessels"."Heartgoverning blood and vessels” was interpreted through studying ASO pathogenesis and therelation between ASO and heart.(2) Experimental research: Yangxintongmai Decoctionwas selected to see its action and mechanism on ASO rabbit by light electron microscope,immunohistochemistry, radio-immunology, enzyme linked immunoassay because thedecoction was supposed to reinforce heart qi, nourish blood and protect circulation. Theconclusion may provide scientific evidence and effective prescription for ASO from themain theory of the "heart governing blood and vessels" in clinic.Results:(1) Theoretical research: the research holds that the lesion of ASO is vesselwhile the pathogenesis of ASO is rooted from the heart and therefore can be treated fromheart. The level of BNP secreted form the heart in ASO was increased and it would reduceET-1and VSMC. We conjecture that BNP secreted from the heart is one of material base of"heart governs the blood and vessels".(2) Experimental research: Yangxintongmai Decoction can change hyperplasia of vscular endothelial cells and VSMC. It can decreaseproliferation percent of VSMC and the content of TC, TG, LDL, ET-1, BNP, Hs-CRP inASO rabbit. It can increase the content of HDL, NO in ASO rabbit.Conclusions: Yangxintongmai Decoction can treat ASO by regulating vscularendothelial cells, inhibiting VSMC, anti-inflammatory and reducing lipid. It providescientific evidence and effective prescription for treating ASO from the main theory of the"heart". BNP secreted from the heart is one of the matter for “heart governing blood andvessels”. It provides scientific basis for interpreting "heart governing blood and vessels".更多还原