基于“一气周流”理论探讨冠心病的病机与 治疗

Discussion on the Pathogenesis and Treatment of Coronary Heart Disease Based on the Theory of “Yi Qi Zhouliu”

摘要: 清代医家黄元御所提出的“一气周流”理论，其强调：“中气者，和济水火之机，升降金木之轴。”以脾胃为枢，心肝脾肾为轮，形成圆周运动。本文基于“一气周流”理论探讨冠心病的病机与治疗，以“中气枢机失调”为主要论点。治疗上以扶助中州，复其斡旋为核心，配以疏达木气(达郁汤)、降泄肺胃(瓜蒌薤白半夏汤)、温补肾阳(右归丸)等治法，形成“枢轴轮转–周流复常”的整体调节策略。该理论通过“脾胃–气机–血脉”的动态联系，将胸痹病机归于中焦失运、五脏气化失衡，治疗立足枢机调复，兼顾脏腑生克，彰显中医“治病求本”的特色优势。

Abstract: The “Yi Qi Zhouliu” theory proposed by the Qing Dynasty physician Huang Yuanyu emphasizes: Central Qi is the mechanism that harmonizes and regulates water and fire, and serves as the axis for the ascent and descent of metal and wood. Taking the spleen and stomach as the pivot, and the heart, liver, spleen, and kidney as the wheels, a circular motion is formed. This paper explores the pathogenesis and treatment of coronary heart disease based on the theory of “unified qi circulation,” with “disorder of the central qi pivot mechanism” as the main argument. The treatment focuses on supporting the middle energizer and restoring its pivotal function as the core approach, complemented by methods such as dispersing and regulating liver qi (Depression-Resolving Decoction), descending and purging lung-stomach qi (Trichosanthes, Chive, and Pinellia Decoction), and warming and tonifying kidney yang (Right-Restoring Pill). This forms an overall regulatory strategy of “pivotal axis rotation - restoring normal circulation”. This theory elucidates the dynamic connection among “spleen-stomach, qi movement, and blood vessels,” attributing the pathogenesis of chest impediment to dysfunction of the middle energizer and imbalance of visceral qi transformation. The treatment focuses on regulating the pivot mechanism while considering the generation-restraint relationships among the zang-fu organs, highlighting the characteristic advantages of traditional Chinese medicine in “treating disease by addressing its root cause.” It provides academic support for clinical management of coronary heart disease and establishes theoretical principles, therapeutic methods, prescriptions, and medications for reference.