基于“玄府–内皮屏障”相关性探讨下肢动脉硬化闭塞症的中医病机及开通玄府法的治疗策略

Discussion on TCM Pathogenesis of Lower Extremity Arteriosclerosis Obliterans and Treatment Strategy of Xuanfu-Dredging Method Based on the Correlation between “Xuanfu and Endothelial Barrier”

摘要: 下肢动脉硬化闭塞症是中老年人常见的周围血管疾病，其发病机制复杂，治疗困难。玄府学说是中医理论体系的重要组成部分，近年来受到广泛关注。结合中医整体观念和取象比类思维，本文基于玄府理论与现代内皮屏障研究，提出“玄府–内皮屏障”相关理论，认为中医之玄府与现代医学之血管内皮屏障在结构、功能、病理等方面具有高度相似性。在此基础上，从玄府闭塞的角度深入探讨ASO的中医病机，认为玄府郁闭、气血津液运行不畅是ASO发生发展的核心病机环节，并贯穿于疾病的全过程。进而提出“开通玄府”作为ASO的重要治疗大法，将风药、虫类通络药、芳香开窍药等具有开通玄府作用的药物应用于ASO的治疗，为ASO的中医药防治提供新的理论视角和治疗思路。

Abstract: Lower extremity arteriosclerosis obliterans is a common peripheral vascular disease in middle-aged and elderly people, with complex pathogenesis and difficult treatment. Xuanfu (subtle striae) theory is an important part of the theoretical system of Traditional Chinese Medicine (TCM), which has received extensive attention in recent years. Combining the holistic concept and analogical categorization thinking of TCM, this paper innovatively proposes the “Xuanfu-endothelial barrier” correlation theory based on the Xuanfu theory and modern endothelial barrier research, holding that TCM Xuanfu and modern medical vascular endothelial barrier are highly similar in structure, function and pathology. On this basis, this paper deeply discusses the TCM pathogenesis of ASO from the perspective of Xuanfu obstruction, and believes that Xuanfu stagnation and obstruction, as well as disordered circulation of qi, blood and body fluid, are the core pathogenesis links of ASO, which run through the whole process of the disease. Furthermore, we propose “dredging Xuanfu” as an important therapeutic method for ASO, and apply drugs with Xuanfu-dredging effects such as wind-drugs, worm-type channel-dredging drugs, and aromatic resuscitation drugs to the treatment of ASO, providing a new theoretical perspective and treatment idea for the prevention and treatment of ASO with TCM.