通讯作者: 高翠, 18741500617@163.com

DOI：10.12201/bmr.202604.00176

• 摘要：冠心病在中医学中多归于“胸痹”“心痛”等范畴。临床上,这类疾病既有血脉痹阻的一面,也常伴见心肌供能不足、线粒体功能受损和损伤持续累积。既往对其病机的认识,多集中于痰浊、瘀血、寒凝、气滞等方面,但对于病程迁延、反复发作以及虚实并见的特点,还需要更连贯的解释框架。“虚气留滞”理论认为,虚为本,滞为标。心气亏虚、宗气不足后,气的推动作用减弱,导致血行失畅,津液输布失常,痰、瘀、浊、毒便可渐次内生,最终导致心脉痹阻、心失所养。现代研究提示,AMPK是心肌能量感受和代谢调控中的关键节点,参与葡萄糖摄取、脂肪酸氧化、线粒体稳态维持及应激保护。冠心病状态下,AMPK相关异常一方面参与缺血心肌损伤,另一方面也可从微观层面说明“虚气失运”之后“留滞渐成”的演变过程。基于此,本文结合虚气留滞理论与冠心病心肌能量代谢及AMPK相关研究,尝试提出“虚气失运—能量失衡—留滞内生—损伤加重”的连续病机链条,以期为中医药防治冠心病提供新的认识角度。

  关键词： 冠心病; 虚气留滞; AMPK; 心肌能量代谢; 线粒体

   

  Abstract: Coronary heart disease is generally classified in traditional Chinese medicine under “chest impediment” and “heart pain.” In clinical practice, it is not only characterized by obstruction of the heart vessels, but is also commonly accompanied by impaired myocardial energy supply, mitochondrial dysfunction, and progressive tissue injury. Earlier interpretations have focused mainly on phlegm turbidity, blood stasis, cold accumulation, and qi stagnation. These views are useful, yet they do not fully explain the chronic, recurrent, and mixed deficiency-excess nature of the disease. The theory of deficient qi retention and stagnation takes deficiency as the root and retention-stagnation as the manifestation. When heart qi is weak and gathering qi is insufficient, propulsion becomes impaired, blood flow slows, and body fluids fail to distribute normally. Over time, phlegm, stasis, turbidity, and toxin may develop internally, eventually obstructing the vessels and depriving the heart of nourishment. Modern studies indicate that AMP-activated protein kinase (AMPK) is a central regulator of myocardial energy sensing and metabolic balance, involved in glucose uptake, fatty acid oxidation, maintenance of mitochondrial homeostasis, and stress adaptation. In coronary heart disease, AMPK-related metabolic disturbance contributes to ischemic myocardial injury and also offers a possible microscopic explanation for the transition from impaired qi movement to endogenous retention and stagnation. On this basis, this paper integrates the theory of deficient qi retention and stagnation with current research on myocardial energy metabolism and AMPK, and proposes a continuous pathodynamic chain of “impaired qi movement–energy imbalance–endogenous retention and stagnation–aggravated injury,” in order to provide a broader theoretical perspective for the prevention and treatment of coronary heart disease with traditional Chinese medicine.

  Key words: coronary heart disease; deficient qi retention and stagnation; AMPK; myocardial energy metabolism; mitochondria

  提交时间：2026-04-29

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• 序号	提交日期	编号	操作
  1	2026-04-01	10.12201/bmr.202604.00176V1	下载

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