Pathogenesis Evolution and Prevention-treatment Strategies for Hypertension-related Coronary Microvascular Dysfunction Based on Collateral Disease Theory
10.13422/j.cnki.syfjx.20261622
- VernacularTitle:基于络病理论探讨高血压相关冠脉微循环障碍的病机演变规律及防治策略
- Author:
Mingyan HUANG
1
;
Linzi LONG
1
;
Xin LIU
1
;
Chao LIU
2
;
Lifang SONG
3
;
Changgeng FU
1
;
Jiahui QIN
3
;
Jieming LU
1
;
Yi LI
1
Author Information
1. Xiyuan Hospital， China Academy of Chinese Medical Sciences， Beijing 100091，China
2. Guang'anmen Hospital， China Academy of Chinese Medical Sciences， Beijing 100053，China
3. Hohhot Traditional Chinese Medicine and Mongolian Medicine Hospital，Hohhot 010020，China
- Publication Type:Journal Article
- Keywords:
hypertension;
coronary microvascular dysfunction;
collateral disease theory;
pathogenesis evolution;
prevention-treatment strategies
- From:
Chinese Journal of Experimental Traditional Medical Formulae
2026;32(23):239-248
- CountryChina
- Language:Chinese
-
Abstract:
This article explores the pathogenesis ， evolution and the prevention-treatment strategies of hypertension-related coronary microvascular dysfunction （H-CMD） from the collateral disease theory. Long-term hypertension may lead to coronary microvascular vasomotor imbalance， endothelial injury， vascular remodeling， microthrombosis， reduced perfusion reserve， and microvascular rarefaction， suggesting a progressive pathological process from functional disturbance to structural injury， collateral obstruction， and insufficient repair. Collateral disease theory emphasizes the network-like distribution， gradual branching， and permeating and nourishing functions of collaterals， as well as the concept that prolonged disease enters the collaterals， providing a reference for understanding coronary microcirculatory dysfunction and malnourishment of heart collaterals. Accordingly， the traditional Chinese medicine （TCM） pathogenesis of H-CMD can be summarized into four interconnected stages： Collateral Qi stagnation， scorching injury of collateral vessels， phlegm-stasis obstruction of collaterals， and collateral deficiency with malnourishment. Collateral Qi stagnation is the initiating stage， mainly corresponding to abnormal coronary microvascular vasomotor regulation and endothelial dysfunction. Scorching injury of collateral vessels represents the developmental stage and is closely associated with inflammation， oxidative stress， and endothelial barrier injury after Qi stagnation transforms into fire. Phlegm-stasis obstruction of collaterals represents the prolonged stage and may aggravate vascular wall thickening， luminal stenosis， microthrombosis， and insufficient microcirculatory perfusion. Collateral deficiency with malnourishment is the late-stage outcome， reflecting deficiency of healthy Qi， collateral damage， Qi-blood malnourishment， and weakened repair capacity， mainly manifested as microvascular rarefaction， occlusion， and microcirculatory homeostatic imbalance. Therapeutically， stage-based syndrome differentiation and the combined strategy of dredging and nourishing collaterals should be emphasized. Specifically， promoting Qi movement， resolving stagnation， soothing the liver， and harmonizing collaterals should be adopted in the early stage. Clearing heat， pacifying the liver， calming and protecting collaterals should be adopted in the developmental stage. Resolving phlegm， activating blood， and dredging collaterals should be implemented in the prolonged stage. Supplementing Qi， nourishing blood， tonifying the kidney， regulating balance， strengthening healthy Qi， and nourishing collaterals should be carried out in the late stage. Related formulas and medicinals may act by regulating the nitric oxide/endothelin-1（NO/ET-1） balance， inhibiting inflammation and oxidative stress， improving microcirculatory perfusion， and promoting angiogenesis and endothelial repair. Collateral disease theory may provide a theoretical basis for understanding the dynamic pathogenesis of H-CMD and for stage-based TCM intervention.
