Discussion on "Maizhongji (脉中积)" Theory of Macrophage Foam in Atherosclerosis
Macrophage foam is a key factor in the occurrence and development of atherosclerosis (AS) and is also an important link in AS preven-tion and treatment.The "Maizhongji (脉中积)" theory suggests that AS is characterized by Xiezhuoneisheng (浊邪内生) and Xinmaijizhi (心脉积滞) as symptoms and Zhengqibuzu (正气不足) and Maibibugu (脉壁不固) as causes,which provides certain guidance for the macrophage foam.Zhengqibuzu can lead to Maibibugu and injuries to Jingmai (经脉).The injury to Jingmai refers to local vascular injury,which is a prerequisite for the deposition of low-density lipoprotein and local vascular inflammation.Zhengqibuzu can lead to Pixushiyun (脾虚失运) and Tanzhuoneisheng (痰浊内生).Tanzhuoneisheng refers to the abnormal increase in low-density lipoprotein and inflammatory factors,which serves as the basis for the macrophage foam.Zhuoxieneisheng (浊邪内生) and Xinmaijizhi (心脉积滞) are a continuous process,including three stages:Tanzhuozuzhi (痰浊阻滞),Tanyuningzhi (痰瘀凝滞),and Xinxueyuzu (心血瘀阻).Tanzhuozuzhi is the process of low-density lipoprotein deposition in local blood vessels and the initiation of local vascular inflammatory reactions by pro-inflamma-tory factors.Tanyuningzhi is the process of excessive phagocytosis of oxidized low-density lipoprotein by macrophages,which transform into foam cells.Xinxueyuzu is the process in which foam cells die by over-phagocytosis of oxLDL and form necrotic cores,which in turn mediate sustained inflammatory reactions and oxidative stress,eventually forming atherosclerotic plaques.Therefore,the regulation of macrophage foam in traditional Chinese medicine (TCM) requires a holistic approach,addressing both symptoms and causes.The treatment focuses on Jianpiy-iqi (健脾益气) and Qutanhuayu (祛痰化瘀) to address symptoms,while Qingrejiedu (清热解毒) to address causes when the patients show long-term Tanyu (痰瘀) and Redu (热毒).Both TCM formulas and TCM drugs can regulate macrophage foam.TCM formulas can be classified into categories such as Yiqihuoxue (益气活血),Yiqihuatan (益气化痰),and Qingrejiedu.They mainly improve macrophage lipid metabolism,delay foam cell formation,inhibit inflammatory reactions in vascular endothelial cells,reduce oxidative damage,and improve the vascular microenvironment,thereby inhibiting the progression of AS.
AtherosclerosisMacrophage foamMaizhongji (脉中积)Traditional Chinese medicine
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