中医对血脂异常的认识与降脂途径摘 要：血脂异常是一种常见的代谢综合征，以总胆固醇(TC)、甘油三酯、低密度脂蛋白胆固醇(LDL)水平升高和高密度脂蛋白胆固醇(HDL)下降为指标；是全球范围内的一种慢性非传染性疾病，它会引发动脉粥样硬化、糖尿病、中风等疾病的发生，是心血管疾病致死率的主要因素，危害着人类健康。目前对血脂异常风险的认识有所提高，西医治疗体系完善，降脂化学药物如他汀类药物已被广泛用于治疗高脂血症，但这些药物有其局限性，甚至会产生肌痛、横纹肌溶解和肝毒素等不良反应；限制其长期应用于临床，因此，采取其他措施作为替代治疗的需求日益增加。中医认为高脂血症的发生与肝、脾的功能失调相关，情志失调、气机运行不畅导致气机壅滞，肝主疏泄的功能紊乱就会影响脾胃的运化功能，导致膏脂的利用、排泄紊乱令血脂升高而发为此病，痰饮和瘀血作为常见的病理产物也影响着血脂稳态，积极采取中医措施予以预防加以控制人体血脂水平具有切实的意义。在中医理论的指导下采取控制饮食、运动疗法、中药治疗、中成药治疗、耳穴疗法以及艾灸与针刺等中医传统方式干预血脂异常的治疗优势，且揭示了其具有多靶点、多途径、不良反应小的特点，以期待为临床治疗提供可靠的思路与线索。 关键词：血脂异常; 调脂; 饮食与运动; 单味中药; 中药复方; 中成药; 耳穴疗法; 艾灸与针刺; Abstract：Dyslipidemia is a common metabolic syndrome, which uses elevated levels of total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL) and decreased high-density lipoprotein cholesterol (HDL) as indicators; it is a global scale It is a chronic non-communicable disease that can cause atherosclerosis, diabetes, stroke and other diseases. It is a major factor in the mortality rate of cardiovascular diseases and endangers human health. At present, the awareness of the risk of dyslipidemia has improved. Western medicine has a complete treatment system. Lipid-lowering chemical drugs such as statins have been widely used to treat hyperlipidemia, but these drugs have their limitations, and even cause myalgia and striated muscle. Adverse reactions such as dissolution and liver toxins; limiting its long-term clinical application, therefore, there is an increasing demand for other measures as alternative treatments. Traditional Chinese medicine believes that the occurrence of hyperlipidemia is related to the dysfunction of the liver and spleen. Emotional imbalance and poor operation of the qi will cause stagnation of the qi. The dysfunction of the liver governing the drainage will affect the spleen and stomachs transport and chemical functions, resulting in ointment. Disorders of the utilization and excretion of lipids increase blood lipids and cause this disease. Phlegm and blood stasis as common pathological products also affect blood lipid homeostasis. Actively adopting traditional Chinese medicine measures to prevent and control human blood lipid levels has practical significance. This article explains that under the guidance of the theory of Chinese medicine, the advantages of traditional Chinese medicine interventions such as diet control, exercise therapy, Chinese medicine treatment, Chinese patent medicine treatment, ear point therapy, and moxibustion and acupuncture, have obvious advantages in the treatment of dyslipidemia, and reveal its multiple targets , Multi-channel, small side effects, with the expectation to provide reliable ideas and clues for clinical treatment. Keyword：dyslipidemia; lipid-regulating; diet and exercise; single Chinese medicine; compound Chinese medicine; Chinese patent medicine; ear point therapy; moxibustion and acupuncture; 血脂异常(Dyslipidemia)，归属于代谢性疾病的范畴，是指血液中的脂质代谢过程出现了紊乱，其发病隐匿，一般情况下患者无明显的症状与体征，大多在体检的过程中发现，其表现为血清总胆固醇(TC)、血清低密度脂蛋白(LDL-C)、血清甘油三酯(TG)水平升高，血清高密度脂蛋白(HDL-C)水平下降1。这种情况的发生与生活方式和饮食习惯的恶化有关，是心血管疾病的一个重要危险因素，同时也会引起中风、糖尿病、脂肪肝等疾病的发生2。近年来血脂异常的患病率呈现出逐年递增的趋势，采取有效措施治疗血脂异常能防止疾病的进一步发展，降低心血管疾病的发生率与病死率，提高患者生活质量。 1、中医对血脂异常的认识 中医中“膏粱”“脂膏”的阐述以及其特性与现代医学中的血脂具有极高的一致性。所谓“脂膏”源自黄帝内经灵枢，“人有脂，有膏，有肉”。灵枢五癃津液别论中提到：“五谷之津液，和而为膏，内渗入于骨空，补益脑髓，而下流于阴股”。论述了机体所需的营养成分是由水谷精微化生的膏脂而构成的3，在体内随着津液的流行而输布全身并储存进而达到营养全身、充实骨骼的作用。若膏脂在体内的输布运化紊乱，则久之成浊，病从中生4,5。脾胃具有腐熟饮食物、运化水谷到达全身的功能，若过食肥甘厚味会加重脾胃的负担，致其功能受损，发生障碍，便无法将多余的食物运行到全身，就会引起脂质的堆积超过了人体所需的正常量，致其周身气血运行受到阻碍，变生它病；例如素问生气通天论云：“膏粱之变，足生大丁”，医镜中：“消瘅，扑击，偏枯萎厥，气逆喘满，肥贵人之膏粱之病”6。肝主疏泄，关系到人体气机的升与降，肝的疏泄功能正常不仅可促进脾胃对饮食物的消化吸收，也对脾升胃降的协调功能有利，能维持气血运行，素问有云：“土得木而达”。一旦情志失调、气机运行不畅导致气机壅滞，肝主疏泄的功能紊乱就会影响脾胃的运化功能，导致膏脂的利用、排泄紊乱令血脂升高而发为此病，经统计表明肝郁脾虚症是高脂血症的常见证候7。痰饮和瘀血是血脂异常的常见病理产物8。中医认为痰饮是人体内水液代谢发生故障所产生的病理产物；瘀血是人体内血液停滞、壅塞脉道所产生的病理产物，其血液粘滞的特点与西医中血流变的异常指标相吻合。当肝失调达，胆气上逆也会影响食物的消化代谢，进而会产生痰饮、瘀血。所以在临床上多用健脾疏肝化痰祛瘀之治则来纠正血脂异常的状态。中医因其多靶点、安全有效、措施多样化的突出优势近年来备受关注，通过整理与归纳，介绍了饮食运动方式、单味中药的活性成分、中药复方、中成药、耳穴疗法以及针刺艾灸等途径在治疗高脂血症中所发挥的作用优势，旨在为临床治疗提供新的思路。