Progress of Traditional Chinese and Western Medicine Clinical Research on Coronary Microcirculatory Dysfunction

冠状动脉微循环障碍(CMD)是一种心肌缺血类疾病，其特征为微血管结构或功能异常，临床表现为心绞痛，但冠脉造影无显著狭窄(INOCA)。主要发病机制包括内皮功能失调(NO/ET-1失衡)、血管平滑肌异常、交感神经紊乱及炎症介导的微血管重构。目前的诊断主要通过有创指标和无创影像学评估微循环功能。在治疗方面，西医侧重改善血流和抗炎等，中医则着重于“活血通络”理论，但精准治疗仍面临挑战。本研究结合西医病理机制与中医辨证论治，希望对今后冠状动脉微血管疾病的临床治疗有一定的借鉴意义。Coronary microvascular dysfunction (CMD) is a myocardial ischemic disorder characterized by structural or functional abnormalities of the microvasculature, clinically presenting as angina pectoris despite the absence of significant stenosis on coronary angiography (ischemia with no obstructive coronary arteries, INOCA). The primary pathogenic mechanisms include endothelial dysfunction (NO/ET-1 imbalance), vascular smooth muscle abnormalities, sympathetic dysregulation, and inflammation-mediated microvascular remodeling. Current diagnostic approaches rely on invasive indicators and non-invasive imaging to assess microcirculatory function. In terms of treatment, Western medicine primarily focuses on improving blood flow and anti-inflammatory strategies, while traditional Chinese medicine (TCM) emphasizes the “activating blood circulation and unblocking collaterals” theory. However, precision therapy remains challenging. This study integrates Western pathological mechanisms with TCM syndrome differentiation and treatment, aiming to provide valuable insights for the clinical management of coronary microvascular diseases in the future.