摘要
“热化”是冠心病的重要病机之一,但以往多拘泥于胸痹“阳微阴弦”而对其重视度不够。《黄帝内经》中即有热邪与“心病”“心痛”有关的描述。在总结梅国强、周仲瑛、陈可冀、张学文、段富津、雷忠义、李士懋、裘沛然、苏荣扎布等国医大师从热论治冠心病的临证经验和学术思想基础上,我们归纳出冠心病“热化”病机的四种主要类型为痰湿郁而化热、瘀热互结、热毒蕴结、阴虚致热,并提炼其辨治要点。痰湿郁而化热,重辨舌脉,治以清热化痰为主,常用陷胸汤类佐以蝉蜕、羌活、荆芥、防风、薄荷、葛根等宣透郁热药物;瘀热互结,当分瘀、热之轻重,治以“凉”“散”为要,多用犀角地黄汤清热凉血;痰瘀日久,热毒蕴结,病情尤剧,可予四妙勇安汤加连翘、虎杖等清热解毒药;阴虚致热,当辨心肾,常用生脉散配伍生地滋补心、肾之阴。病证结合,识机论治,以期进一步完善冠心病理论体系,提高临床疗效。
"Heat transformation"is one of the important pathogenesis of coronary heart disease,but in the past,more attention was paid to"yang insufficient and yin strings"of chest arthralgia and less attention was paid to it.In the Inner Canon of Yellow Emperor,there are descriptions of heat related to"heart disease"and"heart ache".On the basis of summing up the clinical experience and academic thought of National TCM Masters,Mei Guoqiang,Zhou Zhongying,Chen Keji,Zhang Xuewen,Duan Fujin,Lei Zhongyi,Li Shimao,Qiu Peiran and Su Rongzabu in treating coronary heart disease from heat,we concluded 4 main types of pathogenesis of coronary heart disease of phlegm-dampness-depression and heat-inducing,stagnation of blood stasis and heat,retention of toxic heat in the interior and yin-deficiency induced heat.The key points of differentiation and treatment were refined.For phlegm-dampness-depression and heat-inducing,the differentiation of tongue and pulse should be focused,and the treatment should be heat-clearing and phlegmresolving.The commonly used prescription was Xianxiong Decoction with Periostracum Cicadae,Rhizoma et Radix Notopterygii,Herba Schizonepetae,Radix Saposhnikoviae,Herba Menthae,Radix Puerariae and other anti-heat drugs;For stagnation of blood stasis and heat,the blood stasis and heat was differentiated,and it is important to treat with"cool"and"disperse".Xijiao Dihuang Decoction was mainly used to clear heat and cool blood;For retention of toxic heat in the interior,the illness is serious,and it should be treated with heat-clearing and detoxifying Chinese herbs such as Simiao Yong'an Decoction with clearing heat and cooling blood herbs of Fructus Forsythiae and Rhizoma Polygoni Cuspidati;For yin-deficiency inducing heat,the heart and kidney should be differentiated.Shengmai Powder with Radix Rehmanniae Recens was commonly used to nourish heart and kidney yin.In order to further improve the theoretical system of coronary heart disease and improve the clinical efficacy,the combination of disease and syndrome and the treatment of disease and mechanism should be considered.
作者
李子贇
胡镜清
王传池
江丽杰
杨燕
Li Ziyun;Hu Jingqing;Wang Chuanchi;Jiang Lijie;Yang Yan(Third School of Clinical Medicine,Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China;Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;College of Basic Medical Sciences,Hubei University of Traditional Chinese Medicine,Wuhan 430065,China)
出处
《世界科学技术-中医药现代化》
CSCD
北大核心
2019年第10期2009-2012,共4页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
国家科技部重点基础研究计划“973计划”（2014CB542903）：中医证候临床辨证的基础研究，负责人：胡镜清
中国中医科学院基础所中央级公益性科研院所基本科研业务费自主选题项目（YZ1816）：重组高密度脂蛋白（p HDL）包载白藜芦醇靶向治疗动脉粥样硬化的研究，负责人：李子贇
关键词
冠心病
热化
病机
国医大师
Coronary heart disease
Heat transformation
Pathogenesis
National TCM Master
作者简介
通讯作者:胡镜清,研究员,博士研究生导师,主要研究方向:中医药理论构筑与诊疗模式的临床研究方法研究。
