中医药治疗冠心病心绞痛概况
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摘要
冠心病心绞痛可归属"胸痹""心痛"等范畴。始载于《灵枢》,张仲景首次明确提出胸痹心痛,病机为阳微阴弦,本虚标实,创立瓜蒌薤白三方。宋代活血化瘀广泛使用。清代王清任创制五逐瘀汤、补阳还五汤。当代学者认为多与阴寒内侵、体虚劳倦、七情所伤、饮食不节等因素相关;血脉瘀滞贯穿全程,活血化瘀乃基本大法,活血化瘀用复方冠心Ⅱ号、补阳还五汤、益气活血方、血府逐瘀汤、瘀毒清、赤香参通颗粒;豁痰泄浊用化痰降浊方、瓜蒌薤白半夏汤;宽胸理气用柴胡疏肝散;通阳宣痹用四逆汤、枳实薤白桂枝汤、瓜蒌薤白白酒汤;清热解毒用桂枝茯苓汤合黄连解毒汤。中医药治疗可减轻甚至消除症状,心电图和实验室指标有一定改善,疗效确切。
Angina Pectoris of coronary heart disease can be classified as "chest discomfort" and "heart pain". Originally published in Lingshu, ZHANG Zhongjing clearly put forward for the first time that chest discomfort and heartache were related to weak pulse at Yang and stringy pulse at Yin, which were originally deficient and marked as reality, and created the tripartite of Gualou Xiebai. Activating blood circulation and removing blood stasis were widely used in Song Dynasty. WANG Qingren created Wuzhuyu decoction and Buyang Huanwu decoction in Qing Dynasty. Contemporary scholars believe that most of them are related to Yin-cold intrusion, body deficiency and fatigue, seven emotions injury, improper diet and other factors; blood stasis throughout the whole process, promoting blood circulation and removing blood stasis is the basic law;promoting blood circulation and removing blood stasis with compound Guanxin II, Buyang Huanwu decoction,Yiqi Huoxue decoction, Xuefu Zhuyu decoction, Yuduqing, Chixiangshentong granule; eliminating phlegm and removing turbidity with Huatan Jiangzhuo decoction, Gualou Baibanxia decoction; broadening the chest and regulating Qi; Chaihu Shugan powder; Tongyang Xuanbi Sini decoction, Zhishi Xiebai Guizhi decoction,Gualou Xiebai Baijiu decoction; Guizhi Fuling decoction and Huanglian Jiedu decoction for clearing away heat and detoxification. TCM treatment can alleviate or even eliminate symptoms, ECG and laboratory indicators have improved to a certain extent, the curative effect is definite.
Angina Pectoris of coronary heart disease can be classified as "chest discomfort" and "heart pain". Originally published in Lingshu, ZHANG Zhongjing clearly put forward for the first time that chest discomfort and heartache were related to weak pulse at Yang and stringy pulse at Yin, which were originally deficient and marked as reality, and created the tripartite of Gualou Xiebai. Activating blood circulation and removing blood stasis were widely used in Song Dynasty. WANG Qingren created Wuzhuyu decoction and Buyang Huanwu decoction in Qing Dynasty. Contemporary scholars believe that most of them are related to Yin-cold intrusion, body deficiency and fatigue, seven emotions injury, improper diet and other factors; blood stasis throughout the whole process, promoting blood circulation and removing blood stasis is the basic law;promoting blood circulation and removing blood stasis with compound Guanxin II, Buyang Huanwu decoction,Yiqi Huoxue decoction, Xuefu Zhuyu decoction, Yuduqing, Chixiangshentong granule; eliminating phlegm and removing turbidity with Huatan Jiangzhuo decoction, Gualou Baibanxia decoction; broadening the chest and regulating Qi; Chaihu Shugan powder; Tongyang Xuanbi Sini decoction, Zhishi Xiebai Guizhi decoction,Gualou Xiebai Baijiu decoction; Guizhi Fuling decoction and Huanglian Jiedu decoction for clearing away heat and detoxification. TCM treatment can alleviate or even eliminate symptoms, ECG and laboratory indicators have improved to a certain extent, the curative effect is definite.
引文
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[21]刘纲,丁碧云.参芎葡萄糖注射液治疗冠心病不稳定型心绞痛的Meta分析[J].中国中医急症,2016,25(2):272.
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[29]苏伟,高枫,周春刚,等.瓜蒌薤白半夏汤对痰浊闭阻型不稳定型心绞痛患者血浆MMP-9和TIMP-1水平的影响[J].时珍国医国药,2016,27(4):890-892.
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[33]吴秀峰.加味温胆汤治疗痰瘀交阻型冠心病心绞痛30例临床观察[J].黑龙江中医药,2009,38(1):12.
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[36]黄贝莉.四逆汤在冠心病心绞痛患者中的应用观察[J].海峡药学2016,28(9):118-119.
[37]朱德建.枳实薤白桂枝汤对寒凝痰瘀气滞证素不稳定型心绞痛患者FIB、D-D、Hcy及hs-CRP的影响[D].南京:南京中医药大学2018.
[38]阮艳艳.瓜蒌薤白白酒桂枝汤治疗不稳定型心绞痛的疗效观察[J].时珍国医国药,2013,24(6):1451-1452.
[39]蒋庆雨,唐毅华,周玉清,等.从“火热灼脉”学说探析急性冠脉综合征的证治发微[J].中国中医急症,2019,28(2):299-301.
[40]卢笑晖.丁书文从热毒论治冠心病经验介绍[J].中国中医急症2011,20(10):1597.
[41]李鑫辉,黄淼鑫,杜建芳,等.从中医“瘀”“热”“毒”浅析活血清营解毒法治疗冠心病胸痹的理论依据[J].北京中医药大学学报2017,40(2):112-115.
[42]裴强,桑文凤,赵习德.桂枝茯苓汤合黄连解毒汤治疗不稳定型心绞痛[J].中国实验方剂学杂志,2011,18(20):286-289.
[43]朱德建,陆曙.枳实薤白桂枝汤对不稳定型心绞痛患者Hcy及hsCRP影响[J].辽宁中医药大学学报,2018,20(6):209-212.
[44]郗瑞席,孟闫燕,杨巧宁,等.冠心病“瘀”“毒”从化与综合防治[J].中西医结合心脑血管病杂志,2013,11(6):641-642.
[45]王安璐,罗静,于美丽,等.基于陈可冀院士血瘀证辨证方法治疗冠心病稳定性心绞痛的实用性随机对照研究[J].中国中西医结合杂志,2017,37(10):1174-1180.
[2]国家中医药管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[3]陈伟大,高润霖,刘力生,等.2015年中国心血管病报告[J].中国循环杂志,2016,31(6):521-528.
[4]范永升.金匮要略[M].北京:中国中医药出版社,2003.
[5]灵枢经[M].田代华,刘更生,整理.北京:人民卫生出版社,2005:58.
[6]王清任.医林改错[M].李天德,张学文,整理.北京:人民卫生出版社,2005.
[7]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:136.
[8]陈士奎.我国开创的中西医结合科研及其启示(一)--著名中西医结合医学家陈可冀院士与血瘀证及活血化瘀研究[J].中国中西医结合杂志,2016,36(9):1029-1031.
[9]吴浩.清热活血方联合西药治疗慢性稳定性心绞痛20例[J].中国中医药现代远程教育,2017,3(15):102-104.
[10]郎立和,刘晓芹.补阳还五汤化裁治疗气虚血瘀型老年冠心病疗效观察[J].中医学报,2010,25(5):937-938.
[11]王国蕾,胡国恒,李亮,等.益气活血汤治疗冠心病稳定型心绞痛的临床观察[J].现代中西医结合杂志,2017,26(26):2893-2895.
[12]马殿信.血府逐瘀汤治疗气滞血瘀型冠心病心绞痛的临床疗效观察[J].实用心脑肺血管病杂志,2009,17(9):769-770.
[13]宋婷婷,王东海,刘呈宇,等.温阳活血方治疗阳虚血瘀型冠心病心绞痛的疗效观察[J].中西医结合心脑血管病杂志,2014,6(12):668-669.
[14]史大卓.陈可冀院士冠心病病症结合治疗方法学的创新和发展[J].中国中西医结合杂志,2011,31(8):1017-1020.
[15]徐浩,史大卓,殷惠军,等.“瘀毒致变”与急性心血管事件:假说的提出与临床意义[J].中国中西医结合杂志,2008,28(10):70-74.
[16]李圣耀,冒慧敏,薛梅,等.刍议瘀毒内涵及其在冠心病事件发生中的意义[J].中国中西医结合杂志,2017,37(9):1126-1128.
[17]李正兰,王笑梅,张超,等.瘀毒清联合西药治疗冠心病PCI术后再发心绞痛疗效观察[J].实用中医药杂志,2015,31(10):916-917.
[18]刘光颖,张哲,李峥,等.中西医结合干预冠心病稳定型心绞痛气虚血瘀证临床疗效观察[J].中华中医药学刊,2014,32(11):2616-2619.
[19]曲爱民,张吉敏.丹参多酚酸盐治疗冠心病心绞痛的临床疗效及安全性分析[J].中国医药科学,2015,5(18):40-43.
[20]双莲.丹参川芎嗪注射液治疗冠心病心绞痛疗效观察[J].转化医学电子杂志,2015,2(10):75.
[21]刘纲,丁碧云.参芎葡萄糖注射液治疗冠心病不稳定型心绞痛的Meta分析[J].中国中医急症,2016,25(2):272.
[22]郑洪新.中医基础理论[M].北京:中国中医药出版社,2016.
[23]黄帝内经素问[M].田代华,整理.北京:人民卫生出版社,2005176-190.
[24]张琦,赵天才.金匮要略[M].北京:中国医药科技出版社,2012.
[25]姚源璋.冠心病治疗方剂初探[J].山东中医学院学报,1987,11(4):32.
[26]鲁明源.冠心病化痰蠲饮法溯源与评述[J].山东中医药大学学报2007,31(2):103-104.
[27]卢永屹,王祎晟.化痰降浊方对冠心病稳定型心绞痛(痰阻心脉证型)血脂水平的影响[M].中西医结合心脑血管病杂志,2017,15(8):950-952.
[28]郭建恩,米树斌,闫秀川,等.瓜蒌薤白半夏汤对ApoE小鼠血脂代谢、氧化应激和主动脉Lox-1表达的影响[J].中国中药杂志,2017,42(4):752-757.
[29]苏伟,高枫,周春刚,等.瓜蒌薤白半夏汤对痰浊闭阻型不稳定型心绞痛患者血浆MMP-9和TIMP-1水平的影响[J].时珍国医国药,2016,27(4):890-892.
[30]赵益林,林晓忠,张敏州,等.邓铁涛教授以心脾相关学说诊治冠心病经验介绍[J].新中医,2007,39(4):5-6.
[31]吴焕林,林晓忠,皱旭.邓铁涛治疗冠心病临床经验探析[J].辽宁中医学院学报,2005,7(4):312-313.
[32]季长春,董大华,冷庆大,等.中药治疗不稳定性心绞痛疗效观察[J].辽宁中医杂志,2008,35(7):1030-1031.
[33]吴秀峰.加味温胆汤治疗痰瘀交阻型冠心病心绞痛30例临床观察[J].黑龙江中医药,2009,38(1):12.
[34]娄唯鸣.柴胡疏肝散治疗肝气郁结型冠心病心绞痛99例[J].中国实用医药,2011,6(27):162-164.
[35]周玉凤.宽胸理气疏肝法辨证治疗冠心病心绞痛患者的临床观察[J].光明中医,2017,32(24):3574-3576.
[36]黄贝莉.四逆汤在冠心病心绞痛患者中的应用观察[J].海峡药学2016,28(9):118-119.
[37]朱德建.枳实薤白桂枝汤对寒凝痰瘀气滞证素不稳定型心绞痛患者FIB、D-D、Hcy及hs-CRP的影响[D].南京:南京中医药大学2018.
[38]阮艳艳.瓜蒌薤白白酒桂枝汤治疗不稳定型心绞痛的疗效观察[J].时珍国医国药,2013,24(6):1451-1452.
[39]蒋庆雨,唐毅华,周玉清,等.从“火热灼脉”学说探析急性冠脉综合征的证治发微[J].中国中医急症,2019,28(2):299-301.
[40]卢笑晖.丁书文从热毒论治冠心病经验介绍[J].中国中医急症2011,20(10):1597.
[41]李鑫辉,黄淼鑫,杜建芳,等.从中医“瘀”“热”“毒”浅析活血清营解毒法治疗冠心病胸痹的理论依据[J].北京中医药大学学报2017,40(2):112-115.
[42]裴强,桑文凤,赵习德.桂枝茯苓汤合黄连解毒汤治疗不稳定型心绞痛[J].中国实验方剂学杂志,2011,18(20):286-289.
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