温阳通经法治疗老年胸痹心痛经验  

Experience of Treating Chest Arthralgia and Heartache in Elderly by Warming Yang and Dredging Meridians

作　　者：王小康 张朔 王梦娇 嵇克刚 WANG Xiao-kang;ZHANG Shuo;WANG Meng-jiao;JI Ke-gang(Shandong University of Traditional Chinese Medicine,Jinan,Shandong,China,250000;Weifang Hospital of Traditional Chinese Medicine,Weifang,Shandong,China,261000)

机构地区：[1]山东中医药大学,山东济南250000 [2]潍坊市中医院,山东潍坊261000

出　　处：《河南中医》2022年第7期1046-1051,共6页Henan Traditional Chinese Medicine

基　　金：潍坊市卫生和计划生育委员会中医药科研项目(2018-2-008)。

摘　　要：胸痹心痛基本病机为阳微阴弦,“阳微”即阳气亏虚,不仅为上焦阳气不足,亦包含肾阳之不足;“阴弦”之阴邪非单指寒邪,亦包含痰饮、血瘀、气滞。嵇克刚教授在临床实践中总结出“不通”非单指气滞或血瘀,外感六淫之邪气,脾生痰浊之邪、血瘀于脉内、肝气郁滞,均可导致经脉不通,“不荣”即气血不足,不足以荣养经脉及脏腑,治疗胸痹心痛应通补兼施,采用温阳通经的治疗方法。自拟温通丸温阳通经,心阳不足者加桂枝、薤白等温补心阳,助心阳通其血脉;肾气渐亏者加附子、吴茱萸等温补肾阳之品以温肾阳助心阳;脾阳亏虚者加红参及炙黄芪等补中益气之药来温补肾阳;血瘀者加当归、川芎、红花等活血化瘀之品;痰浊者可加半夏、陈皮、瓜蒌等化痰之品;气滞者加枳壳、郁金等理气之品。The basic pathogenesis of chest arthralgia and heartache is yang deficiency with excessive yin exuberance."Yang deficiency"includes not only the deficiency of yang qi in upper energizer,but also the deficiency of kidney yang."Excessive yin exuberance"not only refers to cold evil,but also includes phlegm retention,blood stasis and qi stagnation.Professor Ji Ke-gang has summed up in clinical practice that"obstruction"does not only refer to qi stagnation or blood stasis.The exogenous six pathogens,phlegm turbidity in the spleen,blood stasis in the vessels and stagnation of liver qi can all lead to blocking meridians."No nourishment"means insufficient qi and blood,which is not enough to honor and nourish the meridians and viscera.In the treatment of chest arthralgia and heartache,both dredging and tonifying should be used.The treatment method of warming yang and dredging meridians is put forward.Self-made Warming and Dredging Pill can warm yang and dredge meridians.If the patient has insufficient heart yang,is to add Guizhi(Ramulus Cinnamomi),Xiebai(Bulbus Allii Macrostemi),etc.to help heart yang to dredge its blood vessels.For gradually deficient kidney qi,Fuzi(Radix Aconiti Lateralis Preparata)and Wuzhuyu(Fructus Evodiae),etc.are added to warm kidney yang and help heart yang.For deficiency of spleen yang,Hongshen(Radix et Rhizoma Ginseng Rubra),Zhihuangqi(Radix Astragali Praeparata cum Melle),etc.are added to warm and tonify kidney yang.For blood stasis,Danggui(Radix Angelicae Sinensis),Chuanxiong(Rhizoma Chuanxiong),Honghua(Flos Carthami),etc.are added to promote blood circulation and remove blood stasis.For turbid phlegm,Banxia(Rhizoma Pinelliae),Chenpi(Pericarpium Citri Reticulatae),Gualou(Fructus Trichosanthis),etc.are added to resolve phlegm.For qi stagnation,Zhiqiao(Fructus Aurantii),Yujin(Radix Curcumae)etc.are added to regulate qi.

关 键 词：冠状动脉粥样硬化性心脏病 心绞痛 胸痹心痛 温阳通经法 阳微阴弦 

分 类 号：R256.22[医药卫生—中医内科学]