从“痰湿内蕴”论治冠状动脉粥样硬化性心脏病  

The treatment of coronary heart disease from the perspective of phlegm-dampness retention

作　　者：王海权 张磊[2] 姜枫[2] 李运伦[1] WANG Haiquan

机构地区：[1]山东中医药大学,山东济南250000 [2]山东省中医院,山东济南250000

出　　处：《中医临床研究》2024年第8期82-86,共5页Clinical Journal Of Chinese Medicine

基　　金：国家自然科学基金(81974561);山东省卫健委中西医结合防治常见病、多发病项目(2019—11);山东省中西医结合专病防治项目(2019);山东省自然科学基金博士基金(ZR2017BH091、ZR2019BH033);中国博士后科学基金(2017M612342);2017年山东省保健科技协会科学技术课题(SDBJKT20170080);2017年山东省中医药科技发展计划项目(2017-048、2017-055);齐卫生与健康杰出青年人才项目资助;中西医结合心血管泰山学者工程专项经费资助。

摘　　要：摘冠状动脉粥样硬化性心脏病(简称冠心病)是由冠状动脉粥样硬化引起血管狭窄,心肌缺血缺氧的临床常见综合征。痰湿内蕴是冠心病早期较为常见的重要病机,临床常见胸闷、心痛、肢体困乏、头重如裹、眩晕、恶心、脘腹痞闷、脉滑等表现。古代医家很早就对痰湿之邪与胸闷、心痛之间的关系有了深刻的认知,并各有阐释。痰湿之邪不仅作为重要的病理因素引起冠心病的发病、发展,更是作为独立的病理产物影响着本病的预后与转归,痰湿内蕴作为本病的重要病机贯穿疾病发生发展的始终,并且作为独立的病理因素引起痰气阻滞、血脉瘀阻、痰火酿毒、痰湿困脾等复杂兼证,按照中医辨证论治的基本原则,其具体治法则以燥湿化痰为要,根据其兼证的不同分别施以理气、活血、解毒、健脾等法辅之。临床诊疗案例显示,以燥湿化痰为法治疗冠心病疗效确切,在减轻患者胸闷、胸痛等不适的同时,使痰湿引起的头昏体重、乏力等症状有了明显的改善。文章梳理“痰湿内蕴”理论的起源、发展与完善,剖析“痰湿内蕴”这一重要病机在冠心病的发病、转归中的重要意义,总结燥湿化痰类药物在冠心病治疗中的相关研究与应用,以期为中医中药防治冠心病的临床应用提供更可靠的理论依据。Coronary heart disease is a common clinical syndrome due to coronary atherosclerosis,which causes blood vessel stenosis and myocardial ischemia and hypoxia.Phlegm-dampness retention is an important and common pathogenesis of coronary heart disease in the early stage.The common clinical manifestations are chest tightness,heartache,limb fatigue,head weight,dizziness,nausea,abdominal fullness,and pulse slip.Ancient doctors had a deep understanding of the relationship between the evil of phlegm-dampness,chest tightness and heartache,and had their own explanations.This paper holds that the evil of phlegmdampness not only causes the onset and development of coronary heart disease as an important pathological factor,but also affects the prognosis and outcome of the disease as an independent pathological product.As an important pathogenesis of the disease,the internal retention of phlegm-dampness always runs through the occurrence and development of the disease.It can also be used as an independent pathological factor to cause complicated accompanied syndromes such as block of phlegm,blood stasis,phlegm-fire poisoning,phlegmdampness blocking the spleen,etc..According to the basic principles of TCM syndrome differentiation,the specific treatment rules are to dry dampness and eliminate phlegm,and according to the different syndromes,the methods of regulating Qi(理气),activating blood,detoxifying and strengthening the spleen are supplemented.Clinical diagnosis and treatment cases show that the drying dampness and eliminating phlegm method on coronary heart disease is effective,and dizziness,weight,fatigue and other symptoms caused by phlegm and dampness have been significantly ameliorated while reducing chest tightness and chest pain in patients.This paper reviews the origin,development and improvement of the theory of phlegm-dampness retention,analyzes the significance of phlegm-dampness retention,an important pathogenesis,in the pathogenesis and prognosis of coronary heart disease,and summarizes the relevant research an

关 键 词：冠状动脉粥样硬化性心脏病 痰湿内蕴证 燥湿化痰法 治则治法 

分 类 号：R541[医药卫生—心血管疾病]