邴雅珺教授运用枳实薤白桂枝汤治疗冠状动脉粥样硬化性心脏病临床心得及病案一例  

Professor BING Yajun’s clinical experience in treating coronary heart disease with Zhishi Xiebai Guizhi decoction and one test case

作　　者：侍世琛 邴雅珺[2] 孙涛[2] 丁欢阳 王颖[1] 冉亚丽 SHI Shichen;BING Yajun;SUN Tao;DING Huanyang;WANG Ying;RAN Yali

机构地区：[1]甘肃中医药大学,甘肃兰州730000 [2]甘肃省中医院,甘肃兰州730000

出　　处：《中医临床研究》2024年第15期33-36,共4页Clinical Journal Of Chinese Medicine

摘　　要：冠状动脉粥样硬化性心脏病作为我国中老年人群中的常见病、多发病、危重病,归属于中医学的“胸痹”“心痛”等范畴。文章通过对胸痹病因病机的追本溯源,结合我国古代医家对胸痹的理解和阐释,把“阳微阴弦”确定为胸痹的基本病因。从其脉象上来看,关前为阳,关后为阴,阳微指寸脉微,即上焦阳气不足,胸阳不振;阴弦指尺脉弦,即阴寒太盛,水饮内停,具体表现为上焦心肺阳气虚衰,导致其气化、温煦等功能失常,使病理实邪水湿、痰浊、寒凝、血瘀等痹阻心脉,例如水湿、痰浊、寒凝、血瘀等,从而引起心前区的阵发性闷痛、痞满等症状,中医可将其归为胸阳不振、阴寒上乘的本虚标实病证。吾师邴雅珺教授在临床上治疗胸痹心痛病症二十余年,所遇到的病例大都属痰浊、寒凝等病理实邪导致的胸痹,故主要运用张机(字仲景)《金匮要略》的枳实薤白桂枝汤,治法以宣痹通阳、宽胸散结为主,重视补益阳气、理气活血、化痰祛浊,并且灵活运用活血通脉药物,使得补气之余气行不阻、血活不滞,使机体重新达到清气升、浊气降的阴阳平衡状态。吾师根据胸痹的具体症状、病史,审识病因病机,辨证论治,灵活加减,标本兼治,发挥了中医药在治疗冠状动脉粥样硬化性心脏病中的优势。在临床上,无论是在改善患者症状还是在改善预后等方面都取得了较好的效果。Coronary heart disease is a common,frequently-occurring disease and critical disease in the middle-aged and elderly people in China,which is similar to the category of“chest obstruction”and“heartache”in traditional Chinese medicine.Through tracing the etiology and pathogenesis of chest obstruction,combined with the understanding and interpretation of ancient Chinese doctors,this paper identifies“weak pulse at Yang(阳)and stringy pulse at Yin(阴)”as the basic etiology of chest obstruction.From the point of its pulse,before the Guan(关)is Yang,after the Guan is Yin weak pulse at Yang refers to that the inch pulse is weak,that is,the upper jiao(上焦)Yang is insufficient,the chest Yang is weak;stringy pulse at Yin refers to that the chi pulse is stringy,that is,cold Yin is too full,the water is stopped inside,the specific performance is the heart-lung Yang Qi(阳气)deficiency in the upper jiao,resulting in disorder of its gasification,warming and other functions,so that the pathogenic ubstances such as water dampness,phlegm turbidness,cold coagulation,blood stasis,block the heart pulse resulting in paroxyptic pain in the heart,fullness and other symptoms.In traditional Chinese medicine,it can be classified as chest Yang deficiency and superior Yin cold disease syndrome.My tutor Professor BING Yajun has been treating chest numbness and heartaches in clinic for more than 20 years.Most of the symptoms the tutor encountered are chest numbness caused by phlegm turbidity,cold coagulation and other pathological pathogenic factors.Therefore,the tutor mainly applies Zhishi Xiebai Guizhi decoction(枳实薤白桂枝汤)in Jin’gui Yaolue(《金匮要略》)of ZHANG Ji.The treatment is mainly based on tonifying Qi(气)and activating Yang,relieving chest stiffness to dissipate mass,paying attention to tonifying Yang Qi,regulating Qi and activating blood,resolving phlegm and removing turbidity,and flexibly using drugs to promote blood circulation,so as to achieve the purpose of tonifying Qi while the blood acti

关 键 词：枳实薤白桂枝汤 胸痹 冠状动脉粥样硬化性心脏病 

分 类 号：R256.2[医药卫生—中医内科学]