王阶从“虚-痰-瘀-热-滞”论治冠状动脉狭窄经验  

WANG Jie′s Experience in Treatment of Coronary Artery Stenosis from Perspective of“Deficiency-Phlegm-Blood Stasis-Heat-Stagnation”

作　　者：陈寅萤[1] 王阶[1] CHEN Yinying;WANG Jie(Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《辽宁中医杂志》2024年第10期29-33,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局第二届全国名中医传承工作室建设项目(国中医药办人教函〔2022〕245号);国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号);中央级公益性科研院所基本科研业务费专项(ZZ13-YQ-029);北京市中医管理局第六批北京级中医药专家学术经验继承工作项目(京中医科字〔2021〕169号)。

摘　　要：冠状动脉粥样硬化斑块导致冠状动脉狭窄是冠心病发病的关键和病理基础。目前,冠心病的常规治疗措施包括药物治疗和血运重建,在一定程度上能改善症状,但仍有发生不良心血管事件的风险。全国名中医王阶教授临证经验丰富,在中医辨治冠心病及用药方面独具特色。王教授提出,冠心病的核心病机是“痰瘀滞虚”,四大证候要素紧密结合,互相转化,贯穿于冠心病发生、发展的全过程。王教授认为,冠状动脉狭窄与“虚、痰、瘀、热、滞”病机密切相关,其中“虚”为内在致病之本,“血瘀、痰浊”是主要病理因素,“热毒内蕴”是重要病机,“气滞”是加重病情、干扰疾病转归的重要因素。王教授临证时强调治病求本,病机结合病理,脏腑辨证和病证结合,方证相应指导处方用药,药性结合药理,灵活配伍。治疗上,以益气补肾、活血化痰、清热解毒之法立法组方,擅用经方加减化裁,守机用之,遵旨变通;或合方治疗,兼顾病情;善用对药配伍,强化药效,颇具特色。现将王阶教授在冠状动脉狭窄治疗方面的临床经验总结如下,并附医案一则,以飨同道。Coronary artery stenosis caused by coronary atherosclerotic plaque is the key and pathological basis of coronary heart disease(CHD).Currently,conventional treatment for CHD,including drug therapy and revascularization,can improve symptoms to some extent,but there is still a risk of adverse cardiovascular events.Professor WANG Jie,the national famous traditional Chinese medicine(TCM)professor,has rich experience in clinical diagnosis and treatment of CHD and has unique characteristics in TCM treatment and medication.Professor WANG proposed that“phlegm-blood stasis-stagnation-deficiency”was the core pathogenesis of CHD.These four syndrome elements were closely combined and transformed into each other,and played an important role in the development of CHD.Professor WANG believes that coronary artery stenosis is closely related to the pathogenesis of deficiency,phlegm,blood stasis,heat and stagnation.Deficiency is the underlying cause of the disease,blood stasis and phlegm turbidity are the main pathological factors,heat toxin accumulation is an important pathogenesis,and Qi stagnation is an important factor that aggravates the disease and interferes with the outcome of the disease.In clinical practice,Professor WANG emphasized that treating diseases should be based on the root cause,combining pathogenesis with pathology,syndrome differentiation of Zang-Fu organs with disease and syndrome,guiding prescription medication according to prescription and syndrome,combining pharmacological properties with medicinal properties and flexible compatibility.In terms of treatment,the method of supplementing Qi and tonifying kidney,promoting blood circulation and resolving phlegm,clearing heat and detoxifying is legislated and formulated,and the classic formulae are skillfully used and are used in accordance with the rules and regulations.The treatment also can used the combined formulae,taking into account the condition,making good use of medicinal compatibility and enhancing the efficacy with distinctive features.Here was a

关 键 词：冠状动脉狭窄 胸痹 益气补肾 活血化痰清热 名医经验 

分 类 号：R249[医药卫生—中医临床基础]