从“气火湿瘀”四维辨治冠心病血运重建术后胸痛  

Differentiation and Treatment of Chest Pain after Revascularization of Coronary Heart Disease from Four Dimensions of“Qi,Fire,Dampness and Stasis”

作　　者：殷睿 王新东[1,2] YIN Rui;WANG Xindong(The Third Clinical Medical College,Nanjing University of Chinese Medicine,Nanjing 210028,China;Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China)

机构地区：[1]南京中医药大学第三临床医学院,江苏南京210028 [2]南京中医药大学附属中西医结合医院,江苏南京210028

出　　处：《南京中医药大学学报》2024年第11期1149-1154,共6页Journal of Nanjing University of Traditional Chinese Medicine

基　　金：江苏省中医药领军人才培养项目(SLJ0302);江苏省中医药研究院高质量研究成果后补助项目(HBZ202410);江苏省研究生科研与实践创新计划项目(SJCX24-1057)。

摘　　要：冠心病血运重建术后心脉虽通,然而金刃利器易耗伤气血、惊扰心神,加之脾肾已虚,“气火湿瘀”虚实错杂,导致术后依然胸痛频发。其中气血亏虚,心神惊扰,肝脾肾脏气失和是冠心病血运重建术后胸痛的证候基础;肝郁气结,气郁化火,心肾不交,阴虚火旺,心气亏虚,瘀阻脉络,脾肾阳虚,聚湿成痰,“气火湿瘀”虚实错杂为冠心病血运重建术后胸痛的核心病机。临证需详辨“气火湿瘀”证素和心肝脾肾脏腑之偏向,从证素和脏腑的四维视角提出清心补肾,镇潜安神,益气活血,祛瘀通络,健脾温肾,豁痰宣痹,疏肝养肝,理气宽胸的辨治思路,为冠心病血运重建术后胸痛的临床辨治提供理论依据。Although after the revascularization,heart blood vessel is unobstructed,the excessive use of surgical instruments can easily damage qi and blood,and disturb the mind;meanwhile,spleen and kidney are deficient.The combination of deficiency and excess in“qi,fire,dampness and stasis”leads to frequent chest pain after surgery.Qi and blood deficiency,heart spirit disturbance,and liver,spleen,and kidney qi disharmony are the symptom basis of chest pain after revascularization of coronary heart disease;liver qi stagnation,qi stagnation turning into fire,lack of heart-kidney interaction,yin deficiency and fire hyperactivity,heart qi deficiency,stasis obstructing the meridians,spleen and kidney yang deficiency,dampness accumulation turning into phlegm,and mixed“qi,fire,dampness and stasis”is the core pathogenesis of chest pain after revascularization of coronary heart disease.In clinical practice,it is necessary to distinguish the syndrome factors of qi,fire,dampness,and stasis and the deviation of the heart,liver,spleen,and kidney.From the perspective of the four dimensions of syndrome factors and viscera,the treatment ideas of clearing the heart and tonifying the kidney,calming the mind,replenishing qi and activating blood circulation,removing stasis and unblocking collaterals,strengthening the spleen and warming the kidney,removing phlegm and relieving obstruction,soothing the liver and nourishing the liver,regulating qi and improving chest stuffiness are proposed,which provides a theoretical basis for the clinical diagnosis and treatment of chest pain after revascularization of coronary heart disease.

关 键 词：冠心病 血运重建术后胸痛 胸痹心痛 气火湿瘀 

分 类 号：R242[医药卫生—中医临床基础]