从脏腑气机升降论治胸痹  

Treatment of Chest Stuffiness and Pain from Perspective of Rise and Fall of Zang and Fu Qi Movement

作　　者：董增浩 冯利民[2] DONG Zenghao;FENG Limin(Tianjin University of Traditional Chinese Medicine,Tianjin China 301617;The Second Affiliated Hospital to Tianjin University of Traditional Chinese Medicine,Tianjin China 300250)

机构地区：[1]天津中医药大学,天津301617 [2]天津中医药大学第二附属医院,天津300250

出　　处：《中医学报》2024年第12期2538-2543,共6页Acta Chinese Medicine

基　　金：国家自然科学基金项目(81774016,82274237)。

摘　　要：气的升降出入运动称为气机,是人生命盛衰之根本。胸痹病位在心胸,并非只是心病,涉及多个脏腑,根本病因为诸脏腑功能失调导致心脉痹阻。心与脾胃、肝胆、肺、肾通过经络相连,若气机升降出入失常,脏腑功能失调,则出现气滞血瘀、寒饮凌心、痰浊内生、气血不荣、气血失和等征象,致使心脉失养或运行不畅,发为胸痹心痛。临证时若见肝郁气滞,应治以疏肝理气、和解少阳之柴胡类方;若见心肾不交,应治以交通心肾、水火既济之四逆汤、参附汤;若见脾虚生痰,应治以运化中州、豁痰宣痹之瓜蒌薤白半夏汤;若见心神失养,应治以补益脾胃、荣养心脉之人参养荣汤、生脉散;若见心血瘀阻,应治以补益心肺、行气活血之保元汤、丹参饮等。The movement of Qi in and out is called Qi Ji,which is the root of human life.Chest stuffiness and pain is in the heart and chest.It is not just heart disease,involving multiple Zang and Fu internal organs.The root cause of the disease is the dysfunction of the internal Zang and Fu organs,which leads to Heart meridian blocking.The Heart and the Spleen and Stomach,Liver and Gallbladder,Lung and Kidney are connected through the meridians,the elevation of the Qi in and out is in disorder leads to Zang and Fu dysfunction and then stagnation of Qi and blood stasis,cold Dampness injuring the Heart,Phlegm and Turbidity production,Qi and blood deficiency,Qi and blood disharmony,resulting in malnourishment of the Heart and the development of the chest stuffiness and pain.In clinical practice,for Liver depression and Qi stagnation syndrome,Chaihu kinds formula,which functions in dredging the Liver,regulating Qi and reconciling Shaoyang,should be used;for Heart-Kidney disharmony syndrome,Sini Decoction or Shenfu Decoction,which functions in communicating the Heart and Kidney,or balancing Water and Fire,should be used;for Spleen deficiency producing Phlegm syndrome,Gualou Xiebai Banxia Decoction,which functions in supporting the Middle Jiao and clearing Phlegm to remove stuffiness,should be used;for Heart and spirit malnourishment syndrome,Renshen Yangrong Decoction or Shengmai Powder,which functions in replenishing Spleen and Stomach,and nourishing the Heart meridian,should be used;for Heart blood stagnation syndrome,Baoyuan Decoction or Danshen Drink,which functions in replenishing Heart and Lungs to activate Qi and blood circulation,should be used.

关 键 词：胸痹 气机升降 脏腑气机 

分 类 号：R256.22[医药卫生—中医内科学]