吴焕林教授从“枢机开阖”辨治冠心病术后心绞痛经验  

Professor Wu Huanlin s Experience in Treating Postoperative Angina Pectoris of Coronary Heart Disease from the Perspective of‘Opening and Closing the Pivot’

作　　者：蒲瑞 李瑞菡 王茜 孙娇娇 胡晓蒙 吴焕林 PU Rui;LI Ruihan;WANG Qian;SUN Jiaojiao;HU Xiaomeng;WU Huanlin(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《中医药学报》2024年第12期47-51,共5页Acta Chinese Medicine and Pharmacology

基　　金：国家中医药管理局国际合作司中医药国际合作专项(0610-2040NF020928)。

摘　　要：冠心病术后心绞痛的基本病机为“本虚标实、阳微阴弦”。本虚为心之阴阳气血亏虚,标实为寒痰、血瘀等,加之术后耗伤气血,因虚致实或因实致虚,再添新瘀、新痰等;“阳微阴弦”即阳虚阴盛,上焦阳气衰微无以防御下焦阴邪上犯,阴浊邪气阻滞心脉。吴焕林教授临证时擅用理气调枢法,重视“枢机开阖”理论,提出枢机不利所致的脏腑气血津液失调是“本虚标实、阳微阴弦”重要成因之一,应调畅枢机开阖使气血津液流转畅通,从而使阴阳枢转、气血通运。具体治法为通阳理气、疏肝活血;补肾益心、交通心肾;健脾养心、运化水湿。调和三大枢机,协调阴阳,培植中州,调畅气血,虚实并治。并附验案1则以资佐证。The fundamental pathogenesis of postoperative angina pectoris in coronary heart disease is characterized by“root deficiency and superficiality excess,and yang being deficient while yin is excess.”Root deficiency refers to deficiency in heart yang and blood,while superficiality excess refers to the existence such factors as cold,phlegm,and blood stasis due to deficient root.Postoperatively,two conditions may occur,one is that healthy qi and blood has been consumed,leading to qi and blood deficiency,the other is that excess condition such factors as cold,phlegm,and blood stasis occurs due to the deficiency of healthy qi,or along with the addition of new stasis and phlegm.“Yang being deficient while yin is excess”refers to the decline of upper yang qi,leaving the lower yin pathogenic factors unopposed to invade the heart channels,resulting in stagnation of yin turbidity and pathogenic qi obstructing the heart channels.Professor Wu Huanlin is adept at using the method of regulating qi and adjusting the pivot,emphasizing the theory of“opening and closing the pivot.”He proposes that the imbalance of visceral qi,blood,and fluids caused by unfavorable pivot function is one of the important factors contributing to“root deficiency and superficiality excess,and yang being deficient while yin is excess.”The key approach is to regulate the pivot to facilitate the circulation of qi,blood,and fluids,thereby promoting the transformation of yin and yang and the smooth flow of qi and blood.Specific treatment methods include promoting yang and regulating qi,soothing the liver and activating blood,nourishing the kidney and heart,facilitating communication between the heart and kidney,fortifying the spleen and nourishing the heart,promoting the transformation of water and dampness,and harmonizing the three pivots to coordinate yin and yang,cultivate the center,regulate qi and blood,and treat deficiency and excess simultaneously.One case study is provided for illustration.

关 键 词：冠心病术后心绞痛 枢机开阖 针药联合 名医经验 吴焕林 

分 类 号：R249[医药卫生—中医临床基础]