基于重症病例及现代病理生理机制的胸痹虚证与人参汤方证内涵及其治疗冠心病、风心病、心力衰竭、低血压、肺动脉高压等急危重症体会  

Connotation of deficiency-induced chest impediment and Renshen Decoction based on severe cases and modern pathophysiological mechanisms and its application in treatment of coronary heart disease,rheumatic heart disease,heart failure,hypotension,pulmona

作　　者：熊兴江[1] XIONG Xing-jiang(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：《中国中药杂志》2025年第6期1706-1714,共9页China Journal of Chinese Materia Medica

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目——医疗机构制剂研发与新药转化专项(HLCMHPP2023081);临床科研一体化人才专项(CZ30981);京津冀基础研究合作专项(J230037);中国中医药科技发展中心(国家中医药管理局人才交流中心)联合攻关项目(CXZH202301)。

摘　　要：人参汤出自《金匮要略》,又名理中丸、理中汤,具有温中祛寒,补气健脾功效,主治脾胃虚寒证。临床运用理中丸、理中汤较多,而运用人参汤较少。临床多将该方用于胃溃疡、婴幼儿轮状病毒性腹泻、慢性肾炎、自身免疫性糖尿病、变态反应性鼻炎等治疗,而治疗冠心病心绞痛的报道不多。研究发现,在原文中,胸痹不仅包括冠心病,还包括冠脉微循环障碍、X综合征、冠脉肌桥、心肌病、心脏瓣膜病、心力衰竭、慢性阻塞性肺疾病、肺心病、肺动脉高压、低血压、心律失常等以胸闷为主要临床表现的疾病。人参汤以人参为名,而未提及“理中”,意其靶向并非以中焦为主,而是以元气亏虚、心脉虚脱为主。“胁下逆抢心”包括急性下壁心肌梗死合并胃肠道刺激,及以胸闷为主要临床表现的疾病合并缓慢性心律失常出现迷走神经兴奋、恶心呕吐。人参汤为胸痹虚证而设,相当于现代临床冠心病的并发症阶段,包括急性心肌梗死合并低血压、心源性休克、心力衰竭、缓慢性心律失常,这与同一条文中的枳实薤白桂枝汤所针对的胸痹实证不同。人参汤主治的胸痹,既包括心血管疾病急性期的急危重症阶段,也包括重大疾病的恢复期阶段。在病理生理机制上,人参汤证可能与缺血、心力衰竭、低血压、休克、心率慢等密切相关。在方证鉴别上,人参汤需与枳实薤白桂枝汤、柴胡加龙骨牡蛎汤相鉴别。人参汤是古代的“心三联”。Renshen Decoction is derived from the Synopsis of the Golden Chamber and is also known as Lizhong Pills or Lizhong Decoction,with the effects of warming the middle,dispelling cold,tonifying Qi,and strengthening the spleen,primarily treating spleen-stomach deficiency-cold syndrome.In modern clinical practice,Lizhong Pills and Lizhong Decoction are more frequently used,while Renshen Decoction is less common.Currently,this decoction is often applied in the treatment of gastric ulcers,infantile rotavirus diarrhea,chronic nephritis,autoimmune diabetes,allergic rhinitis,and other conditions,but reports on its use for coronary heart disease and angina pectoris are limited.Research has shown that in the original text,chest impediment(chest pain and stuffiness)includes not only coronary heart disease but also conditions such as coronary microcirculation disorders,X syndrome,coronary artery bridge,cardiomyopathy,heart valve disease,heart failure,chronic obstructive pulmonary disease,pulmonary heart disease,pulmonary arterial hypertension,hypotension,arrhythmia,and other diseases characterized by chest tightness.The name Renshen Decoction focuses on Panax ginseng without mentioning"Lizhong",indicating that its primary target is not the middle energizer but rather the deficiency of vital Qi and the collapse of the heart vessel."Qi counterflow from the hypochondrium and rushing up to chest"encompasses acute inferior myocardial infarction combined with gastrointestinal irritation,and diseases with chest tightness as the main clinical manifestation combined with slow arrhythmias associated with vagus nerve excitement,nausea,and vomiting.Renshen Decoction is formulated for the deficiency-induced chest impediment,corresponding to the complication stage of coronary heart disease in modern clinical practice,which includes acute myocardial infarction with hypotension,cardiogenic shock,heart failure,and bradyarrhythmia.This differs from the excess-induced chest impediment addressed by Zhishi Xiebai Guizhi Decoction in the same articl

关 键 词：人参汤 胸痹虚证 冠心病 心力衰竭 低血压 肺动脉高压 

分 类 号：R259[医药卫生—中西医结合]