朱宗元教授心系疾病学术思想继承及治疗气虚血瘀型冠心病慢性心衰临床研究
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摘要
恩师朱宗元教授,为国家级名老中医专家。1962年毕业于上海中医学院后,作为首批支援边疆少数民族地区的医学事业的知识分子,来到内蒙古医学院中蒙医系,从事教学和临床工作,
老师在长期临床实践中精研经典,遵从古训,不断认真学习,刻苦钻研,在内科疾病,尤其是心脑血管疾病、脾胃病、骨关节病、肾脏病诊治方面积累了丰富经验。
本论文旨在全面总结老师在心系疾病方面的学术思想及临床经验,挖掘老师学术思想的渊源。本论文主要分为三部分：
第一部分朱宗元老师学术渊源概述
朱宗元教授熟读经典著作,尤其推崇经典《内经》,《伤寒论》,《温热论》,《脾胃论》,朱老临证应用的方药多源于古典医著,但他师古而不拘经,在临床中,朱老师对这些医家的理论思想、方药多能融会贯通。
1.根据《内经》“心主火”、心为人身之主宰而立论,故认为人身之阳气以心火为根本,治疗心系疾病宜温补阳气。根据《难经》“命门者,诸神精之所舍,原气之所系也……”的理论,及“命门”的水火为五脏六腑阴阳之根本、肾藏真阳助心火的理论,提出治疗心系疾病宜补肾壮阳以助心阳。
2.根据《内经》“心生血”、《灵枢·决气》“中焦受气取汁,同化而赤,是谓血。”之说,及李东垣《脾胃论》“脾胃内伤,百病由生”,注重培土补中,重视补肾固本治法的应用,体现出补益先、后天的学术思想。
3.叶氏云：“久病必入络”。络病的治疗大法：“通血脉,攻坚垒,佐以辛香行气,是络病大旨。”朱老提出活血化瘀之法治疗心系疾病。
第二部分朱宗元老师学术思想与临床经验总结
1学术思想
1.1重视传统中医医籍的学习
认为经典是中医学习的基础,所谓“经典”,是指在某一学科领域内,在一定的时代,最重要的最具典范的著作。读经典才能够深刻领会各种学说思想,灵活运用理法方药。
1.2积极倡导现代中医
现代中医是在“经典中医”的基础上,用现代科学技术与人文哲学的手段和方法,来研究、提高、创新“经典中医学”。
1.3中医哲学思维
中医理论基本上是建立在古代哲学基础之上的,因此哲学思想对中医的影响是深远的。
2辨证论治特点
2.1辨证论治与辨病施治相结合
朱老在临床中灵活应用“病证结合”或“无证从病、无病从证”及“舍证从病、舍病从证”等取舍方法,沟通两者对疾病本质的认识,提高临床疗效。
2.2抓主症,注重问诊
主症是病机的集中体现,是疾病的最突出表现,也是医者需要迅速、及时解决的问题。故抓主症可以明确辨证思路。
2.3理论基础
2.3.1正虚为本,邪实为标
心系病证以心脏虚损(心气、心阳、心血、心阴)为本,其中强调心气、心阳不足。邪实,不外乎气滞、痰阻、血瘀,寒凝。
2.3.2病位在心,关联五脏
若脾胃虚弱,化源不足,无以养心,心脾两虚,或脾虚不运宗气不生,运血无力,瘀血内生,或饮食不节胃失和降,清气不升,浊气上逆蒙蔽心阳则发为心痹。
心主血脉而肝藏血,肝肾同源,精血互生又心肾相交,水火济济,以平为期,若肾阴虚,精不化血,心脉空虚,蜷缩挛急,或真阴不足,心火独亢,心肾不交则发。肝属木,木气冲和条达,不致遏郁,则血脉通畅,瘀血不生。
肺通调水道,肺气不利,水运失健,痰浊内生,痹阻胸阳,则发为胸痹、心悸。
3治疗用药特点治疗心系疾病,六点为要
3.1补益心气、温补阳气
病位在心,心主血,赖心气以推动,气血以流通为贵,心气不足,帅血无力,血行不畅而瘀血内生,“治病必求于本”,故朱老认为补益心气为治疗心系疾病的根本,心气又有赖于心阳的温煦,故温补阳气亦为治本之法。重视补益脾肾,体现出补益先、后天的学术思想。
3.2阴中求阳、阳中求阴
根据心为火脏,肾藏真阳助心火的理论,朱老强调补火之法,注重于温补肾阳,即补命门之火。根据阳中求阴、阴中求阳、阴阳相济、阳生阴长,用补骨脂加强桂枝的温通心阳之用。用麦冬、五味子滋阴,与党参相合,取生脉之意。3.3活血通脉、通络止痛
叶氏云：“久病必入络”。朱老师以为久病入络、勿忘化瘀,慢性疾患迁延日久,病邪深入,血络受病。通血脉,攻坚垒是治疗络病的主要方法,用药与一般的活血化瘀药有所不同,须借助于虫蚁之类。
3.4滋阴养血、养心安神
依据中医心主血,心阴虚不能潜纳心阳,心火独亢,心血虚不能充盈脉道,心脉失养,治宜滋阴养血、养心安神。
3.5衷中参西,中西结合
今天中医药的发展,决不能排斥利用现代化手段,而是要合理借助这些高科技手段的检查和实验方法,研究中医理论的科学性,合理评价中医临床疗效,但决不能以简单的西医认识来判断中医理论的对错。
3.6用药特色——精专量小,重点突出
经过长期的临床实践,研究观察,朱老认为治疗疾病重要的是对症用药,找对病根,药物配伍,而不是大剂量的药物堆砌,药量小既减轻了患者的经济负担,能够充分体现中医药治病“效、便、廉”的特点,获得较好的社会效益。
4病案赏析
4.1冠心病病案
4.2颈椎病病案
4.3心血管神经症病案
5经验总结
5.1冠心病心绞痛的临床证治以心脏Ⅰ号方为基础,随证加减。
5.2从颈椎论治心系病证的临床证治
颈椎是连接人体大脑与脏腑(心脏)、肢体的重要部位,也是气血循行的重要枢纽,一旦颈椎气血郁滞,脉络瘀阻,上不能充养脑窍,下不能养心神,故可以从颈椎论治。
5.3心血管神经症的临床证治
重视心肾两脏,强调气血、阴阳的调和、平衡。
6创新点
笔者在老师治疗心系疾病六要点基础上,采用兼以宣肃肺气法治疗冠心病慢性心衰,强调肺在心衰治疗的作用,选用桔梗宣发肺气、引药上行、兼以保肺,合葶苈大枣泻肺汤同用,并结合杏仁、苏子宣肃肺气,体现提壶揭盖的功效,更好的起到通调水道的作用
第三部分气虚血瘀型冠心病慢性心衰治疗的临床研究
目的：观察心衰汤治疗气虚血瘀型慢性心衰的临床疗效及安全性,探讨心衰汤治疗慢性心衰的作用机理,为指导临床用药提供可靠的理论依据。
方法：气虚血瘀型慢性心衰患者60例按随机对照法将患者随机分为两组,对照组30例采用西药常规治疗,治疗组30例在对照组的基础上加用心衰汤,疗程均为4周,观察治疗前后患者的心衰疗效,心功能分级,中医证候积分,中医证候单项疗效,六分钟步行试验,NT-proBNP。
结果：
心衰汤联合西医常规治疗能明显提高慢性心衰患者的临床疗效,与对照组比较有差异性(p<0.05)。
心衰汤联合西医常规治疗能明显改善慢性心衰患者的心功能分级,与对照组比较有差异性(p<0.05)。
心衰汤联合西医常规治疗能明显改善慢性心衰患者的中医证候积分,与对照组比较有差异性(p<0.05)。
心衰汤联合西医常规治疗能明显提高慢性心衰患者的中医证候单项疗效,在心悸、气短、胸痛、疲倦乏力、汗出等中医单项证候中与对照组比较有差异性(p<0.05),面肢浮肿两组无差异性(p>0.05)。
心衰汤联合西医常规治疗能明显降低慢性心衰患者的NT-proBNP与对照组比较有差异性(p<0.05)。
两组患者治疗后均无不良反应,说明心衰汤是安全有效的。
结论：心衰汤治疗气虚血瘀型慢性心衰患者疗效确切,能够明显改善患者的心衰疗效、临床症状。
My mentor Zhu Zongyuan, as the National Celebrated Traditional Chinese Medicine Expert. He graduated from ShangHai Trad it ional Chinese Medicine Col lege at1962. And he was one of the medical science Experts who support the Border and minor i ty, The first at that t ime. My mentor comes from Inner Mongol ia Medical College, Traditional Chinese medicine and Mongolian Department. And work for teaching and Clinical work. My mentor base the ancient experience. Assiduously study from the Cinical work, and have the Extensive experience in medical illness, especially, in the Cardiovascular and cerebrovascular diseases, Stomach diseases, arthropathy, nephropathy, he has Extensive experience in these fields.
This Paper Purpose on that comprehensive summary my mentor's academic thinking and clinical experience in the field of Cardiovascular disease and in-depth study my mentor's ideology.
My paper divided into two parts:
Part1Teacher Zhu Academic origin
Professor Zhu read classics, especially praise highly with,,,, the Prescription he used mostly rooted in the classics, but he didn't limited in those books, in clinic, professor Zhu brought the authors'theories and methods together and understand thoroughly.
1. Based on the theory "the heart fire " in the,and that heart master people's activity, we trust the Yang Qi of human body rooted in heart fire, so cure the heart diseases should warming Yang Qi. Besides, said,"Ming Men is the key base of energy and vitality." So we regard "Ming Men"as the basis of viscera, then we think cure the heart disease should warming the Yang Qi of kidney to improve the Yang Qi of heart.
2. Based on the theory "the heart makes blood " in the, said,"in Zhong Jiao where turns the Qi and other factors into red juice, it is called blood." And Lidongyuan'ssaid,"If the spleen and stomach hurts, every kinds of disease comes." Then we pay more attention on invigorating the spleen and stomach, at the same time, value the importance of invigorating kidney
3. Ye said," Chronic illness transforming to collaterals ". the Principle using of treatment for collaterals' disease is that "dredge the collateral, using the acrid drug, besides the drug of sweet flavor with warm nature".
Part2Summary professor Zhu' s academic thinking and clinical exper ience
1.Academic thinking
1.1Value studying on the ancient books of traditional Chinese medicine
Professor Zhu regards the classics as the basic of TCM studying, the classics is most important woks in its subject areas, which is the most typical in the special era. In the classics, we can learn a variety of theories and ideas, and the ways of using the medicines and drugs.
1.2Actively promote the Modern TCM
The Modern TCM is based on the "Classical Chinese medicine", with the way of Modern science and technology and Humanities and Philosophy to study, improve, Innovation the Classical Chinese medicine.
1.3Traditional Chinese Medicine and Philosophy thinks
Chinese medicine theory built on the basis of Ancient Phi losophy,so, Philosophy have a significant impact on the Traditional Chinese Medicine.
2. The characteristic of professor Zhu's treatment based on symptom' differentiation
2.1Combine the treatment based on symptoms'differentiation with the distinguishing of diseases.
Professor Zhu improves the clinical effect through the choice of combination of disease with symptoms, or without symptom take the disease, without disease take the symptom, and withdraw symptoms take the disease, withdraw the disease, take the symptoms.
2.2Grasp the main symptom, lay emphasis on inquiry
The main symptom is the embodiment of pathogenesis, and the most prominent manifestation of disease, so the doctors should solve it instantly. Grasping the main symptom makes dialectical thinking much more clear.
2.3Theoretical basis
2.3.1Weakness of body is fundamental, existence of pathogenic factors is the appearance.
The heart disease based on the deficiency of heart (heart Qi, heart Yang, heart Blood, heart Yin), especially the deficiency of the heart Qi and heart Yang. Existence of pathogenic factors, including stagnation of Qi, stagnation of phlegm, stasis of blood, coagulation of cold.
2.3.2The location of disease is the heart, but related with all the viscera
The deficiency of spleen and stomach, causing the lack of supplies of heart. The deficiency of spleen and heart, or the deficiency of spleen makes the Zong Qi weakness, extravasated blood occurs, or bad habits of dinning hurts the stomach, and the function of elevating refined substances and lowering turbid essence are also reduced, turbid essence deceive the hear Yang result in the heart disease.
Heart control the blood vessel, liver keep and store the blood, liver and kidney are isogeny, the Jing and blood promote and limit each other to keep balance. The deficiency of kidney Yin may leave the heart Yang's hyperfunction. Liver Qi should be free from obstructed, then the blood vessel can be clear, without extravasated blood. Lung Qi out of function will make more phlegm, blocking the chest Yang, cause the Xiong Bi and cardiopalmus.
3. Six characters of curing the heart disease
3.1Tonifying heart Qi, warming Yang Qi
The disease located in heart, heart master blood, heart Qi push it circulate in the vessel, the deficiency of heart Qi can cause extravasated blood,"treatment should seek in the basic reason", so professor Zhu regards tonifying heart Qi as the root of the coronary disease treatment. Heart Qi depends on heart Yang's warming, so warming Yang Qi also is the core treatment.
3.2Seek Yang in Yin, seek Yin in Yang
Basic on theory that heart is the fire viscera, and kidney store the real Yang to promote Heart fire, so professor Zhu emphasis on nourish the Fire, which means the Ming Men Fire. As the Yin and Yang can support each other, so he use Buguzhi to enhance the Guizhi's function of warming heart Yang. Using Maidong, Wuweizi nourish Yin, combine with Dangshen, aim to give birth the pulse.
3.3Invigorate the circulation of blood, dredge collaterals to analgesia.
Ye said," chronic illness transforming to collaterals." Professor Zhu thinks chronic pain transforming to collaterals, so remember removing blood stasis when treat the chronic disease, as the drugs, it's different from the usual, he uses such as pests and ant.
3.4Nourishing Yin and blood, tranquilizing by nourishing the heart
For heart master blood, the deficiency of heart Yin makes heart Yang sthenic, heart blood turns to deficient can't fill the blood vessel, which can't nourishing the heart vessel, we should nourishing Yin and blood, tranquilizing by nourishing the heart to treat this condition
3.5Combine the Traditional Chinese medicine with modern medicine
We should take advantage of the modern technologies, such as the experimental inspection methods, to study the scientificalness of Traditional Chinese medicine, do rational evaluation of Chinese medicine clinical curative effect, but mustn't judge the theory of traditional Chinese medicine correct or not just by the way of modern mendicine.
3.6Characteristic of drug using—little dose and effect concentration
Through a long term of clinical work, professor Zhu value the symptomatic treatment mostly, find the real reason, use the correct drug, not the big dose of many drug. In this way, reducing the economic burden of the patients, and save the precious drug resources, to obtain better social benefit.
4Medical Records Appreciation
4.1Coronary heart disease Medical Records
4.2Cervical spondylosis Medical Records
4.3Cardiovascular neurosis Medical Records
5Lessons Learned
5.1Clinical Treatment of angina pectoris
Used Heart I prescriptions is a foundation, according to the card-like addition and subtraction
5.2From the cervical spine on the treatment of Clinical Treatment of heart disease and syndrome
The cervical spine is connected to the human brain and viscera (heart), an important part of the limb, Is also an important hub of the blood through the line, once the cervical blood stagnation, the context of stasis, not sufficient to support the brain awakened, can not be raised mind, it is treatment of from the cervical spine.
5.3Clinical Treatment of cardiovascular neurosis
Heart and kidney is very important, emphasizing the Qi and Blood, Yin and Yang is harmony and balance.
6Innovation
The author in teacher's treatment of heart disease in six points on the basis of Xuan Su lung treatment of coronary heart disease with chronic heart failure, and stressed the role of the lung in the treatment of heart failure, the choice of the lung of the Campanulaceae declared, cited drug uplink of Paul lung, the co Tinglizi jujube Xiefei soup, combined with almonds, Suzi Xuan Su lung, reflecting the effect of mentioning pot Uncovery better play the role of the water passage.
Part3Qi deficiency and Blood Stasis of Chronic heart failure treatment and Clinical Study
Purposes:Observation of Xinshuai decoction Qi deficiency and Blood Stasis treatment of chronic heart failure clinical efficacay and safety to explore the treatment of cardiac xinshuai decoctionof chronic heart failure, clinical use as a guide to provide a reliable theoretical basis.
Materials and method:Qi deficiency and blood stasis in patients with chronic heart failure randomized controlled by60cases of law were randomly divided into two groups, control group (30cases) the use of conventional western medicine treatment, the treatment group (30cases) in the control group based on the use of xinshuai decoction,4weeks of treatment. Observed before and after treatment efficacy in patients with heart failure, cardiac function, TCM Syndrome points, single effect of TCM Syndrome, Six minute walking test.
Results:
Xinshuai decoction conventional Western medicine combined therapy can significantly improve the clinical efficacy in patients with heart failure, compared with the control group were different (p<0.05);
Xinshuai decoction conventional Western medicine combined therapy can significantly improve cardiac function in patients with heart failure classification, compared with the control group were different (p<0.05) Xinshuai decoction joint conventional Western medicine can significantly improve the scores of Chinese medicine in patients with heart failure syndrome effects, compared with the control group were different (p<0.05); Xinshuai decoction joint conventional Western medicine can significantly improve the treatment of heart palpitations, shortness of breath, chest tightness, fatigue syndrome sweating, TCM individual syndromes compared with the control group have differences(p<0.05), surface floating limb swelling two groups had no difference (p>0.05).
Xinshuai decoction joint conventional Western medicine can significantly reduce the chronic heart failure patients with NT-proBNP(p<0.05) has the difference. Two groups of patients group were no adverse reactions after treatment on cardiac Xinshuai decoction of toxic side effects on the human body did not, is safe and effective.
Conclusion:The treatment of cardiac Xinshuai decoction deficiency and blood stasis in patients with chronic heart failure is effective and can significantly improve the efficacy in patients with heart failure, clinical symptoms and quality of life.
5.The Innovation:
Besides the upper six points, the writer put forward that descending the lung Qi to cure the coronary heart disease and chronic heart failure.
老师在长期临床实践中精研经典,遵从古训,不断认真学习,刻苦钻研,在内科疾病,尤其是心脑血管疾病、脾胃病、骨关节病、肾脏病诊治方面积累了丰富经验。
本论文旨在全面总结老师在心系疾病方面的学术思想及临床经验,挖掘老师学术思想的渊源。本论文主要分为三部分：
第一部分朱宗元老师学术渊源概述
朱宗元教授熟读经典著作,尤其推崇经典《内经》,《伤寒论》,《温热论》,《脾胃论》,朱老临证应用的方药多源于古典医著,但他师古而不拘经,在临床中,朱老师对这些医家的理论思想、方药多能融会贯通。
1.根据《内经》“心主火”、心为人身之主宰而立论,故认为人身之阳气以心火为根本,治疗心系疾病宜温补阳气。根据《难经》“命门者,诸神精之所舍,原气之所系也……”的理论,及“命门”的水火为五脏六腑阴阳之根本、肾藏真阳助心火的理论,提出治疗心系疾病宜补肾壮阳以助心阳。
2.根据《内经》“心生血”、《灵枢·决气》“中焦受气取汁,同化而赤,是谓血。”之说,及李东垣《脾胃论》“脾胃内伤,百病由生”,注重培土补中,重视补肾固本治法的应用,体现出补益先、后天的学术思想。
3.叶氏云：“久病必入络”。络病的治疗大法：“通血脉,攻坚垒,佐以辛香行气,是络病大旨。”朱老提出活血化瘀之法治疗心系疾病。
第二部分朱宗元老师学术思想与临床经验总结
1学术思想
1.1重视传统中医医籍的学习
认为经典是中医学习的基础,所谓“经典”,是指在某一学科领域内,在一定的时代,最重要的最具典范的著作。读经典才能够深刻领会各种学说思想,灵活运用理法方药。
1.2积极倡导现代中医
现代中医是在“经典中医”的基础上,用现代科学技术与人文哲学的手段和方法,来研究、提高、创新“经典中医学”。
1.3中医哲学思维
中医理论基本上是建立在古代哲学基础之上的,因此哲学思想对中医的影响是深远的。
2辨证论治特点
2.1辨证论治与辨病施治相结合
朱老在临床中灵活应用“病证结合”或“无证从病、无病从证”及“舍证从病、舍病从证”等取舍方法,沟通两者对疾病本质的认识,提高临床疗效。
2.2抓主症,注重问诊
主症是病机的集中体现,是疾病的最突出表现,也是医者需要迅速、及时解决的问题。故抓主症可以明确辨证思路。
2.3理论基础
2.3.1正虚为本,邪实为标
心系病证以心脏虚损(心气、心阳、心血、心阴)为本,其中强调心气、心阳不足。邪实,不外乎气滞、痰阻、血瘀,寒凝。
2.3.2病位在心,关联五脏
若脾胃虚弱,化源不足,无以养心,心脾两虚,或脾虚不运宗气不生,运血无力,瘀血内生,或饮食不节胃失和降,清气不升,浊气上逆蒙蔽心阳则发为心痹。
心主血脉而肝藏血,肝肾同源,精血互生又心肾相交,水火济济,以平为期,若肾阴虚,精不化血,心脉空虚,蜷缩挛急,或真阴不足,心火独亢,心肾不交则发。肝属木,木气冲和条达,不致遏郁,则血脉通畅,瘀血不生。
肺通调水道,肺气不利,水运失健,痰浊内生,痹阻胸阳,则发为胸痹、心悸。
3治疗用药特点治疗心系疾病,六点为要
3.1补益心气、温补阳气
病位在心,心主血,赖心气以推动,气血以流通为贵,心气不足,帅血无力,血行不畅而瘀血内生,“治病必求于本”,故朱老认为补益心气为治疗心系疾病的根本,心气又有赖于心阳的温煦,故温补阳气亦为治本之法。重视补益脾肾,体现出补益先、后天的学术思想。
3.2阴中求阳、阳中求阴
根据心为火脏,肾藏真阳助心火的理论,朱老强调补火之法,注重于温补肾阳,即补命门之火。根据阳中求阴、阴中求阳、阴阳相济、阳生阴长,用补骨脂加强桂枝的温通心阳之用。用麦冬、五味子滋阴,与党参相合,取生脉之意。3.3活血通脉、通络止痛
叶氏云：“久病必入络”。朱老师以为久病入络、勿忘化瘀,慢性疾患迁延日久,病邪深入,血络受病。通血脉,攻坚垒是治疗络病的主要方法,用药与一般的活血化瘀药有所不同,须借助于虫蚁之类。
3.4滋阴养血、养心安神
依据中医心主血,心阴虚不能潜纳心阳,心火独亢,心血虚不能充盈脉道,心脉失养,治宜滋阴养血、养心安神。
3.5衷中参西,中西结合
今天中医药的发展,决不能排斥利用现代化手段,而是要合理借助这些高科技手段的检查和实验方法,研究中医理论的科学性,合理评价中医临床疗效,但决不能以简单的西医认识来判断中医理论的对错。
3.6用药特色——精专量小,重点突出
经过长期的临床实践,研究观察,朱老认为治疗疾病重要的是对症用药,找对病根,药物配伍,而不是大剂量的药物堆砌,药量小既减轻了患者的经济负担,能够充分体现中医药治病“效、便、廉”的特点,获得较好的社会效益。
4病案赏析
4.1冠心病病案
4.2颈椎病病案
4.3心血管神经症病案
5经验总结
5.1冠心病心绞痛的临床证治以心脏Ⅰ号方为基础,随证加减。
5.2从颈椎论治心系病证的临床证治
颈椎是连接人体大脑与脏腑(心脏)、肢体的重要部位,也是气血循行的重要枢纽,一旦颈椎气血郁滞,脉络瘀阻,上不能充养脑窍,下不能养心神,故可以从颈椎论治。
5.3心血管神经症的临床证治
重视心肾两脏,强调气血、阴阳的调和、平衡。
6创新点
笔者在老师治疗心系疾病六要点基础上,采用兼以宣肃肺气法治疗冠心病慢性心衰,强调肺在心衰治疗的作用,选用桔梗宣发肺气、引药上行、兼以保肺,合葶苈大枣泻肺汤同用,并结合杏仁、苏子宣肃肺气,体现提壶揭盖的功效,更好的起到通调水道的作用
第三部分气虚血瘀型冠心病慢性心衰治疗的临床研究
目的：观察心衰汤治疗气虚血瘀型慢性心衰的临床疗效及安全性,探讨心衰汤治疗慢性心衰的作用机理,为指导临床用药提供可靠的理论依据。
方法：气虚血瘀型慢性心衰患者60例按随机对照法将患者随机分为两组,对照组30例采用西药常规治疗,治疗组30例在对照组的基础上加用心衰汤,疗程均为4周,观察治疗前后患者的心衰疗效,心功能分级,中医证候积分,中医证候单项疗效,六分钟步行试验,NT-proBNP。
结果：
心衰汤联合西医常规治疗能明显提高慢性心衰患者的临床疗效,与对照组比较有差异性(p<0.05)。
心衰汤联合西医常规治疗能明显改善慢性心衰患者的心功能分级,与对照组比较有差异性(p<0.05)。
心衰汤联合西医常规治疗能明显改善慢性心衰患者的中医证候积分,与对照组比较有差异性(p<0.05)。
心衰汤联合西医常规治疗能明显提高慢性心衰患者的中医证候单项疗效,在心悸、气短、胸痛、疲倦乏力、汗出等中医单项证候中与对照组比较有差异性(p<0.05),面肢浮肿两组无差异性(p>0.05)。
心衰汤联合西医常规治疗能明显降低慢性心衰患者的NT-proBNP与对照组比较有差异性(p<0.05)。
两组患者治疗后均无不良反应,说明心衰汤是安全有效的。
结论：心衰汤治疗气虚血瘀型慢性心衰患者疗效确切,能够明显改善患者的心衰疗效、临床症状。
My mentor Zhu Zongyuan, as the National Celebrated Traditional Chinese Medicine Expert. He graduated from ShangHai Trad it ional Chinese Medicine Col lege at1962. And he was one of the medical science Experts who support the Border and minor i ty, The first at that t ime. My mentor comes from Inner Mongol ia Medical College, Traditional Chinese medicine and Mongolian Department. And work for teaching and Clinical work. My mentor base the ancient experience. Assiduously study from the Cinical work, and have the Extensive experience in medical illness, especially, in the Cardiovascular and cerebrovascular diseases, Stomach diseases, arthropathy, nephropathy, he has Extensive experience in these fields.
This Paper Purpose on that comprehensive summary my mentor's academic thinking and clinical experience in the field of Cardiovascular disease and in-depth study my mentor's ideology.
My paper divided into two parts:
Part1Teacher Zhu Academic origin
Professor Zhu read classics, especially praise highly with
1. Based on the theory "the heart fire " in the
2. Based on the theory "the heart makes blood " in the
3. Ye said," Chronic illness transforming to collaterals ". the Principle using of treatment for collaterals' disease is that "dredge the collateral, using the acrid drug, besides the drug of sweet flavor with warm nature".
Part2Summary professor Zhu' s academic thinking and clinical exper ience
1.Academic thinking
1.1Value studying on the ancient books of traditional Chinese medicine
Professor Zhu regards the classics as the basic of TCM studying, the classics is most important woks in its subject areas, which is the most typical in the special era. In the classics, we can learn a variety of theories and ideas, and the ways of using the medicines and drugs.
1.2Actively promote the Modern TCM
The Modern TCM is based on the "Classical Chinese medicine", with the way of Modern science and technology and Humanities and Philosophy to study, improve, Innovation the Classical Chinese medicine.
1.3Traditional Chinese Medicine and Philosophy thinks
Chinese medicine theory built on the basis of Ancient Phi losophy,so, Philosophy have a significant impact on the Traditional Chinese Medicine.
2. The characteristic of professor Zhu's treatment based on symptom' differentiation
2.1Combine the treatment based on symptoms'differentiation with the distinguishing of diseases.
Professor Zhu improves the clinical effect through the choice of combination of disease with symptoms, or without symptom take the disease, without disease take the symptom, and withdraw symptoms take the disease, withdraw the disease, take the symptoms.
2.2Grasp the main symptom, lay emphasis on inquiry
The main symptom is the embodiment of pathogenesis, and the most prominent manifestation of disease, so the doctors should solve it instantly. Grasping the main symptom makes dialectical thinking much more clear.
2.3Theoretical basis
2.3.1Weakness of body is fundamental, existence of pathogenic factors is the appearance.
The heart disease based on the deficiency of heart (heart Qi, heart Yang, heart Blood, heart Yin), especially the deficiency of the heart Qi and heart Yang. Existence of pathogenic factors, including stagnation of Qi, stagnation of phlegm, stasis of blood, coagulation of cold.
2.3.2The location of disease is the heart, but related with all the viscera
The deficiency of spleen and stomach, causing the lack of supplies of heart. The deficiency of spleen and heart, or the deficiency of spleen makes the Zong Qi weakness, extravasated blood occurs, or bad habits of dinning hurts the stomach, and the function of elevating refined substances and lowering turbid essence are also reduced, turbid essence deceive the hear Yang result in the heart disease.
Heart control the blood vessel, liver keep and store the blood, liver and kidney are isogeny, the Jing and blood promote and limit each other to keep balance. The deficiency of kidney Yin may leave the heart Yang's hyperfunction. Liver Qi should be free from obstructed, then the blood vessel can be clear, without extravasated blood. Lung Qi out of function will make more phlegm, blocking the chest Yang, cause the Xiong Bi and cardiopalmus.
3. Six characters of curing the heart disease
3.1Tonifying heart Qi, warming Yang Qi
The disease located in heart, heart master blood, heart Qi push it circulate in the vessel, the deficiency of heart Qi can cause extravasated blood,"treatment should seek in the basic reason", so professor Zhu regards tonifying heart Qi as the root of the coronary disease treatment. Heart Qi depends on heart Yang's warming, so warming Yang Qi also is the core treatment.
3.2Seek Yang in Yin, seek Yin in Yang
Basic on theory that heart is the fire viscera, and kidney store the real Yang to promote Heart fire, so professor Zhu emphasis on nourish the Fire, which means the Ming Men Fire. As the Yin and Yang can support each other, so he use Buguzhi to enhance the Guizhi's function of warming heart Yang. Using Maidong, Wuweizi nourish Yin, combine with Dangshen, aim to give birth the pulse.
3.3Invigorate the circulation of blood, dredge collaterals to analgesia.
Ye said," chronic illness transforming to collaterals." Professor Zhu thinks chronic pain transforming to collaterals, so remember removing blood stasis when treat the chronic disease, as the drugs, it's different from the usual, he uses such as pests and ant.
3.4Nourishing Yin and blood, tranquilizing by nourishing the heart
For heart master blood, the deficiency of heart Yin makes heart Yang sthenic, heart blood turns to deficient can't fill the blood vessel, which can't nourishing the heart vessel, we should nourishing Yin and blood, tranquilizing by nourishing the heart to treat this condition
3.5Combine the Traditional Chinese medicine with modern medicine
We should take advantage of the modern technologies, such as the experimental inspection methods, to study the scientificalness of Traditional Chinese medicine, do rational evaluation of Chinese medicine clinical curative effect, but mustn't judge the theory of traditional Chinese medicine correct or not just by the way of modern mendicine.
3.6Characteristic of drug using—little dose and effect concentration
Through a long term of clinical work, professor Zhu value the symptomatic treatment mostly, find the real reason, use the correct drug, not the big dose of many drug. In this way, reducing the economic burden of the patients, and save the precious drug resources, to obtain better social benefit.
4Medical Records Appreciation
4.1Coronary heart disease Medical Records
4.2Cervical spondylosis Medical Records
4.3Cardiovascular neurosis Medical Records
5Lessons Learned
5.1Clinical Treatment of angina pectoris
Used Heart I prescriptions is a foundation, according to the card-like addition and subtraction
5.2From the cervical spine on the treatment of Clinical Treatment of heart disease and syndrome
The cervical spine is connected to the human brain and viscera (heart), an important part of the limb, Is also an important hub of the blood through the line, once the cervical blood stagnation, the context of stasis, not sufficient to support the brain awakened, can not be raised mind, it is treatment of from the cervical spine.
5.3Clinical Treatment of cardiovascular neurosis
Heart and kidney is very important, emphasizing the Qi and Blood, Yin and Yang is harmony and balance.
6Innovation
The author in teacher's treatment of heart disease in six points on the basis of Xuan Su lung treatment of coronary heart disease with chronic heart failure, and stressed the role of the lung in the treatment of heart failure, the choice of the lung of the Campanulaceae declared, cited drug uplink of Paul lung, the co Tinglizi jujube Xiefei soup, combined with almonds, Suzi Xuan Su lung, reflecting the effect of mentioning pot Uncovery better play the role of the water passage.
Part3Qi deficiency and Blood Stasis of Chronic heart failure treatment and Clinical Study
Purposes:Observation of Xinshuai decoction Qi deficiency and Blood Stasis treatment of chronic heart failure clinical efficacay and safety to explore the treatment of cardiac xinshuai decoctionof chronic heart failure, clinical use as a guide to provide a reliable theoretical basis.
Materials and method:Qi deficiency and blood stasis in patients with chronic heart failure randomized controlled by60cases of law were randomly divided into two groups, control group (30cases) the use of conventional western medicine treatment, the treatment group (30cases) in the control group based on the use of xinshuai decoction,4weeks of treatment. Observed before and after treatment efficacy in patients with heart failure, cardiac function, TCM Syndrome points, single effect of TCM Syndrome, Six minute walking test.
Results:
Xinshuai decoction conventional Western medicine combined therapy can significantly improve the clinical efficacy in patients with heart failure, compared with the control group were different (p<0.05);
Xinshuai decoction conventional Western medicine combined therapy can significantly improve cardiac function in patients with heart failure classification, compared with the control group were different (p<0.05) Xinshuai decoction joint conventional Western medicine can significantly improve the scores of Chinese medicine in patients with heart failure syndrome effects, compared with the control group were different (p<0.05); Xinshuai decoction joint conventional Western medicine can significantly improve the treatment of heart palpitations, shortness of breath, chest tightness, fatigue syndrome sweating, TCM individual syndromes compared with the control group have differences(p<0.05), surface floating limb swelling two groups had no difference (p>0.05).
Xinshuai decoction joint conventional Western medicine can significantly reduce the chronic heart failure patients with NT-proBNP(p<0.05) has the difference. Two groups of patients group were no adverse reactions after treatment on cardiac Xinshuai decoction of toxic side effects on the human body did not, is safe and effective.
Conclusion:The treatment of cardiac Xinshuai decoction deficiency and blood stasis in patients with chronic heart failure is effective and can significantly improve the efficacy in patients with heart failure, clinical symptoms and quality of life.
5.The Innovation:
Besides the upper six points, the writer put forward that descending the lung Qi to cure the coronary heart disease and chronic heart failure.
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