史载祥学术思想及升陷祛瘀法治疗心血管疾病的理论及临床研究
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摘要
史载祥教授是第三、四批全国名老中医药专家学术经验继承工作指导老师,从事中西医结合临床四十余载,积累了丰富的临床经验,尤其擅长治疗心血管疾病、慢性肾脏病、糖尿病及其他疑难杂病。本文共分两部分,第一部分介绍了史载祥教授主要的学术思想和临床经验；第二部分就史载祥教授运用升陷祛瘀法治疗心血管疾病的学术思想,分别从理论渊源、理论研究及临床研究等方面进行了深入地探讨。
第一部分首先介绍了史载祥教授主要的学术思想。包括：1.阐发血瘀证及活血化瘀理论史载祥教授将血瘀证形成的病机概括为“内结之血”、“离经之血”、“污秽之血”三个方面,进一步丰富和发展了血瘀证的病机理论,拓展了血瘀证的范围。他认为“瘀血”是许多疾病共同的病理因素,活血化瘀在许多疑难病、慢性病治疗中发挥重要作用。他根据血瘀证形成的病因及兼并症,制定不同的治法方药,如：散寒化瘀法、清热化瘀法、行气化瘀法、益气化瘀法、养血化瘀法、止血化瘀法、祛痰化瘀法、软坚化瘀法等。他根据药物来源、作用强度、临床应用等将活血化瘀药物进行了分类,对于我们临床正确选用活血化瘀药物具有一定的指导作用。2.强调气、血、水相关史载祥教授认为气、血、水三者在生理上互相转化,共同维持脏腑正常的功能活动；在病理上互相影响,是脏腑功能失调及疾病发生、发展的内在根源。气血水在一定程度上反映了疾病的发展演变规律。在气、血、水三者的关系中,气具有主导地位。治疗上强调气血水同治。3.奇经八脉辨治疾病史载祥教授认为奇经辨证是中医辨证体系的重要组成部分,尤其是在某些慢性疑难病的诊治中发挥重要的作用。他在临床上运用奇经辨证时常从以下几方面入手：(1)从奇经循行部位(2)从奇经所主病证(3)结合其他辨证方法。在奇经病的治法上,继承了叶天士的“通补”之法,以补益肝、填补下焦为主,常用血肉有情之品。临床应用具体体现在从督脉论治脑、脊柱病变,从冲任论治妇科疾病,从阴维论治心痛等。4.擅长运用经方史载祥教授擅长运用经方治疗现代医学的疑难危重疾病,他在临床上应用经方有以下的特点：(1)抓主症,但见一证便是(2)析病机,拓展应用范围(3)重化裁,提高临床疗效(4)融中西,密切结合现代医学。5.用药灵活变通他认为中药的剂量应该根据具体病情制定,该大则大,该小则小。他对于某些峻烈、毒性的药物使用颇有心得,使用峻烈药物时注重炮制、用法及用量,强调中病即止。注重外用药,以提高临床疗效。6.提倡病证结合他既重视中医辨证,也重视西医诊断,强调病证结合,才能抓住疾病的本质,提高临床疗效。临床上要找出中医药治疗的切入点,体现中医药多层面、多靶点的整体治疗优势,充分展示中医药的独特疗效。
其次总结了史载祥教授的主要临床经验。初步总结了史载祥教授治疗心血管疾病、糖尿病及慢性肾脏病的临床经验。1.冠心病冠心病心绞痛的病机主要分为虚实两方面：一是“不通则痛”,为胸中大气下陷,不能推动气血津液运行,痰浊瘀血痹阻心脉所致；二是“不荣则痛”,为肾中阴阳两虚,不能温养奇经八脉,血不养心所致。治疗上强调标本缓急,不稳定型心绞痛以祛邪为主,治以辛香温通,豁痰祛瘀。稳定型心绞痛以扶正与祛邪兼顾,治以益气升陷,活血祛瘀,或温补阴阳,调其奇经。2.慢性心力衰竭慢性心衰的病机初期以心气不足,大气下陷为主,后期以肾阳虚衰,水湿泛滥为主,瘀血贯穿了慢性心衰整个的病理过程。治疗上强调分期论治,初期益气升陷,活血祛瘀；晚期温补肾阳,活血利水；并善于阴中求阳、活血利水。3.高血压高血压病主要的病机是肝旺痰阻,治疗以平肝潜阳,化痰熄风为主。某些特殊类型的高血压,如更年期高血压、妊娠高血压等,又有阴阳两虚、脾虚湿阻等不同的病机特点。强调以中西医结合的方法治疗高血压病,各取所长,以提高疗效。4.快速性心律失常本病病位在心,与肝、脾、肾功能失调密切相关。在病机上有虚实两端,虚有气虚、肾虚,实有痰热、瘀血,治疗上既强调辨证论治,又注意结合现代药理研究成果。5.缓慢性心律失常病机有虚实两端,虚则有气虚、阳虚,实则有瘀血、痰浊等。治疗上当攻补兼施,主要治以益气升陷,补肾助阳,化痰祛瘀之法。6.病毒性心肌炎本病病因是外感温热或风热时邪,侵袭心肺,耗伤气阴,日久引起胸中大气下陷,导致瘀血、水湿内生。治疗以益气升陷,活血解毒为主。7.糖尿病糖尿病的基本证型已经发生了变化,气阴两虚、瘀血阻络是糖尿病及并发症的基本病机。自拟益气养阴,活血通络的愈消方以治疗糖尿病及糖尿病并发症。8.失眠总因阳盛阴虚,阳不入阴,心神被扰所致。实证多从痰热、心火论治,虚证多从阴阳两虚论治,久病多从瘀血论治。9.慢性肾小球肾炎病机以邪实为主,正虚为次,多为因实致虚。湿热蕴结下焦,瘀热内结是其主要的病理基础。治疗上主张清热利湿,凉血活血为主。10.慢性肾衰竭本病属本虚标实,本虚为脾肾阳虚,标实为湿、毒、瘀,治疗上以温补脾肾,利湿泄浊祛瘀为主,常以温脾汤合真武汤加味治疗。均附典型病案。
第二部分首先综述了大气理论的历史渊流及“升陷汤”在心血管疾病的临床应用。大气最早见于《黄帝内经》。张仲景在继承《内经》大气理论的基础上,首次将大气理论运用到临床实践。清代喻嘉言对大气理论有了进一步地阐释和发挥。清末民初张锡纯结合自己的临床体会,对大气的生理、病理及证治进行了系统的论述,使大气理论进一步完善。大气发生于先天肾中之元气,培养于后天水谷之气,积贮于胸膺空旷之府,相通于自然界之清气。大气的生理作用归纳起来有以下几方面：(一)走息道以司呼吸。(二)贯心脉以行气血。(三)统摄全身气机。大气的病变概括起来分为大气痹阻、大气上逆和大气下陷三种。治疗上分别以转大气、降大气、升大气为主。另外,对升补大气的代表方剂“升陷汤”在现代心血管疾病的临床应用进行了综述。
其次探讨了心血管疾病气陷血瘀病机的理论基础。史载祥教授根据心血管疾病的证候特点,并受张锡纯《医学衷中参西录》中大气下陷理论的启发,结合中医气血理论及升降理论,提出了心血管疾病“气陷血瘀”的共同病机特点。试述了气陷与气虚的异同,气陷与血瘀的关系。从大气及大气下陷的现代医学本质研究中提示,大气下陷与现代医学心肺功能不全密切相关,大气下陷证是多种心血管疾病中常见的证型之一。并阐释了气陷血瘀病机在不同心血管疾病中的作用。
最后观察了升解通瘀颗粒治疗冠心病心绞痛的临床疗效。目的：观察升解通瘀颗粒治疗冠心病心绞痛的临床疗效和安全性。方法：将108例冠心病心绞痛气陷血瘀证患者随机分为治疗组(56例)和对照组(52例),治疗组给予升解通瘀颗粒治疗,对照组给予通心络胶囊治疗,疗程均为4周。观察心绞痛疗效、心电图、中医证候改善情况、血脂及安全性指标。结果：治疗后两组心绞痛积分、中医证候积分均有显著的改善(P<0.01),但组间差异无统计学意义(P>0.05)。治疗组心绞痛总有效率(83.92%)优于对照组(73.08%),但差异无统计学意义(P>0.05)。治疗组中医证候总有效率(82.14%)优于对照组(59.62%),差异有统计学意义(P<0.05)。治疗组治疗后HDL-C与治疗前比较升高,差异有统计学意义(P<0.01),结论：升解通瘀颗粒能够有效地改善冠心病心绞痛患者的临床症状,具有与通心络相当的疗效。并在改善中医证候方面,明显优于通心络。同时,升解通瘀颗粒还能升高HDL-C,改善冠心病患者的血脂代谢异常。升解通瘀颗粒治疗冠心病心绞痛安全有效。
通过继承、挖掘、整理名老中医专家的学术思想及临床经验,从中提炼出新的理论与学说,是中医学术继承与发展的关键。只有这样,才能使中医药理论不断深化和完善,才能更加符合现代临床实际的要求。
Professor Shi Zai-xiang is one of the mentors of the third and fourth generation for training qualified Traditional Chinese Medicine (TCM) doctors to carry on the experience of national well-known and senior TCM experts. With more than forty years of clinical practice in integrated TCM and Western medicine, he is an experienced physician, specialized in treating cardiovascular diseases, chronic kidney diseases, diabetes as well as other various kinds of complicated diseases. This thesis is composed of two chapters. The first chapter provides an introduction to Professor Shi Zai-xiang's primary academic thoughts and clinical experience. From the perspectives of theoretical origin and investigation, clinical studies, etc. the second chapter probes into his theories of "filling up qi collapse and removing blood stasis" for the treatment of cardiovascular diseases.
The first chapter begins with an introduction to main academic thoughts of Professor Shi Zai-xiang, which is summarized as follows.1. Elucidating the theory of promoting blood circulation to remove blood stasis. Professor Shi Zai-xiang encapsulated the pathogenesis of the blood-stasis syndrome into three aspects, i.e."stagnation of circulation","blood leaving the channel " and "filthy blood", which further enriched and developed the pathogenesis theories of the blood-stasis syndrome and expanded the scope of this syndrome. He argued that "blood stasis" is a common pathological factor of many diseases and thereby promoting blood circulation to remove blood stasis plays an important role in treating many difficult, complicated and chronic diseases. According to the causes of the blood-stasis syndrome and its complications, he developed different therapeutic formulas to remove blood stasis, such as dispersing coldness, clearing heat, activating qi, benefiting qi, nourishing blood, stopping bleeding, eliminating phlegm, resolving masses, etc. He classified medicines for promoting blood circulation to remove blood stasis according to their sources, intensity, and clinical applications and this classification serves as guiding principles for drug selection in clinical practice.2. Emphasizing the correlation of qi, blood and water. Professor Shi Zai-xiang proposed that qi, blood and water transform into each other in the physiological condition and jointly contribute to maintain normal functions of organs. In the pathological condition, their interaction may serve as the internal causes for organ dysfunction and occurrence and development of diseases. To some extent, the three materials reflect the law of disease development and prognosis. Of the three materials, qi takes the leading role. The treatment should target at these materials together.3. Using eight extraordinary channels for diagnosis and treatment. Professor Shi Zai-xiang proposed that using extraordinary channels for differentiation of symptoms is an important component of TCM, which plays an especially significant role in diagnosis and treatment of some chronic, difficult and complicated diseases. When adopting extraordinary channels for symptom differentiation, he often began with:(1) the running course of the channels,(2) the syndromes governed by the channels and (3) in combination of other approaches of symptom differentiation. In treating the diseases governed by extraordinary channels, he carried on Ye Tianshi's therapy of "overall supplementing" and prescribed medications taken from creatures having blood and flesh, aiming predominantly at invigorating liver and filling up lower jiao. The application of these theories in clinical practice is presented as treating cerebral and spinal diseases from the governor channel, treating gynecological diseases from conception and chong channels, and treating cardiodynia from the yin link channel.4. Excelling at prescribing classical formulae. Professor Shi Zai-xiang was proficient at prescribing classical formulae for the treatment of modern difficult, complicated and severe diseases. He demonstrated the following characteristics when using classical formulae:(1) identifying the exclusively core symptom;(2) analyzing the causes of diseases and expanding the scope of using classical formulae;(3) stressing symptom differentiation to improve clinical efficacy;(4) combining TCM and Western medicine and closely integrating modern and traditional medicines.5. Making appropriate adaptations when necessary. He held that the dose of TCM should depend on and vary with disease conditions. He had rich experience in urgent prescriptions and toxic drugs. For urgent prescriptions, special attention should be paid to drug processing, usage and dose and the medication should be stopped as soon as the symptoms are gone. Drugs for external use are emphasized as well to improve treatment efficacy.6. Advocating the integration of TCM and Western medicine. He argued that scientific and technological achievements of modern medicine must be taken full use of to support TCM inheritance and development. One should be good at seeking for the situations where TCM can be used for treatment, so as to demonstrate the overall TCM advantages of multi-layer and multi-target treatment and its distinctive effects.
Then, Professor Shi Zai-xiang's primary clinical experience in treating cardiovascular diseases, diabetes and chronic kidney diseases are summarized.1. Coronary heart diseases. The pathogencsis of coronary heart diseases is composed of both deficiency and excess. Firstly, the pain can result from blockade of heart vessel by phlegm and blood stasis, since daqi collapses in lungs and is unable to promote circulation of qi, blood and fluid. Secondly, the pain can result from lack of flourishment due to yang and yin deficiency in kidney, which leads to the inability to warm eight extraordinary channels and further causes poor blood circulation in the heart. The treatment of the diseases places a great emphasis on differentiating between manifestation and root causes, and between urgent and chronic symptoms. For unstable angina pectoris, the treatment should focus on eliminating pathogenic factors by means of warmly dredging blood vessels by spicy materials and removing blood stasis and phlegm. For stable angina pectoris, comparable emphasis should be placed on strengthening body resistance and eliminating pathogenic factors This can be achieved via benefiting qi, raising the collapse and promoting blood circulation to remove blood stasis, or warmly invigorating yang and yin and regulating extraordinary channels.2. Chronic heart failure. The initial stage of chronic heart failure shows the syndrome of heart qi deficiency and daqi collapse, whereas the later stage presents with kidney yang deficiency and fluid-dampness excess. Blood stasis can be found throughout the disease process. Accordingly, different types of treatment should be given at different stages. At the initial stage, the disease is treated by benefiting and raising qi and promoting blood circulation to remove blood stasis. At the later stage, the disease is treated by warming and recuperating kidney yang, activating blood circulation and inducing diuresis. During treatment, doctors should be skillful at seeking yang in Yin, promoting blood circulation and inducing diuresis.3. Hypertension. The main pathogenesis of hypertension is haptic hyperactivity and phlegm obstruction. Therefore, the treatment should target at suppressing hyperactive liver yang, dissipating phlegm and calming endogenous wind. Some special types of hypertension, e.g. involutional hypertension and hypertension in pregnancy, have their distinctive pathogenetic characteristics, such as deficiency of both yin and yang, and dampness obstruction due to spleen deficiency. During the treatment, emphasis should be placed on the integration of TCM and Western medicine and combining their strong points to improve the efficacy.4. Achyarrhythmia. This disease roots in the heart and closely correlates with the dysfunction of liver, spleen and kidney. Both deficiency and excess contribute to the pathogenesis of the disease. Deficiency can manifest itself in qi and kidney whereas excess can be shown as phlegm-heat and blood stasis. Therefore, for treatment, special attention should be paid to syndrome differentiation as well as combination with achievements in modern pharmacological studies.5. Bradyarrhythmia. The pathogenesis of the disease involves both deficiency and excess. Deficiency can manifest itself in qi and kidney and excess can be shown as blood stasis and turbid phlegm. Treatment of this disease should focus on both reinforcement and elimination, by means of benefiting and raising qi, invigorating kidney and reinforcing yang, and removing phlegm and blood stasis.6. Viral myocarditis. This disease is caused by exogenous seasonal pathogens such as warm-heat and wind-heat, which invade heart and lungs and consume up qi and yin. When this condition lasts long enough, daqi in the chest will collapse and lead to blood stasis and fluid-dampness inside the body. Thus, the treatment for this disease should target at benefiting and raising qi and promoting blood circulation to remove toxic substances.7. Diabetes. Basic syndrome types of diabetes have changed. The pathogenetic features of diabetes and its complications are deficiency in qi and yin and blood stasis blocking collaterals. Therefore the treatment involves benefiting qi and nourishing yin and promoting blood circulation to remove obstruction in collaterals.8. Insomnia. Insomnia is primarily ascribed to yang excessiveness and yin deficiency, which results in inability of yang to transform into yin and disturbance of heart-mind. Treating excess symptoms usually start with phlegm-heat and heart fire. Treating deficiency symptoms generally start with deficiency of both yin and yang. For patients long suffering from the disease, the treatment can start with blood stasis.9. Chronic glomerulonephritis. The pathogenesis of the disease primarily involves excessive pathogens and to a lesser extent, deficiency of body resistance probably resulting from excess. Dampness-heat stagnating in lower jiao and causing heat accumulation inside the body constitutes the major pathological basis of the disease. Therefore, the treatment should aim at clearing heat and promoting dieresis, cooling blood and promoting blood circulation.10. Chronic renal failure. The disease presents with deficiency of root causes and excess in manifestation. The former can be shown as yang deficiency in spleen and kidney and the latter can exhibited as dampness, poisoning and stagnation. So it is primarily treated by warmly invigorating spleen and kidney, promoting dieresis and evacuation and removing blood stasis. A common formula for this disease is the combination of the decoction of warming spleen and the Suplemented Zhenwu Decoction. Typical cases for each disease are provided as well.
The second chapter begins with a literature review on the origin of the daqi theory and clinical application of the Shengxian Decoction in the treatment of cardiovascular diseases. The first documented appearance of the word "daqi" was found in Huangdi Neijing, based on which Zhang Zhong-jing was the first one to apply this theory into clinical practice. In the Qing Dynasty, Yu Jia-yan interpreted the theory more clearly and further developed it in clinical treatment. By the late Qing and early Republic periods, combined with his own clinical experience, Zhang Xi-chu enriched the theory of daqi by providing a systematic elaboration on the physiology, pathology, diagnosis and treatment of daqi. Daqi originates in congenitally primordial qi in the kidney, grows in acquired qi from food and water, stores in the chest and communicates with qi from the nature. The physiological roles of daqi include:1) governing breathing in the respiratory tract;2) rotating qi and blood in the cardiovascular system;3) governing qi movement in the whole body. The pathological changes of daqi can be summarized in three aspects:blockade, adverse rising and collapse, which could be treated by rotating, lowering and raising qi, respectively. In addition, studies on clinical application of the Shengxian Decoction, the typical prescription for raising and supplementing qi, in cardiovascular diseases are also reviewed in this section.
Next, the theoretical background of qi collapse and blood stasis is discussed. Based on symptoms of cardiovascular diseases and deeply influenced by the theory of daqi collapse in Integrating TCM and Western Medicine written by Zhang Xi-chun, Professor Shi Zai-xiang combined the theory of qi and blood and the theory of qi ascending and descending and proposed that qi collapse and blood stasis is a common pathogenesis of cardiovascular diseases. He discussed the similarities and differences between qi collapse and qi deficiency and the relationships between qi collapse and blood stasis. Modern studies on the nature of daqi and daqi collapse suggested that daqi collapse is closely associated with cardiopulmonary insufficiency and that the syndrome of daqi collapse is one of the common syndrome of several cardiovascular diseases. Moreover, Professor Shi Zai-xiang also elaborated on the possible roles of qi collapse and blood stasis in different cardiovascular diseases.
Finally, the effect of Shengjie Tongyu granules in the treatment of angina pectoris resulting from coronary heart diseases was investigated. Objective:to investigate the effect and safety of Shengjie Tongyu granules in the treatment of angina pectoris resulting from coronary heart diseases. Methods:108patients with the qi-deficiency-and-blood-stasis type of angina pectoris were randomly divided into treatment group (N=56) and control group (N=52). For four weeks, patients in the treatment group were treated with Shengjie Tongyu granules whereas patients in the control group were given the Tongxinluo capsule. We evaluated the treatment efficacy, cardiograph, TCM syndromes, blood lipids and safety indices. Results:Both groups showed significant improvement in symptoms of angina pectoris and TCM syndromes (P＜0.01), but no significant differences were found between groups (P＞0.05). Total efficacy rate of angina pectoris in the treatment group (83.92%) was superior to that in the control group (73.08%), even though there was no significant differences between groups (P＞0.05). Total efficacy rate of TCM syndromes in the treatment group (82.14%) was significantly higher than that in the control group (59.62%, P＜0.05). Additionally, the treatment group showed an increased level of HDL-C compared with the baseline (P＜0.01). Conclusion:Shengjie Tongyu granules can effectively improve the symptoms of angina pectoris resulting from coronary heart disease and the effects are comparable with the Tongxinluo capsule. In addition, this drug displays superiority over the Tongxinluo capsule in improving TCM symptoms. It can also increase HDL-C levels and ameliorate the blood lipid metabolism abnormalities in patients with coronary heart disease. Finally, the safety of treating angina pectoris with Shengjie Tongyu granules is satisfactory.
A key for TCM inheritance and development is to inherit, discover and sort out academic thoughts and clinical experience of well-known and senior TCM experts, and to summarize new theories and doctrines. Only through this approach can TCM theories undergo continuous deepening and improvement, and better fulfill modern clinical demands.
第一部分首先介绍了史载祥教授主要的学术思想。包括：1.阐发血瘀证及活血化瘀理论史载祥教授将血瘀证形成的病机概括为“内结之血”、“离经之血”、“污秽之血”三个方面,进一步丰富和发展了血瘀证的病机理论,拓展了血瘀证的范围。他认为“瘀血”是许多疾病共同的病理因素,活血化瘀在许多疑难病、慢性病治疗中发挥重要作用。他根据血瘀证形成的病因及兼并症,制定不同的治法方药,如：散寒化瘀法、清热化瘀法、行气化瘀法、益气化瘀法、养血化瘀法、止血化瘀法、祛痰化瘀法、软坚化瘀法等。他根据药物来源、作用强度、临床应用等将活血化瘀药物进行了分类,对于我们临床正确选用活血化瘀药物具有一定的指导作用。2.强调气、血、水相关史载祥教授认为气、血、水三者在生理上互相转化,共同维持脏腑正常的功能活动；在病理上互相影响,是脏腑功能失调及疾病发生、发展的内在根源。气血水在一定程度上反映了疾病的发展演变规律。在气、血、水三者的关系中,气具有主导地位。治疗上强调气血水同治。3.奇经八脉辨治疾病史载祥教授认为奇经辨证是中医辨证体系的重要组成部分,尤其是在某些慢性疑难病的诊治中发挥重要的作用。他在临床上运用奇经辨证时常从以下几方面入手：(1)从奇经循行部位(2)从奇经所主病证(3)结合其他辨证方法。在奇经病的治法上,继承了叶天士的“通补”之法,以补益肝、填补下焦为主,常用血肉有情之品。临床应用具体体现在从督脉论治脑、脊柱病变,从冲任论治妇科疾病,从阴维论治心痛等。4.擅长运用经方史载祥教授擅长运用经方治疗现代医学的疑难危重疾病,他在临床上应用经方有以下的特点：(1)抓主症,但见一证便是(2)析病机,拓展应用范围(3)重化裁,提高临床疗效(4)融中西,密切结合现代医学。5.用药灵活变通他认为中药的剂量应该根据具体病情制定,该大则大,该小则小。他对于某些峻烈、毒性的药物使用颇有心得,使用峻烈药物时注重炮制、用法及用量,强调中病即止。注重外用药,以提高临床疗效。6.提倡病证结合他既重视中医辨证,也重视西医诊断,强调病证结合,才能抓住疾病的本质,提高临床疗效。临床上要找出中医药治疗的切入点,体现中医药多层面、多靶点的整体治疗优势,充分展示中医药的独特疗效。
其次总结了史载祥教授的主要临床经验。初步总结了史载祥教授治疗心血管疾病、糖尿病及慢性肾脏病的临床经验。1.冠心病冠心病心绞痛的病机主要分为虚实两方面：一是“不通则痛”,为胸中大气下陷,不能推动气血津液运行,痰浊瘀血痹阻心脉所致；二是“不荣则痛”,为肾中阴阳两虚,不能温养奇经八脉,血不养心所致。治疗上强调标本缓急,不稳定型心绞痛以祛邪为主,治以辛香温通,豁痰祛瘀。稳定型心绞痛以扶正与祛邪兼顾,治以益气升陷,活血祛瘀,或温补阴阳,调其奇经。2.慢性心力衰竭慢性心衰的病机初期以心气不足,大气下陷为主,后期以肾阳虚衰,水湿泛滥为主,瘀血贯穿了慢性心衰整个的病理过程。治疗上强调分期论治,初期益气升陷,活血祛瘀；晚期温补肾阳,活血利水；并善于阴中求阳、活血利水。3.高血压高血压病主要的病机是肝旺痰阻,治疗以平肝潜阳,化痰熄风为主。某些特殊类型的高血压,如更年期高血压、妊娠高血压等,又有阴阳两虚、脾虚湿阻等不同的病机特点。强调以中西医结合的方法治疗高血压病,各取所长,以提高疗效。4.快速性心律失常本病病位在心,与肝、脾、肾功能失调密切相关。在病机上有虚实两端,虚有气虚、肾虚,实有痰热、瘀血,治疗上既强调辨证论治,又注意结合现代药理研究成果。5.缓慢性心律失常病机有虚实两端,虚则有气虚、阳虚,实则有瘀血、痰浊等。治疗上当攻补兼施,主要治以益气升陷,补肾助阳,化痰祛瘀之法。6.病毒性心肌炎本病病因是外感温热或风热时邪,侵袭心肺,耗伤气阴,日久引起胸中大气下陷,导致瘀血、水湿内生。治疗以益气升陷,活血解毒为主。7.糖尿病糖尿病的基本证型已经发生了变化,气阴两虚、瘀血阻络是糖尿病及并发症的基本病机。自拟益气养阴,活血通络的愈消方以治疗糖尿病及糖尿病并发症。8.失眠总因阳盛阴虚,阳不入阴,心神被扰所致。实证多从痰热、心火论治,虚证多从阴阳两虚论治,久病多从瘀血论治。9.慢性肾小球肾炎病机以邪实为主,正虚为次,多为因实致虚。湿热蕴结下焦,瘀热内结是其主要的病理基础。治疗上主张清热利湿,凉血活血为主。10.慢性肾衰竭本病属本虚标实,本虚为脾肾阳虚,标实为湿、毒、瘀,治疗上以温补脾肾,利湿泄浊祛瘀为主,常以温脾汤合真武汤加味治疗。均附典型病案。
第二部分首先综述了大气理论的历史渊流及“升陷汤”在心血管疾病的临床应用。大气最早见于《黄帝内经》。张仲景在继承《内经》大气理论的基础上,首次将大气理论运用到临床实践。清代喻嘉言对大气理论有了进一步地阐释和发挥。清末民初张锡纯结合自己的临床体会,对大气的生理、病理及证治进行了系统的论述,使大气理论进一步完善。大气发生于先天肾中之元气,培养于后天水谷之气,积贮于胸膺空旷之府,相通于自然界之清气。大气的生理作用归纳起来有以下几方面：(一)走息道以司呼吸。(二)贯心脉以行气血。(三)统摄全身气机。大气的病变概括起来分为大气痹阻、大气上逆和大气下陷三种。治疗上分别以转大气、降大气、升大气为主。另外,对升补大气的代表方剂“升陷汤”在现代心血管疾病的临床应用进行了综述。
其次探讨了心血管疾病气陷血瘀病机的理论基础。史载祥教授根据心血管疾病的证候特点,并受张锡纯《医学衷中参西录》中大气下陷理论的启发,结合中医气血理论及升降理论,提出了心血管疾病“气陷血瘀”的共同病机特点。试述了气陷与气虚的异同,气陷与血瘀的关系。从大气及大气下陷的现代医学本质研究中提示,大气下陷与现代医学心肺功能不全密切相关,大气下陷证是多种心血管疾病中常见的证型之一。并阐释了气陷血瘀病机在不同心血管疾病中的作用。
最后观察了升解通瘀颗粒治疗冠心病心绞痛的临床疗效。目的：观察升解通瘀颗粒治疗冠心病心绞痛的临床疗效和安全性。方法：将108例冠心病心绞痛气陷血瘀证患者随机分为治疗组(56例)和对照组(52例),治疗组给予升解通瘀颗粒治疗,对照组给予通心络胶囊治疗,疗程均为4周。观察心绞痛疗效、心电图、中医证候改善情况、血脂及安全性指标。结果：治疗后两组心绞痛积分、中医证候积分均有显著的改善(P<0.01),但组间差异无统计学意义(P>0.05)。治疗组心绞痛总有效率(83.92%)优于对照组(73.08%),但差异无统计学意义(P>0.05)。治疗组中医证候总有效率(82.14%)优于对照组(59.62%),差异有统计学意义(P<0.05)。治疗组治疗后HDL-C与治疗前比较升高,差异有统计学意义(P<0.01),结论：升解通瘀颗粒能够有效地改善冠心病心绞痛患者的临床症状,具有与通心络相当的疗效。并在改善中医证候方面,明显优于通心络。同时,升解通瘀颗粒还能升高HDL-C,改善冠心病患者的血脂代谢异常。升解通瘀颗粒治疗冠心病心绞痛安全有效。
通过继承、挖掘、整理名老中医专家的学术思想及临床经验,从中提炼出新的理论与学说,是中医学术继承与发展的关键。只有这样,才能使中医药理论不断深化和完善,才能更加符合现代临床实际的要求。
Professor Shi Zai-xiang is one of the mentors of the third and fourth generation for training qualified Traditional Chinese Medicine (TCM) doctors to carry on the experience of national well-known and senior TCM experts. With more than forty years of clinical practice in integrated TCM and Western medicine, he is an experienced physician, specialized in treating cardiovascular diseases, chronic kidney diseases, diabetes as well as other various kinds of complicated diseases. This thesis is composed of two chapters. The first chapter provides an introduction to Professor Shi Zai-xiang's primary academic thoughts and clinical experience. From the perspectives of theoretical origin and investigation, clinical studies, etc. the second chapter probes into his theories of "filling up qi collapse and removing blood stasis" for the treatment of cardiovascular diseases.
The first chapter begins with an introduction to main academic thoughts of Professor Shi Zai-xiang, which is summarized as follows.1. Elucidating the theory of promoting blood circulation to remove blood stasis. Professor Shi Zai-xiang encapsulated the pathogenesis of the blood-stasis syndrome into three aspects, i.e."stagnation of circulation","blood leaving the channel " and "filthy blood", which further enriched and developed the pathogenesis theories of the blood-stasis syndrome and expanded the scope of this syndrome. He argued that "blood stasis" is a common pathological factor of many diseases and thereby promoting blood circulation to remove blood stasis plays an important role in treating many difficult, complicated and chronic diseases. According to the causes of the blood-stasis syndrome and its complications, he developed different therapeutic formulas to remove blood stasis, such as dispersing coldness, clearing heat, activating qi, benefiting qi, nourishing blood, stopping bleeding, eliminating phlegm, resolving masses, etc. He classified medicines for promoting blood circulation to remove blood stasis according to their sources, intensity, and clinical applications and this classification serves as guiding principles for drug selection in clinical practice.2. Emphasizing the correlation of qi, blood and water. Professor Shi Zai-xiang proposed that qi, blood and water transform into each other in the physiological condition and jointly contribute to maintain normal functions of organs. In the pathological condition, their interaction may serve as the internal causes for organ dysfunction and occurrence and development of diseases. To some extent, the three materials reflect the law of disease development and prognosis. Of the three materials, qi takes the leading role. The treatment should target at these materials together.3. Using eight extraordinary channels for diagnosis and treatment. Professor Shi Zai-xiang proposed that using extraordinary channels for differentiation of symptoms is an important component of TCM, which plays an especially significant role in diagnosis and treatment of some chronic, difficult and complicated diseases. When adopting extraordinary channels for symptom differentiation, he often began with:(1) the running course of the channels,(2) the syndromes governed by the channels and (3) in combination of other approaches of symptom differentiation. In treating the diseases governed by extraordinary channels, he carried on Ye Tianshi's therapy of "overall supplementing" and prescribed medications taken from creatures having blood and flesh, aiming predominantly at invigorating liver and filling up lower jiao. The application of these theories in clinical practice is presented as treating cerebral and spinal diseases from the governor channel, treating gynecological diseases from conception and chong channels, and treating cardiodynia from the yin link channel.4. Excelling at prescribing classical formulae. Professor Shi Zai-xiang was proficient at prescribing classical formulae for the treatment of modern difficult, complicated and severe diseases. He demonstrated the following characteristics when using classical formulae:(1) identifying the exclusively core symptom;(2) analyzing the causes of diseases and expanding the scope of using classical formulae;(3) stressing symptom differentiation to improve clinical efficacy;(4) combining TCM and Western medicine and closely integrating modern and traditional medicines.5. Making appropriate adaptations when necessary. He held that the dose of TCM should depend on and vary with disease conditions. He had rich experience in urgent prescriptions and toxic drugs. For urgent prescriptions, special attention should be paid to drug processing, usage and dose and the medication should be stopped as soon as the symptoms are gone. Drugs for external use are emphasized as well to improve treatment efficacy.6. Advocating the integration of TCM and Western medicine. He argued that scientific and technological achievements of modern medicine must be taken full use of to support TCM inheritance and development. One should be good at seeking for the situations where TCM can be used for treatment, so as to demonstrate the overall TCM advantages of multi-layer and multi-target treatment and its distinctive effects.
Then, Professor Shi Zai-xiang's primary clinical experience in treating cardiovascular diseases, diabetes and chronic kidney diseases are summarized.1. Coronary heart diseases. The pathogencsis of coronary heart diseases is composed of both deficiency and excess. Firstly, the pain can result from blockade of heart vessel by phlegm and blood stasis, since daqi collapses in lungs and is unable to promote circulation of qi, blood and fluid. Secondly, the pain can result from lack of flourishment due to yang and yin deficiency in kidney, which leads to the inability to warm eight extraordinary channels and further causes poor blood circulation in the heart. The treatment of the diseases places a great emphasis on differentiating between manifestation and root causes, and between urgent and chronic symptoms. For unstable angina pectoris, the treatment should focus on eliminating pathogenic factors by means of warmly dredging blood vessels by spicy materials and removing blood stasis and phlegm. For stable angina pectoris, comparable emphasis should be placed on strengthening body resistance and eliminating pathogenic factors This can be achieved via benefiting qi, raising the collapse and promoting blood circulation to remove blood stasis, or warmly invigorating yang and yin and regulating extraordinary channels.2. Chronic heart failure. The initial stage of chronic heart failure shows the syndrome of heart qi deficiency and daqi collapse, whereas the later stage presents with kidney yang deficiency and fluid-dampness excess. Blood stasis can be found throughout the disease process. Accordingly, different types of treatment should be given at different stages. At the initial stage, the disease is treated by benefiting and raising qi and promoting blood circulation to remove blood stasis. At the later stage, the disease is treated by warming and recuperating kidney yang, activating blood circulation and inducing diuresis. During treatment, doctors should be skillful at seeking yang in Yin, promoting blood circulation and inducing diuresis.3. Hypertension. The main pathogenesis of hypertension is haptic hyperactivity and phlegm obstruction. Therefore, the treatment should target at suppressing hyperactive liver yang, dissipating phlegm and calming endogenous wind. Some special types of hypertension, e.g. involutional hypertension and hypertension in pregnancy, have their distinctive pathogenetic characteristics, such as deficiency of both yin and yang, and dampness obstruction due to spleen deficiency. During the treatment, emphasis should be placed on the integration of TCM and Western medicine and combining their strong points to improve the efficacy.4. Achyarrhythmia. This disease roots in the heart and closely correlates with the dysfunction of liver, spleen and kidney. Both deficiency and excess contribute to the pathogenesis of the disease. Deficiency can manifest itself in qi and kidney whereas excess can be shown as phlegm-heat and blood stasis. Therefore, for treatment, special attention should be paid to syndrome differentiation as well as combination with achievements in modern pharmacological studies.5. Bradyarrhythmia. The pathogenesis of the disease involves both deficiency and excess. Deficiency can manifest itself in qi and kidney and excess can be shown as blood stasis and turbid phlegm. Treatment of this disease should focus on both reinforcement and elimination, by means of benefiting and raising qi, invigorating kidney and reinforcing yang, and removing phlegm and blood stasis.6. Viral myocarditis. This disease is caused by exogenous seasonal pathogens such as warm-heat and wind-heat, which invade heart and lungs and consume up qi and yin. When this condition lasts long enough, daqi in the chest will collapse and lead to blood stasis and fluid-dampness inside the body. Thus, the treatment for this disease should target at benefiting and raising qi and promoting blood circulation to remove toxic substances.7. Diabetes. Basic syndrome types of diabetes have changed. The pathogenetic features of diabetes and its complications are deficiency in qi and yin and blood stasis blocking collaterals. Therefore the treatment involves benefiting qi and nourishing yin and promoting blood circulation to remove obstruction in collaterals.8. Insomnia. Insomnia is primarily ascribed to yang excessiveness and yin deficiency, which results in inability of yang to transform into yin and disturbance of heart-mind. Treating excess symptoms usually start with phlegm-heat and heart fire. Treating deficiency symptoms generally start with deficiency of both yin and yang. For patients long suffering from the disease, the treatment can start with blood stasis.9. Chronic glomerulonephritis. The pathogenesis of the disease primarily involves excessive pathogens and to a lesser extent, deficiency of body resistance probably resulting from excess. Dampness-heat stagnating in lower jiao and causing heat accumulation inside the body constitutes the major pathological basis of the disease. Therefore, the treatment should aim at clearing heat and promoting dieresis, cooling blood and promoting blood circulation.10. Chronic renal failure. The disease presents with deficiency of root causes and excess in manifestation. The former can be shown as yang deficiency in spleen and kidney and the latter can exhibited as dampness, poisoning and stagnation. So it is primarily treated by warmly invigorating spleen and kidney, promoting dieresis and evacuation and removing blood stasis. A common formula for this disease is the combination of the decoction of warming spleen and the Suplemented Zhenwu Decoction. Typical cases for each disease are provided as well.
The second chapter begins with a literature review on the origin of the daqi theory and clinical application of the Shengxian Decoction in the treatment of cardiovascular diseases. The first documented appearance of the word "daqi" was found in Huangdi Neijing, based on which Zhang Zhong-jing was the first one to apply this theory into clinical practice. In the Qing Dynasty, Yu Jia-yan interpreted the theory more clearly and further developed it in clinical treatment. By the late Qing and early Republic periods, combined with his own clinical experience, Zhang Xi-chu enriched the theory of daqi by providing a systematic elaboration on the physiology, pathology, diagnosis and treatment of daqi. Daqi originates in congenitally primordial qi in the kidney, grows in acquired qi from food and water, stores in the chest and communicates with qi from the nature. The physiological roles of daqi include:1) governing breathing in the respiratory tract;2) rotating qi and blood in the cardiovascular system;3) governing qi movement in the whole body. The pathological changes of daqi can be summarized in three aspects:blockade, adverse rising and collapse, which could be treated by rotating, lowering and raising qi, respectively. In addition, studies on clinical application of the Shengxian Decoction, the typical prescription for raising and supplementing qi, in cardiovascular diseases are also reviewed in this section.
Next, the theoretical background of qi collapse and blood stasis is discussed. Based on symptoms of cardiovascular diseases and deeply influenced by the theory of daqi collapse in Integrating TCM and Western Medicine written by Zhang Xi-chun, Professor Shi Zai-xiang combined the theory of qi and blood and the theory of qi ascending and descending and proposed that qi collapse and blood stasis is a common pathogenesis of cardiovascular diseases. He discussed the similarities and differences between qi collapse and qi deficiency and the relationships between qi collapse and blood stasis. Modern studies on the nature of daqi and daqi collapse suggested that daqi collapse is closely associated with cardiopulmonary insufficiency and that the syndrome of daqi collapse is one of the common syndrome of several cardiovascular diseases. Moreover, Professor Shi Zai-xiang also elaborated on the possible roles of qi collapse and blood stasis in different cardiovascular diseases.
Finally, the effect of Shengjie Tongyu granules in the treatment of angina pectoris resulting from coronary heart diseases was investigated. Objective:to investigate the effect and safety of Shengjie Tongyu granules in the treatment of angina pectoris resulting from coronary heart diseases. Methods:108patients with the qi-deficiency-and-blood-stasis type of angina pectoris were randomly divided into treatment group (N=56) and control group (N=52). For four weeks, patients in the treatment group were treated with Shengjie Tongyu granules whereas patients in the control group were given the Tongxinluo capsule. We evaluated the treatment efficacy, cardiograph, TCM syndromes, blood lipids and safety indices. Results:Both groups showed significant improvement in symptoms of angina pectoris and TCM syndromes (P＜0.01), but no significant differences were found between groups (P＞0.05). Total efficacy rate of angina pectoris in the treatment group (83.92%) was superior to that in the control group (73.08%), even though there was no significant differences between groups (P＞0.05). Total efficacy rate of TCM syndromes in the treatment group (82.14%) was significantly higher than that in the control group (59.62%, P＜0.05). Additionally, the treatment group showed an increased level of HDL-C compared with the baseline (P＜0.01). Conclusion:Shengjie Tongyu granules can effectively improve the symptoms of angina pectoris resulting from coronary heart disease and the effects are comparable with the Tongxinluo capsule. In addition, this drug displays superiority over the Tongxinluo capsule in improving TCM symptoms. It can also increase HDL-C levels and ameliorate the blood lipid metabolism abnormalities in patients with coronary heart disease. Finally, the safety of treating angina pectoris with Shengjie Tongyu granules is satisfactory.
A key for TCM inheritance and development is to inherit, discover and sort out academic thoughts and clinical experience of well-known and senior TCM experts, and to summarize new theories and doctrines. Only through this approach can TCM theories undergo continuous deepening and improvement, and better fulfill modern clinical demands.
引文
1王莹.论血瘀证与活血化瘀.长春中医药大学学报,2007,23(5)：5-6
2谷万里.史载祥教授中西医结合血瘀证学术思想研究.中华中医药学会血栓病分会成立大会暨首届学术研讨会论文汇编
3史载祥,谷万里.高血压病的微循环障碍与中西医结合研究.全国中西医结合防治动脉硬化及心脑血管病高层研讨会—第七次全国中西医结合血瘀证及活血化瘀研究学术大会
4谷万里.史载祥运用活血化瘀法治疗汗证临床经验.中国中医药信息杂志,2006,13(5)：86
5李格.史载祥教授治疗汗证验例.中医研究,2006,19(5)：56-57
6沈庆法.叶天士对奇经八脉的认识与应用.上海中医药杂志,1979,(3)：12-14
7谷万里.史载祥教授治疗急性化脓性脊髓炎临床经验.中国中西医结合急救杂志,2006,13(4)：250-251
8李春岩,邵明晶,史载祥.中医药治疗顽固性腹痛伴晕厥1例.中国中西医结合杂志,2011,31(12)：1703-1704
9史载祥.冠脉微循环障碍及中西医结合治疗.中日友好医院学报,2005,19(6)：362-364
10李格.史载祥中西医结合治疗高血压的临床思路和经验.中国中西医结合心脑 血管病杂志,2006,4(3)：235-237
11史载祥.从“朱良春现象”看中医学术的继承与创新.中医药通报,2007,6(4)：1-2
12史载祥.皓月当空大师风范-纪念著名中医学家陈继明先生.中国中医药报,2009-12-28
13谷万里,史载祥.从心血管疾病谈中医药的疗效评价.中医杂志,2006,47(6)：415-416
1唐·王冰,黄帝内经素问.北京：人民卫生出版社,1963,6
2南京中医学院中医系.黄帝内经灵枢译释[M].上海：科学技术出版社,1986.3
3汉·张机,金匮要略方论.北京：人民卫生出版社,1956,3
4清·喻昌,医门法律.北京：中国中医药出版社,2002,2
5民国·张锡纯,医学衷中参西录.石家庄.河北科技出版社.1985.8
6张介宾.类经.北京：人民卫生出版社,1957
1张万义,孙宝杰.升补宗气法治疗老年冠心病心绞痛发作临床对照观察.中国中医急症,1997,6(6)：248
2张玲军.升陷活血汤治疗老年冠心病140例疗效观察.湖南中医药导报,2002,8(12)：749
3严序之.升陷汤合四物汤治疗气虚血瘀型冠心病心绞痛26例.实用中医内科杂志,2009,23(8)：
4金镖,胡敬宝.升陷汤治疗老年人冠心病心绞痛37例.陕西中医,2000,21(9)：414
5李康.升陷汤治疗不稳定型心绞痛临床观察.中医药临床杂,2007,19(1)：16-17.
6戴娟.升陷汤合小陷胸汤加味治疗急性冠脉综合征疗效观察.中国中医急症,2011,20(2)194-195
7李东晓.升陷汤合卡维地洛治疗冠心病左心室功能不全疗效观察.湖北中医杂志,2001,23(4)：3-4
8李忠业.浅议《医学衷中参西录》升补胸中大气法治疗心衰病的意义.中国中医急症,2007,16(1)：84
9刘忠良,曹志安.中西医结合治疗慢性心力衰竭65例临床观察. 中西医结合心脑血管病杂志,2008,6(1)：11—12.
10王杰方.中药汤剂治疗慢性心力衰竭40例疗效观察.中国中医药现代远程教育,2008,6(12)：1533.
11王小祥.加味升陷汤治疗左心衰竭42例临床观察. 云南中医中药杂志,2009,30(5)：29—30
12李兰波.升陷汤治疗慢性心力衰竭50例临床观察.光明中医,2008,23(5)：634-635
13鲁文涛.升陷汤加味治疗慢性充血性心力衰竭48例.河南中医,2011,31(3)
14刘炜,刘玉洁,张军.升陷汤加味方治疗病态窦房结综合征的临床观察.河北中医,2010,32(1)：42—43
15赵卫,张军,刘炜.升陷汤合桂枝甘草汤加味治疗窦性心动过缓48例.河北中医,2010,32(10)：1501-1502
16强立新,赵建红,王玉华.升陷汤加味方治疗病态窦房结综合征100例疗效观察.世界中西医结合杂志,2011,6(9)：796-797
17曹洪欣,朱海燕.大气下陷证与病毒性心肌炎相关性机理的理论探讨.陕西中医,2002,23(2)：141—143.
18张凤巧,韩丽华.升陷汤加减治疗病毒性心肌炎36例疗效观察.中医药信息,2010,27(3)：91-92
19李建新,邵永强.升陷汤治疗原发性低血压27例.当代医学,2008,14(24)：174
20陈娟.四君升陷汤治疗低血压126例.现代中医药,2002, (5)：37
21孙强,肖永兴,刘丛群.加味升陷汤治疗低血压的临床观察.中国现代药物应用,2009,3(10)：136
22张凤巧.升陷汤治疗心脏神经官能症32例.世界中医药,2009,4(3)：148
1曹洪欣,朱海燕.大气下陷证与病毒性心肌炎相关性机理的理论探讨.陕西中医,2002,23(2)：141—143.
2房玉涛.大气下陷证与肺动脉高压相关性机理探讨.中国中医药信息杂志,2009,16(9)：88—89.
3房玉涛.52例肺动脉高压患者中医证候研究.中国中医药信息杂志,2008,15(10)：17—19.
4姜燕,吴先奇,韩又云.病态窦房结综合征中医病机探讨.中医研究,2001,14(5)：2—3.
1陈在嘉,高润霖.冠心病[M].北京：人民卫生出版社,2002：1-5.
2刘德恒,许真真,郭伟聪.冠心病心绞痛395例中医证型特点探讨[J].中医杂志,1995,36(10)：617.
3李鸥,徐浩,高铸烨.1072例冠心病住院患者中医证候分布特点的多中心横断面研究.中西医结合心脑血管病杂志,2011,9(4)385-386.
4吴焕林,阮新民, 杨小波,等.319例冠心病患者证候分布规律分析.中国中西医结合杂志,2007,27(6)：498-500.
5国际心脏病学会和协会及世界卫生组织临床命名标准化联合专题组.缺血性心脏病的命名及诊断标准[J].中华心血管病杂志,1981,(91)：75-76.
6全国中西医结合防治冠心病心绞痛、心律失常座谈会.冠心病心绞痛及心电图疗效评定标准[S].1979.
7郑筱萸.中药新药临床研究指导原则(试行)[M].北京：中国医药科技出版社,2002：68-73.
8崔刚,魏凤玲,周建平.益气逐瘀颗粒的主要药效学研究.中国实验方剂学杂志,2008,14(6)：30-33.
9余云昶,史载祥,姜良铎.升解通瘀汤对大鼠缺血再灌注损伤的心肌保护作用.陕西中医,2008,29(6)747-749.
10余云昶,姜良铎,史载祥.升解通瘀汤对大鼠心脏缺血再灌注损伤的心功能影响.中国中医急症,2008,17(3)354-356.
2谷万里.史载祥教授中西医结合血瘀证学术思想研究.中华中医药学会血栓病分会成立大会暨首届学术研讨会论文汇编
3史载祥,谷万里.高血压病的微循环障碍与中西医结合研究.全国中西医结合防治动脉硬化及心脑血管病高层研讨会—第七次全国中西医结合血瘀证及活血化瘀研究学术大会
4谷万里.史载祥运用活血化瘀法治疗汗证临床经验.中国中医药信息杂志,2006,13(5)：86
5李格.史载祥教授治疗汗证验例.中医研究,2006,19(5)：56-57
6沈庆法.叶天士对奇经八脉的认识与应用.上海中医药杂志,1979,(3)：12-14
7谷万里.史载祥教授治疗急性化脓性脊髓炎临床经验.中国中西医结合急救杂志,2006,13(4)：250-251
8李春岩,邵明晶,史载祥.中医药治疗顽固性腹痛伴晕厥1例.中国中西医结合杂志,2011,31(12)：1703-1704
9史载祥.冠脉微循环障碍及中西医结合治疗.中日友好医院学报,2005,19(6)：362-364
10李格.史载祥中西医结合治疗高血压的临床思路和经验.中国中西医结合心脑 血管病杂志,2006,4(3)：235-237
11史载祥.从“朱良春现象”看中医学术的继承与创新.中医药通报,2007,6(4)：1-2
12史载祥.皓月当空大师风范-纪念著名中医学家陈继明先生.中国中医药报,2009-12-28
13谷万里,史载祥.从心血管疾病谈中医药的疗效评价.中医杂志,2006,47(6)：415-416
1唐·王冰,黄帝内经素问.北京：人民卫生出版社,1963,6
2南京中医学院中医系.黄帝内经灵枢译释[M].上海：科学技术出版社,1986.3
3汉·张机,金匮要略方论.北京：人民卫生出版社,1956,3
4清·喻昌,医门法律.北京：中国中医药出版社,2002,2
5民国·张锡纯,医学衷中参西录.石家庄.河北科技出版社.1985.8
6张介宾.类经.北京：人民卫生出版社,1957
1张万义,孙宝杰.升补宗气法治疗老年冠心病心绞痛发作临床对照观察.中国中医急症,1997,6(6)：248
2张玲军.升陷活血汤治疗老年冠心病140例疗效观察.湖南中医药导报,2002,8(12)：749
3严序之.升陷汤合四物汤治疗气虚血瘀型冠心病心绞痛26例.实用中医内科杂志,2009,23(8)：
4金镖,胡敬宝.升陷汤治疗老年人冠心病心绞痛37例.陕西中医,2000,21(9)：414
5李康.升陷汤治疗不稳定型心绞痛临床观察.中医药临床杂,2007,19(1)：16-17.
6戴娟.升陷汤合小陷胸汤加味治疗急性冠脉综合征疗效观察.中国中医急症,2011,20(2)194-195
7李东晓.升陷汤合卡维地洛治疗冠心病左心室功能不全疗效观察.湖北中医杂志,2001,23(4)：3-4
8李忠业.浅议《医学衷中参西录》升补胸中大气法治疗心衰病的意义.中国中医急症,2007,16(1)：84
9刘忠良,曹志安.中西医结合治疗慢性心力衰竭65例临床观察. 中西医结合心脑血管病杂志,2008,6(1)：11—12.
10王杰方.中药汤剂治疗慢性心力衰竭40例疗效观察.中国中医药现代远程教育,2008,6(12)：1533.
11王小祥.加味升陷汤治疗左心衰竭42例临床观察. 云南中医中药杂志,2009,30(5)：29—30
12李兰波.升陷汤治疗慢性心力衰竭50例临床观察.光明中医,2008,23(5)：634-635
13鲁文涛.升陷汤加味治疗慢性充血性心力衰竭48例.河南中医,2011,31(3)
14刘炜,刘玉洁,张军.升陷汤加味方治疗病态窦房结综合征的临床观察.河北中医,2010,32(1)：42—43
15赵卫,张军,刘炜.升陷汤合桂枝甘草汤加味治疗窦性心动过缓48例.河北中医,2010,32(10)：1501-1502
16强立新,赵建红,王玉华.升陷汤加味方治疗病态窦房结综合征100例疗效观察.世界中西医结合杂志,2011,6(9)：796-797
17曹洪欣,朱海燕.大气下陷证与病毒性心肌炎相关性机理的理论探讨.陕西中医,2002,23(2)：141—143.
18张凤巧,韩丽华.升陷汤加减治疗病毒性心肌炎36例疗效观察.中医药信息,2010,27(3)：91-92
19李建新,邵永强.升陷汤治疗原发性低血压27例.当代医学,2008,14(24)：174
20陈娟.四君升陷汤治疗低血压126例.现代中医药,2002, (5)：37
21孙强,肖永兴,刘丛群.加味升陷汤治疗低血压的临床观察.中国现代药物应用,2009,3(10)：136
22张凤巧.升陷汤治疗心脏神经官能症32例.世界中医药,2009,4(3)：148
1曹洪欣,朱海燕.大气下陷证与病毒性心肌炎相关性机理的理论探讨.陕西中医,2002,23(2)：141—143.
2房玉涛.大气下陷证与肺动脉高压相关性机理探讨.中国中医药信息杂志,2009,16(9)：88—89.
3房玉涛.52例肺动脉高压患者中医证候研究.中国中医药信息杂志,2008,15(10)：17—19.
4姜燕,吴先奇,韩又云.病态窦房结综合征中医病机探讨.中医研究,2001,14(5)：2—3.
1陈在嘉,高润霖.冠心病[M].北京：人民卫生出版社,2002：1-5.
2刘德恒,许真真,郭伟聪.冠心病心绞痛395例中医证型特点探讨[J].中医杂志,1995,36(10)：617.
3李鸥,徐浩,高铸烨.1072例冠心病住院患者中医证候分布特点的多中心横断面研究.中西医结合心脑血管病杂志,2011,9(4)385-386.
4吴焕林,阮新民, 杨小波,等.319例冠心病患者证候分布规律分析.中国中西医结合杂志,2007,27(6)：498-500.
5国际心脏病学会和协会及世界卫生组织临床命名标准化联合专题组.缺血性心脏病的命名及诊断标准[J].中华心血管病杂志,1981,(91)：75-76.
6全国中西医结合防治冠心病心绞痛、心律失常座谈会.冠心病心绞痛及心电图疗效评定标准[S].1979.
7郑筱萸.中药新药临床研究指导原则(试行)[M].北京：中国医药科技出版社,2002：68-73.
8崔刚,魏凤玲,周建平.益气逐瘀颗粒的主要药效学研究.中国实验方剂学杂志,2008,14(6)：30-33.
9余云昶,史载祥,姜良铎.升解通瘀汤对大鼠缺血再灌注损伤的心肌保护作用.陕西中医,2008,29(6)747-749.
10余云昶,姜良铎,史载祥.升解通瘀汤对大鼠心脏缺血再灌注损伤的心功能影响.中国中医急症,2008,17(3)354-356.