姜德友教授治疗慢性心力衰竭临床经验
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摘要
[目的]总结姜德友教授对慢性心力衰竭病因病机及其辨证论治的临床经验。[方法]分析姜德友教授治疗慢性心力衰竭的辨治思路,阐述姜教授对该病病因病机的认识,详细论证其辨证分型,并附临床医案加以验证。[结果]姜德友教授认为慢性心衰的病因病机是内外相因,本虚标实。本虚系心之本位正气不足,发病初期以心气虚为主,随着疾病的发展变化,最终导致阴阳两虚。标实包括水饮、痰浊和瘀血,进而影响体内水液和血液循行,形成水饮内停、痰浊蕴肺、水血互结、痰瘀互结等证。姜德友教授将慢性心力衰竭分为心气虚证,气阴两虚、心血瘀阻证,气虚血瘀证,心肾阳虚证,阳气亏虚、血瘀水停证5个临床证型,对其症型分别应用心力加、参景益心汤、补气通脉汤、补火汤、自拟参苈加进行治疗。所举验案中,气阴两虚心血瘀阻证型,用参景益心汤加减治疗;心肾阳虚证,用补火汤加减;气虚血瘀证,用补气通脉汤加减化裁治疗,疗效显著。[结论]姜教授对慢性心力衰竭的病因病机、辨治分型及治法方药均具有独到见解,临床上疗效显著,值得学习效法。
[Objective] To elaborate the clinical experience of syndrome differentiation and treatment of chronic heart failure from the perspective of traditional medicine, and summarize the obvious therapeutic effect, which is beneficial to clinical diagnosis and treatment. [Method] Professor JIANG Deyou's understanding of the etiology and pathogenesis of chronic heart failure was analyzed. The five clinical syndromes of heart-Qi deficiency, Qi-Yin deficiency, heart-blood stasis, Qi deficiency and blood stasis, heart-kidney Yang deficiency, Yang deficiency and blood stasis water stopping were applied respectively with Xinlijia, Shenjing Yixin Decoction, Buqi Tongmai Decoction and Buhuo Decoction. The treatment of self-made Shen Li Jia is the basis of observation, and is verified by clinical medical records. [Result] Professor JIANG Deyou believes that the etiology and pathogenesis of chronic heart failure is nothing more than internal and external factors. Ben deficiency and Biaoshi are deficient in benign Qi of the heart. At the beginning of the disease, the deficiency of heart Qi is the main cause. With the development of the disease, Yin and Yang deficiency eventually occurs. The standard facts include water drinking, phlegm turbidity and blood stasis, which lead to endogenous water drinking, phlegm turbidity and blood stasis. Pro. JIANG Deyou divides chronic heart failure into 5 clinical syndromes, i.e. heart Qi deficiency, both deficiency of Qi and Yin and heart blood stasis, Qi deficiency blood stasis, Yang deficiency of heart and kidney, deficient Yang and blood stasis water retention, which are treated with the following methods respectively:Xinlijia, Shenjing Yixin Decoction, Buqi Tongmai Decoction, Guhuo Decoction and self-made Shenlijia. In the cited cases, revised Shenjing Yixin Decoction was applied for both deficiency of Qi and Yin and stasis block, Buhuo Decoction for Yang deficiency of heart and kidney, Buqi Tongmai Decoction for Qi deficiency and blood stasis, all got marked curative effect.[Conclusion] Professor JIANG has significant clinical effects in treating chronic heart failure, and later generations of doctors deserve to learn.
[Objective] To elaborate the clinical experience of syndrome differentiation and treatment of chronic heart failure from the perspective of traditional medicine, and summarize the obvious therapeutic effect, which is beneficial to clinical diagnosis and treatment. [Method] Professor JIANG Deyou's understanding of the etiology and pathogenesis of chronic heart failure was analyzed. The five clinical syndromes of heart-Qi deficiency, Qi-Yin deficiency, heart-blood stasis, Qi deficiency and blood stasis, heart-kidney Yang deficiency, Yang deficiency and blood stasis water stopping were applied respectively with Xinlijia, Shenjing Yixin Decoction, Buqi Tongmai Decoction and Buhuo Decoction. The treatment of self-made Shen Li Jia is the basis of observation, and is verified by clinical medical records. [Result] Professor JIANG Deyou believes that the etiology and pathogenesis of chronic heart failure is nothing more than internal and external factors. Ben deficiency and Biaoshi are deficient in benign Qi of the heart. At the beginning of the disease, the deficiency of heart Qi is the main cause. With the development of the disease, Yin and Yang deficiency eventually occurs. The standard facts include water drinking, phlegm turbidity and blood stasis, which lead to endogenous water drinking, phlegm turbidity and blood stasis. Pro. JIANG Deyou divides chronic heart failure into 5 clinical syndromes, i.e. heart Qi deficiency, both deficiency of Qi and Yin and heart blood stasis, Qi deficiency blood stasis, Yang deficiency of heart and kidney, deficient Yang and blood stasis water retention, which are treated with the following methods respectively:Xinlijia, Shenjing Yixin Decoction, Buqi Tongmai Decoction, Guhuo Decoction and self-made Shenlijia. In the cited cases, revised Shenjing Yixin Decoction was applied for both deficiency of Qi and Yin and stasis block, Buhuo Decoction for Yang deficiency of heart and kidney, Buqi Tongmai Decoction for Qi deficiency and blood stasis, all got marked curative effect.[Conclusion] Professor JIANG has significant clinical effects in treating chronic heart failure, and later generations of doctors deserve to learn.
引文
[1]孟媛,毛秉豫,韦汉文.西医辨病与中医辨证相结合的慢性心衰辨证论治[J].浙江中医药大学学报,2017,41(6):474-477.
[2]陶雯,李七一.李七一诊治心力衰竭经验[J].中国中医药信息杂志,2018,25(7):102-104.
[3]武梦羚,宋耀鸿.基于“阴中求阳”理论治疗慢性心力衰竭的思路[J].安徽中医药大学学报,2016,35(3):17-19.
[4]陈飞,褚雪飞,焦志玲,等.姜德友诊疗心力衰竭病临证经验[J].中华中医药杂志,2017,32(2):612-614.
[5]王清任.医林改错[M].北京:人民卫生出版社,2005:40.
[6]李梴.医学入门[M].北京:中国中医药出版社,1995:339.
[7]陈飞,褚雪飞,焦志玲,等.姜德友诊疗心力衰竭病临证经验[J].中华中医药杂志,2017,32(2):612-614.
[8]孙许涛,姜德友,张安琪,等.姜德友辨治心系疾病经验[J].中医学报,2018,33(6):1009-1013.
[9]周其刚,王丽英.益气养心汤联合西药常规疗法治疗慢性心功能不全30例[J].浙江中医药大学学报,2013,37(5):572-573.
[2]陶雯,李七一.李七一诊治心力衰竭经验[J].中国中医药信息杂志,2018,25(7):102-104.
[3]武梦羚,宋耀鸿.基于“阴中求阳”理论治疗慢性心力衰竭的思路[J].安徽中医药大学学报,2016,35(3):17-19.
[4]陈飞,褚雪飞,焦志玲,等.姜德友诊疗心力衰竭病临证经验[J].中华中医药杂志,2017,32(2):612-614.
[5]王清任.医林改错[M].北京:人民卫生出版社,2005:40.
[6]李梴.医学入门[M].北京:中国中医药出版社,1995:339.
[7]陈飞,褚雪飞,焦志玲,等.姜德友诊疗心力衰竭病临证经验[J].中华中医药杂志,2017,32(2):612-614.
[8]孙许涛,姜德友,张安琪,等.姜德友辨治心系疾病经验[J].中医学报,2018,33(6):1009-1013.
[9]周其刚,王丽英.益气养心汤联合西药常规疗法治疗慢性心功能不全30例[J].浙江中医药大学学报,2013,37(5):572-573.