《金匮要略》分期辨治“心病”
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摘要
《金匮要略》乃"医方之祖,而治杂病之宗也",既有"心病"专篇论述,且有散见他篇的分期辨治。早期-心气不足,胸闷短气,气伤是主要表现,胸闷短气为并发症,治以参麦饮。中期-心阳不足,温煦功能减退,胸闷短气,心中空虚惕惕而动,脉结代等,治以小建中汤、桂枝甘草汤、炙甘草汤、桂枝去芍药加蜀漆牡蛎龙骨救逆汤。后期-痰瘀内阻,胸痹心痛,胸阳不振,阴寒内生,殃及心脉瘀滞不通而出现胸痹心痛,治以瓜蒌薤白白酒汤、栝蒌薤白半夏汤、薏苡附子散、乌头赤石脂丸。冠心病可归属为"胸痹""真心痛""心悸"等范畴,辨证可根据心气、心阳损伤程度早诊断,及时发现,分期诊治,截断病势。研究整理张仲景心病分期论治思路,对防治心病有重要指导意义。
"Synopsis of Golden Chamber"(金匮要略) is the "ancestor of the medical side, and the sect of the disease"(心病), which has a special chapter on "heart disease", and there are scattered stages of differentiation.Early-lack of heart, chest tightness and shortness of breath, Qi injury is the main performance, chest tightness and shortness of breath for complications, treated with Shenmai drink(参脉饮). In the mid-term, the heart is not enough, the warming function is diminished, the chest tightness is short, the heart is hollow and the heart is empty, and the pulse is replaced. The treatment is Xiao Jianzhong decoction(小建中汤), Guizhi Gancao decoction(桂枝甘草汤), Zhigancao decoction(炙甘草汤). Late-sputum internal resistance, chest pain, chest and Yang, Yin and cold endogenous, sputum and heart stagnation and stagnation, chest pain, heartache. Cure with Gualou Xiebai Baijiu decoction(瓜蒌薤白白酒汤), Gualou Xiebai Banxia decoction(瓜蒌薤白半夏汤), Yiyi Fuzi powder(薏苡附子散), Wutou Chishizhi pill(乌头赤石脂丸). Coronary heart disease can be classified into the categories of "chest", "true heart pain" and "heart palpitations". Syndrome differentiation can be diagnosed according to the degree of heart and heart-yang damage, timely detection, staged diagnosis and treatment, and truncation of disease. Studying and sorting out the thoughts of Zhang Zhongjing's heart disease and staging, it has important guiding significance for the prevention and treatment of heart disease.
"Synopsis of Golden Chamber"(金匮要略) is the "ancestor of the medical side, and the sect of the disease"(心病), which has a special chapter on "heart disease", and there are scattered stages of differentiation.Early-lack of heart, chest tightness and shortness of breath, Qi injury is the main performance, chest tightness and shortness of breath for complications, treated with Shenmai drink(参脉饮). In the mid-term, the heart is not enough, the warming function is diminished, the chest tightness is short, the heart is hollow and the heart is empty, and the pulse is replaced. The treatment is Xiao Jianzhong decoction(小建中汤), Guizhi Gancao decoction(桂枝甘草汤), Zhigancao decoction(炙甘草汤). Late-sputum internal resistance, chest pain, chest and Yang, Yin and cold endogenous, sputum and heart stagnation and stagnation, chest pain, heartache. Cure with Gualou Xiebai Baijiu decoction(瓜蒌薤白白酒汤), Gualou Xiebai Banxia decoction(瓜蒌薤白半夏汤), Yiyi Fuzi powder(薏苡附子散), Wutou Chishizhi pill(乌头赤石脂丸). Coronary heart disease can be classified into the categories of "chest", "true heart pain" and "heart palpitations". Syndrome differentiation can be diagnosed according to the degree of heart and heart-yang damage, timely detection, staged diagnosis and treatment, and truncation of disease. Studying and sorting out the thoughts of Zhang Zhongjing's heart disease and staging, it has important guiding significance for the prevention and treatment of heart disease.
引文
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[8]程金波,卫洪昌,章忱,等.麦冬提取物抗犬心肌缺血的药效学实验研究[J].中国病理生理杂志,2001,17(8):810.
[9]蒋仕丽,章蕴毅,陈道峰.异型南五味子丁素、五味子酚和(+)-安五脂素对血小板聚集的影响[J].复旦学报(医学版),2005,32(4):467.
[10]张隐庵.黄帝内经素问集注[M].北京:学苑出版社,2002.
[11]张晋升.张仲景治疗心悸的方证辨治探析[J].辽宁中医药大学学报,2015,17(12):112-114.
[12]尤在泾.金匮要略心典[M].李云海,张志峰,校注.北京:中国医药科技出版社,2014:43.
[13]李赛美,李宇航.伤寒论讲义[M].北京:人民卫生出版社,2012.
[14]钱潢.伤寒溯源集[M].周宪宾,陈居伟,校注.北京:学苑出版社,2009.
[15]唐荣华.炙甘草汤治疗脉结代心动悸的体会[J].中国中医急症,2011,20(3):392-393.
[16]胡久略,黄显章.炙甘草汤抗心律失常作用的实验研究[J].时珍国医国药,2008,19(5):1189-1190.
[17]袁杰.炙甘草汤对大鼠在体心肌缺血-再灌注损伤后左心功能及抗氧化酶的影响[J].时珍国医国药,2008,19(2):411-412.
[2]付新伟.《金匮要略》辨治心悸方证探析[J].中医研究,2016,29(5):6-8.
[3]季绍良,成肇智.中医诊断学[M].北京:人民卫生出版社,2002:141.
[4]张琦,赵天才.金匮要略[M].北京:中国医药科技出版社,2012.
[5]张山泰.《金匮要略》“短气”新解[J].中医药临床杂志,2009,21(5):377-378.
[6]宋柯.参麦七味饮治疗气阴两虚型冠心病心绞痛的临床研究[D].济南:山东中医药大学,2015.
[7]郭自强,朱陵群,张立平.党参对大鼠离体工作心脏缺血/再灌注损伤的保护作用[J].北京中医药大学学报,1995,18(5):39.
[8]程金波,卫洪昌,章忱,等.麦冬提取物抗犬心肌缺血的药效学实验研究[J].中国病理生理杂志,2001,17(8):810.
[9]蒋仕丽,章蕴毅,陈道峰.异型南五味子丁素、五味子酚和(+)-安五脂素对血小板聚集的影响[J].复旦学报(医学版),2005,32(4):467.
[10]张隐庵.黄帝内经素问集注[M].北京:学苑出版社,2002.
[11]张晋升.张仲景治疗心悸的方证辨治探析[J].辽宁中医药大学学报,2015,17(12):112-114.
[12]尤在泾.金匮要略心典[M].李云海,张志峰,校注.北京:中国医药科技出版社,2014:43.
[13]李赛美,李宇航.伤寒论讲义[M].北京:人民卫生出版社,2012.
[14]钱潢.伤寒溯源集[M].周宪宾,陈居伟,校注.北京:学苑出版社,2009.
[15]唐荣华.炙甘草汤治疗脉结代心动悸的体会[J].中国中医急症,2011,20(3):392-393.
[16]胡久略,黄显章.炙甘草汤抗心律失常作用的实验研究[J].时珍国医国药,2008,19(5):1189-1190.
[17]袁杰.炙甘草汤对大鼠在体心肌缺血-再灌注损伤后左心功能及抗氧化酶的影响[J].时珍国医国药,2008,19(2):411-412.