冠心病合并心衰水肿的证治探讨
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摘要
本虚标实是冠心病合并心衰水肿的基本病机,本虚常常为心的气血阴阳虚损,特别是以心之气、阳亏虚为主要;标实则指瘀血、水饮。虚实夹杂,相互交错,久病迁延不愈,则会导致气虚阳日益虚甚,引起血瘀、水停从而引发水肿。该病的病位主要在心,与肺、脾、肾三脏关系密切。冠心病合并心衰水肿多由饮食不节、外感六淫、情志失常及久病体虚所导致。通常将其证型分为心肺气虚、心肾阳虚、血瘀饮停和痰湿阻滞。文章就冠心病合并心衰水肿的病因病机、证候分析及辨证论治展开探讨。
The pathogenesis of coronary heart disease with heart failure and edema is deficiency in origin and excess in superficiality. The deficiency in origin is the deficiency of Yin,Yang,Qi and blood,especially the Qi and Yang deficiency of heart.The excess in superficiality means blood stasis and phlegm retention. The deficiency and excess are mixed. Long duration can cause the deficiency of Qi and Yang is more and more deficient,leading to edema because of blood stasis. The disease position is mainly in heart,and is closely related to lung,spleen and kindey. The etiology and pathogenesis is mostly because of unbalanced diet,the six exogenous evils,modern disorder and weakness due to chronic disease. It is parted into the deficiency of Qi in heart and lung,the deficiency of Yang in heart and kidney,edema because of blood stasis and accumulation of phlegm-damp in collaterals. This article mainly explained the etiology and pathogenesis,syndrome analysis and treatment based on syndrome differentiation of coronary heart disease combined with heart failure and edema.
The pathogenesis of coronary heart disease with heart failure and edema is deficiency in origin and excess in superficiality. The deficiency in origin is the deficiency of Yin,Yang,Qi and blood,especially the Qi and Yang deficiency of heart.The excess in superficiality means blood stasis and phlegm retention. The deficiency and excess are mixed. Long duration can cause the deficiency of Qi and Yang is more and more deficient,leading to edema because of blood stasis. The disease position is mainly in heart,and is closely related to lung,spleen and kindey. The etiology and pathogenesis is mostly because of unbalanced diet,the six exogenous evils,modern disorder and weakness due to chronic disease. It is parted into the deficiency of Qi in heart and lung,the deficiency of Yang in heart and kidney,edema because of blood stasis and accumulation of phlegm-damp in collaterals. This article mainly explained the etiology and pathogenesis,syndrome analysis and treatment based on syndrome differentiation of coronary heart disease combined with heart failure and edema.
引文
[1]张明雪,曹洪欣.冠心病中医研究[M].北京:中国中医药出版社,2010:1-3.
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[3]石学敏,戴锡孟,王键.中医内科学[M].北京:中国中医药出版社,2009:292-293.
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[8]沈会.心力衰竭古今中医文献的整理与研究[D].北京:北京中医药大学,2006.
[9]陈宝明.升陷汤治疗冠心病临床举隅[J].中级医刊,1992(4):248.
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[11]陈玉珍.以参附汤为主治疗急性心力衰竭的体会[J].中医药研究,1993(5):47.
[12]刘渡舟.金匮要略诠解[M].天津:天津科学技术出版社,1983.
[13]刘硕,常艳鹏,张明雪.冠心病合并心衰症候特征[J].中国老年病学杂志,2015(6):1457-1458.
[14]吴燊荣.补阳还五汤加减治疗慢性风心病顽固性心力衰竭[J].中西医结合杂志,1988(2):100.
[15]刘志军,金华,曹强,等.心力衰竭水肿从脾胃论治机理探讨[J].中国中医药科技,2015,22(6):658-659,663.
[2]陈灏珠,钟南山,陆再英.内科学[M].北京:人民卫生出版社,2013:162-163.
[3]石学敏,戴锡孟,王键.中医内科学[M].北京:中国中医药出版社,2009:292-293.
[4]王义强,邓悦,于金娜,等.冠心病中医病因、病机及诊治的古代文献回顾[J].环球中医药,2013,6(4):297-300.
[5]王冰,注.黄帝内经素问[M].北京:人民卫生出版社,1963.
[6]张琦.金匮要略讲义[M].上海:上海科学技术出版社,2008.
[7]张锡纯.医学衷中参西录[M].太原:山西科学技术出版社,2009.
[8]沈会.心力衰竭古今中医文献的整理与研究[D].北京:北京中医药大学,2006.
[9]陈宝明.升陷汤治疗冠心病临床举隅[J].中级医刊,1992(4):248.
[10]唐宗海.血证论[M].上海:上海人民出版社,1977.
[11]陈玉珍.以参附汤为主治疗急性心力衰竭的体会[J].中医药研究,1993(5):47.
[12]刘渡舟.金匮要略诠解[M].天津:天津科学技术出版社,1983.
[13]刘硕,常艳鹏,张明雪.冠心病合并心衰症候特征[J].中国老年病学杂志,2015(6):1457-1458.
[14]吴燊荣.补阳还五汤加减治疗慢性风心病顽固性心力衰竭[J].中西医结合杂志,1988(2):100.
[15]刘志军,金华,曹强,等.心力衰竭水肿从脾胃论治机理探讨[J].中国中医药科技,2015,22(6):658-659,663.