病毒性心肌炎中医证候学专家问卷分析

Analysis of the Expert Questionnaires on TCM Syndromes of Viral Myocarditis

目的:从专家经验角度研究病毒性心肌炎的中医证候学。方法:在系统整理文献资料和总结既往临床工作的基础上,制定病毒性心肌炎中医证候学专家问卷,采取现场问卷、现场回收的方式进行专家问卷。结果:大部分专家认为病毒性心肌炎与中医的心悸、胸痹和温病密切相关;其发病的关键因素是邪毒、气阴两虚、瘀血、痰浊;主要病机为邪毒侵心,耗气伤阴,瘀阻心络,心脉失养;证候要素以热毒、气阴两虚为主,挟痰挟瘀为患;中医辨证分型为邪毒侵心型、气阴两虚型及瘀阻心络型;其治法为解毒护心,益气养阴,活血通络;邪毒侵心型常以银翘散加减,气阴两虚型常以生脉散合炙甘草汤加减,瘀阻心络型常以血府逐瘀汤加减。结论:病毒性心肌炎属于本虚标实之证,本虚为心之气阴两虚,标实为热毒,兼挟痰瘀。

Objective： To research the TCM syndromes of viral myocarditis from the perspective of experts. Method： Based on the systematic summarizing previous literatures and clinical therapies, we designed the questionnaires on TCM syndromes of VMC, carried out questionnaire by the way of On - site survey. Results ： The majority of the experts think that the VMC is closely related to cardiopalmus, pectoral stuffiness pain and epidemic febrile disease in the range of TCM, whose key factors of pathogenesis are toxin, deficiency of both qi and yin ,static blood and phlegm, and main path- ogenesis are heart invasion by toxin, deficiency of qi and yi, blockade of heart vessel, malnutrition of heart blood and vessel. The syndrome elements of TCM are toxin,deficiency of qi and yi as the dominance, accompanied by static blood and phlegm, while the syndrome differentiations are heart invasion by toxin,syndrome of deficiency of qi and yi and syn- drome of blockade of heart vessel, and the rules of treatments are clearing toxicity and nourishing heart, replenishing qi and nourish yin and promoting blood circulation for removing blood stasis. The treatments of the type of heart invasion by toxin offer takes the modified YinQiao Powder, while the types of deficiency of qi and yi and blockade of heart vessel take modified ShengMai Powder and ZhiGanCao Decoction and XueFu ZhuYu Decoction respectively. Conclusion ： The VMC is a disease which belongs to the syndrome of deficiency of root cause and excess of manifestation in the range of TCM. The former is deficiency of both qi and yin of heart, while the later is toxin, accompanied by static blood and phlegm.