史载祥教授从虚实两端辨治冠心病心绞痛经验

Clinical experience of professor SHI Zai-xiang in treating angina pectoris from deficiency and excess

史载祥教授在继承前人理论的基础上,根据冠心病的病证特点,提出冠心病心绞痛的病机主要分为虚实两端: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;稳定型心绞痛当以扶正与祛邪兼顾,治以益气升陷,活血祛瘀,或温补阴阳,调其奇经。取得了较好的临床疗效。

Based on the inheriting predecessors＇ theory and the pathologic features of coronary heart disease, professor SHI Zai-xiang deems that the pathogenesis of coronary heart disease and angina are two aspects of deficiency and excess. One is ‘stoppage causes pain＇, due to the sinking of Daqi in the chest, which can＇t promote the movement of qi, blood, fluid, phlegm, and blood stasis block the heart vessel. The other is ‘the lack of nourishment causes pain＇, due to deficiency of kidney yin and yang, which can＇t warm and nourish Eight Extraordinary Meridians, and blood can＇t nourish the heart. Therefore, he emphasizes the superficiality and origin in treating angina pectoris according to acute or chronic. The principle of treating unstable angina is elimination of pathogen, warmly dredging channels and removing phlegm and blood stasis. The principle of treating stable angina is both elimination of pathogen and support of vital qi, supplementing and ascending qi and removing blood stasis, or warmly nourishing yin and yang and Eight Extraordinary Meridians, which achieves a good clinical efficacy.