汤益明辨治心律失常46例经验探讨

Discussion of Tang Yiming' s Experiences in the Treatment of 46 Cases of Arrhythmia

总结和探讨汤益明老先生治疗心律失常的经验。汤老在病案中将心律失常的证型主要分为:邪毒犯心,耗气伤阴;气阴两虚,心神失养;心阳不足,气虚血瘀;心肾阳虚,寒滞瘀阻;气机紊乱,心神不宁。对各种证型其采用辨证与辨病并举,西药与方药齐施的中西医结合的方法治疗。并对室性早搏、阵发性室上性心动过速或心房颤动、病态窦房结综合征、心脏神经官能症等系统阐述发病机制及用药经验。如对室性早搏(尤其是病毒性心肌炎所致)应用中医药治疗,既可针对病因(各种侵犯心肌的病毒),及时清热解毒,祛除邪气,避免和减轻病毒对心肌细胞的进一步侵害,还可根据邪毒耗气伤阴的基本病理,益气养阴,调整机体免疫功能,防止继发性免疫反应对心肌组织及传导系统的损伤。

Mr. Tang Yiming＇s experiences in treatment of arrhythmia were summarized and explored in the paper. In Mr. Tang＇ s cases,arrhythmia is differentiated as pathogenic toxin attacking the heart,consumption of qi and injury of yin; qi and yin deficiency,malnutrition of heart mind; heart yang insufficiency,qi deficiency and blood stagnation; heart and kidney yang deficiency,cold and stasis retention; disturbance of qi activity,disturbance of heart mind. No matter which pattern / syndrome,the differentiation of pattern / syndrome and the differentiation of disease are carried on simultaneously and western medicines and herbal formulas are integrated in treatment. The etiologic mechanism and medicinal experiences were explained systematically for the treatment of ventricular premature beat（ VPB）,paroxysmal supraventricular tachycardia（ PSVT） or atrial fibrillation（ AF）,sick sinus syndrome（ SSS） and cardiac neurosis. For example,in the treatment of VPB（ especially the case caused by viral myocarditis）,Chinese medicines work on the etiology（ various virus attacking myocardium）,clearing heat,detoxification,removing pathogens,avoiding and alleviating the further damages of virus to myocardial cells. Additionally,Chinese medicines act on benefiting qi,nourishing yin,regulating body immune function and preventing the secondary immune reaction from the injuries to myocardial tissue and conductive system.