心包积液中医辨治规律探讨

Rules of Syndrome Differentiation and Treatment for Pericardial Effusion in Chinese Medicine

心包积液由心包或全身多种疾病所引起,根据其临床表现将其归属于中医"心水"范畴。该病是因正气不足,外邪侵袭,久痹入心,或心包受损,气机失调,水与血运行障碍而停聚于心包所导致的一种本虚标实性疾病。心包积液的治疗以扶正祛邪为原则,扶正包括益气、温阳和滋阴;祛邪当以利水为主,气、血、水同调,汗、利、下同施。心包积液根据渗出液与漏出液的不同,分别给予清热凉血解毒与益气温阳利水的基本治疗;同时根据心包积液的病因可分为结核性心包积液、狼疮性心包积液、甲状腺功能减退症性心包积液、尿毒症性心包积液和肿瘤性心包积液等类型,不同病因心包积液的病机亦不同,故予以不同治疗方法。

Pericardial effusion,caused by pericardium disease or many other systemic diseases,belongs to＂heart edema＂in Chinese medicine based on its clinical manifestations. It is a disease with deficiency in origin and excess in superficiality,and water and blood retention in pericardium due to healthy Qi deficiency,pathogenic Qi attack and long-time Bi syndrome moving into the heart,or pericardium damage and disorder of Qi movement. The therapeutic principle is strengthening the body resistance to eliminate pathogenic factors. Strengthening the body resistance includes boosting Qi,warming Yang and enriching Yin. To eliminate pathogenic factors,promoting urination should be focused on,Qi,blood and water should be regulated at the same time,and sweat promotion,urination promotion and purgation should all be used. According to the difference between transudate and diffusate,heat-clearing blood-cooling toxin-resolving method or Qi-boosting Yang-warming urination-promoting method will be used. Meanwhile,according to the different causes,pericardial effusion can be divided into tuberculous pericardial effusion,lupus pericardial effusion,hypothyroidism pericardial effusion,uremic pericardial effusion,tumor pericardial effusion,and other types. Since pericardial effusion with different causes has different pathogenesis,the therapeutic method should be different.