基于针灸治疗的冠心病心绞痛的病因病机初探

Etiology and Pathogenesis of Coronary Heart Disease-induced Angina Pectoris Based on Acupuncture and Moxibustion Therapy

目的通过检索古代医籍、现代文献中有关针灸治疗冠心病心绞痛的相关文献,初步探讨基于针灸治疗的冠心病心绞痛的病因病机。方法 2016年7月—2017年11月,通过计算机在中国知网(CNKI)国学宝典数据库、中华古籍资源库、上海市中医文献馆、超星数字图书馆网站、贵州省数字图书馆、维普网等数据库检索1911年及之前公开出版的综合性医籍、医经、方书、代表性针灸医籍,并手动查阅现有数据库(贵阳中医学院图书馆)中的古代医籍;计算机检索CNKI、维普网、万方数据知识服务平台、贵州省数字图书馆1949—2017年发表的有关针灸治疗冠心病心绞痛的相关文献。采用聚类分析法分析冠心病心绞痛的病因病机。结果本研究共纳入64篇古代医籍文献及53篇现代文献。聚类分析结果显示,血瘀,痰浊阻滞,心气不足,气滞血瘀,阳虚为第一类;饮食不节,血虚,心肝脾肾亏虚,风冷邪气乘于心,气机不畅、气血阻滞,热邪、痰热,寒凝,脏腑虚弱、外邪他脏邪及心,阴虚,寒凝、寒邪为第二类;其他为第三类。结论寒凝、热邪等外来之邪,痰瘀气滞,五脏虚损,阴阳气血亏虚是冠心病心绞痛的常见病因;五脏虚损,阴阳气血亏虚是冠心病心绞痛的病理学基础;饮食不节,情志不调是导致冠心病心绞痛的不良习惯;寒,火,痰,瘀是冠心病心绞痛发生发展过程中的重要因素;冠心病心绞痛病位在心,病变常涉及肺脏、脾脏、肾脏。

Objective To search ancient medical books and current literatures to collect pertinent literatures about acupuncture and moxibustion therapy for coronary heart disease-induced angina pectoris,to initially investigate the etiology and pathogenesis of coronary heart disease-induced angina pectoris based on acupuncture and moxibustion therapy.Methods From July2016to July2017,comprehensive medical writings,medical classics,medical formulary and representative writings of acupuncture and moxibustion publicly published at or before1911were searched by computer in the GXBD of CNKI,Chinese Ancient Books Resource Base,Shanghai Traditional Chinese Medicine Library,the Super Star Digital Library,Digital Library of Guizhou Province and VIP,and ancient medical books in Library of Guiyang College of Traditional Chinese Medicine were manually looked up,meanwhile current literatures about acupuncture and moxibustion therapy for coronary heart diseaseinduced angina pectoris(publicly published from1949to2017)were searched by computer in CNKI,VIP,Wanfang Data Knowledge Service Platform and Digital Library of Guizhou Province.Clustering analysis was used to analyze the etiology and pathogenesis of coronary heart disease-induced angina pectoris.Results This study enrolled64ancient medical books and53current literatures.Clustering analysis results showed that,blood stasis,phlegm blocking,deficiency of heart Qi,Qi stagnation and blood stasis,deficiency of Yang were categorized as the first species;improper diet,deficiency of blood,deficiency of heart,liver,spleen and kidney,wind and cold pathogen with heart involved,Qi function deficiency combined with Qi and blood blocking,heat pathogen and phlegm-heat,heart weakness with exogenous and other organs pathogen,deficiency of Yin,cold congealing and cold pathogen were categorized as the second species;other etiological factor were categorized as the third species.Conclusion Exogenous pathogenic factors(such as cold congealing and fire pathogen),phlegm stasis and Qi stagnation,weakness of the five viscera,Yinyang-qixue deficiency are common etiological factors of coronary heart diseaseinduced angina pectoris,meanwhile weakness of the five viscera and Yinyang-qixue deficiency are the pathobiologic basis of coronary heart disease-induced angina pectoris;bad habits such as improper diet and emotions may result in coronary heart disease-induced angina pectoris;cold pathogen,fire pathogen,phlegm and stasis are important influencing factors in the occurrence and development of coronary heart disease-induced angina pectoris;the disease location of coronary heart diseaseinduced angina pectoris is heart,usually complicate with lung,spleen and kidney lesions.