中医药治疗冠心病心绞痛概况

General Situation of Chinese Medicine in Treating Angina Pectoris of Coronary Heart Disease

冠心病心绞痛可归属"胸痹""心痛"等范畴。始载于《灵枢》,张仲景首次明确提出胸痹心痛,病机为阳微阴弦,本虚标实,创立瓜蒌薤白三方。宋代活血化瘀广泛使用。清代王清任创制五逐瘀汤、补阳还五汤。当代学者认为多与阴寒内侵、体虚劳倦、七情所伤、饮食不节等因素相关;血脉瘀滞贯穿全程,活血化瘀乃基本大法,活血化瘀用复方冠心Ⅱ号、补阳还五汤、益气活血方、血府逐瘀汤、瘀毒清、赤香参通颗粒;豁痰泄浊用化痰降浊方、瓜蒌薤白半夏汤;宽胸理气用柴胡疏肝散;通阳宣痹用四逆汤、枳实薤白桂枝汤、瓜蒌薤白白酒汤;清热解毒用桂枝茯苓汤合黄连解毒汤。中医药治疗可减轻甚至消除症状,心电图和实验室指标有一定改善,疗效确切。

Angina Pectoris of coronary heart disease can be classified as "chest discomfort" and "heart pain". Originally published in Lingshu, ZHANG Zhongjing clearly put forward for the first time that chest discomfort and heartache were related to weak pulse at Yang and stringy pulse at Yin, which were originally deficient and marked as reality, and created the tripartite of Gualou Xiebai. Activating blood circulation and removing blood stasis were widely used in Song Dynasty. WANG Qingren created Wuzhuyu decoction and Buyang Huanwu decoction in Qing Dynasty. Contemporary scholars believe that most of them are related to Yin-cold intrusion, body deficiency and fatigue, seven emotions injury, improper diet and other factors;blood stasis throughout the whole process, promoting blood circulation and removing blood stasis is the basic law;promoting blood circulation and removing blood stasis with compound Guanxin II, Buyang Huanwu decoction,Yiqi Huoxue decoction, Xuefu Zhuyu decoction, Yuduqing, Chixiangshentong granule;eliminating phlegm and removing turbidity with Huatan Jiangzhuo decoction, Gualou Baibanxia decoction;broadening the chest and regulating Qi;Chaihu Shugan powder;Tongyang Xuanbi Sini decoction, Zhishi Xiebai Guizhi decoction,Gualou Xiebai Baijiu decoction;Guizhi Fuling decoction and Huanglian Jiedu decoction for clearing away heat and detoxification. TCM treatment can alleviate or even eliminate symptoms, ECG and laboratory indicators have improved to a certain extent, the curative effect is definite.