王行宽教授辨治慢性心力衰竭继发肺部感染临床经验

Professor WANG Xingkuan's Experience in the Treatment of Patients with Pulmonary Infection Secondary to Chronic Heart Failure Based on Syndrome Differentiation

介绍全国名中医王行宽教授辨治慢性心力衰竭继发肺部感染的临床经验。王教授认为慢性心力衰竭所致内生之痰饮湿浊与外感六淫等邪气搏结,蕴生湿热之邪,在病机演变中起主导作用。治疗上主张宣利湿热与清营养阴并重,常以三仁汤合清营汤加减进行治疗,意在宣透渗利、驱邪外出的基础上顾护心营。而湿热之邪壅闭渐盛亦能袭扰中焦,造成高热稽留,炼灼脏腑津气为痰,治疗时要注重辨痰的性质,并灵活调整治法方药,常用方剂在三仁汤、清营汤的基础上又有麻杏石甘汤、小陷胸汤、沙参麦冬汤治之。此外,针对湿热伏居阴分所致潮热时间不同的特点,以青蒿鳖甲汤或清骨散治疗夜热早凉型患者,柴芩温胆汤治疗白昼潮热型患者,临床疗效佳。

This paper introduced Professor WANG Xingkuan's experience in the treatment of pulmonary infection secondary to chronic heart failure.It is believed that the pathogenic Qi such as phlegm dampness and turbid phlegm caused by heart failure and exogenous six pathogens are combined in the lung,and the dampness and heat caused by depression play a leading role in the development of pathogenesis.For the treatment,the idea is to emphasize both the promotion of dampness and heat and the clearing nutrient Qi and nourishment Yin.It is often treated with modified Sanren Decoction and Qingying Decoction in order to protect the heart and nutrient Qi on the basis of promoting diuresis and expelling pathogenic factors.The gradual accumulation of dampness heat can also disturb middle jiao,and cause high heat retention,thus burning the viscera and fluid Qi into phlegm.The treatment needs to distinguish the nature of phlegm,flexibly adjust the treatment methods and prescriptions.On the basis of the above,the commonly used prescriptions include Maxing Shigan Decoction,Xiaoxianxiong Decoction,Shashen Maidong Decoction.In addition,in view of the characteristics of tidal fever in different time caused by damp heat hiding in Yin level,Qinghao Biejia Decoction or Qinggu Powder were used to treat the patients with night heat and early cooling,and Chaiqin Wendan Decoction was used to treat the patients with tidal fever at daytime,with good clinical efficacy.