仲景方在心阳不振型缓慢性心律失常的临床运用

Clinical Application of Zhongjing’s Formulae in Treatment of Bradyarrhythmia with Heart Yang Failure

缓慢性心律失常是临床的常见病之一,是心血管疾病重要死因之一。目前西医主要以增加心肌灌注、抗心律失常以及起搏技术为主,但仍存在短板。中医药对缓慢性心律失常治疗有着一定的优势,可以与西医治疗相互补充。临床工作中发现,缓慢性心律失常中以心阳不振型为多,辨证论治须从益气温阳入手。张仲景在《伤寒论》以及《金匮要略》中记载了桂枝甘草汤、桂枝甘草龙骨牡蛎汤以及桂枝加龙骨牡蛎汤三方,运用于缓慢性心律失常,分别对心阳不振、心阳不振兼有亡阳以及心阳虚衰引发的阴阳两虚之缓慢性心律失常有着一定的临床疗效。着眼于心阳不振型缓慢性心律失常,从病因病机、原文方义、临床举例等方面,来探讨仲景经方在临床上的运用心得,开拓中医药治疗此类疾病的诊疗思路,以期借鉴。

Bradyarrhythmia is one of the common clinical diseases and one of the important death causes of cardiovascular diseases. At present,western medicine mainly focuses on increasing myocardial perfusion,antiarrhythmia and pacing technology,but there are still short plates. Traditional Chinese medicine has certain advantages in the treatment of bradyarrhythmia,which can complement western medicine. In the clinical work,the author found that most patients with the bradyarrhythmias werethe non vibration type of heart Yang. In Treatise on Febrile Diseases and Synopsis of The Golden Chamber,ZHANG Zhongjing recorded three prescriptions of Guizhi Gancao Decoction,Guizhi Gancao Longgu Muli Decoction and Guizhi plus Longgu MuliDecoction. The author applied them to treat slow arrhythmia,which has a certain clinical effect on the slow arrhythmia of deficiency of Yin and Yang,deficiency of heart Yang with Yang exhaustion and deficiency of heart Yang. This paper focused on the slow arrhythmia of heart Yang type,discussed the clinical application experience of Zhongjing’s classic formulae from the aspects of etiology,pathogenesis,original meaning and clinical examples,so as to open up the diagnosis and treatment thinking of traditional Chinese medicine in the treatment of such diseases for reference.