从心肾相交理论探讨冠脉介入术后再发心绞痛的中医药治疗

Discussion on the Therapy of Traditional Chinese Medicine in the Treatment of Angina Pectoris after Coronary Intervention from Intercourse between Heart and Kidney Theory

基于心肾相交理论分析冠脉介入术后再发心绞痛的病机,概括为心病及肾、肾病及心、心肾俱病以及心肾相交升降通路受阻等方面,以水湿、气滞、血瘀为重要病理因素,虚实夹杂,导致心火独亢,肾水不升。PCI术后再发心绞痛的治疗需通补并用,心病及肾、肾病及心、心肾俱病则以清心火、温肾水、温补心肾为主,升降受阻以健脾化湿、疏肝理气为主,同时兼顾活血化瘀,以达水火既济、阴平阳秘。辨证分别选用桂枝甘草汤、黄连阿胶汤、交泰丸,栀子豉汤、二陈汤、柴胡疏肝散加减治疗。临证须辨虚实、辨阴阳相结合,注重气机调节。

The pathogenesis of recurrent angina pectoris after coronary intervention was analyzed based on the theory of heart-kidney intersection.It can be summarized as heart disease and kidney,nephropathy and heart,heart and kidney diseases,as well as the obstruction of heart-kidney intersection lifting pathway.Water dampness,qi stagnation and blood stasis are the important pathological factors,which lead to hyperactivity of heart fire and no rise of kidney water.The treatment of angina pectoris after PCI needs tonifying and using.The way is to clear heart fire,warm kidney water,warm heart and kidney.Obstruction of the rising and falling need to strengthen the spleen,moisten the liver and regulate qi.According to syndrome differentiation,Guizhi Gancao decoction,Huanglian Ejiao decoction,Jiaotai pill,Zhizichi decoction,Erchen decoction and Chaihu Shugan powder were selected.Clinical evidence requires a combination of the real and virtual,yin and yang,while paying attention to air conditioning.