中医药防治更年期心悸述评

Review on Prevention and Treatment of Climacteric Palpitations with TCM

更年期心悸病机有心肾不交,阴虚火旺;肝肾亏虚,肝气郁滞;精血亏虚,气滞血瘀;心脾两虚,阴虚阳亢;肾阴阳俱虚。中医治法有滋阴降火,交通心肾;滋补肝肾,养血理气;滋阴养血,活血化瘀;益气补血,健脾养心;调理冲任,平衡阴阳。目前,更年期心悸的病因病机尚不十分清楚,辨证分型无统一标准;其次,中医药对更年期心悸治疗大多局限于经验总结和个案报道,无统一诊断标准和疗效判定标准,研究结果很难被广泛认同;第三,对主观症状的改善和生活质量的提高是中医药防病治病的优势,但近年鲜有以生活质量为疗效指标的报道。因此,可基于随机对照试验设计理念,开展前瞻、随机、对照研究,制定统一的疗效评价标准,建立包括生活质量量表在内的多维结局指标评价体系,并进行相关机制探讨。

The pathogenesis of climacteric palpitations includes disharmony of heart and kidney,yin deficiency and excessive fire;deficiency of liver and kidney,stagnation of liver qi;deficiency of essence and blood,qi stagnation and blood stasis;deficiency of both heart and spleen,deficiency of yin and hyperactivity of yang;kidney yin and yang deficiency.TCM treatments include nourishing yin and reducing fire,coordinating the heart and kidney;nourishing the liver and kidney,nourishing blood and regulating qi;nourishing yin and blood,promoting blood circulation and removing blood stasis;replenishing qi and nourishing blood,invigorating the spleen and nourishing the heart;regulating thoroughfare and conception vessels,balance yin and yang.At present,first,the etiology and pathogenesis of climacteric palpitations is not very clear,and there is no unified standard for syndrome differentiation.Second,TCM treatments of climacteric palpitations are mostly limited to experience summary and case report,without unified diagnostic criteria and curative effect judgment criteria,so the research results are difficult to be widely recognized.Third,the improvement of subjective symptoms and quality of life is the advantage of TCM in disease prevention and treatment,but there are few reports in recent years regarding quality of life as the index of curative effect.Therefore,based on the concept of randomized controlled trial design,we can carry out prospective,randomized and controlled studies,formulate a unified evaluation standard of curative effect,establish a multi-dimensional outcome evaluation system including quality of life scale,and explore the relevant mechanism.