基于“损其心者,调其营卫”探讨快速型心律失常的辨治

Discussion on Application of"Regulating Yingwei in Case of Heart Damage"in Tachyarrhythmia

快速型心律失常是临床中常见的一类心律失常性疾病,中医典籍《难经》载:“损其心者,调其营卫”,提出了从营卫角度论治心系疾病的思想。本文以营卫特点为切入点,从理论基础、核心病机、基本治则和重点方药配伍4个方面探讨了“调和营卫”的治则思想在快速型心律失常辨治中的运用。笔者认为营卫和调是维持心搏正常的生理基础,而营卫失调则是本病的核心病机,因此在治疗上应以调和营卫为基本大法,笔者结合营卫的特点认为“调营卫”的核心即是调脾胃、调气血及调阴阳,盖脾胃得运则心神得养,气血和利则心脉得通,阴平阳秘则心神得安。在遣方用药时可选用桂枝类方、安神定律汤加减以调和营卫,宁心止悸。本文将理论探讨与临证实践相结合,并附典型验案一则,以期为临床辨治本病提供新的思路与方法。

Tachyarrhythmia is a common arrhythmia disease in clinics.The classic book of traditional Chinese medicine,Nan Jing,put forward the treatment principle of"Regulating Yingwei in case of heart damage".It presented the idea of treating the cardiovascular disease from the perspective of Yingwei.Based on the characteristics of Yingwei,We discussed the application of the method of"Regulating Yingwei"in the treatment of tachyarrhythmia from the four aspects:theoretical connotation,key pathological mechanism,basic treatment principles,and key drugs.We believe that the normal function of Yingwei is the guarantee to maintain the normal heartbeat,while the dysfunction of Yingwei is the core pathogenesis of the disease.So it is proposed that the treatment is ought to be based on regulating Yingwei.We think that the core idea of"Regulating Yingwei"is to regulate the spleen and stomach to make the heart full of vitality,regulate Qi and Blood to make the blood run smoothly,and regulate Yin and Yang to reduce palpitation.In terms of drug selection,Guizhi decoction and AnshenDinglu decoction are recommended to be used to reconcile Yingwei and reduce palpitations.We combined theoretical discussion with clinical practice and attached a typical case to provide new ideas and methods for clinical diagnosis and treatment of the disease.