心律失常的中医认识与经方治疗策略

Arrhythmia:innovative understanding from traditional Chinese medicine and treatment by classic herbal formulas

心律失常为心血管病领域的常见病、多发病,我国约有2000万心律失常患者,给公共卫生健康带来沉重负担。目前,药物与手术治疗已成为心律失常的常规治疗手段。然而,“治”心律失常药物存在“致”心律失常的不良反应、手术治疗尚存在一定的失败率与复发率,因此心律失常的临床治疗效果亟待提升。心律失常属于中医学“心悸”范畴。在病因病机上,与肝郁气滞、痰浊内蕴、水饮凌心、火热扰心、瘀阻心脉、寒凝心脉及气血阴阳亏虚密切相关。因此,提出郁悸、痰悸、饮悸、火悸、瘀悸、寒悸、虚悸7种中医证型。在经方治疗策略上,郁悸推荐柴胡加龙骨牡蛎汤,痰悸推荐温胆汤,饮悸推荐苓桂术甘汤等苓桂剂,火悸推荐三黄泻心汤,瘀悸推荐血府逐瘀汤,寒悸推荐麻黄附子细辛汤,虚悸则根据气血阴阳的不足,推荐桂枝甘草汤、桂枝甘草龙骨牡蛎汤、黄连阿胶汤、炙甘草汤、归脾汤等。若证型相兼,则合方而治。基于“方证对应”与“病机结合病理,药性结合药理”的中西医整合医学思想,该研究提出在心律失常的中医治疗中,主张有是证用是方,倡导“病机-病理-药性-药理”四位一体的中西医整合诊疗模式,进一步提升经方治疗心律失常的临床疗效。

Arrhythmia,a common and frequently occurring cardiovascular disease,causes a heavy burden on the public health of China.Approximately 20 million patients are suffering from this disease in China and treated by pharmacological and surgical therapies.However,antiarrhythmic drugs can cause arrhythmia and surgical treatment has the risks of failure and recurrence.Therefore,the clinical outcome of arrhythmia remains to be improved.According to the traditional Chinese medicine(TCM)theory,arrhythmia is a disease of palpitation induced by 7 conditions:liver depression and Qi stagnation,accumulation of turbid phlegm,fluid retention attacking the heart,fire-heat disturbing the heart,stasis obstruction of heart vessel,cold congealing in heart vessel,and the deficiency of Qi,blood,Yin,and Yang.Therefore,this study concisely proposed 7 TCM syndromes of arrhythmia,including the palpitation due to depression,phlegm,fluid retention,fire,blood stasis,cold,and deficiency.The corresponding treatment strategies were recommended as follows:Chaihu Longgu Muli Decoction for the palpitation due to depression,Wendan Decoction for the palpitation due to phlegm,Linggui Zhugan Decoction for the palpitation due to fluid retention,Sanhuang Xiexin Decoction for the palpitation due to fire,Xuefu Zhuyu Decoction for the palpitation due to blood stasis,and Mahuang Fuzi Xixin Decoction for the palpitation due to cold,and Guizhi Gancao Decoction,Guizhi Gancao Longgu Muli Decoction,Huanglian Ejiao Decoction,Zhigancao Decoction,and Guipi Decoction for the palpitation due to the deficiency of Qi,blood,Yin,and Yang.Multiple formulas should be combined if the patient presents several TCM syndromes simultaneously.According to the principles of the correspondence between formula and syndrome and the treatment with consideration to both pathogenesis and pathology and both herbal nature and pharmacology,this study proposed an integrated treatment model of"pathogenesis-pathology-nature-pharmacology"to enhance the clinical efficacy of classic herbal formulas in the treatment of arrhythmia.