基于“心部于表”理论探讨胸痹证治

Discussion on the treatment of chest pain based on the theory of‘heart governing the exterior'

胸痹是临床常见疾病,基于《黄帝内经》“心部于表”理论,结合临床,探讨外感风寒导致胸痹的机理和治法方药。心为阳脏,其象类火,心气的运动趋势为向外向上,心阳敷布体表发挥温煦之功,心血输布体表发挥滋润濡养之效。心与营卫关系紧密,营卫周流全身,布达体表有赖于心气的推动作用。心藏神任物,控制体表的感知觉并调控人体视听言动等外在活动。在病理方面,心火过于亢盛,火气外浮,会导致痈肿疮疡等皮肤病变,相同体表感受风寒之邪会影响营卫正常循行,影响心阳宣通,阻滞气血运行,进而导致胸痹。故外感风寒导致的胸痹应采用辛温解表的治法,使心阳宣通,气血和畅,心脉心体得以濡养,则胸痹可除。

Chest pain is a common clinical diease.Based on the theory of‘heart governing the exterior'in Huangdi Neijing and combined with clinical practice,this paper explores the mechanism and treatment of chest pain caused by the evil of wind and cold.The heart is yang zang,which is like fire,and the movement trend of the heart qi is outward and upward.The heart yang diverge to body surface to exert the function of warmth,and the blood of the heart is transported to the body surface to exert the effect of moisturizing and nourishing.The heart is closely related to the ying-wei,the ying-wei circulating the whole body and distributing the body surface depends on the driving role of heart qi.The heart stores the spirit,controls the perception of the body surface and regulates the external activities of the human body,such as watching,hearing,speech and movement.In terms of pathology,excessive hyperactivity of heart fire will lead to skin lesions such as carbuncle,swelling and sores,while body surface feels the evil of wind and cold will affect the normal circulation of ying qi and wei qi,affect the spread of heart yang,hinder the circulation of qi and blood,and then lead to chest pain.Therefore,the chest pain caused by the evil of wind and cold should be treated by relieving superficies syndrome with pungent and warm natured drugs,so that the heart yang is publicizing,the qi and blood is smooth,the heart can be nurtured,and the chest pain can be eliminated.