毛德西辨治胸痹心痛经验

MAO Dexi’s experience in treating precordial pain with chest discomfort

冠状动脉粥样硬化性心脏病(简称冠心病)属于中医学“胸痹心痛”范畴,现代医学一致认为胸痹心痛的基本病机为本虚标实,虚证多为心气亏虚、胸阳不振,实证多认为血瘀、痰湿、气滞、寒凝等。毛德西教授在本虚标实理论基础上,结合当代时代特色及临床经验,对本虚标实理论进行进一步阐发,认为气阴亏虚是胸痹心痛的根本病机。毛德西教授临床以生脉散为基础方加减治疗该病,对气阴亏虚明显者,予自拟益气养阴汤方治疗。毛德西教授认为,血瘀是胸痹心痛始终存在的病理状态,活血化瘀是临床治疗胸痹心痛需要贯穿始终的治法,临床以冠心二号方加减治疗。痰浊是胸痹心痛另外一个重要的标实证候,且在当代呈增多趋势,是当代胸痹心痛的特色之一,临床中以大补心汤加减治疗。此外,寒凝心脉也是常见证型之一,毛德西教授喜用芳香温通药物治疗,临床常以宽胸丸加减。水饮内停是毛德西教授对胸痹心痛“阴弦”病机的进一步发挥,认为“阴弦”主要是水饮内停为患,临床中以苓桂术甘汤加减治之,病情严重者合真武汤加减治疗。临床中证型单一者少见,往往为复合证型,辨证论治时需把握本虚标实的偏重。

Coronary atherosclerotic heart disease(CHD)belongs to the category of precordial pain with chest discomfort in TCM.Modern medicine unanimously believes that the basic pathogenesis of precordial pain with chest discomfort is deficiency in origin and excess in superficiality.The deficiency syndrome is mostly Qi(气)deficiency in the heart and Yang(阳)listlessC in the chest,and the excess syndrome is mostly blood stasis,phlegm-dampness,Qi stagnation,cold coagulation,etc..On the basis of the theory of deficiency in origin and excess in superficiality,Professor MAO Dexi elaborates the theory of deficiency in origin and excess in superficiality in combination with the characteristics of contemporary times and clinical experience,believes that the deficiency of Qi and Yin(阴)was the fundamental pathogenesis of precordial pain with chest discomfort.In clinic,the disease was treated with Shengmai San(生脉散),and the patients with obvious deficiency of Qi and Yin were treated with the Yiqi Yangyin decoction(益气养阴汤).Professor MAO Dexi believes that blood stasis is the pathological state of precordial pain with chest discomfort,and promoting blood circulation is the clinical treatment method of precordial pain with chest discomfort that needs to be carried out throughout the treatment.The Guanxin No.2 formula(冠心二号方)is used to treat the disease.Phlegm turbidity is another important excessive symptom of precordial pain with chest discomfort,and its incidence is increasing in contemporary times.Phlegm turbidity is one of the characteristics of precordial pain with chest discomfort,and is treated with the Da Buxin decoction(大补心汤).In addition,cold coagulation in heart is also one of the common types,Professor MAO Dexi likes to use aromatic-warm medicines to treat this type,and Kuanxiong Wan(宽胸丸)is mainly used clinically.The internal stagnant fluid is a further exertion of the pathogenesis of string-like pulse of precordial pain with chest discomfort by Professor MAO Dexi,and it is considered that string-like pulse is mainly caused by internal stagnant fluid.In clinical practice,the Linggui Zhugan decoction(苓桂术甘汤)is added or subtracted by the professor to treat internal stagnant fluid,and those with severe disease conditions are treated with the Zhenwu decoction(真武汤).The single syndrome type is rare in clinic,and it is often a compound syndrome type.In syndrome differentiation and treatment,it is necessary to grasp the emphasis on deficiency in origin and excess in superficiality.