从“扶正祛邪”辨治不稳定型心绞痛探析

Treatment and Differentiation of Unstable Angina Pectoris Based on the Theory of“Fuzheng Quxie”

不稳定型心绞痛(UAP)属于急性冠脉综合征,是一种由于突发诱因导致的斑块破裂、糜烂,产生心肌缺血,以频发加剧的心前区绞痛为特征的严重疾病。中医认为本病属虚实夹杂,邪盛正虚,斗争剧烈,虚在脾胃受损与阳气亏虚,导致水湿痰浊不化,与瘀血互结于心脉,脉管狭窄,供血不足导致心肌受损。日久后痰瘀互结形成的斑块受到突发不良条件的刺激,致血管中斑块从底层糜烂、破裂,成为毒邪,堵塞心脉,发为UAP疾病。治疗时先祛邪后扶正,祛邪不伤正。扶正不恋邪,其中祛邪除痰、瘀、气滞,用药平和,不用峻猛之品,辅以补气、养血扶正。祛邪后舌腻减退,扶正时补气而不燥,补血养血而不滋腻,若病势转坏,急剧疼痛,亡阴亡阳,那么应中西医配合,救命为主,扶正固脱,使用中医注射液、汤剂、针刺与芳香疗法结合的方式,多剂型、多给药途径进行治疗。

Unstable angina pectoris(UAP)belongs to acute coronary syndrome.It is a serious disease characterized by frequent exacerbation of precordial angina pectoris,which is caused by plaque rupture and erosion,resulting in myocardial ischemia.According to traditional Chinese medicine(TCM),the disease is a mixture of deficiency and excess,excessive pathogenic factors and deficiency,and the struggle is intense.Deficiency in the spleen and stomach is damaged and yang qi is deficient,resulting in water damp phlegm turbidity,and blood stasis is interlinked to the heart vessel,vascular stenosis,and insufficient blood supply,leading to myocardial damage.After a long time,the plaques formed by the interaction of phlegm and blood stasis are stimulated by emotion and fatigue,which cause the plaques in the blood vessels to erode and rupture from the bottom,become toxic pathogens,and block the heart,which is called UAP disease.During the treatment,the pathogens should be removed first and then the health should be strengthened.Fuzheng will disperse evil,which removes phlegm,blood stasis,qi stagnation.Uses gentle drugs,not strong medicines,and be supplemented by tonifying qi and nourishing blood.After eliminating pathogens,the greasy tongue is reduced,while strengthening qi but not dryness,nourishing blood and nourishing blood but not greasy.If the disease gets worse,the pain is sharp and the yin and yang are lost,then the combination of Chinese and western medicine should be applied to save lives,strengthening the body,and using traditional Chinese medicine injection,decoction,acupuncture and aromatherapy.