急性冠脉综合征热毒病机辨治策略

Differentiation and Treatment Strategies for the Pathogenesis of Heat Toxicity in Acute Coronary Syndrome

急性冠脉综合征(ACS)是一组由急性心肌缺血引起的临床综合征。ACS以脏腑虚损为本,痰瘀为标,热毒为变。痰热、郁热、瘀热化生热毒,热毒痹阻心脉是ACS基本病机。热毒多由气分传变入血,气分、血分辨治是ACS热毒病机辨治纲领。热毒结胸、邪滞气分,治宜分消祛除痰、湿、积、滞等秽浊有形实邪,通达气机,清宣透散,火郁发之,清热解毒,予升降散、栀子豉汤、柴胡剂、越鞠保和丸、小陷胸汤加枳实、瓜蒌薤白半夏汤、黄连解毒汤、凉膈散、宣白承气汤等辨证加减;热入营血,热毒夹瘀,治宜凉血活血解毒、益气养阴生津,予四妙勇安汤、生脉散、《证治准绳》养心汤、炙甘草汤等经典名方辨证治之。结合中医古籍文献记载以及现代研究成果,深入挖掘ACS热毒病机气分血分辨治的理法方药,可为中医药治疗ACS提供精准指导。

Acute coronary syndrome(ACS)is a group of clinical syndromes caused by acute myocardial ischemia.ACS,with the root cause of deficiency of zang-fu organs,symptoms marked by phlegm stasis and changed by heat toxicity.Phlegm heat,stagnated heat,stasis heat producing heat toxicity,and heat toxicity obstructing heart pulse is the basic pathogenesis of ACS.Heat toxicity is mostly transferred from qifen to xuefen,and differentiation of qifen and xuefen is the mechanism and treatment of ACS heat toxicity.Heat toxicity chest binding,evil stagnation in qifen,the treatment should be divided to eliminate phlegm,dampness,accumulation,stagnation and other visible and solid evil,enabling access to qi,clearing stagnated heat and fire stagnation,clearing heat and detoxification,and the medicines include the modified Shengjiang Powder,Zhizichi Decoction,Chaihu Mixture,Yueju Baohe Pills,Xiaoxianxiong Decoction with Zhishi,Gualou Xiebai Banxia Decoction,Huanglian Jiedu Decoction,Liangji Powder,Xuanbai Chengqi Decoction according to syndrome differentiation.Heat invading into yingfen and xuefen with heat toxicity and blood stasis,the treatment should be cooling blood and activating blood detoxification,replenishing qi,nourishing yin and promoting fluid production,and the medicines include Simiao Yong′an Decoction,Shengmai Powder,Yangxin Decoction in Standards for Diagnosis and Treatment,Zhigancao Decoction and other classic prescription according to syndrome differentiation.Combining ancient Chinese medicine literature records and modern research results,the theory,method and medicine in the differentiation and treatment of ACS heat toxicity by qifen and xuefen are deeply explored to provide accurate guidance for TCM treatment of ACS.