基于“血-脉-心-神”一体观探析稳定型心绞痛合并失眠的辨治思路

Exploration of Clinical Thoughts for Treatment of Stable Angina with Insomnia under the Guidance of the"Blood-Pulse-Heart-Spirit"

以“血-脉-心-神”一体观为指导,认为稳定型心绞痛合并失眠以血脉不利为基本病机,血脉不利导致心体和心神失养,故提出以通脉安神为核心治则。发病之初为肝失疏泄、气血紊乱;病进之由为脾虚痰滞、痰瘀阻脉;中心环节为血脉不利、心阴不足。针对肝郁血瘀证、痰瘀阻脉证、心阴虚证,分别施以五脏神宁方疏肝通脉、半夏厚朴汤合瓜蒌薤白半夏汤化痰通脉、运脾调心汤养阴通脉,辨证施治的同时配合重镇安神、养血安神法贯穿治疗全程,达双心同调、形神同治之目的。

Guided by the concept of"blood-pulse-heart-spirit",it is believed that stable angina combined with insomnia is caused by disturbance of blood vessels,which leads to loss of nourishment for the heart body and heart spirit,so the core treatment principle is to regulate the blood vessels and calm the mind.At the beginning of the disease,it shows as the liver fails to govern the free flow of qi,and disorders qi and blood;during the progress of the disease,it shows as spleen deficiency and phlegm stagnation,phlegm and blood stasis obstructing the vessels;the central mechanism of the disease shows as disturbance of blood vessels and insufficient heart yin.For the pattern of liver depression and blood stasis,pattern of phlegm and blood stasis blocking the vessels,and pattern of heart yin deficiency,it is recommended to treat by Wuzang Shenning Formula(五脏神宁方)to dredge the liver and regulate the vessels,Banxia Houpo Decoction(半夏厚朴汤)plus Gualou Xiebai Banxia Decoction(瓜蒌薤白半夏汤)to dissolve phlegm and regulate the vessels,and Yunpi Tiaoxin Decoction(运脾调心汤)to nourish the yin and regulate the vessels.Throughout the treatment,pattern differentiation and treatment is accompanied by the method of calming the mind with heavy sedatives and nourishing the blood to calm the mind,so as to achieve the purpose of regulating mind and heart together and treating the body and spirit at the same time.