李方洁温阳活血辨治老年阳虚血瘀“迟脉”(心动过缓)

LI Fangjie's/李方洁 Experience in Treating Senile “Slow Pulse”/迟脉 with yang deficiency and blood stasis/阳虚血瘀 by Wenyang Huoxue/温阳活血(Bradycardia)

李方洁教授认为老年"迟脉"(心动过缓)与老年心肺功能降低,血管弹性下降,动脉功能不良,心脏慢性供血不足等密切相关,所谓"心之合脉也",心动过缓则脉率减慢。多系老年阳气不足,瘀血阻脉;病位在心,病本在肾;乃心肾阳气虚衰,血运不畅,瘀阻脉道。强调老年"迟脉"乃阴盛阳亏、阳失健运,所谓"寒气入经而稽迟"是也,"迟来一息至惟三,阳不胜阴气血寒"。提出温阳活血辨治原则,擅用经方,强调"有是证用是方""方证对应",常用麻黄附子细辛汤合血府逐瘀汤加减化裁,或多方合用,增强温通化瘀之效,提升心率,改善全身症状;临证但见阳虚、血瘀,则合用麻黄附子细辛汤、血府逐瘀汤;舌越淡、脉越迟,就越加强温阳之品。组方配伍用药更熟练把握道地药材、药性偏颇、古法炮制,体现方中有药、药中有方,灵活运用药味配伍,注重组方用药与患者表现和病机精准契合,效如桴鼓。李方洁教授特别指出,临证应打破中西医界限,运用整体观全方位评价干预效果,从病人角度审视,充分考虑患者感受,不仅仅取决指标数据的改善,把患者当成得了病的"人",而不是一个得了病的"器官"。附心肾阳虚,瘀阻脉络,心肾阳虚、中焦虚寒窦性心动过缓验案2则。

Professor Li Fangjie/李方洁believes that senile'slow pulse'/迟脉(bradycardia)is closely related to decreased cardiopulmonary function,decreased vascular elasticity,poor arterial function and chronic cardiac insufficiency,etc.This is called'the heart joins with the pulse',and bradycardia means the slowly pulse rate.It because of yangqi deficiency and blood stasis.Location of disease is heart.The key of pathogenesis is kedney.It is yangqi deficiency of heart and kidney,poor blood supply and blood stasis.She emphasizes that senile'slow pulse'becauses of yin excessive causing yang deficiency and dysfunction of yang in transportation,which is called'cold into the meridians and collaterals leads to slow pulse','late comes a rest to only three,the positive cloudy vitality is extremely cold'.She puts forward the principle of wenyang and huoxue and is good at applying classical prescription.She emphasizes that'prescription is square of syndrome'and'formula corresponds to syndromes'in clinic.She commonly uses Ephedra Fuzi Asarum soup and Xuefu zhuyu soup or other addition to enhance the effect of wenyang and huoxue,increase the heart rate and improve systemic symptoms.Once yang deficiency and blood stasis exist in clinical,Ephedra Fuzi Asarum soup and Xuefu zhuyu soup can be used.More paler tongue and more slower pulse should match up more wenyang drugs.The combination of prescription drugs should be more skilled grasp genuine regional drug、medicinal biased and method in the ancient way.So it can reflect formula and crude drug having each other.Be flexible use of compatibility and pay attention to the making prescription according to patient clinical manifestations and pathogenesis.So it can achieve good results.Professor Li Fangjie points out in particular that the boundary of traditional Chinese and western medicin should be broken in clinic.The effect of intervention will be evaluated comprehensively with the holistic view.Look at it from the patient’s point of view and consider the patient’s feelings.It is not just a matter of improving the data and treating the patient as a'person'rather than an'organ'.Two bradycardia proved cases of heart and kidney yang deficiency and blood stasis,heart and kidney yang deficiency and zhongjiao deficiency cold sinus are added.