胸痹(冠心病)证候演变规律的临床研究

The study on the distribution and evolution of the syndromes of thoracic obstruction(CHD)

对 4 8 2例胸痹 (冠心病 )病人进行临床跟踪 ,调查证候的分布、组合形式及证候的动态变化 ,结果发现 :胸痹证候分布广泛 ,临床以心气虚、心阳虚、痰浊、血瘀为多 ,分别占初诊的 4 2 .74 %、39.4 2 %、85 .2 7%、74 .6 9% ,证候常相兼出现 ,可单见 1证 ,也有 6证并见 ,初诊平均 3证以上并见 ,虚、痰、瘀、郁、滞在胸痹的发病过程中经常发生 ,并且互化。证候也是动态变化的 ,治疗后 4周、8周 ,2证组合迅速增多 ,由 13.2 8%增加到 2 0 .90 % ;3证、4证保持恒定 ;5证组合明显减少 ,由 14 .73%降到 4 .96 % ,说明临床病情复杂 ,证候错杂多见。随着治疗 ,病情得以缓解 ,证候组合逐渐简单化 ,本质矛盾逐渐显露。 2证组合和 3证组合常反映其证候复杂性的实质 ,多为阳虚血瘀证 ,阳虚痰阻证 ,阳虚痰阻血瘀证。证明心阳虚证、痰浊证、血瘀证等证候一经出现 ,往往贯穿疾病的始终 ,是胸痹主要证候 ,而寒凝证、气滞证、热郁证等为继发证候 。

Through the clinical research on 482 cases of the patients of thoracic obstruction(CHD),study the distribution,combination and evolution of the syndromes.The result is :The distribution is general.There are more syndromes of deficiency of heart-energy,deficiency of heart-yang,sputum,and blood stasis.It contains 42.74%,39.42%,85.27% and 74.69% separately in the preliminary diagnosis.The syndromes often appear simultaneously,there is one syndromes and six syndromes.There are more three syndromes averagely in the preliminary diagnosis.The combination of 2 syndromes increase quickly from 13.28% to 20.90% through the treatment of 4 weeks and 8weeks.The combination of 3 and 4 syndromes keep constant.The combination of 5 syndromes decrease from 14.73% to 4.96% .It means that the pathogenetic condition is complicated.There are more combinations of the syndromes.they become simple after the treatment and the essential contradict appear.The combination of 2 syndrome and 3 syndrome often reflect the essence of pathogenesis.They are yang asthenia-blood stasis,yang asthenia-sputum and yang asthenia-sputum-blood stasis.It certifies that the syndromes of deficiency of heart-yang,sputum and blood stasis often exist constantly after appearance,and they are the essence of the pathogenesis.The syndromes of cold coagulation,Qi-stagnation and heat accumulation are secondum pathogenesis and the rest are the aggravated and evoked pathogenesis.They constitute the concrete differentiation of syndromes of thoracic obsturction.