摘要
通法是通过疏调脏腑经络、气血津液郁滞壅停,使机体达到邪去正安,阴阳归于调和的方法,分为宣通玄府、攻通邪气、和通阴阳及补虚通滞。通法在冠心病中有着较好的临床应用,冠心病属中医学"胸痹心痛"范畴,病机关键在于"血脉不通",疏通血脉乃冠心病正治之法。其要有四:其一,宣通心之玄府,如寒凝痹阻玄府,阳气不得宣散,可用桂枝、荜拨、良姜、细辛等辛温之品宣通心阳;若心胸之阳气郁滞于内,气血不能通达渗灌而作心痛,可加茯苓、泽泻,针对动脉粥样硬化和炎症反应,可用清热解毒抗炎方药,加黄连、大黄。其二,攻通心之脉络,瘀血可用丹参、川芎、三七等,痰浊宜瓜蒌、薤白、半夏等,寒邪则宜沉香、吴茱萸等;久病入络,加麝香、檀香活通心之络脉。其三,和通心之神明,可用桂枝、黄连、肉桂等交通心肾,据证可选养心安神、镇心安神、开窍醒神等法以安神定志,加枣仁、远志、龙骨之属。其四,补通心之气血,冠心病之虚证大分气虚与肾虚两类,补气强心为治疗冠心病第一要义,补气宜气血同补,强心通脉,选八珍汤加丹参、红花;补肾宜心肾同补,补肾活血,选补心气之人参、黄芪,补肾气之淫羊藿、巴戟天等,酌加丹参、熟地黄,即成补肾活血之法,也是冠心病肾虚血瘀的正治之法,对中老年及久病患者较为适用。通法既可用于临床各科也可用于冠心病。
Tong(dredging)method in traditional Chinese medicine(TCM)emphasizes soothing the stagnated Qi,blood,and body fluid in zang-fu organs,meridians,and collaterals to remove pathogens,reinforce vital Qi,and balance Yin and Yang of the human body. Tong method can be adopted to disperse sweat pore,attack pathogenic Qi,harmonize Yin and Yang,as well as tonify deficiency,and resolve stagnation. It has been proved effective in treating coronary heart disease(CHD), which falls into the category of "chest impediment and heart pain" in TCM,with the key pathogenesis lying in blood vessel obstruction. Therefore,dredging blood vessels is the primary therapeutic principle for CHD. Specifically,there are four aspects. The first is dispersing and dredging the sweat pore of the heart. If the sweat pore is occluded by pathogenic cold,which makes Yang-qi undissipated,Cinnamomi Ramulus,Piperis Longi Fructus,Alpiniae Officinarum Rhizoma,and Asari Radix et Rhizoma can be prescribed for warming and dredging heart Yang. If the Yang-qi of the heart and chest stagnated in the body,which hinders Qi and blood to nourish the myocardium,resulting in chest pain,Poria and Alismatis Rhizoma can be prescribed. For CHD due to atherosclerosis and inflammation,heatclearing,toxin-removing,and inflammation-resisting Chinese medicinal herbs such as Coptidis Rhizoma and Rhei Radix et Rhizoma are recommended. The second is attacking and dredging the collaterals of the heart.Salviae Miltiorrhizae Radix et Rhizoma,Chuanxiong Rhizoma,Notoginseng Radix et Rhizoma,etc. can be prescribed for blood stasis,Trichosanthis Fructus,Allii Macrostemonis Bulbus,Pinelliae Rhizoma,etc. for phlegm,and Aquilariae Lignum Resinatum,Euodiae Fructus,etc. for pathogenic cold. Since the chronic disease can affect collaterals,Moschus and Santali Albi Lignum can be added to promote blood circulation and remove the obstruction of collaterals of the heart. The third is harmonizing and dredging the mind. Cinnamomi Ramulus,Coptidis Rhizoma,Cinnamomi Cortex,etc. are selected for restoring the coordination between the heart and the kidney. According to the specific syndrome,the methods of nourishing the mind and calming the nerves through tranquilizing the mind,calming down the mind,and inducing resuscitation can be selected using such Chinese medicines as Ziziphi Spinosae Semen, Polygalae Radix, and Draconis Ossa. The fourth is tonifying and dredging the Qi and blood of the heart. The deficiency syndrome of CHD is divided into Qi deficiency and kidney deficiency. Invigorating Qi and strengthening the heart are the first essentials for the treatment of CHD. In Qi invigoration,Qi and blood must be strengthened simultaneously to strengthen the heart and clear the pulse.Hence,Bazhentang modified by Salviae Miltiorrhizae Radix et Rhizoma and Carthami Flos can be chosen. In kidney Qi tonifying,kidney and heart must be strengthened simultaneously,and the methods of tonifying kidney and activating blood can be used. Ginseng Radix et Rhizoma and Astragali Radix are considered as the first choice for tonifying heart Qi,and Epimedii Folium and Morindae Officinalis Radix for tonifying kidney Qi,which are added with Salviae Miltiorrhizae Radix et Rhizoma and Rehmanniae Radix Praeparata to obtain the kidney-tonifying and blood-activating prescription. It is suitable for treating CHD due to kidney deficiency and blood stasis. Simultaneous treatment of heart and kidney is more suitable for middle-aged and elderly patients and chronically ill patients. Tong method can be used in various clinical diseases as well as CHD.
作者
王阶
周思远
刘超
惠小珊
何浩强
WANG Jie;ZHOU Si-yuan;LIU Chao;HUI Xiao-shan;HE Hao-qiang(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Graduate School of Beijing University of Chinese Medicine,Beijing 100029,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2022年第1期1-6,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金面上项目(81974556)
国家重点研发计划项目(2020YFC2002701)。
关键词
通法
理论内涵
临床应用
冠心病
理论探讨
Tong(dredging)method
theoretical connotation
clinical application
coronary heart disease(CHD)
theoretical discussion
