王振涛从虚分期辨治扩张型心肌病经验介绍
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R249;R542.2

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国家中医药管理局第七批师承项目(国中医药办人教函〔2021〕272号);河南省中医药青苗人才培养项目(豫中医〔2018〕6号);河南省中 医药科学研究专项课题(20-21ZY2116)


Experience Introduction of WANG Zhentao in Treating Dilated Cardiomyopathy from Deficiency Based on Syndrome Differentiation and Treatment by Stages
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    摘要:

    介绍王振涛教授从虚分期辨治扩张型心肌病的临床经验。王振涛教授认为,扩张型心肌病在病理上以心室重构为主,中医病机以心气亏虚为本,血瘀、水停为标,多虚、瘀、水等虚实夹杂。治疗上,从虚着手,分三期辨治,早期阶段无临床症状或症状轻微,主要有气虚血瘀证、气阴两虚血瘀证,方选抗纤益心方、生脉散、冠心Ⅱ号方加减;中期阶段主要有气虚血瘀水停、气阴两虚血瘀水停证,前者抗纤益心方的基础上加用泻肺平喘、利水消肿的药物,后者用生脉饮、猪苓汤加减;晚期阶段主要有阳虚血瘀水停证、阳气衰竭证,方选心衰康方加减,在抢救基础上可予参附汤、独参汤以回阳救逆。总之,辨治扩张型心肌病宜注重中西结合,旨在减少心肌损伤、抑制心室重构和延缓病变的发展。

    Abstract:

    Abstract: This paper introduces Prof. WANG Zhentao's clinical experience in treating dilated cardiomyopathy from deficiency based on syndrome differentiation and treatment by stages. Prof. WANG Zhentao believes that dilated cardiomyopathy is pathologically due to ventricular remodeling, and its pathogenesis in Chinese medicine is considered the depletion of heart qi as its root,and blood stasis and water retention as its branch; and the disease is mainly mixed with deficiency, stasis and water. The treatment can start with the deficiency,and treat it from three stages based on syndrome differentiation and treatment. At the early stage, there are no clinical symptoms or there are mild symptoms; and the main syndromes are the syndrome of qi deficiency and blood stasis,and the syndrome of qi-yin deficiency and blood stasis;the former could be treated with Kangxianyixin prescription and Shengmai powder,and the latter could be treated with modified Guanxin II prescription. In the middle stage,the main syndromes are the syndrome of qi deficiency, blood stasis and water retention, and the syndrome of qi- yin deficiency,blood stasis and water retention;the former can be additionally treated with medicine that can drain the lung and relieve panting,and that can promote urination and reduce swelling based on the use of Kangxianyixin prescription,and the latter can be treated with modified Shengmai yin and Zhuling tang. At the late stage, the main syndromes are the syndrome of yang deficiency, blood stasis and water retention,and the syndrome of declined and exhausted yang qi;the former can be treated with modified Xinshuaikang,and the latter can be additionally treated with Shenfu tang and Dushen Decoction to restore yang to rescue from counterflow based on medical rescue. In conclusion, the treatment of dilated cardiomyopathy should pay attention to the integration of Chinese and western medicine therapy,in order to reduce myocardial injury,inhibit ventricular remodeling and delay the development of the disease.

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冯尧伟,杨凤鸣,李康,古苏婷,刘舜禹,指导:王振涛.王振涛从虚分期辨治扩张型心肌病经验介绍[J].新中医,2022,54(14):193-198

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  • 在线发布日期: 2022-07-21
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