【作者】 戴国华；

【导师】 林慧娟；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2004， 博士

【摘要】 本研究在回顾冠心病中医学理论的基础上，结合导师运用风药治疗冠心病的临床经验，提出了冠心病风病说，意在强调风邪致病的因素，重视风药在治疗冠心病中的作用。为此，拟定了中药祛风生脉颗粒，对其治疗冠心病心绞痛的疗效和安全性进行了较系统的临床观察。同时，制作大鼠心肌缺血模型，运用冠状血管造影、免疫组化技术等，证实了祛风生脉颗粒具有促进缺血心肌血管生成的作用。其内容分为三部分。理论探讨 冠心病风病说 在冠心病“本虚标实”病机指导下，结合导师重用风药治疗冠心病多年的经验，提出冠心病属中医学“风病”范畴。认为心肾阳虚、气血失调是冠心病发病的基础，风邪是冠心病重要的致病因素，脉滞风阻是冠心病发作的关键病理环节。因而，确立了祛风活血通络、补肾益气生脉的治疗方法，研制成中药祛风生脉颗粒，由海风藤、肉桂、川芎、黄芪、麦冬、羌活组成，用于治疗冠心病疗效显著。 冠心病心肌缺血血管生成的中医研究思路与方法 以中医学“生脉”、“生血”、“生肌”方面的理论为切入点，坚持辨证论治的原则，认为祛风补肾通络法是研究冠心病心肌缺血血管生成的最佳治法，并提出“风药生脉”、“补肾生脉”的观点。指出冠状动脉造影是观察中医药促进血管生成情况最直观的形态学指标，检测血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)和VEGFmRNA、bFGFmRNA等相关因子的变化，以探讨其作用机制。 目的 观察祛风生脉颗粒治疗冠心病心绞痛的临床疗效。 方法 选择冠心病稳定型劳累性心绞痛患者60例，随机单盲分为两组，试验组和对照组各30例，分别予以祛风生脉颗粒和复方丹参滴丸对照治疗4周。 结果 试验组和对照组心绞痛总有效率分别为93.33％、70.00％；心电图疗效，试验组和对照组总有效率分别为73.33％、46.67％，两组比较差异有显著性(P＜0.05)；心络风阻、肾虚血瘀证治疗前后积分，试验组总有效率为86.67％，对照组总有效率为60％，其差异有显著性(P＜0.05)；试验组治疗后动态心电图心肌缺血总负荷明显更多还原

【Abstract】 Based on reviewing the studies of TCM about coronary heart disease and relating the tutors clinical experience, the research puts forward that the theory of "Wind Disease". Wind-cause-disease and wind-medicine-apply are emphasized in the theory. According to the new theory, the Qu Feng Sheng Mai Granule was made, and it’s clinical curative effect and security was observed. At the same time, model of myocardial ischemia on rat was done. Through development of coronary vein and immunity histochemistry, the research approves that Qu Feng Sheng Mai Granule has a function of accelerating blood vessel’s creation. The thesis comprises three portions.Theory DiscussionThe "Wind Disease" theory of coronary heart disease Guidanced by the pathogenesis of "Ben-deficiency and Biao-excession", combining the tutors clinical experience of putting wind-medicine in a very important position, the research puts forward that coronary heart disease is a part of "Wind Disease". On coronary heart disease, the theory figures that: Deficiency of heart-and kidney-yang and simultaneous disorder of qi-and blood is the basic of sicken; Wind is the important pathogenic factor; Vessel-block and wind-block is the key pathology tache. So, the therapeutic methods was established: dispelling wind promoting blood circulation and removing obstruction in the channels, nourishing the kidney supplementing qi and activating pulse. And the Qu Feng Sheng Mai Granule was made, comprising caulis piperis futokadsurae chuanxiong rhizomes loranthus mulberry misteletoe notoginseng ophiopogon root cinnamon, etc. It’s curative effect on treating coronary heart disease is remarkable.Disquisitive idea and mean of TCM on creating blood vessel in myocardial ischemia of coronary heart disease Based on the theory of TCM such as activatingpulse hematosis and promoting tissue regeneration, insisting on the principle of "diagnosis and treatmeat based on overall analysis of the illness and the patient’s condition", the research figures that dispelling wind nourishing the kidney and removing obstruction in the channel is the best method to coronary heart disease, and puts forward "wind-medicine activate pulse" "nourishing the kidney activate pulse", points out that coronary vein development is the key tache of settling the problem of accelerating vessel-create or not through TCM, observes the effect on VEGF FGF VEGFmRNA and FGFmRNA, to probe into it’s action mechanism.更多还原