冠心病心绞痛古今中医文献整理与研究

【作者】 李柳骥；

【导师】 严季澜；

【作者基本信息】 北京中医药大学 ， 中医医史文献， 2007， 博士

【摘要】 冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease),指冠状动脉粥样硬化使血管腔狭窄或阻塞,或(和)因冠状动脉功能性改变(痉挛)导致心肌缺血缺氧或坏死而引起的心脏病,心绞痛是因心肌暂时的缺血、缺氧引起的以发作性胸痛为主要表现的一组临床综合征,95﹪由冠状动脉粥样硬化性心脏病所致。现代社会,随着生活方式等影响因素的变化,疾病谱较之过去也发生了很大变化,以心血管疾病为代表的慢性病成为危害人类健康的主要疾病,其发病率逐渐增高,危害性越来越大,因此开展对该类疾病的综合研究,对于促进人类的身心健康,提高生活质量,均具有极其重要的意义。冠心病心绞痛作为临床常见的疾病,其典型表现及类似记载很早就出现在我国古代文献中,自先秦至民国时期,历代医家对于该病的病因病机、辨证分型、治法方药、预防调摄等方面均积累了大量的理论认识与临床经验;现代以来,中医对该病更为重视,在逐步完善其病因学、证候学、治疗学等理论的同时,当代医家在继承发挥古代医家观点认识的基础上,结合各种新的研究手段以及现代医学观点,就冠心病心绞痛的辨证治疗等提出了许多新思路,积累了众多宝贵的实践经验。本文在系统搜集古今中医文献资料的基础上,以文献学方法为主,对相关资料进行了深入的分析研究,系统阐述了冠心病心绞痛的学术发展源流及现状,全面总结了历代医家的辨治经验。力图全面反映历代医家诊治该病的学术观点和临床经验,为辨治冠心病心绞痛提供丰富而翔实的参考资料,也必将有助于开拓该病的研究和治疗思路。本文分为上篇和下篇两部分。上篇为古代文献研究,重在阐述冠心病心绞痛的学术发展源流,分别论述了冠心病心绞痛的病名、病因病机、病证分类、治则治法、预防调摄等的学术发展概况,同时结合统计分析方法,对古代胸痹心痛处方及医案进行了初步研究,并对心绞痛相关的若干理论问题进行了阐发,提出了新的治疗观点。下篇为现代文献研究,重在反映冠心病心绞痛的当代研究概况,全面总结了1949年以来国内对于冠心病心绞痛的辨证分型特点、各家论治观点、名医治疗经验、处方用药进展、各类治疗方法等,并旁及基础研究及国外相关研究。对于全面把握冠心病心绞痛的学术发展现状、促进本病基础与临床研究的深入发展均具有重要意义。论文全面总结了历代医家对肝心痛与热证心痛的论述,从理论和临床两方面分析了肝心痛与热证心痛的现实意义;在继承古今医家理论的基础上,明确提出了心绞痛治疗当重扶阳、调气的观点,并举出了温阳散寒、补气助阳、通阳宣痹、回阳救逆的“扶阳四法”,认为从肺脾二脏入手调理气虚、气滞病机,扶助正气,壮大阳气,祛除阴邪,是冠心病心绞痛治疗之关键,从而为本病的治疗提供了新的思路。更多还原

【Abstract】 Coronary atherosclerotic heart disease is a kind of heart disease caused by Atherosclerosis which makes the Lumen of blood vessel narrow or blocked;or(and) caused by the functional changes of coronary artery( spasm ) which result in ischemia, anoxia or even necrosis of cardiac muscle. Angina Pectoris is a set of clinical syndrome caused by ephemeral ischemia and anoxia of cardiac muscle, the main manifestation is paroxysmal chest pain, 95 percent of Angina Pectoris is caused by coronary atherosclerotic heart disease. In modern society, as the changing of influencing factors such as life style etc., the spectrum of disease has changed a lot than before, chronic diseases represented by cardiovascular diseases have become the primary hazardous diseases to human health, the incidence rate has been rising gradually, and perniciousness is getting more and more serious. Therefore, it is very important to develop the integrated study of this kind of disease so as to promote human being’s physical and mental health and improve the quality of life.The typical symptoms and similar recordation about Angina Pectoris, a familiar clinical disease, have appeared in Chinese ancient literature. Medical experts of past dynasties from Early- Ch’in to Republics have accumulated a lot of theoretical knowledge and clinical experience including the etiopathogenisis and pathogenesis of syndrome, syndrome differentiation classification, treatment and prescription, prevention and health care. In modern times, traditional Chinese medicine pay more attention on it.Modern physicians consummate etiology, theory of syndrome and therapeutics step by step, they inherit and bring ancient physicians’viewpoints into clinical practice.Many new means of research and viewpoints of modern medicine are used in TCM,modern physicians bring many new thoughts about treatment based on syndrome differentiation forward,accumulate lots of valuable practical experiences. Using the method of philology mainly, this thesis collects TCM documents in all ages, analyses and studies the related documents in depth, sets forth systematically the history and actuality about the academic development of Angina Pectoris, summarizes across-the-board the treatment experience based on syndrome differentiation of medical experts of past dynasties. The study tries to reflect the academic viewpoints and clinical experiences about diagnosis and therapy of medical experts of past dynasties in every aspect ,provide abundant and accurate reference on differentiating and treating Angina Pectoris, which will be helpful to open the mind of studying and treating this disease.The thesis is divided into two parts, the first part studies on the ancient literatures ,the emphasis of this part is elaborating academic development course of Angina Pectoris. I discuss the general situation about academic development ,including the name of disease ,causes and pathogenesis, classification of disease and syndrome, therapeutic principles and methods, prevention and health care, and so on .I also use statistical and analytical method to study the ancient prescriptions and case records on pectoral stuffiness pain and cardiodynia, explain some theoretical questions about Angina Pectoris ,put some new therapeutic viewpoints forward.The second part of the thesis studies on modern literatures, the emphasis of which reflects the general situation of modern study on Angina Pectoris. I summarize documents published at home since 1949 till now roundly, discuss issues such as characters of syndrome differ classification, different therapeutic viewpoints, famous doctors’clinical experience, progress of medicine and prescription, all kinds of treatment methods etc. This thesis also involves basic study and related overseas study. So it is important to grasp the academic developing actuality of Angina Pectoris roundly and promote basal and clinical study.This thesis summarize recordation of medical experts of past dynasties about liver heart pain and heat syndrome heart pain, analyze the practical meaning about the two issues in both academic and clinical aspects. Based on inheriting theories of ancient and modern medical experts, I put forward the viewpoint definitely that supporting yang and regulating qi is very important in treating Angina Pectoris, summarize the four means of supporting yang including warming yang for dispelling cold, benefiting qi for supporting yang, freeing yang and moving impediment, restoring yang and rescuing patient from collapse. I believe that the key of treating Angina Pectoris is regulating lung and spleen’s pathogenesis of deficiency of qi or qi stagnation, supporting vital qi and reinforcing yang to eliminate yin pathogen, therefore it provides a new idea to treat this kind of disease.更多还原