【作者】 晋献春；

【导师】 戴裕光；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2009， 博士

【摘要】 戴裕光教授是全军著名中医药学家,临床涉猎内、妇、儿多科,尤其在中医内科杂病方面多有心得,积累了丰富的临证经验。他认为学习当精博结合,要勤、学、恒、思、悟;临证重视整体体质,强调天地人参;用药强调动静结合,寒温并用;形成了给邪找出路、用补必泻的独特思路;提出治疗脾胃病以畅达气机为先;顾护阳气,脾肾为先;益精补阴,肝肾为本等原则。临证中善用经方,师而不泥,不拘陈法,革旧鼎新,广收博采,轻廉有效,常用拟方、效方从方剂学方向体现其学术思想和用方原则。充血性心力衰竭(congestive heart failure,CHF)是一种复杂的临床综合征,是各种心脏病的严重阶段,其发病率高,治疗较为困难,往往成为心血管病的主要致死原因。近年来现代医学的治疗逐渐从强心、利尿、扩血管向阻断心肌重构因子、阻止甚至逆转心室重构转变,使CHF致残率、病死率明显下降。尽管如此,由于CHF自然发病规律,现有药物并未能完全阻断其病理进程,且这些药物存在这样或那样的副作用,从而阻止了其在临床中的应用。导师在精研《黄帝内经》、《伤寒论》、《金匮要略》、《血证论》等经典著作及历代医家著述基础上,认为充血性心衰的病机为:初为阳气亏虚,继之瘀血停滞,终致水饮内停,而瘀血水饮作为病理性致病因素进一步损伤阳气,从而形成虚实夹杂的恶性循环。治疗当以温阳益气、化瘀利水为法,并依据不同的发展阶段有所侧重。心衰初期,以益气温阳治本为主兼以化瘀利水,心衰末期以益气温阳化瘀利水兼重。在心衰稳定期,本虚为主,以补气、温阳治本为主兼以化瘀利水,心衰发作加重期,以标为主,治以化瘀、利水治标为主,佐以益气温阳。强心汤是戴裕光教授治疗CHF验方之一,具有益气温阳、活血利水之功效,为进一步验证该方之疗效,进行了临床研究。本研究采用随机、平行对照的临床研究方法,对强心汤治疗CHF的疗效和不良反应进行了研究。经8周治疗观察,结果表明,强心汤治疗CHF在总体疗效、中医证候总疗效方面均优于芪苈强心胶囊。两组均能改善Ⅱ级、Ⅲ级心功能;心悸、胸闷、气短、乏力等单项证侯;心率≥100次/分、颈静脉充盈、下肢水肿等体征;以及EF、SV,6分钟步行试验;且治疗组优于对照组(P＜0.05或P＜0.01)。两组在改善Ⅳ级心功能、畏寒肢冷、以及心率＜60次/分等无明显差异(P＞0.05)。两组均未见明显的不良反应。更多还原

【Abstract】 Professor Daiyuguang was one of famous TCM doctors in PLA.He dabbled in internal medicine,gynecology and pediatrics,especially accumulated abundant clinical experience in miscellaneous disease.He thought students should read all kinds of books and well-known medical works carefully to apply them well and should be diligent,bookish,constant,thinking and realizing.He emphasized that human,heaven and earth should be a trinity and the constitution and the influences of environmental factors should be considered in diagnosis and treatment Activity and calmness should be integrated and cold and warm chinese medicine should be used simultaneously.He formed his special idea of finding the way to expel the evil and reduction must be used when tonification was used. Also he put forward that regulating the functional activities of Qi was the first step to treat spleen and stomach diseases,protecting the Yang qi of the spleen and kidney and benefiting Yin essence of the liver and kidney was the root.Professor Dai’s common used and proved formulas embodied his academic thoughts and selection of modifying prescription from pharmacology of TCM formula.Congestive Heart Failure(CHF) was a compound clinical syndrome and the severest stage of all kinds of heart disease,characterized by high morbidity,being difficult to be treated and being main cause of death of cardiovascular disease.In recent years,principles of treatment in western medicine changed from cardiac stimulating,diuresis and vascular relaxation to blocking myocardial remodeling factor and stopping and reversing myocardial remodeling,greatly decreasing mutilation rate and case fatality rate of CHF.Nevertheless,to some extent,the use of those drags was limited clinically because natural pathogenic process of CHF couldn’t be completely blocked by those drugs and side effects of those drugs. Professor Daiyuguang thought CHF’s pathogenesis was a vicious circle of deficiency syndrome mingles with excess caused by deficiency of yang, stagnation of blood stasis and fluid-retention stagnation in the interior after he studied a lot of TCM classics like Yellow Emperor’s Canon Internal Medicine. Warming Yang and benefiting Qi and removing blood stasis and promoting diuresis were the main therapeutic methods.In different stage,different method of treatment should be used.In the initial stage,warming Yang and benefiting Qi should be the main method of treatment.In the latest stage,Warming Yang and benefiting Qi and removing blood stasis and promoting diuresis should be used simultaneously.In the stable stage,warming Yang and benefiting Qi should be the main method of treatment.In the outbreak stage,removing blood stasis and promoting diuresis should be the main method of treatment.Qiangxin decoction was a proved formula which was used by professor Daiyuguang to treat CHF and had therapeutic effect of supplementing qi and warming yang,removing blood stasis and promoting diuresis.Clinical research has been done to prove therapeutic effect of the formula.This study was a random positive medicine controlled trial.Therapeutic effect and adverse event of Qiangxin decoction was observed simultaneously.It indicated that Qiangxin decoction was superior to Qili qiangxin capsule in total effectiveness rate,TCM syndrome effectiveness rate,and et al,8 weeks after treatment.Ⅱ、Ⅲgrade heart function,symptoms like palpitation,chest distress,short breath and et al,signs like heart rate(HR≥100分),edema of lower limbs and et al,and EF、SV,6ms walking test improved in both groups and the trial group was superior to the control group(P＜0.05或P＜0.01).And there was no significant difference in improvingⅣgrade heart function,aversion to cold and cold limbs and signs like heart rate(HR＜60次/分) between the two groups(P＞0.05) after the treatment.No obvious adverse event was found in the two groups.更多还原