【作者】 仇玉平；

【导师】 郭伟星；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2009， 博士

【摘要】 背景:快速性心律失常是临床上的常见病,重者可导致猝死。目前中医药虽在治疗部分快速性心律失常中显示了良好的临床疗效,但也存在辨证论治方法单一、理论和实践脱节等不足。本研究归纳总结了运用金元时代临床家李东垣阴火学说辨证论治快速性心律失常临床经验,希望能够丰富心律失常的中医辨证论治体系,在中医理论和实践方面有所创新。目的:从理论及临床两个方面,探讨李东垣“阴火”学说在快速性心律失常发病中的作用和机理,以及以益气、祛火、养阴为主的治疗方法在快速性心律失常中的重要地位,为心律失常的治疗提供新的理论指导和治疗方法。方法:通过系统的文献回顾和理论探讨,提出“脾虚气陷,阴火内生”是快速性心律失常的重要病机,系统总结了快速性心律失常阴火证的不同治疗方法,并以“益气升阳,泻火养阴”立法,使用宁心定悸合剂对冠心病所致早搏(阴火上冲型)患者进行系统的临床治疗观察,并与参松养心胶囊进行对照。结果:1.宁心定悸合剂组治疗冠心病所致早搏(阴火上冲型)总有效率为89.13%,参松养心胶囊组总有效率为60.87%,两组比较有显著性差异(P<0.01)。2.宁心定悸合剂试验组改善患者整体症状总有效率为86.96%,参松养心胶囊对照组总有效率为43.48%,两组比较有显著性差异(P<0.01)。3.宁心定悸合剂组与对照组比较,在改善心肌缺血,缓解焦虑、抑郁情绪,提高心率变异,降低NT-proBNP水平,改善心功能等方面都有较好的疗效。结论:以李东垣阴火学说论治快速性心律失常方法可行,以“益气升阳,泻火养阴”法治疗冠心病所致早搏(阴火上冲型)疗效确切。更多还原

【Abstract】 Background:Arrhythmia is a clinical familiar disease,the sever degree may put the patient in danger of sudden death. At present TCM shows favorable clinic effect on part of tachyarrhythmia, however, it has some shortages such as single way in syndrome differentiation and treatment, losing contact between theory and practice, etc. This research conclude and summarize the clinic experience of syndrome differentiation and treatment of tachyarrhythmia system with“Yin-Fire”theory of the famous Climician in Jinyuan Dynasty Dongyuan Li. Hope to enrich the syndrome differentiation and treatment of tachyarrhythmia system and bring forth some new ideas in theory and practice of Chinese Traditional Madicine. Object: From theory and clinic, discuss the uses and principle of treating Tachyarrhythmia with Dong-yuan Li’s“Yin-Fire”theory, and discuss the importance of treating tachyarrhythmia mainly with replenishing qi, clearing heat and nourishing yin, aim to provide new theory and clinical method for treatment . Methods: Through literature system reviewing and theory discussing, raising“Qi sinking due to deficiency in spleen and Yin-Fire arising in Vivo”is the important pathogenesis of arrhythmia, summarizing in system the different clinical methods of arrhythmia with the characteristic of Yin-Fire. Use the treatment—Replenishing Qi and Elevating Yang, Heat Purging Fire and Nourishing Yin. Use Ningxindingji Mixture to treat the premature beat patients resulted by coronary heart disease (Yin-Fire uprush type) and observe systemly, and compare with Shensongyangxin Capsule. Results: 1.The total effect rate of the Ningxindingji Mixture group in treating tachyarrhythmia was 89.13%, which was evidently higher than that of the control group of 60.87%(P<0.01). 2.The total effect rate of ameliorating symptom of the Ningxindingji Mixture group was 86.96%, which was obviously superior of that of the control group of 43.48%(P<0.01). 3.The curative group had remarkable effect upon improving myocardial ischemia, relaxing the anxiety and depression, improving HRV, decreasing NT-proBNP, improving cardiac function,etc. Conclusion: The method of treating Tachyarrhythmia with Dong-yuan Li’s“Yin-Fire”theory is workable, and it is effective to treat the premature beat patients resulted by coronary heart disease (Yin-Fire uprush type) with Replenishing Qi and Elevating Yang, Heat Purging Fire and Nourishing Yin.更多还原