黄丽娟分期论治冠心病经皮冠状动脉介入治疗术后再发心绞痛经验拾萃

赵凡莹; 陈子奇; 周峻; 孙文军; 王振裕; 刘子旺; 黄 丽娟(指导)

doi:10.3969/j.issn.2095-6606.2023.06.015

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黄丽娟分期论治冠心病经皮冠状动脉介入治疗术后再发心绞痛经验拾萃

名老中医经验 | 更新时间：2023-12-08

- 黄丽娟分期论治冠心病经皮冠状动脉介入治疗术后再发心绞痛经验拾萃
- Huang Lijuan’s experience in staged treatment of recurrent angina after percutaneous coronary intervention of coronary heart disease
- 现代中医临床 2023年30卷第6期页码：67-70,79
- 作者机构：
  
  1.北京中医药大学第三附属医院　北京　100029
  2.首都医科大学附属北京中医医院
- 作者简介：
  
  赵凡莹，女，在读博士生
  #刘子旺，男，博士，主任医师，博士生导师，E-mail：liuziw@163.com
- 基金信息：
  
  首都卫生发展科研专项(首发2022－2－7035)
- DOI：10.3969/j.issn.2095-6606.2023.06.015
  中图分类号： R256.2; R259
- 收稿：2022-12-07，
  
  纸质出版：2023-11-30
- 稿件说明：
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赵凡莹, 陈子奇, 周峻, 等. 黄丽娟分期论治冠心病经皮冠状动脉介入治疗术后再发心绞痛经验拾萃[J]. 现代中医临床, 2023,30(6):67-70,79.

ZHAO Fanying, CHEN Ziqi, ZHOU Jun, et al. Huang Lijuan’s experience in staged treatment of recurrent angina after percutaneous coronary intervention of coronary heart disease[J]. Modern Chinese Clinical Medicine, 2023, 30(6): 67-70,79.
赵凡莹, 陈子奇, 周峻, 等. 黄丽娟分期论治冠心病经皮冠状动脉介入治疗术后再发心绞痛经验拾萃[J]. 现代中医临床, 2023,30(6):67-70,79. DOI： 10.3969/j.issn.2095-6606.2023.06.015.

ZHAO Fanying, CHEN Ziqi, ZHOU Jun, et al. Huang Lijuan’s experience in staged treatment of recurrent angina after percutaneous coronary intervention of coronary heart disease[J]. Modern Chinese Clinical Medicine, 2023, 30(6): 67-70,79. DOI： 10.3969/j.issn.2095-6606.2023.06.015.

摘要

经皮冠状动脉介入治疗(PCI)是冠状动脉粥样硬化性心脏病(CHD)患者重要的治疗方法。中医将冠心病PCI术后再发心绞痛归属于“胸痹心痛”“卒心痛”等范畴。黄丽娟认为PCI术后再发心绞痛总属本虚标实证，本虚以气虚、阴虚、阳虚为主，标实以气滞、血瘀、痰浊、寒凝为要。本病五脏俱损，主要责之于心，以肝、脾、肾为要。在PCI术后2年间再发心绞痛者为初期阶段，此期以气阴两虚、心血瘀阻证为主，治以益气养阴、活血化瘀，方用生脉散合血府逐瘀汤加减。在PCI术后2～5年间反复发作心绞痛者为中期阶段，此期为气虚血瘀痰浊俱重、兼肝郁脾虚，治以活血化痰祛瘀、调肝理脾益气，基本方为瓜蒌薤白半夏汤合逍遥散加减。在PCI术后仍反复发作心绞痛病程5年以上者为晚期阶段，此期以气血瘀滞、心肾阳虚寒凝为主，治疗重在温肾助阳，兼益气活血化痰通络。此外，重视心身同调、尤以疏肝理脾为要，强调气血相关、气血同治。并结合临床验案加以阐释。

Abstract

Percutaneous coronary intervention (PCI) is an important treatment for patients with coronary atherosclerotic heart disease. Traditional Chinese medicine categorizes the recurrence of angina pectoris after PCI for coronary heart disease (CHD) into "

xiong bi xin tong

(chest impediment and pain)" and "

cu xin tong

(sudden heart pain)" . Prof. Huang Lijuan believes that angina after PCI always belongs to the syndrome of deficiency as the root and excess as the branch. The root is mainly characterized by qi

yin

and yang deficiency

while the excess involves primarily qi stagnation

blood stasis

phlegm turbidity

and cold coagulation. This disease causes damage to all five organs

and the heart is mostly affected

with the liver

spleen

and kidneys as the key. The initial stage is for those who experience recurrent angina pectoris 2 years after PCI. This stage is mainly characterized by qi yin deficiency and heart blood stasis obstruction

with the treatment of supplementing qi and nourishing yin

invigorating blood and resolving stasis

and the best suitable formula is Shengmai Powder (Pulse-Engendering Powder) combined with Xuefu Zhuyu Decoction (Blood Stasis Expelling Decoction). Patients with recurrent angina pectoris within 2-5 years after PCI surgery are in the middle stage. This stage is characterized by severe qi deficiency

blood stasis

phlegm turbidity

and liver stagnation and spleen deficiency. The treatment is to invigorate blood

eliminate phlegm and stasis

regulate the liver and spleen

and replenish qi. The basic formula is Gualou Xiebai Banxia Decoction (Trichosanthes

Chinese Chive and White Wine Decoction) combined with Xiaoyao Powder (Free Wanderer Powder)

with possible adjustments to the formula as needed. Those who still experience recurrent angina after PCI with a course of more than 5 years are in the advanced stage. This stage is mainly characterized by qi and blood stasis

deficiency of heart and kidney yang

and cold coagulation. The treatment focuses on warming the kidney and assisting yang

as well as supplementing qi

invigorating blood

resolving phlegm

and unblocking collaterals. In addition

we attach great importance to the harmony of mind and body

with a particular emphasis on soothing the liver and regulating the spleen

emphasizing the correlation between qi and blood

and the simultaneous treatment of qi and blood. This study comes with proven case records to further explain Prof. Huang’s clincial ideas.

关键词

Keywords

references

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