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基于"络瘀"理论探讨通法在房颤治疗的应用

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黄帝内经创立经络学说,并将其分为"经脉"与"络脉"。络脉为经脉的横出别支,通过特殊的组织结构使气血津液散步于全身,贯通营卫、保障经气周流,为气血渗灌、沟通经脉、反应病候的重要结构。心房颤动(atrial fibrillation,AF)简称房颤,房颤以心房机械功能恶化为特征,伴有不协调心房电激活,是临床上常见的持续性心律失常。房颤中医归属心悸,其描述首见于《素问·玉机真藏论篇》:"真脾脉至,弱而乍数乍疏"。而"乍数乍疏"正是房颤脉的典型脉象特点。后有历代医家对心悸的诸多见解,其中清代医家王清任等认为心悸为血虚、瘀血致病,并发展了瘀血理论。中医理论认为,人体以通为常。"通法"有狭义和广义之分:狭义之通法指运用泻下、攻逐等法将胃、肠中的瘀堵积滞从魄门而解。如《素问·阴阳应象大论篇》:"其下者,引而竭之",多用于正气尚存,邪实未除的病证;广义的"通法"包含甚广。凡是畅调气机、疏通血脉的方法都归其范畴。研究基于络病学说,认为房颤与络脉瘀阻相关。该文以"络瘀"理论为切入点,探析"通法"在房颤治疗的应用,从广义理解和运用通法,认为通法须究虚实,根据病机不同,治疗须分清标本虚实,各有所侧重。
Exploring Application of Dredging Method in Treatment of Atrial Fibrillation Based on Theory of"Blood Stasis in Collateral"
Huangdi Neijing established the theory of meridians and collaterals,which was divided into"meridians"and"col-laterals".The collateral vessels are the transverse branches of the meridians.Through a special organizational structure,Qi,blood and body fluids are integrated throughout the body,ensuring the circulation of meridians and Qi,and serving as an important structure for the infiltration of Qi and blood,communication of meridians and response to symptoms.Atrial fibrillation(AF)is characterized by deterioration of atrial mechanical function,accompanied by uncoordinated atrial electrical activation,and is a common persistent arrhythmia in clinical practice.Atrial fibrillation belongs to palpitations in traditional Chinese medicine,and its description is first seen in Suwen:"The true spleen pulse reaches,it is weak and sparse at first glance."And"sparse at first glance"is a typical pulse characteristic of atrial fibrillation pulse.Later on,there were many opinions on palpitations from medi-cal experts throughout history,among which Qing Dynasty medical experts such as WANG Qingren believed that palpitations were caused by blood deficiency and stasis,and developed the theory of blood stasis.According to traditional Chinese medicine theory,the human body is regulated by circulation.The"dredging method"can be divided into narrow and broad senses.The narrow dredging method refers to the use of methods such as purging to relieve blood stasis and stagnation in the stomach and intestines.For example,in Suwen·Yin Yang Corresponds to the Elephant Discourse:"The evils in the lower part should be removed by purging method."It is mostly used for diseases and syndromes when the positive Qi still exists and the evil is not eliminated.The broad term encompasses a wide range.All methods of regulating Qi and unblocking blood vessels belong to its category.This study is based on the theory of collateral disease and believes that AF is related to blood stasis in collateral.Starting from the the-ory of"blood stasis in collateral",this article explored the application of"dredging method"in the treatment of AF.From a broad understanding and application of dredging method,it is believed that dredging method must investigate the deficiency and excess,and according to different pathogenesis,the treatment must distinguish the deficiency and excess with different focuses.

blood stasis in collateralatrial fibrillationpalpitationdredging method

韩子薇、张明雪

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辽宁中医药大学,辽宁沈阳 110847

辽宁中医药大学附属,辽宁沈阳 110032

络瘀 房颤 心悸 通法

2024

实用中医内科杂志
辽宁省中医药学会,中华中医药学会,辽宁省中医药研究院

实用中医内科杂志

影响因子:0.421
ISSN:1671-7813
年,卷(期):2024.38(8)