冠心病合并中风不同分期治则治法研究

发布时间：2018-10-11 18:14

【摘要】：目的:探寻冠心病合并中风各阶段每一证型的主要治法、遣方、用药,筛选并制定有效的基础诊疗方案及证候层面的诊疗方案,为冠心病合并中风的中医规范化诊疗提供理论依据。方法:冠心病合并中风治则治法临床专家调查问卷。将调查问卷使用R3.1.2统计分析平台及Microsoft Office 2007办公软件,以列联表、堆叠条形图形式汇总统计,并应用组合分析、排序分析方法对数据进行统计分析。结果:得出冠心病合并中风的不同分期分期治则治法。急性期热毒炽盛、阴竭阳脱证,应用清热解毒、回阳救阴治法,方选犀角地黄汤等,用药优选清营解毒、温阳固脱、大补元气药;急性期风阳痰火、蒙蔽清窍证,应用潜阳熄风、泻火豁痰开窍治法,方选清热导痰汤等,用药优选清热化痰、化浊开窍、泻肝熄风药。恢复期气虚痰瘀证应用益气化痰、活血化瘀治法,益气类方选四君子汤等,用药优选补益元气、健脾化痰、养血活血药(祛痰类方选半夏白术天麻汤加减,用药优选健脾化痰药;祛瘀类方选黄芪桂枝五物汤加减,用药优选养血活血、活血化瘀药);恢复期气虚络滞证应用益气理血通络治法,方选补阳还五汤等,用药优选益气通络、养血活血、活血化瘀药。后遗症期气虚瘀阻证应用益气、活血化瘀治法,方选黄芪桂枝五物汤等,用药优选健脾益气、补益元气、活血化瘀、活血养血药。后遗症期肝肾亏虚证应用补益肝肾、燮理阴阳治法,方选大定风珠等,用药优选滋阴潜阳、补肾填精药。结论:冠心病合并中风不同分期治则治法研究得出了专家共识,具有一定的临床应用价值,可为冠心病合并中风的中医规范化诊疗提供科学的理论依据。
[Abstract]:Objective: to explore the main treatment methods, prescriptions and medication of each syndrome type in each stage of coronary heart disease complicated with apoplexy, and to screen and formulate effective basic diagnosis and treatment plan and syndromes level diagnosis and treatment plan. To provide a theoretical basis for the standardized diagnosis and treatment of coronary heart disease with stroke. Methods: coronary heart disease combined with apoplexy was investigated by clinical experts questionnaire. R3.1.2 statistical analysis platform and Microsoft Office 2007 office software were used to collect the statistics in the form of column table and stacked bar chart, and the combined analysis and ranking analysis were used to analyze the data. Results: different stages of coronary heart disease combined with stroke were obtained. In the acute period, heat poison is flourishing, Yin is exhausted and Yang is removed from syndromes, the method of clearing heat and detoxification, returning yang to save yin, and the prescription of rhinoceros horn and Rehmannia, etc., are used to select the best medicine for clearing away the toxin, warming the yang and detoxification, and replenishing the Yuan Qi medicine; in the acute period, wind, yang, phlegm and fire are used to blind the clear resuscitation syndrome, Using the methods of removing latent yang, eliminating phlegm and removing phlegm, and selecting the decoction of clearing away heat and guiding phlegm, the medicine can be used to clear away heat and dissipate phlegm, to remove turbid and open orifices, and to dissipate the wind of purging liver. Qi deficiency and phlegm stasis syndrome in convalescence period were used to improve qi and dissipate phlegm, invigorate blood circulation and remove blood stasis, and invigorate qi, invigorate spleen and dissipate phlegm, and nourish blood and promote blood circulation, such as removing phlegm and removing phlegm, removing blood and removing blood stasis, removing phlegm and reducing Rhizoma Atractylodes Rhizoma Gastrodia decoction, etc. The prescription of removing blood stasis is to select decoction of Huangqi, Guizhi and Wuwu, to use drugs to improve blood circulation, to promote blood circulation, to remove blood stasis); to apply the method of supplementing qi, regulating blood circulation and dredging collaterals, and so on; to use the method of invigorating qi, regulating blood circulation and regulating collaterals, and so on; to use medicine to select and replenish qi and unblock collaterals. Nourishing blood and promoting blood circulation, promoting blood circulation and removing blood stasis medicine. The syndrome of Qi deficiency and stagnation in sequelae was used to promote qi, promote blood circulation and remove blood stasis, and the prescription of Huangqi Guizhi Wuwu decoction was selected to strengthen spleen and invigorate qi, replenish yuan qi, invigorate blood circulation and remove blood stasis, and promote blood circulation and nourish blood. The deficiency of liver and kidney in sequelae period was treated with tonifying liver and kidney, treating Yin and Yang by Xieli, selecting Fengzhu, etc., using medicine to nourish yin and put away yang, nourishing kidney and filling essence medicine. Conclusion: the research on different stages of coronary heart disease combined with stroke treatment method has reached a consensus of experts, which has certain clinical application value, and can provide scientific theoretical basis for the standardization of TCM diagnosis and treatment of coronary heart disease complicated with apoplexy.
【作者单位】：辽宁中医药大学;沈阳市第二中医医院;沈阳市健康教育中心;辽宁中医药大学附属医院;中国人民大学统计学院;
【基金】：国家自然科学基金面上项目(81273698) 辽宁省中医药临床学(专)科能力建设项目(2012-lnzyxzk-01) 辽宁省特聘教授项目沈阳市科技计划项目(F12-155-9-00)
【分类号】：R255.2;R259

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