[Experience in syndrome differentiation and treatment of palpitation].

نویسنده

  • Ming Ge
چکیده

心悸虽为患者自觉心内跳动 、心慌不安之病症 , 但究其原因 ,不独在心 。 脏腑功能失调 ,气血阴阳虚 衰 ,均可导致心悸 。 临床上 ,我们发现心悸以老年患 者多见 。 人至老年 ,脏器虚衰 。 如心气不足 ,心血亏 虚 ,无以自养 ;肝血不足或木不生火 ,不能荣心 ;脾气 不旺 ,生化乏源 ,无以养心 ;肺体不润 ,宣肃失司 ,致 心脉不畅 ,或内生痰饮 ,均可发生心悸 。 老年心悸的 治疗 ,尤当重肾 。 因为年老脏器虚衰 ,尤以肾虚为根 本 ,诸脏不足 ,均与肾虚有关 。 心为离火 ,阳中有阴 , 肾为坎水 ,阴中有阳 ,其位有上下之分 ,赖气机升降 , 使心肾交通 ,水火既济 ,阴阳互滋 。 而心本乎肾源 , 肾脏虚惫 ,则肾水不能上滋心阴以济心火 ,肾阳不能 上温心阳以鼓动血脉 ,或加重心脏原有证候 ,使心神 不安 ,心悸遂作 。 枟景岳全书 · 怔忡惊恐枠云 :“此证 盖阴虚于下 ,则宗气无根 ,而气不归源 ,所以在上则 浮撼于胸臆 ,在下则振动于脐旁 ,虚微者动亦微 ,虚 甚者动亦甚 。”其临床特征有心悸健忘 ,头晕胸闷 ,腰 膝酸软 ,或是畏寒怕冷 ,或五心烦热 ,尺脉沉弱 。 治 疗益气养心的同时 ,注意补肾 。 用药上 ,多将熟地 、 仙灵脾同用 ,以取阴中求阳 ,阳中求阴 ,以达阴阳平 秘之意 。 它药如山茱萸 、枸杞子 、桑寄生 、何首乌 、五 味子等都可随证选用 。 例 1 王某 ,男 ,74 岁 ,2005 年 11 月 14 日就 诊 。 患者年高肺肾已亏 ,气阴两虚 ,心悸少寐 ,短气 不足以息 ,脘痞纳呆 ,动则面赤生火 ,五心烦热 ,四肢 发麻 ,大便溏薄 ,苔花剥 ,脉象不调 。 治当壮水补火 。 熟地 、北沙参各 12 g ,仙灵脾 10 g ,熟附片 3 g , 赤芍 、白芍 、法半夏 、核桃肉各 9 g ,陈皮 、五味子各 6 g ,煅牡蛎 15 g ,灵磁石(先煎)30 g ,肉桂 1 g 。 上 方服 5 剂 ,心悸气短 ,火生面赤 ,脉象不整等症俱减 轻 ,遂以本方加减调服月余 ,诸证悉平 。

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عنوان ژورنال:
  • Zhong xi yi jie he xue bao = Journal of Chinese integrative medicine

دوره 5 1  شماره 

صفحات  -

تاریخ انتشار 2007