摘要
心脏神经症是中医心内科门诊最常见的疾病之一,中医将其归纳为“心悸”“胸痹心痛”“不寐”“郁症”和“脏躁”的范畴。该文总结六经辨证源于《伤寒论》,是涵盖其他辨证方法和6个辨治层次(病、证、脉)和体系的集合。心脏神经症根据其症状分布在太阳、少阴、少阳、厥阴、阳明、太阴六经之中。“心悸”分布在以太阳病为主的四经中,太阳病“心悸”的主方是桂枝甘草汤。“胸痹心痛”分散在以太阴病为主的三经中,太阴病“胸痹心痛”的主方为瓜蒌薤白剂。“不寐”包括以阳明病为主的两经中,阳明病“不寐”如阳明有热时,主方为栀子豉汤;而里热和血虚血热时,用黄连阿胶汤。“郁证”散布在以少阳病为主的四经中,少阳病“郁证”主方是小柴胡汤。“脏躁”见于太阴病,但在临床中多与少阳病及阳明病共存,主方为甘麦大枣汤。经方是临床疗效的源头,是一切时方的本源。在治疗过程中先辨六经,再辨方证,既可单用经方,也可经方与经方合用,也可经方与时方合用,方证相应,使心脏神经症的中医诊断更加精准,治疗更加灵活高效。
Cardiac neurosis is one of the most common diseases in the outpatient department of traditional Chinese medicine cardiology.Traditional Chinese medicine classifies it into the categories of“palpitations”“chest tightness and heartache”“insomnia”“depression”and“visceral restlessness”.The six classics syndrome differentiation originated from theTreatiseonColdDamage and is a collection of other methods of syndrome differentiation and six levels and systems of diagnosis and treatment(disease,syndrome,pulse).Cardiac neurosis is distributed among the six meridians of the Taiyang,Shaoyin,Shaoyang,Jueyin,Yangming,and Taiyin according to its symptoms.“Palpitations”are distributed in the four meridians mainly affected by solar diseases,and the main prescription for“palpitations”in solar diseases is Guizhi Gancao Decoction(桂枝甘草汤).“Chest obstruction and heartache”are scattered in the three meridians mainly affected by Taiyin disease,and the main formula for“chest obstruction and heartache”in Taiyin disease is Gualou Xiebai Decoction(瓜蒌薤白剂).“Insomnia”includes the two meridians mainly related to Yangming disease.When Yangming disease is“insomnia”,such as when Yangming has heat,the main prescription is Zhizichi Decoction(栀子豉汤);When there is internal heat and blood deficiency,use Huanglian Ejiao Decoction(黄连阿胶汤).The“depression syndrome”is scattered in the four meridians mainly affected by Shaoyang disease,and the main prescription for Shaoyang disease“depression syndrome”is Xiaochaihu Decoction(小柴胡汤).“Dirty restlessness”is seen in Taiyin disease,but it often coexists with Shaoyang disease and Yangming disease in clinical practice.The main prescription is Ganmai Dazao Decoction(甘麦大枣汤).Classic prescriptions are the source of clinical efficacy and the origin of all prescriptions.In the treatment process,the six meridians should be distinguished first,and then the prescription and syndrome should be distinguished.It is possible to use the prescription alone,combine the prescription with the prescription,or combine the prescription with the time prescription.The prescription and syndrome should correspond to each other,making the traditional Chinese medicine diagnosis of cardiac neurosis more accurate and the treatment more flexible and efficient.
作者
卢正华
方思奇
王艺霖
史海蛟
LU Zhenghua;FANG Siqi;WANG Yilin;SHI Haijiao(Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China;Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China)
出处
《辽宁中医药大学学报》
2025年第9期5-9,共5页
Journal of Liaoning University of Traditional Chinese Medicine
基金
国家中医药管理局第五批全国中医临床优秀人才研修项目(国中医药办人教函[2021]271号)
辽宁省科技计划联合计划(2024-MSLH-308)。
关键词
经方
六经辨证
心脏神经症
classical prescription
syndrome differentiation of six channeis theory
cardiac neurosis
