摘要
目的探讨“汤液经法图”理论体系在1例胸痹伴头汗患者中药治疗中进行药学监护的应用价值。方法采用回顾性分析法分析1例冠状动脉粥样硬化性心脏病(胸痹)伴头汗的老年女性患者的药学监护过程。患者以间断胸闷、憋气30年,加重伴心悸1个月为主诉入院。在常规予苏合香丸及丹参酮ⅡA磺酸钠注射液控制胸痹主症的同时,临床药师基于“汤液经法图”理论体系,结合患者出头汗、口干、小便异常等表现,辨证为脾实合肺虚为主、兼夹肾实证,确立辛味泻脾、酸味补肺、甘味泻肾的治疗原则。首次予中药汤剂化肝煎合小柴胡汤加减方,组方配伍结构为“六辛五苦五酸一甘”,服用5 d后,反酸、烧心、呃逆、睡眠改善,但出头汗、口干、小便色黄量少等症状未见缓解。调整组方为桑蚕方合桂枝汤加减方,配伍结构改为“六酸五辛三苦二甘一咸”,增加酸味药比例,以加强补肺,服用3 d后,出头汗、口干症状减轻,但小便异常症状仍未改善。临床医师与临床药师会诊,将组方结构调整为“四酸三甘二辛一苦”,以酸味补肺、甘味泻肾为主,继续服用5 d。结果2次调整组方后,患者出头汗、口干、小便色黄量少等症状均明显改善,且未见不良反应。结论“汤液经法图”理论体系可为中药组方的合理性分析与动态调整提供理论依据,有助于临床药师深入参与个体化治疗方案的制订与优化。
Objective To investigate the application value of the theoretical system of"Tang Ye Jing Fa Map"in the pharmaceutical care of a patient with chest paralysis and head sweating treated with traditional Chinese medicine(TCM).Methods A retrospective analysis was conducted to analyze the pharmaceutical care process of an elderly female patient with coronary heart disease(chest paralysis)and head sweating.The patient was admitted with the main complaint of intermittent chest tightness and breath-holding for 30 years,aggravated with palpitations for one month.While routine administration of Suhexiang Pills and DanshentongⅡA Sodium Sulfonate Injection was used to control the main symptoms of chest paralysis,the clinical pharmacist used the theoretical system of"Tang Ye Jing Fa Map",and based on the patient′s symptoms such as sweating,dry mouth,and abnormal urination,differentiated the patient′s syndrome into spleen excess combined with lung deficiency as the main manifestation with kidney spleen excess syndrome,and established the treatment principles of pungent flavors to purge the spleen,acidic flavors to tonify the lungs,and sweet flavors to purge the kidneys.For the first time,the modified Huagan Decoction combined with Xiaochaihu Decoction was adopted,with a prescription structure of"six pungent,five bitter,five sour and one sweet".After taking the medicine for 5 d,the patient′s symptoms such as acid reflux,heartburn,eructation and poor sleep were better than before,but symptoms such as head sweating,dry mouth,and a small amount of yellow urine did not improve.The prescription was adjusted to the modified Sangcan Formula combined with Guizhi Decoction,and the compatibility structure was changed to"six acids,five pungent,three bitter,two sweet,and one salty",and the proportion of acidic medicines was increased to tonify lung function.After taking the medicine for 3 d,the patient′s symptoms such as head sweating and dry mouth were improved,but the symptoms of abnormal urination still did not improve.The clinical physician and clinical pharmacist consulted and adjusted the prescription structure to four acid,three sweet,two pungent and one bitter",with acidic herbs that tonified the lungs and sweet herbs that purged the kidneys as the mainstay,and then continued to take the medicine for 5 d.Results After two rounds of adjustments of the prescription,the patient′s symptoms such as head sweating,dry mouth,and a small amount of yellow urine significantly improved,and no adverse drug reactions were observed.Conclusion The theoretical system of"Tang Ye Jing Fa Map"can provide a theoretical basis for the rational analysis and dynamic adjustment of TCM prescriptions,and help clinical pharmacists to participate deeply in the formulation and optimization of individualized treatment plans.
作者
齐明月
刘南阳
赵依佳
吕旭潇
晋齐中
金锐
QI Mingyue;LIU Nanyang;ZHAO Yijia;LYU Xuxiao;JIN Qizhong;JIN Rui(Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan,Shandong 250014,China;Capital Medical University Xiyuan Hospital,Beijing 100091,China;Peking University Frist Hospital-Miyun Hospital,Beijing 101500,China;Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China)
出处
《中国药业》
2026年第5期140-144,共5页
China Pharmaceuticals
基金
中国中医科学院科技创新工程重大攻关项目[CI2021A03805]
中国中医科学院西苑医院提升中医药临床循证证据级别研究专项面上项目[XYZX0202-07]
山东中医药学会临床药学科研专项基金项目[SDACM202204]
山东省药学会医院药学高质量发展专项科研学术活动项目[SDSYXH-46-2025-20]。
关键词
汤液经法图
中药
药学监护
胸痹
出头汗
"Tang Ye Jing Fa Map"
traditional Chinese medicine
pharmaceutical care
chest paralysis
head sweating
