魏执真学术思想与临床经验总结及对其治疗快速型心律失常证治规律的研究
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摘要
恩师魏执真教授为国家级名老中医专家。我有幸作为徒弟拜读于魏老师身边三载,收获极大。
魏老师1962年毕业于北京中医学院(现北京中医药大学),是新中国培养的第一批接受现代中医药学高等教育的专业人才。在校期间,受教于秦伯未、任应秋、施今墨等当代中医大师。她潜心向医,孜孜不倦,问道解惑,从无懈怠,以勤学好问、手不释卷而闻名于全院师生之中。毕业前特经选拔,拜师我国著名的现代中医学家、教育家、学者秦伯未先生,颇得秦氏之妙。1963年即与秦老共同编著出版了《中医临证备要》一书。该书系统地总结了秦先生的中医学思想。毕业后就职于北京中医医院,从事内科及心血管科的临床、教学和科研工作。魏老师在长期临床实践中精研经典,遵从古训,谨承师教,通晓进展,熟知现状,不断认真学习,刻苦钻研,反复总结,在内科疾病,尤其是心脑血管疾病和糖尿病的诊治方面积累了丰富经验,特别对心律失常、糖尿病性心脏病、脑动脉硬化、脑供血不足做了非常深入的研究,取得了优异成绩,先后荣获卫生部、国家中医药管理局、北京市科委及北京市中医管理局颁发的重要科技成果奖项11项,更因擅治心律失常而曼声海外。魏老师行医近五十载,临证之得,秘不自珍,笔耕不辍,著作等身。临证上立法遣方师古而不泥于古,用药精专,轻灵纯正,别有意味。
本论文旨在全面总结魏老师的学术思想及临床经验,重点解析魏老师在心律失常方面独特的辨证论治思路,通过古训、师承,了解老师学术思想的渊源。并通过对魏老师治疗快速型心律失常的病例收集整理,进行用药频率分析、聚类分析和辨病用药分析等,以及初步分析总结快速型心律失常患者的常见证候要素,从而对魏老师治疗快速型心律失常的证治规律进行更深入一步地研究。
本论文主要分为三大部分。
第一部分为魏执真老师学术渊源概述。
以魏老师擅长治疗之心律失常为切入点,探寻老师的学术渊源。在系统查阅古代文献之后,回顾古代医家对“心悸”病因病机的认识和治则治法,从中挖掘魏老师心律失常辨证论治思路所依据的古训。魏老师敬遵古训,博览群书,吸取历代各医家之精华,尤其深受李时珍《濒湖脉学》之影响,创立了心律失常“以脉为主,四诊合参,分为两类、十型、三证候”的辨证思路和方法。同时学习秦伯未先生的著作,以进一步挖掘魏老师在治疗心脑血管疾病方面的学术思想渊源。魏老师谨承师教,临证时主张辨证与辨病相结合,并且要以辨证为先,理法方药力求丝丝入扣；在心系疾病的治疗用药上重视调气和血,慎用活血破血之品。
魏老师不但遵从古训,谨承师教,而且通晓进展,熟知现状,勤于临床,勇于探索,悉心观察,反复总结,从而建立了心律失常独特的辨证思路和方法,以及调脉系列方药,特别是治疗快速型心律失常,以“凉血清热”立法,为国内首创。
第二部分为魏执真老师学术思想和临床经验总结。
通过临床跟师门诊,学习并总结魏老师在心脑血管病方面的诊疗思路和经验。
魏老师擅长治疗心律失常、冠心病心绞痛、糖尿病性心脏病、充血性心力衰竭、心肌病、脑动脉粥样硬化和高血压等病。她认为,多数心血管疾病的基本病机为心脏亏虚,血脉瘀阻或流通不畅,治法主张益气养心,理气活血通脉。在此基础上,根据不同疾病,加入相应治法,如快速型心律失常加凉血清热法；充血性心力衰竭则按照影响肺、肝、脾胃、肾的不同,分别加泻肺利水、养阴柔肝、健脾利湿、温肾利水之法。糖尿病性心脏病分消渴病胸痹、消渴病心悸、消渴病心衰分别论治,在胸痹、心悸、心衰治法的基础上,更重用养阴清热之品；心肌病则根据表现心衰、心律失常的不同,而分别施治。
魏老师重视理气药的运用,因“气为血之帅,气行则血行”,但需注意,要理气而不破气。魏老师并主张要“和血”,即选择活血而不伤正的药物,切勿轻易选用破血逐瘀之品。
临证时,魏老师主张辨证准、立法慎、选方精、用药稳,做到理法方药丝丝入扣。魏老师不仅在药物的选择上慎之又慎,而且在药物的剂量和加减上也是谨之又谨。她的处方用药,轻灵纯正,看似平淡,实则蕴藏深意。
该部分总结了魏老师治疗心律失常、充血性心力衰竭、冠心病心绞痛、脑动脉硬化等的临床经验,其中重点介绍魏老师治疗心律失常的经验。
魏老师综合历代医家关于心悸的论述,又精研《濒湖脉学》,吸收先贤之精华,结合个人长期的临床实践,形成了她独特的治疗心律失常“以脉为主,四诊合参,分为两类、十型、三证候”的辨证论治的思路和方法。
魏老师强调脉象在心律失常的辨证中占有重要地位。各种心律失常都各自有其相应的主脉,各个主脉也都有其相应的主病。临床辨证时首先需弄清脉象,才能抓住心律失常病因病机的根本。同时要四诊合参,逐步审因,分为两类十型加以论治。
两类即阳热类和阴寒类。前者类似于现代医学的快速型心律失常,后者则类似于缓慢型心律失常。每类又各分为五型。阳热类心律失常的病机为心脏亏虚,血脉瘀阻,瘀而化热。魏老师认为,“热”是致病的关键,这里的“热”是血中之瘀热,故“凉血清热法”是治法中之关键。阴寒类心律失常的病机为心脾肾阳气亏虚或兼阴血不足,寒湿、痰饮之邪阻滞心脉,心脉瘀阻流通不畅。针对十种证型,魏老师自拟了“调脉汤”系列方药。
三证侯即心律失常治疗过程中所出现的气机郁结、神魂不宁和风热化毒三种证候,此时必须给予特别的重视,甚至根据“急则治其标”的原则,先治其兼证,方可取效。三种证候中,以风热化毒证候影响最大。
第三部分是对魏执真老师治疗快速型心律失常证治规律的研究。
收集2008年10月～2011年9月期间的魏老师诊治的快速型心律失常病例,共325份,进行用药频率分析、因子分析、聚类分析、辨病用药分析等,以及初步分析总结快速型心律失常患者的常见证候要素。结果表明：
1.325份病例中,魏老师共用中药88种,用药频率最高99.4%,最低0.3%。用药频率在前10位者有香附、丹皮、赤芍、黄连、乌药、麦冬、五味子、香橼、佛手和沙参。
2.88份房颤病例中,魏老师共用中药74种。用药频率>50%者有太子参、沙参、麦冬、五味子、白芍、香附、香橼、佛手、乌药、丹皮、赤芍和黄连。Logistic回归分析结果表明,茯苓、白芍、乌药、生地、太子参和香橼的回归系数均>1,0R值>5,有统计学意义(P<0.001或P<0.05)。
3.对早搏、窦性心动过速和阵发性室上性心动过速的用药频率分析结果显示,用药>50%者均为沙参、麦冬、五味子、香附、香橼、佛手、乌药、丹皮、赤芍和黄连。
4.47例方中有炒白术,其中用量10g的有14例,患者舌苔白黄相兼且厚者；用量15g的有4例,苔黄厚或黄腻；用量30g的有29例,为大便溏软、苔薄者。
5.在325份病例中,症状出现频率大于30%者有心悸、口干喜饮、乏力、气短和胸闷,在10%-30%之间者有大便溏或大便干、入睡困难、胃胀和早醒。
6.将>10%的症状做为高频症状进行因子分析,结果表明,心悸、气短、乏力和胸闷4个症状为主要成分。口干喜饮、大便干和入睡困难与心悸的相关性较大；乏力、便溏和早醒与气短的相关性较大。
7.将>10%的症状做为高频症状进行聚类分析,得到3组症状。第1组症状心悸、口干喜饮；第2组症状气短、乏力；第3组症状胸闷、胃胀、大便干、入睡难、早醒、便溏。
从以上结果得出结论：
1.魏执真教授治疗快速型心律失常的主要药物有太子参、沙参、麦冬、五味子、香附、香橼、佛手、乌药、丹皮、赤芍和黄连,它们组成了治疗快速型心律失常的基本方。
2.白芍、生地在房颤的治疗中具有较强的特异性。
3.快速型心律失常的常见症状为：心悸、口干喜饮、乏力、气短和胸闷,并常伴有胃胀、入睡困难和早醒。
4.快速型心律失常的病性证候要素主要有阴虚、气虚、气滞和热,病位证候要素主要有心、脾。
创新点：经过3年的跟师学习和自己的临床实践,我提出以下一些创新思路。
1.快速型心律失常的患者中有部分存在中焦虚寒的体质。我认为,遇到这样的患者,初诊时即可于方中加入小量干姜温胃散寒,可以防止药物寒凉伤胃,防止出现胃部不适情况。
2.我认为,更年期综合征的患者多有阴虚内热、肝郁化火、肝阳上亢的特点,故可将清凉滋补调脉汤和柔肝清眩汤应用于此类患者。
3.有一些高血压的患者服用魏老师自拟之“柔肝清眩汤”后,超声心动图提示舒张功能不全得到改善。由此,我认为,柔肝清眩汤可扩大临床应用领域,用于舒张功能不全的患者,或许可为治疗舒张功能不全开辟一条新的途径。
4.魏老师以玉竹治疗糖尿病患者食欲旺盛,我认为,可以利用玉竹缓脾、抑制过旺食欲的这一功效,扩大其应用,用于甲状腺功能亢进患者。
5.据《本草求真》载,白术亦有缓脾生津之效,故此我认为,可将生白术与玉竹联合应用于糖尿病患者。
My mentor Professor Wei Zhizhen is a senior expert in traditional Chinese medicine well known nationaly. I am lucky enough to persue my doctor degree under her guidance for three years and have benefited a lot.
Professor Wei, graduated from Beijing Medical College of TCM (now Beijing University of Chinese Medicine) in 1962, is one of the first doctors who specialize in traditional Chinese medicine got their medical degree through formal high education system. While at medical school, she was taught by contemporary Chinese medicine masters such as Qin Bowei, Ren YingQiu, Shi Jinmo, etc. She is devoted to medicine learning in perseverance, seeking knowledge without slack, and she is well-known among peers at the academy for her diligence and persistence in learning. As top in her class, she was selected to be apprentice to Dr. Qin Bowei, a famous modern Chinese medicine scientist, educator and scholar. She learned a lot from Dr. Qin, and even published a book "Guidelines in TCM Clinical Practice" as a co-author with Dr. Qin in 1963. The book is all about Dr. Qin's clinical experience and academic theories in Chinese medicine. Professor Wei began her career in Beijing Chinese Medicine Hospital after graduation. As a cardiologist, she's not only specializing in clinical practice, but also involve in teaching and research. Professor Wei studies the medical classics and follows the ancient motto, inheriting her teacher Dr. Qin's academic ideology, she is also familiar with medicine progress, studies hard constantly,so she had accumulated rich experience of treating medical diseases,especially in cardiovascular disease and diabetes,such as arrhythmia, diabetic cardiopathy, cerebral atherosclerosis and cerebral circulation insufficiency. Professor Wei had obtained 11 adwards, including Ministry of Health, State Administration of Traditional Chinese Medicine, Beijing Municipal Science and Technology Commission, etc, she is famous at home and abroad because of treating arrhythmia. After practicing for nearly fifty years, Professor Wei has published a lot of books to share her experience from clinical practice instead of keeping secret to herself. Her syndrome differentiation and treatment comes from traditional method but is not limited to that, which is accurate and pure, brisk and significant.
This study aims to summarize Professor Wei's academic ideology and clinical experience, to focus on her unique differentiation and treatment ideology in arrhythmia, to seek the origin of the teacher's academic ideology through ancient classics and experience from teachers. And I collected cases of tachyarrhythmia treated by Professor Wei, analyzed the common syndrome elements of tachyarrhythmia and Professor Wei's medication characteristics,through SPSS16.0 statistical software, by using frequency, fatctors analysis, hierarchical cluster analysis and logistic regression methods. In this way, to further discover Professor Wei's principle of syndrome-treatment of tachyarrhythmia.
This thesis mainly divided into three major contents.
The first part is about the origins of Professor Wei's academic ideology.
In this part, I Reviewed ancient literature, and researched how the physicians at that time thought about "heart palpitations" in pathogenesis and how they treated it, to find the basic theory Professor Wei is based in syndrome differentiation of arrhythmia. Professor Wei creats her unique ideology in differentiation and treatment of arrhythmia which is "combination of four diagnosis with emphasis of pulsing, dividing into two classifications, ten kinds and three syndromes", following the ancient motto, absorbing the quintessence of other physicians by well-reading, and is especially influenced by the book "Pulse Diagnosis" which was written by Li Shizhen.
I also read the writings of Dr. Qin Bowei to further discover origins of Professor Wei's academic ideology in treating cardiovascular diseases. Professor Wei inherits Dr. Qin's academic ideology, she advocates that syndrome differentiation and disease differentiation should be combined, and a physician should put syndrome differentiation first, diagnosis and treatment should be closely connected. In the treatment of cardiovascular diseases, Professor Wei advocates "regulating Qi and harmonizing Blood", be careful with taking removing stasis drug.
Professor Wei thinks that it is very important to combine theory with practice, she works hard and summarizes her experience in cilinal practice, in this way, Professor Wei creats her unique ideology in dirrerentiation and treatment of arrhythmia and series of prescriptions of "pulse regulating soup". Especially in treatment of tachyarrhythmia, her "cooling blood and clearing heat" treatment is a national initiative.
The second section of the thesis is to summarize the academic thoughts and clinical experiences of Professor Wei.
Through clinical work, learn and summarize Professor Wei's thoughts and experience in diagnosis and treatment of cardiovascular and cerebrovascular diseases.
Professor Wei specializes in the treatment of arrhythmia, coronary angina, diabetes heart disease, congestive heart failure, cardiomyopathy, cerebral atherosclerosis and hypertension and other diseases. She believes that the basic pathogenesis of most cardiovascular diseases is heart deficiency, blood stasis or poor circulation. She advocates nourishing qi and heart, regulating qi and activating blood circulation. Based on this, depending on different diseases, add appropriate treatment such as:cooling blood and clearing heat for tachyarrhythmia; congestive heart failure is treated with clearing lung for diruesis, nourishing yin and liver, promoting spleen and diuresis in accordance with the condition how the lung, liver, spleen and stomach and kidney is affected respectively. Diabetes heart diseases are differentiated as Diabetes chest stuffiness, Diabetes heart palpitations and Diabetes heart failure. Come to the treatment, in addition to the regular treatment of chest stuffiness, heart palpitations and heart failure Diabetes, it should be emphasis in clearing heat and nourishing heat. For cardiomyopathy, the treatment will be different depends on heart failure or arrhythmia.
Professor Wei emphasizes the use of qi drug as "qi is the commander of blood, smooth flow of qi results in good blood circulation". However, note that it's necessary to regulating qi instead of forcing qi. Professor Wei also advocates "harmonizing blood", namely, choose medicine which can harmonize blood without hurting vital qi. Never choose removing stasis drug.
In clinical practice, Professor Wei advocates accuracy in differentiation, treatment principle, formula formation and selection of medication, so that diagnosis and treatment are closely connected. Professor Wei is cautious not only in the choice of drugs, but also in dosage as well as formula adjustment. Her prescription is light and accurate, looks plain, but bears profound meanings in them.
And in this part I summarize Professor Wei's experiences of treating arrhythmia, congestive heart failure, coronary angina, cerebral atherosclerosis, etc. Now I would like to take arrhythmia for an example.
Professor Wei combs courses of generations of ancient physicians about heart palpitations, and thoroughly studies "Pulse Diagnosis". Combining the wisdom of sages and her long-term clinical practice, she creates her unique ideology in differentiation and treatment of arrhythmia which is "combination of four diagnosis with emphasis of pulsing, dividing into two classifications, ten kinds and three syndromes".
Professor Wei stresses that pulse condition plays an important role in diagnosis of cardiac arrhythmia. Each arrhythmia has corresponding main pulse which also has its corresponding main disease. During syndrome differentiation, first thing needs to do is to understand the pulse so as to get the fundamental pathogenesis of cardiac arrhythmias. Then, refer to other 3 diagnostic methods and finally analyzing the causes, dividing into two classifications and ten kinds.
Two classifications are yang-heat and yin-cold. The former is similar to tachyarrhythmia in modern medicine and the latter is similar to arrhythmias. Each classification is divided into five different kinds respectively. The pathogenesis of yang-heat arrhythmia is heart deficiency, blood stasis with heat. Professor Wei believes that "heat" is the main cause of disease, the "heat" here refers to heat in blood, so "cooling blood and clearing heat" is the key treatment. The pathogenesis of yin-cold arrhythmia is yang deficiency of heart, spleen and kidney, or with deficiency of yin blood, combined with cold-dampness, phlegm stagnation, systolic stasis and poor circulation. Aimed at the syndromes of the ten kinds, Professor Wei prepares series of prescriptions of "pulse regulating soup".
Three syndromes are stagnation of qi and vital energy, restless spirit and poison from wind heat in arrhythmia, which deserve special attention. At these stage, apply the principle "treat evident symptom in urgent condition" to achieve effective results. Among the three syndromes, poison from wind heat is the most dangerous one.
In the third part of this thesis is to study Professor Wei's principle of syndrome-treatment of tachyarrhythmia.
I collected cases of tachyarrhythmia treated by Professor Wei from Oct.2008 to Sep.2011, there are 325 cases altogether. I analyzed the common syndrome elements of tachyarrhythmia and Professor Wei's medication characteristics, through SPSS16.0 statistical software, by using frequency, fatctors analysis, hierarchical cluster analysis and logistic regression methods. The results show that:
1. In 325 cases, Professor Wei uses 88 kinds of herbs, the highest frequency of usage is 99.4%, while the lowest is 0.3%. The top 10 are: Cyperus, Cortex Moutan Radicis, Radix Paeoniae Rubra, Rhizoma Coptidis, Radix Linderae, Radix Ophiopogonis, Fructus Schisandrae, Citron, Fingered Citron and Radix Glehniae.
2. In the 88 cases of atrial fibrillation, Professor Wei uses 74 kinds of herbs. The frequency greater than 50%:Radix Pseudostellariae, Radix Glehniae, Radix Ophiopogonis, Fructus Schisandrae, Radix Paeoniae Alba, Cyperus, Citron, Fingered Citron, Radix Linderae, Cortex Moutan Radicis, Radix Paeoniae Rubra and Rhizoma Coptidis. The results of logistic regression analysis show that:the regression coefficients of Poria Cocos, Radix Paeoniae Alba, Radix Linderae, Radix Rehmanniae, Radix Pseudostellariae and Citron were greater than 1, the "OR" are greater than 5, with statistical significance (P<0.001 or P<0.05).
3. The results of using drugs frequency analysis in the treatment of premature beats, sinus tachycardia and paroxysmal supraventricular tachycardia show that:The frequency greater than 50%:Radix Glehniae, Radix Ophiopogonis, Fructus Schisandrae, Cyperus, Citron, Fingered Citron, Radix Linderae, Cortex Moutan Radicis, Radix Paeoniae Rubra and Rhizoma Coptidis.
4. Professor Wei uses Rhizoma Atractylodis Macrocephalae in 47 cases, among the 47 patients, there are 14 cases using dose of 10g and the patients have white and yellow and thick fur; there are 4 cases using dose of 15g and the patients have yellow and thick fur; there are 29 cases using dose of 30g and the patients have thin white fur and loose stool.
5. in the 325 cases, frequencies of symptoms greater than 30%: palpitations, dry mouth with desire for drink, fatigue, shortness of breath and tightness in the chest, from 10% to 30%:stool pond or dry stool, difficulty in falling asleep, abdominal distension and wake up early.
6. To analyze the symptoms whose frequencies are greater than 10% by factor analysis, the results show that:the main components of tachyarrhythmia are palpitations, shortness of breath, fatigue and chest tightness. Dry mouth with desire for drink, dry stool and difficulty in falling asleep are closely related to palpitations; fatigue, loose stools and wake up early are closely related to shortness of breath.
7. To analyze the symptoms whose frequencies are greater than 10% by cluster analysis, I get 3 groups of symptoms. The first groups of symptoms are palpitations, dry mouth with desire for drink; the second groups of symptoms are shortness of breath, fatigue; the third groups of symptoms are chest tightness, abdominal distension, dry stool, difficulty in falling asleep, waking up early and loose stools.
So I may safely draw the conclusions as follows:
1. Professor Wei usually uses herbs such as Radix Pseudostellariae, Radix Glehniae, Radix Ophiopogonis, Fructus Schisandrae, Cyperus, Citron, Fingered Citron, Radix Linderae, Cortex Moutan Radicis, Radix Paeoniae Rubra and Rhizoma Coptidis while treating tachyarrhythmia, and these herbs make up the basic prescription in the treatment of tachyarrhythmia.
2. Radix Paeoniae Alba and Radix Rehmanniae have higher specificity in the treatment of atrial fibrillation.
3. The common symptoms of tachyarrhythmia are:palpitations, dry mouth with desire for drink, fatigue, shortness of breath and tightness in the chest, usually with abdominal distention, difficulty in falling asleep and wake up early.
4. The most common characteristic-syndrome elements of tachyarrhythmia are Yin deficiency, Qi deficiency, Qi stagnation and heat; while bit-syndrome elements are heart and spleen.
innovation:After three years of study with Professor Wei, also by my own clinical practice, I have some thougts as my innovation.
1. Some patients have deficient and cold syndrome in middle-Jiao, so I think that we might add a small dose of Rhizoma Zingiberis, it might keep stomach from injuries and prevent the discomfort symptoms by the herbs.
2. I think that patients with menopausal syndrome have syndrome of endogenous heat due to Yin deficiency, fire syndrome due to stagnation of liver-Qi, syndrome of hyperactivity of the liver-Yang, so we could use the "cooling and nourishing soup regulating pulse" and the "Rou Gan Qing Xuan Tang" in these patients.
3. Some hypertensive patients'diastolic function improved after taking the "Rou Gan Qing Xuan Tang", so I think that the soup could be used in patients with diastolic dysfunction, and it might be a new way to treat diastolic dysfunction.
4. Professor Wei treats diabetes patient who has strong appetite with polygonatum, so I think that the herb could be used in hyperthyreosis patients.
5. According to an antient Chinese book, Atractylodes macrocephala koidz has the effect of "huan pi sheng jin", so I think that we could take Atractylodes macrocephala koidz and polygonatum in the treatment of diabetes.
魏老师1962年毕业于北京中医学院(现北京中医药大学),是新中国培养的第一批接受现代中医药学高等教育的专业人才。在校期间,受教于秦伯未、任应秋、施今墨等当代中医大师。她潜心向医,孜孜不倦,问道解惑,从无懈怠,以勤学好问、手不释卷而闻名于全院师生之中。毕业前特经选拔,拜师我国著名的现代中医学家、教育家、学者秦伯未先生,颇得秦氏之妙。1963年即与秦老共同编著出版了《中医临证备要》一书。该书系统地总结了秦先生的中医学思想。毕业后就职于北京中医医院,从事内科及心血管科的临床、教学和科研工作。魏老师在长期临床实践中精研经典,遵从古训,谨承师教,通晓进展,熟知现状,不断认真学习,刻苦钻研,反复总结,在内科疾病,尤其是心脑血管疾病和糖尿病的诊治方面积累了丰富经验,特别对心律失常、糖尿病性心脏病、脑动脉硬化、脑供血不足做了非常深入的研究,取得了优异成绩,先后荣获卫生部、国家中医药管理局、北京市科委及北京市中医管理局颁发的重要科技成果奖项11项,更因擅治心律失常而曼声海外。魏老师行医近五十载,临证之得,秘不自珍,笔耕不辍,著作等身。临证上立法遣方师古而不泥于古,用药精专,轻灵纯正,别有意味。
本论文旨在全面总结魏老师的学术思想及临床经验,重点解析魏老师在心律失常方面独特的辨证论治思路,通过古训、师承,了解老师学术思想的渊源。并通过对魏老师治疗快速型心律失常的病例收集整理,进行用药频率分析、聚类分析和辨病用药分析等,以及初步分析总结快速型心律失常患者的常见证候要素,从而对魏老师治疗快速型心律失常的证治规律进行更深入一步地研究。
本论文主要分为三大部分。
第一部分为魏执真老师学术渊源概述。
以魏老师擅长治疗之心律失常为切入点,探寻老师的学术渊源。在系统查阅古代文献之后,回顾古代医家对“心悸”病因病机的认识和治则治法,从中挖掘魏老师心律失常辨证论治思路所依据的古训。魏老师敬遵古训,博览群书,吸取历代各医家之精华,尤其深受李时珍《濒湖脉学》之影响,创立了心律失常“以脉为主,四诊合参,分为两类、十型、三证候”的辨证思路和方法。同时学习秦伯未先生的著作,以进一步挖掘魏老师在治疗心脑血管疾病方面的学术思想渊源。魏老师谨承师教,临证时主张辨证与辨病相结合,并且要以辨证为先,理法方药力求丝丝入扣；在心系疾病的治疗用药上重视调气和血,慎用活血破血之品。
魏老师不但遵从古训,谨承师教,而且通晓进展,熟知现状,勤于临床,勇于探索,悉心观察,反复总结,从而建立了心律失常独特的辨证思路和方法,以及调脉系列方药,特别是治疗快速型心律失常,以“凉血清热”立法,为国内首创。
第二部分为魏执真老师学术思想和临床经验总结。
通过临床跟师门诊,学习并总结魏老师在心脑血管病方面的诊疗思路和经验。
魏老师擅长治疗心律失常、冠心病心绞痛、糖尿病性心脏病、充血性心力衰竭、心肌病、脑动脉粥样硬化和高血压等病。她认为,多数心血管疾病的基本病机为心脏亏虚,血脉瘀阻或流通不畅,治法主张益气养心,理气活血通脉。在此基础上,根据不同疾病,加入相应治法,如快速型心律失常加凉血清热法；充血性心力衰竭则按照影响肺、肝、脾胃、肾的不同,分别加泻肺利水、养阴柔肝、健脾利湿、温肾利水之法。糖尿病性心脏病分消渴病胸痹、消渴病心悸、消渴病心衰分别论治,在胸痹、心悸、心衰治法的基础上,更重用养阴清热之品；心肌病则根据表现心衰、心律失常的不同,而分别施治。
魏老师重视理气药的运用,因“气为血之帅,气行则血行”,但需注意,要理气而不破气。魏老师并主张要“和血”,即选择活血而不伤正的药物,切勿轻易选用破血逐瘀之品。
临证时,魏老师主张辨证准、立法慎、选方精、用药稳,做到理法方药丝丝入扣。魏老师不仅在药物的选择上慎之又慎,而且在药物的剂量和加减上也是谨之又谨。她的处方用药,轻灵纯正,看似平淡,实则蕴藏深意。
该部分总结了魏老师治疗心律失常、充血性心力衰竭、冠心病心绞痛、脑动脉硬化等的临床经验,其中重点介绍魏老师治疗心律失常的经验。
魏老师综合历代医家关于心悸的论述,又精研《濒湖脉学》,吸收先贤之精华,结合个人长期的临床实践,形成了她独特的治疗心律失常“以脉为主,四诊合参,分为两类、十型、三证候”的辨证论治的思路和方法。
魏老师强调脉象在心律失常的辨证中占有重要地位。各种心律失常都各自有其相应的主脉,各个主脉也都有其相应的主病。临床辨证时首先需弄清脉象,才能抓住心律失常病因病机的根本。同时要四诊合参,逐步审因,分为两类十型加以论治。
两类即阳热类和阴寒类。前者类似于现代医学的快速型心律失常,后者则类似于缓慢型心律失常。每类又各分为五型。阳热类心律失常的病机为心脏亏虚,血脉瘀阻,瘀而化热。魏老师认为,“热”是致病的关键,这里的“热”是血中之瘀热,故“凉血清热法”是治法中之关键。阴寒类心律失常的病机为心脾肾阳气亏虚或兼阴血不足,寒湿、痰饮之邪阻滞心脉,心脉瘀阻流通不畅。针对十种证型,魏老师自拟了“调脉汤”系列方药。
三证侯即心律失常治疗过程中所出现的气机郁结、神魂不宁和风热化毒三种证候,此时必须给予特别的重视,甚至根据“急则治其标”的原则,先治其兼证,方可取效。三种证候中,以风热化毒证候影响最大。
第三部分是对魏执真老师治疗快速型心律失常证治规律的研究。
收集2008年10月～2011年9月期间的魏老师诊治的快速型心律失常病例,共325份,进行用药频率分析、因子分析、聚类分析、辨病用药分析等,以及初步分析总结快速型心律失常患者的常见证候要素。结果表明：
1.325份病例中,魏老师共用中药88种,用药频率最高99.4%,最低0.3%。用药频率在前10位者有香附、丹皮、赤芍、黄连、乌药、麦冬、五味子、香橼、佛手和沙参。
2.88份房颤病例中,魏老师共用中药74种。用药频率>50%者有太子参、沙参、麦冬、五味子、白芍、香附、香橼、佛手、乌药、丹皮、赤芍和黄连。Logistic回归分析结果表明,茯苓、白芍、乌药、生地、太子参和香橼的回归系数均>1,0R值>5,有统计学意义(P<0.001或P<0.05)。
3.对早搏、窦性心动过速和阵发性室上性心动过速的用药频率分析结果显示,用药>50%者均为沙参、麦冬、五味子、香附、香橼、佛手、乌药、丹皮、赤芍和黄连。
4.47例方中有炒白术,其中用量10g的有14例,患者舌苔白黄相兼且厚者；用量15g的有4例,苔黄厚或黄腻；用量30g的有29例,为大便溏软、苔薄者。
5.在325份病例中,症状出现频率大于30%者有心悸、口干喜饮、乏力、气短和胸闷,在10%-30%之间者有大便溏或大便干、入睡困难、胃胀和早醒。
6.将>10%的症状做为高频症状进行因子分析,结果表明,心悸、气短、乏力和胸闷4个症状为主要成分。口干喜饮、大便干和入睡困难与心悸的相关性较大；乏力、便溏和早醒与气短的相关性较大。
7.将>10%的症状做为高频症状进行聚类分析,得到3组症状。第1组症状心悸、口干喜饮；第2组症状气短、乏力；第3组症状胸闷、胃胀、大便干、入睡难、早醒、便溏。
从以上结果得出结论：
1.魏执真教授治疗快速型心律失常的主要药物有太子参、沙参、麦冬、五味子、香附、香橼、佛手、乌药、丹皮、赤芍和黄连,它们组成了治疗快速型心律失常的基本方。
2.白芍、生地在房颤的治疗中具有较强的特异性。
3.快速型心律失常的常见症状为：心悸、口干喜饮、乏力、气短和胸闷,并常伴有胃胀、入睡困难和早醒。
4.快速型心律失常的病性证候要素主要有阴虚、气虚、气滞和热,病位证候要素主要有心、脾。
创新点：经过3年的跟师学习和自己的临床实践,我提出以下一些创新思路。
1.快速型心律失常的患者中有部分存在中焦虚寒的体质。我认为,遇到这样的患者,初诊时即可于方中加入小量干姜温胃散寒,可以防止药物寒凉伤胃,防止出现胃部不适情况。
2.我认为,更年期综合征的患者多有阴虚内热、肝郁化火、肝阳上亢的特点,故可将清凉滋补调脉汤和柔肝清眩汤应用于此类患者。
3.有一些高血压的患者服用魏老师自拟之“柔肝清眩汤”后,超声心动图提示舒张功能不全得到改善。由此,我认为,柔肝清眩汤可扩大临床应用领域,用于舒张功能不全的患者,或许可为治疗舒张功能不全开辟一条新的途径。
4.魏老师以玉竹治疗糖尿病患者食欲旺盛,我认为,可以利用玉竹缓脾、抑制过旺食欲的这一功效,扩大其应用,用于甲状腺功能亢进患者。
5.据《本草求真》载,白术亦有缓脾生津之效,故此我认为,可将生白术与玉竹联合应用于糖尿病患者。
My mentor Professor Wei Zhizhen is a senior expert in traditional Chinese medicine well known nationaly. I am lucky enough to persue my doctor degree under her guidance for three years and have benefited a lot.
Professor Wei, graduated from Beijing Medical College of TCM (now Beijing University of Chinese Medicine) in 1962, is one of the first doctors who specialize in traditional Chinese medicine got their medical degree through formal high education system. While at medical school, she was taught by contemporary Chinese medicine masters such as Qin Bowei, Ren YingQiu, Shi Jinmo, etc. She is devoted to medicine learning in perseverance, seeking knowledge without slack, and she is well-known among peers at the academy for her diligence and persistence in learning. As top in her class, she was selected to be apprentice to Dr. Qin Bowei, a famous modern Chinese medicine scientist, educator and scholar. She learned a lot from Dr. Qin, and even published a book "Guidelines in TCM Clinical Practice" as a co-author with Dr. Qin in 1963. The book is all about Dr. Qin's clinical experience and academic theories in Chinese medicine. Professor Wei began her career in Beijing Chinese Medicine Hospital after graduation. As a cardiologist, she's not only specializing in clinical practice, but also involve in teaching and research. Professor Wei studies the medical classics and follows the ancient motto, inheriting her teacher Dr. Qin's academic ideology, she is also familiar with medicine progress, studies hard constantly,so she had accumulated rich experience of treating medical diseases,especially in cardiovascular disease and diabetes,such as arrhythmia, diabetic cardiopathy, cerebral atherosclerosis and cerebral circulation insufficiency. Professor Wei had obtained 11 adwards, including Ministry of Health, State Administration of Traditional Chinese Medicine, Beijing Municipal Science and Technology Commission, etc, she is famous at home and abroad because of treating arrhythmia. After practicing for nearly fifty years, Professor Wei has published a lot of books to share her experience from clinical practice instead of keeping secret to herself. Her syndrome differentiation and treatment comes from traditional method but is not limited to that, which is accurate and pure, brisk and significant.
This study aims to summarize Professor Wei's academic ideology and clinical experience, to focus on her unique differentiation and treatment ideology in arrhythmia, to seek the origin of the teacher's academic ideology through ancient classics and experience from teachers. And I collected cases of tachyarrhythmia treated by Professor Wei, analyzed the common syndrome elements of tachyarrhythmia and Professor Wei's medication characteristics,through SPSS16.0 statistical software, by using frequency, fatctors analysis, hierarchical cluster analysis and logistic regression methods. In this way, to further discover Professor Wei's principle of syndrome-treatment of tachyarrhythmia.
This thesis mainly divided into three major contents.
The first part is about the origins of Professor Wei's academic ideology.
In this part, I Reviewed ancient literature, and researched how the physicians at that time thought about "heart palpitations" in pathogenesis and how they treated it, to find the basic theory Professor Wei is based in syndrome differentiation of arrhythmia. Professor Wei creats her unique ideology in differentiation and treatment of arrhythmia which is "combination of four diagnosis with emphasis of pulsing, dividing into two classifications, ten kinds and three syndromes", following the ancient motto, absorbing the quintessence of other physicians by well-reading, and is especially influenced by the book "Pulse Diagnosis" which was written by Li Shizhen.
I also read the writings of Dr. Qin Bowei to further discover origins of Professor Wei's academic ideology in treating cardiovascular diseases. Professor Wei inherits Dr. Qin's academic ideology, she advocates that syndrome differentiation and disease differentiation should be combined, and a physician should put syndrome differentiation first, diagnosis and treatment should be closely connected. In the treatment of cardiovascular diseases, Professor Wei advocates "regulating Qi and harmonizing Blood", be careful with taking removing stasis drug.
Professor Wei thinks that it is very important to combine theory with practice, she works hard and summarizes her experience in cilinal practice, in this way, Professor Wei creats her unique ideology in dirrerentiation and treatment of arrhythmia and series of prescriptions of "pulse regulating soup". Especially in treatment of tachyarrhythmia, her "cooling blood and clearing heat" treatment is a national initiative.
The second section of the thesis is to summarize the academic thoughts and clinical experiences of Professor Wei.
Through clinical work, learn and summarize Professor Wei's thoughts and experience in diagnosis and treatment of cardiovascular and cerebrovascular diseases.
Professor Wei specializes in the treatment of arrhythmia, coronary angina, diabetes heart disease, congestive heart failure, cardiomyopathy, cerebral atherosclerosis and hypertension and other diseases. She believes that the basic pathogenesis of most cardiovascular diseases is heart deficiency, blood stasis or poor circulation. She advocates nourishing qi and heart, regulating qi and activating blood circulation. Based on this, depending on different diseases, add appropriate treatment such as:cooling blood and clearing heat for tachyarrhythmia; congestive heart failure is treated with clearing lung for diruesis, nourishing yin and liver, promoting spleen and diuresis in accordance with the condition how the lung, liver, spleen and stomach and kidney is affected respectively. Diabetes heart diseases are differentiated as Diabetes chest stuffiness, Diabetes heart palpitations and Diabetes heart failure. Come to the treatment, in addition to the regular treatment of chest stuffiness, heart palpitations and heart failure Diabetes, it should be emphasis in clearing heat and nourishing heat. For cardiomyopathy, the treatment will be different depends on heart failure or arrhythmia.
Professor Wei emphasizes the use of qi drug as "qi is the commander of blood, smooth flow of qi results in good blood circulation". However, note that it's necessary to regulating qi instead of forcing qi. Professor Wei also advocates "harmonizing blood", namely, choose medicine which can harmonize blood without hurting vital qi. Never choose removing stasis drug.
In clinical practice, Professor Wei advocates accuracy in differentiation, treatment principle, formula formation and selection of medication, so that diagnosis and treatment are closely connected. Professor Wei is cautious not only in the choice of drugs, but also in dosage as well as formula adjustment. Her prescription is light and accurate, looks plain, but bears profound meanings in them.
And in this part I summarize Professor Wei's experiences of treating arrhythmia, congestive heart failure, coronary angina, cerebral atherosclerosis, etc. Now I would like to take arrhythmia for an example.
Professor Wei combs courses of generations of ancient physicians about heart palpitations, and thoroughly studies "Pulse Diagnosis". Combining the wisdom of sages and her long-term clinical practice, she creates her unique ideology in differentiation and treatment of arrhythmia which is "combination of four diagnosis with emphasis of pulsing, dividing into two classifications, ten kinds and three syndromes".
Professor Wei stresses that pulse condition plays an important role in diagnosis of cardiac arrhythmia. Each arrhythmia has corresponding main pulse which also has its corresponding main disease. During syndrome differentiation, first thing needs to do is to understand the pulse so as to get the fundamental pathogenesis of cardiac arrhythmias. Then, refer to other 3 diagnostic methods and finally analyzing the causes, dividing into two classifications and ten kinds.
Two classifications are yang-heat and yin-cold. The former is similar to tachyarrhythmia in modern medicine and the latter is similar to arrhythmias. Each classification is divided into five different kinds respectively. The pathogenesis of yang-heat arrhythmia is heart deficiency, blood stasis with heat. Professor Wei believes that "heat" is the main cause of disease, the "heat" here refers to heat in blood, so "cooling blood and clearing heat" is the key treatment. The pathogenesis of yin-cold arrhythmia is yang deficiency of heart, spleen and kidney, or with deficiency of yin blood, combined with cold-dampness, phlegm stagnation, systolic stasis and poor circulation. Aimed at the syndromes of the ten kinds, Professor Wei prepares series of prescriptions of "pulse regulating soup".
Three syndromes are stagnation of qi and vital energy, restless spirit and poison from wind heat in arrhythmia, which deserve special attention. At these stage, apply the principle "treat evident symptom in urgent condition" to achieve effective results. Among the three syndromes, poison from wind heat is the most dangerous one.
In the third part of this thesis is to study Professor Wei's principle of syndrome-treatment of tachyarrhythmia.
I collected cases of tachyarrhythmia treated by Professor Wei from Oct.2008 to Sep.2011, there are 325 cases altogether. I analyzed the common syndrome elements of tachyarrhythmia and Professor Wei's medication characteristics, through SPSS16.0 statistical software, by using frequency, fatctors analysis, hierarchical cluster analysis and logistic regression methods. The results show that:
1. In 325 cases, Professor Wei uses 88 kinds of herbs, the highest frequency of usage is 99.4%, while the lowest is 0.3%. The top 10 are: Cyperus, Cortex Moutan Radicis, Radix Paeoniae Rubra, Rhizoma Coptidis, Radix Linderae, Radix Ophiopogonis, Fructus Schisandrae, Citron, Fingered Citron and Radix Glehniae.
2. In the 88 cases of atrial fibrillation, Professor Wei uses 74 kinds of herbs. The frequency greater than 50%:Radix Pseudostellariae, Radix Glehniae, Radix Ophiopogonis, Fructus Schisandrae, Radix Paeoniae Alba, Cyperus, Citron, Fingered Citron, Radix Linderae, Cortex Moutan Radicis, Radix Paeoniae Rubra and Rhizoma Coptidis. The results of logistic regression analysis show that:the regression coefficients of Poria Cocos, Radix Paeoniae Alba, Radix Linderae, Radix Rehmanniae, Radix Pseudostellariae and Citron were greater than 1, the "OR" are greater than 5, with statistical significance (P<0.001 or P<0.05).
3. The results of using drugs frequency analysis in the treatment of premature beats, sinus tachycardia and paroxysmal supraventricular tachycardia show that:The frequency greater than 50%:Radix Glehniae, Radix Ophiopogonis, Fructus Schisandrae, Cyperus, Citron, Fingered Citron, Radix Linderae, Cortex Moutan Radicis, Radix Paeoniae Rubra and Rhizoma Coptidis.
4. Professor Wei uses Rhizoma Atractylodis Macrocephalae in 47 cases, among the 47 patients, there are 14 cases using dose of 10g and the patients have white and yellow and thick fur; there are 4 cases using dose of 15g and the patients have yellow and thick fur; there are 29 cases using dose of 30g and the patients have thin white fur and loose stool.
5. in the 325 cases, frequencies of symptoms greater than 30%: palpitations, dry mouth with desire for drink, fatigue, shortness of breath and tightness in the chest, from 10% to 30%:stool pond or dry stool, difficulty in falling asleep, abdominal distension and wake up early.
6. To analyze the symptoms whose frequencies are greater than 10% by factor analysis, the results show that:the main components of tachyarrhythmia are palpitations, shortness of breath, fatigue and chest tightness. Dry mouth with desire for drink, dry stool and difficulty in falling asleep are closely related to palpitations; fatigue, loose stools and wake up early are closely related to shortness of breath.
7. To analyze the symptoms whose frequencies are greater than 10% by cluster analysis, I get 3 groups of symptoms. The first groups of symptoms are palpitations, dry mouth with desire for drink; the second groups of symptoms are shortness of breath, fatigue; the third groups of symptoms are chest tightness, abdominal distension, dry stool, difficulty in falling asleep, waking up early and loose stools.
So I may safely draw the conclusions as follows:
1. Professor Wei usually uses herbs such as Radix Pseudostellariae, Radix Glehniae, Radix Ophiopogonis, Fructus Schisandrae, Cyperus, Citron, Fingered Citron, Radix Linderae, Cortex Moutan Radicis, Radix Paeoniae Rubra and Rhizoma Coptidis while treating tachyarrhythmia, and these herbs make up the basic prescription in the treatment of tachyarrhythmia.
2. Radix Paeoniae Alba and Radix Rehmanniae have higher specificity in the treatment of atrial fibrillation.
3. The common symptoms of tachyarrhythmia are:palpitations, dry mouth with desire for drink, fatigue, shortness of breath and tightness in the chest, usually with abdominal distention, difficulty in falling asleep and wake up early.
4. The most common characteristic-syndrome elements of tachyarrhythmia are Yin deficiency, Qi deficiency, Qi stagnation and heat; while bit-syndrome elements are heart and spleen.
innovation:After three years of study with Professor Wei, also by my own clinical practice, I have some thougts as my innovation.
1. Some patients have deficient and cold syndrome in middle-Jiao, so I think that we might add a small dose of Rhizoma Zingiberis, it might keep stomach from injuries and prevent the discomfort symptoms by the herbs.
2. I think that patients with menopausal syndrome have syndrome of endogenous heat due to Yin deficiency, fire syndrome due to stagnation of liver-Qi, syndrome of hyperactivity of the liver-Yang, so we could use the "cooling and nourishing soup regulating pulse" and the "Rou Gan Qing Xuan Tang" in these patients.
3. Some hypertensive patients'diastolic function improved after taking the "Rou Gan Qing Xuan Tang", so I think that the soup could be used in patients with diastolic dysfunction, and it might be a new way to treat diastolic dysfunction.
4. Professor Wei treats diabetes patient who has strong appetite with polygonatum, so I think that the herb could be used in hyperthyreosis patients.
5. According to an antient Chinese book, Atractylodes macrocephala koidz has the effect of "huan pi sheng jin", so I think that we could take Atractylodes macrocephala koidz and polygonatum in the treatment of diabetes.
引文
[1]黄帝内经素问校释(下册).北京：人民卫生出版社,1982.
[2]黄帝内经素问校释(上册).北京：人民卫生出版社,1982.
[3]明·马莳.黄帝内经灵枢注证发微.北京：科学技术文献出版社,2000.
[4]冯世纶.胡希恕讲伤寒杂病论.北京：人民军医出版社,2007.
[5]沈炎南,脉经校注.北京：人民卫生出版社,1993.
[6]唐·孙思邈.孙真人千金方.北京：人民卫生出版社,1995.
[7]唐·王焘.外台秘要.上海：上海古籍出版社,1991.
[8]陈言.三因极一病证方论.北京：人民卫生出版社,1983.
[9]重订严氏济生方.北京：人民卫生出版社,1980.
[10]刘完素.素问玄机原病式.北京：人民卫生出版社,1998.
[11]刘完素.素问病机气宜保命集.北京：人民卫生出版社,1998.
[12]金·李东垣.脾胃论.东垣医集.北京：人民卫生出版社,1993.
[13]金·李东垣.内外伤辨惑论.东垣医集.北京：人民卫生出版社,1993.
[14]朱震亨.丹溪心法.丹溪医集.北京：人民卫生出版社,1993.
[15]明·虞搏,医学正传.北京：人民卫生出版社,1965.
[16]王肯堂医学全书.北京：中国中医药出版社,1999.
[17]明·张介宾.景岳全书(一).上海：上海古籍出版社,1991.
[18]濒湖脉学白话解.北京：人民卫生出版社,1999.
[19]清·王清任.医林改错.北京：中国中医药出版社,1995.
[20]秦伯未著,吴大真,王凤岐辑.秦伯未医学名著全书.北京：中医古籍出版社,2003.
[1]单书健,陈子华.古今名医临证金鉴.心悸怔忡卷.北京：中医中医药出版社,1999：109,172,192,224.
[2]吴焕林,周文斌.邓铁涛教授治疗心悸(心律失常)临床经验.中医药信息,2005,22(5)：60-61.
[3]何欣.何立人教授辨治心律失常的临床经验.辽宁中医杂志,2008,35(12)：1813-1814.
[4]牛慧佳.汪慰寒教授心悸从胃论治验案举隅.河南中医,2007,27(3)：71.
[5]张娟.周宜轩治疗心律失常的经验.中医药临床杂志,2004,16(1)：17-18.
[6]高剑虹.心悸的临床论治.北京中医,2006,25(2)：98-99.
[7]卢富华.黄春林治疗心律失常的经验.湖北中医杂志,2005,27(4)：23-24.
[81谢心,沈琳,孙丽华.林钟香治疗心律失常临证经验撷析.辽宁中医杂志,2007,34(6)：720-721.
[9]贝自强.奚凤霖诊治心律失常的临床经验.中国医药学报,2004,19(10)：613-615.
[10]章怡祎.顾仁樾辨证论治心悸经验撷菁.上海中医药杂志,2007,41(8)：7-8.
[11]张会珍,赵志国,张一昕.许占民教授辨治心悸的临床经验.河北中医药学报,2006,21(4)：28-29.
[12]李魁岸,周国雄.炙甘草汤加减治疗心脏期前收缩的初步观察.中医杂志,1964,7：23-24.
[13]李斯炽.心悸辨证论治验案.新医药学杂志,1977,1：31-36
[14]何文坚,李一新.“早搏一方”加味治疗早搏50例疗效观察.新医学,1978,9(4)：179-180.
[15]包松年.心律失常五证辨治和体会.江苏中医杂志,1982,5：52-53.
[16]贝润浦.姜春华治疗心律失常的经验.福建中医药,1983,5：30-33
[17]魏执真.辨证治疗期前收缩4例.中医杂志,1986,4：41-42.
[18]王振涛,韩丽华.中医辨治快速型心律失常的思路与方法.中医杂志,2005,46(10)：783-784.
[19]刘梅,杜武勋.浅谈中医药治疗快速型心律失常的体会.天津中医学院学报,2002,21(2)：15.
[20]牛媛媛,朱翠玲.朱翠玲教授治疗快速性心律失常经验撷要.光明中医,2010,25(3)：385-386.
[21]李勋.益气生脉汤治疗快速心律失常疗效分析.中国医药导报,2008,5(8)：81-82.
[22]赵永华.从内风论治快速型心律失常初探.江苏中医药,2002,23(1 0)：18-19.
[23]王坚,李旭.安心定悸汤改善快速性心律失常患者心率、血压及血液流变指标的作 用.中国临床康复,2006,10(47)：147-149.
[24]任凤蓝,刘建东,张洁,张雅玲.悸安冲剂治疗快速性心律失常的临床研究.华北煤炭医学院学报,2001,3(4)：410-411.
[25]安辉,缪灿铭,林凯旋.生脉复律汤治疗快速型心律失常的疗效观察.中华中医药学刊,2009,27(5)：1046-1047.
[26]邢月朋,张伟,于惠卿,刘真,邢峰丽.养心定悸冲剂治疗快速性心律失常的临床研究.中国中西医结合急救杂志,2004,11(4)：218-220.
[27]赵国定,宋海萍,蔡征宇,等.冠心灵胶囊治疗快速心律失常92例临床观察.上海中医药杂志,2005,39(1)：7-8.
[28]陈耀平,高大伟,张波.养血息风为主治疗快速心律失常临床观察.河北中医药学报,2001,16(1)：10-11.
[29]洪永春,周金枝,王和木.稳心颗粒与胺碘酮治疗快速型心律失常临床研究.实用心脑肺血管病杂志,2010,18(7)：934-935.
[30]霍有萍,张树林,吴相锋.参松养心胶囊治疗室性期前收缩临床观察.中国中医药信息杂志,2007,14(9)：63-64.
[31]《中国心脏起搏与心电生理杂志》编辑部,中国生物医学工程学会,心脏起搏与电生理分会.心脏猝死的防治建议.中国心脏起搏与心电生理杂志,2002,16(6)：401-414.
[32]Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics-2009 update:A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation,2009,119:e21-e181.
[33]黄峻.心血管疾病诊断流程与治疗策略.北京：科学出版社,2007：112-115.
[34]张海澄,佟光明.期前收缩的临床意义及其治疗.实用心脑肺血管病杂志,2006,14(1)：14-15.
[1]陈明哲.心脏病学.北京：北京医科大学出版社,1999：593-599,632.
[2]清·唐容川.血证论.北京：中国中医药出版社,1996：22.
[3]元·朱丹溪.丹溪手镜.北京：人民卫生出版社,1982：11.
[4][清]顾观光辑；杨鹏举校注.神农本草经.北京：学苑出版社,2007：86.
[2]黄帝内经素问校释(上册).北京：人民卫生出版社,1982.
[3]明·马莳.黄帝内经灵枢注证发微.北京：科学技术文献出版社,2000.
[4]冯世纶.胡希恕讲伤寒杂病论.北京：人民军医出版社,2007.
[5]沈炎南,脉经校注.北京：人民卫生出版社,1993.
[6]唐·孙思邈.孙真人千金方.北京：人民卫生出版社,1995.
[7]唐·王焘.外台秘要.上海：上海古籍出版社,1991.
[8]陈言.三因极一病证方论.北京：人民卫生出版社,1983.
[9]重订严氏济生方.北京：人民卫生出版社,1980.
[10]刘完素.素问玄机原病式.北京：人民卫生出版社,1998.
[11]刘完素.素问病机气宜保命集.北京：人民卫生出版社,1998.
[12]金·李东垣.脾胃论.东垣医集.北京：人民卫生出版社,1993.
[13]金·李东垣.内外伤辨惑论.东垣医集.北京：人民卫生出版社,1993.
[14]朱震亨.丹溪心法.丹溪医集.北京：人民卫生出版社,1993.
[15]明·虞搏,医学正传.北京：人民卫生出版社,1965.
[16]王肯堂医学全书.北京：中国中医药出版社,1999.
[17]明·张介宾.景岳全书(一).上海：上海古籍出版社,1991.
[18]濒湖脉学白话解.北京：人民卫生出版社,1999.
[19]清·王清任.医林改错.北京：中国中医药出版社,1995.
[20]秦伯未著,吴大真,王凤岐辑.秦伯未医学名著全书.北京：中医古籍出版社,2003.
[1]单书健,陈子华.古今名医临证金鉴.心悸怔忡卷.北京：中医中医药出版社,1999：109,172,192,224.
[2]吴焕林,周文斌.邓铁涛教授治疗心悸(心律失常)临床经验.中医药信息,2005,22(5)：60-61.
[3]何欣.何立人教授辨治心律失常的临床经验.辽宁中医杂志,2008,35(12)：1813-1814.
[4]牛慧佳.汪慰寒教授心悸从胃论治验案举隅.河南中医,2007,27(3)：71.
[5]张娟.周宜轩治疗心律失常的经验.中医药临床杂志,2004,16(1)：17-18.
[6]高剑虹.心悸的临床论治.北京中医,2006,25(2)：98-99.
[7]卢富华.黄春林治疗心律失常的经验.湖北中医杂志,2005,27(4)：23-24.
[81谢心,沈琳,孙丽华.林钟香治疗心律失常临证经验撷析.辽宁中医杂志,2007,34(6)：720-721.
[9]贝自强.奚凤霖诊治心律失常的临床经验.中国医药学报,2004,19(10)：613-615.
[10]章怡祎.顾仁樾辨证论治心悸经验撷菁.上海中医药杂志,2007,41(8)：7-8.
[11]张会珍,赵志国,张一昕.许占民教授辨治心悸的临床经验.河北中医药学报,2006,21(4)：28-29.
[12]李魁岸,周国雄.炙甘草汤加减治疗心脏期前收缩的初步观察.中医杂志,1964,7：23-24.
[13]李斯炽.心悸辨证论治验案.新医药学杂志,1977,1：31-36
[14]何文坚,李一新.“早搏一方”加味治疗早搏50例疗效观察.新医学,1978,9(4)：179-180.
[15]包松年.心律失常五证辨治和体会.江苏中医杂志,1982,5：52-53.
[16]贝润浦.姜春华治疗心律失常的经验.福建中医药,1983,5：30-33
[17]魏执真.辨证治疗期前收缩4例.中医杂志,1986,4：41-42.
[18]王振涛,韩丽华.中医辨治快速型心律失常的思路与方法.中医杂志,2005,46(10)：783-784.
[19]刘梅,杜武勋.浅谈中医药治疗快速型心律失常的体会.天津中医学院学报,2002,21(2)：15.
[20]牛媛媛,朱翠玲.朱翠玲教授治疗快速性心律失常经验撷要.光明中医,2010,25(3)：385-386.
[21]李勋.益气生脉汤治疗快速心律失常疗效分析.中国医药导报,2008,5(8)：81-82.
[22]赵永华.从内风论治快速型心律失常初探.江苏中医药,2002,23(1 0)：18-19.
[23]王坚,李旭.安心定悸汤改善快速性心律失常患者心率、血压及血液流变指标的作 用.中国临床康复,2006,10(47)：147-149.
[24]任凤蓝,刘建东,张洁,张雅玲.悸安冲剂治疗快速性心律失常的临床研究.华北煤炭医学院学报,2001,3(4)：410-411.
[25]安辉,缪灿铭,林凯旋.生脉复律汤治疗快速型心律失常的疗效观察.中华中医药学刊,2009,27(5)：1046-1047.
[26]邢月朋,张伟,于惠卿,刘真,邢峰丽.养心定悸冲剂治疗快速性心律失常的临床研究.中国中西医结合急救杂志,2004,11(4)：218-220.
[27]赵国定,宋海萍,蔡征宇,等.冠心灵胶囊治疗快速心律失常92例临床观察.上海中医药杂志,2005,39(1)：7-8.
[28]陈耀平,高大伟,张波.养血息风为主治疗快速心律失常临床观察.河北中医药学报,2001,16(1)：10-11.
[29]洪永春,周金枝,王和木.稳心颗粒与胺碘酮治疗快速型心律失常临床研究.实用心脑肺血管病杂志,2010,18(7)：934-935.
[30]霍有萍,张树林,吴相锋.参松养心胶囊治疗室性期前收缩临床观察.中国中医药信息杂志,2007,14(9)：63-64.
[31]《中国心脏起搏与心电生理杂志》编辑部,中国生物医学工程学会,心脏起搏与电生理分会.心脏猝死的防治建议.中国心脏起搏与心电生理杂志,2002,16(6)：401-414.
[32]Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics-2009 update:A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation,2009,119:e21-e181.
[33]黄峻.心血管疾病诊断流程与治疗策略.北京：科学出版社,2007：112-115.
[34]张海澄,佟光明.期前收缩的临床意义及其治疗.实用心脑肺血管病杂志,2006,14(1)：14-15.
[1]陈明哲.心脏病学.北京：北京医科大学出版社,1999：593-599,632.
[2]清·唐容川.血证论.北京：中国中医药出版社,1996：22.
[3]元·朱丹溪.丹溪手镜.北京：人民卫生出版社,1982：11.
[4][清]顾观光辑；杨鹏举校注.神农本草经.北京：学苑出版社,2007：86.
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