王宗仁教授治疗冠心病的学术经验研究
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摘要
王宗仁教授德技双馨,在心脑血管疾病的中西医结合治疗方面积累了丰富的临床经验。他平素修身养性,宁静致远;勤求古训,通古晓今;理论实践兼顾,重视学以致用;认为诊治过程应始终坚持辨病与辨证相结合;察色按脉与现代检查并用;倡导汇通中西医,急缓分期而治;善于古为今用,提出“气虚血瘀”疾病群观点;强调在临床治疗时应重视气血和顾护阳气;认为病不只是治病,贵在防病于未然;采用仁术济世,已桃李满天下。本文从以上10个方面概述导师王宗仁教授的学术经验。冠心病心绞痛是心血管疾病的常见病、多发病,严重威胁着人们的生命和生活质量。其发病机理主要与血管内皮损伤、血小板和凝血因子的活化、高血脂,尤其与免疫炎症反应等因素造成动脉粥样硬化斑块不稳定及继发血栓形成等因素有关。王宗仁教授根据中医理论、前人经验及临床应用体会,认为冠心病心绞痛属于中医学“胸痹”、“心痛”范畴,气虚血瘀是冠心病心绞痛病机之关键,益气活血法是治疗冠心病的基本治则,研制成由黄芪、丹参、当归、红花、桂枝组成的芪丹通脉片,具有益气活血、通脉止痛的功效。研究发现:芪丹通脉片明显改善心绞痛疗效和心悸、气短、乏力等症状;还能显著延长凝血时间,降低血脂。免疫炎症方面,芪丹通脉片能明显降低免疫球蛋白G(IgG)、补体3(C3)水平和CD4~+/CD8~+比值;还能明显降低白介素-6(IL-6)、IL-8、肿瘤坏死因子α(TNF-α)、高敏C反应蛋白(hs-CRP)、内皮素-1(ET-1)和同型半胱氨酸(Hcy)水平。综上所述,芪丹通脉片治疗气虚血瘀型冠心病不稳定型心绞痛有确切疗效,其疗效机理可能是通过抗凝、降脂、调节免疫功能和抑制炎症反应等起作用,是一个安全、有效的制剂,值得进一步深入研究。运用Meta分析,对益气活血法对冠心病心绞痛(气虚血瘀证)的疗效及安全性系统评价,结果表明:益气活血法能提高冠心病心绞痛(气虚血瘀证)的治疗疗效,且不良反应少。
Professor Wang Zongren is a man of strong moral fiber and good medical technology.He has increased knowledge and experience in treating cardiocerebral vascular disease with integrated traditional and western medicine.He gets used to self-cultivation and leading a quiet life.He usually workes hard on ancient motto and is familiarity with the ancient and present.He believes that it is important to insist on giving attention on both theory and practice,especially on appling what they have learned.He insisted that a diagnosis and treatment is thorough based on a diagnosis in accordance with integrated syndromes and diseases,including both observation of colours and pulse condition and modern tests.He has connected chinese traditional medicine and western medicine,treating on urgent,delay and staging.He put forward to settle the clinical problems with making the past serve the present,and he proposed viewpoint of disease groups " qi deficiency and blood stasis".He believes that it is very important to insist on relating Qi with blood and protecting Yang-Qi in treatment.It is also emphasized protection before the onset of disease by tutor.He developed humanity medical technology for benefiting society and his pupils work all over our country.The tutor's academic experience is summarized from the above ten aspects in this paper.Angina pectoris in coronary heart disease is a frequently-occurring disease that is commonly seen in cardiovascular system.Angina pectoris has been seriously threatened the people's life and quality of life with ascending incidence in recent years.The injury of vascular endothelial cell,activation of platelet and blood coagulation factors,imbalance of procoagulation and anticoagulation, hyperlipoidemia and especially inflammation factor could conrtibute to cause plaque instability and secondary thrombosis.Based on the theory of traditional Chinese medicine(TCM),predecessors' experience and understanding of clinical practice,Prof.Wang Zongren thinks that angina pectoris belongs to the "chest bi-syndrome" or "cardialgia" category in TCM,and Qi deficiency and blood stasis is the TCM's key of pathogenesis of "cardialgia".So boosting Qi and activating blood therapy is basic therapeutic principle of "chest pain".A formula designated Qidan Tongmai Tablet(QDTMT) was developed by tutor.And QDTMT consists of compounds of extractives of traditional Chinese herbs from dried roots of Astragalus membranaceus,Saliva miltiorrhiza(Labiate),Angelica sinensisi (Umbelliferae),the dried flower of Carthamus tinctorius(Compositae) and dried twig of Cinnamomum cassia(Lauraceae) and functions as invigorating Qi and promoting blood circulation.The result of research indicated that QDTMT had curative effects in the angina pectoris and palpitation,shortness of breath and languidness.It also prolonged Clotting time and decreased blood fat.As far as the inflammatory media and immune molecular were concerned,the serum levels of IgG and C3,the ratio of CD4~+/CD8~+ significantly lowered in the QDTMT group. The serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitive C-reactive protein(hs-CRP),endothelin-1(ET-1) and homocysteine(Hcy) also notablely decreased in the QDTMT group after treatment.And no obvious and serious side effects were found.In conclusion,QDTMT has specific effect in treating UA patients with the syndrome of blood stasis due to Qi deficiency, indicating that QDTMT could operates through improving anticoagulation and regulating blood fat and immune function,and inhibiting inflammatory reaction. Therefore,it is worthy to be studied deeply.On the other hand,Meta-analysis was carried out to evaluated the the curative effect and safety on angina pectoris due to Qi-deficiency and blood stasis by Qi-supplementing and Blood-Quickening,the results showed that the Qi-supplementing and Blood-Quickening could improve curative effect and decrease adverse reactions.
Professor Wang Zongren is a man of strong moral fiber and good medical technology.He has increased knowledge and experience in treating cardiocerebral vascular disease with integrated traditional and western medicine.He gets used to self-cultivation and leading a quiet life.He usually workes hard on ancient motto and is familiarity with the ancient and present.He believes that it is important to insist on giving attention on both theory and practice,especially on appling what they have learned.He insisted that a diagnosis and treatment is thorough based on a diagnosis in accordance with integrated syndromes and diseases,including both observation of colours and pulse condition and modern tests.He has connected chinese traditional medicine and western medicine,treating on urgent,delay and staging.He put forward to settle the clinical problems with making the past serve the present,and he proposed viewpoint of disease groups " qi deficiency and blood stasis".He believes that it is very important to insist on relating Qi with blood and protecting Yang-Qi in treatment.It is also emphasized protection before the onset of disease by tutor.He developed humanity medical technology for benefiting society and his pupils work all over our country.The tutor's academic experience is summarized from the above ten aspects in this paper.Angina pectoris in coronary heart disease is a frequently-occurring disease that is commonly seen in cardiovascular system.Angina pectoris has been seriously threatened the people's life and quality of life with ascending incidence in recent years.The injury of vascular endothelial cell,activation of platelet and blood coagulation factors,imbalance of procoagulation and anticoagulation, hyperlipoidemia and especially inflammation factor could conrtibute to cause plaque instability and secondary thrombosis.Based on the theory of traditional Chinese medicine(TCM),predecessors' experience and understanding of clinical practice,Prof.Wang Zongren thinks that angina pectoris belongs to the "chest bi-syndrome" or "cardialgia" category in TCM,and Qi deficiency and blood stasis is the TCM's key of pathogenesis of "cardialgia".So boosting Qi and activating blood therapy is basic therapeutic principle of "chest pain".A formula designated Qidan Tongmai Tablet(QDTMT) was developed by tutor.And QDTMT consists of compounds of extractives of traditional Chinese herbs from dried roots of Astragalus membranaceus,Saliva miltiorrhiza(Labiate),Angelica sinensisi (Umbelliferae),the dried flower of Carthamus tinctorius(Compositae) and dried twig of Cinnamomum cassia(Lauraceae) and functions as invigorating Qi and promoting blood circulation.The result of research indicated that QDTMT had curative effects in the angina pectoris and palpitation,shortness of breath and languidness.It also prolonged Clotting time and decreased blood fat.As far as the inflammatory media and immune molecular were concerned,the serum levels of IgG and C3,the ratio of CD4~+/CD8~+ significantly lowered in the QDTMT group. The serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitive C-reactive protein(hs-CRP),endothelin-1(ET-1) and homocysteine(Hcy) also notablely decreased in the QDTMT group after treatment.And no obvious and serious side effects were found.In conclusion,QDTMT has specific effect in treating UA patients with the syndrome of blood stasis due to Qi deficiency, indicating that QDTMT could operates through improving anticoagulation and regulating blood fat and immune function,and inhibiting inflammatory reaction. Therefore,it is worthy to be studied deeply.On the other hand,Meta-analysis was carried out to evaluated the the curative effect and safety on angina pectoris due to Qi-deficiency and blood stasis by Qi-supplementing and Blood-Quickening,the results showed that the Qi-supplementing and Blood-Quickening could improve curative effect and decrease adverse reactions.
引文
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[1]刘红旭,刘平.中医药防治心血管疾病的临床特色优势.北京中医.2007,26(7):396-399
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[3]张秋雁,邓冰湘.冠心病心绞痛临床中医证型分布的回顾性分析.中医研究.2005,18(11):23-24
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