袁海波教授治疗冠心病心律失常经验探讨

目的：探讨全国第三批名老中医袁海波教授治疗冠心病心律失常的临床经验。方法：跟随袁海波教授师承学习记录其案例,并领会袁老对袁氏复脉静汤的分析。结果：袁老所治案例均收良效。结论：袁海波教授临床经验丰厚,辨证运用袁氏复脉静汤治冠心病心律失常有良效。     

淡漠型甲状腺功能亢进症中医症因考辨

中医无淡漠型甲亢之病名,但根据其临床所表现的明显消瘦、心悸、乏力、神经质或神情淡漠、嗜睡、厌食、呕吐、腹泻、头晕、昏厥等主要症状和肢体震颤等体征,多归属于我国古医籍所载的＂瘿劳＂、＂瘿病＂、＂虚劳＂、＂羸瘦＂、＂心悸＂、＂怔忡＂、＂郁证＂、＂多寐＂、＂呕吐＂、＂泄泻＂、＂痉证＂、＂痿证＂、＂眩晕＂、＂厥证＂等范畴。虽然淡漠型甲亢的临床表现涉及中医众多病证,但从其疾病的整体发病情况来看,辨证总不离于脾肾两虚、阳气亏耗之证。     

李妍怡教授从心肾相交论治心悸经验总结＊

李妍怡教授认为心肾不交是心悸的主要病机，治疗应以交通心肾为目标，调补阴阳为方法，辨证论治为原则。认为临床多有阴虚火旺、上热下寒、阴阳俱损三种表现，并重视痰饮、气结、血瘀、风邪等病理产物的治疗。现将其经验综述如下，以飨同道。     

A 48-Year-Old Man Presenting to a Primary Care Clinic With Dyspnea on Exertion

The causes and differential diagnoses of undifferentiated dyspnea in middle-aged adults can be daunting to any practitioner. Conducting a thorough history and physical examination elucidates likely differentials while eliminating those less likely. A thorough knowledge of evidence-based practice guiding diagnosis and medical management allows the primary care provider to deliver safe, efficient care and make appropriate referrals. This case highlights the outcomes associated with appropriate identification, initial medical management, and referral to proper specialists in a typical patient presentation.     

基于因子分析的心悸证候要素研究

目的：通过因子分析的方法,探索心悸的中医证候要素,为该病的辨证提供参考。方法：通过收集522例古今医案中患者四诊信息,保留出现率≥15％的四诊信息,应用因子分析降维处理提取心悸主要证候要素。结果：通过因子分析得到11个公因子（证候要素）,可反映阴虚、阳虚、气虚、血虚、痰、火等病理性质,病位在心、肾、脾、肺、肝等脏腑,可归为心神不宁、阴虚火旺、心阳虚、心血不足、痰火扰心等证型。结论：运用因子分析在一定程度上揭示了心悸证候特点,在中医证候研究中有很好的应用前景。     

丹参注射液+参附注射液联合西药治疗心肾阳虚型慢性心力衰竭随机平行对照研究

[目的]观察中西医结合治疗心肾阳虚型慢性心力衰竭疗效[方法]使用随机平行对照方法,将72例住院患者按随机数字表法随机分为两组。对照组36例利尿、强心、扩血管等,速尿20mg,1~2次/周;西地兰0.2mg静推,1次/d;硝酸甘油20mg+5%葡萄糖250mL静滴,1次/d;美托洛尔12.5~25mg,1次/d;依那普利10mg,1次/d。治疗组36例丹参注射液20Ml+参附注射液40~60mL+葡萄糖100mL静滴,1次/d;西药治疗同对照组。两组均连续治疗14d为1疗程。观测两组治疗前后心功能分级变化、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效12例,有效15例,无效9例,恶化0例,总有效率75.00%。对照组显效10例,有效11例,无效14例,恶化0例,总有效率58.30%。治疗组疗效优于对照组(P0.05)。[结论]中西医结合治疗心肾阳虚型慢性心力衰竭效果显著,值得推广。     

辨证分型治疗冠心病心肌缺血85例临床观察

[目的]观察辨证分型治疗冠心病心肌缺血疗效。[方法]使用前瞻性设计方法,对85例门诊患者1饮困心脾-肝胆火盛,温阳祛饮,清肝泻火,凉血活血,茯苓桂枝丸合龙胆泻肝汤(茯苓30g,桂枝20g,丹皮,桃仁,白芍各15g,龙胆草,黄芩,栀子,泽泻,木通,柴胡,甘草各10g),水煎服,1剂/d,水煎300mL,早晚口服;2饮困心脾-肝郁气滞,温阳祛饮,疏肝理气,方用茯苓桂枝丸合小柴胡汤加减(茯苓30g,桂枝20g,丹皮,桃仁,白芍,柴胡,半夏,党参,生姜,甘草,大枣各10g),水煎服,1剂/d,水煎300mL,早晚口服。3心脾两虚,温阳健脾祛饮,补益气血,苓桂术甘汤合八珍汤(茯苓30g,桂枝20g,白术,党参,甘草,当归,川芎,白芍,熟地各10g),水煎服,1剂/d,水煎300mL,早晚口服。4水饮凌心,振奋心阳,化气行水,真武汤合五苓散加减(茯苓30g,桂枝20g,附子10~20g,白术,白芍各10g,)水煎服,1剂/d,水煎300mL,早晚口服。连续治疗5周为1疗程。观测临床症状、心电图、不良反应。治疗1疗程,判定疗效。[结果]治愈47例,显效23例,有效12例,无效3例,总有效率96.50%。[结论]辨证分型治疗冠心病心肌缺血,疗效满意,无副作用,值得推广。     

从瘀热搏结辨治心悸

从瘀热搏结病机及临证遣方用药总结首届岐黄学者方祝元教授辨治心悸的学术经验.方教授认为瘀热搏结是心悸的病机关键之一,治疗上应以化瘀清热为要,同时兼顾气阴、脏腑并治.以此学术思想指导心悸的临证治疗,取得了较好的疗效.     

Differential Manifestation of Cardiovascular Complaints as a Function of Utilization of Ergogenic Supplements

Introduction : The rate of use of dietary supplements among young adults is significant. While the military makes significant restrictions on the use of certain pharmacologic drugs and actively tests for illegal drugs in a deployed environment, there is a near‐unlimited supply of body‐enhancing supplements available at military exchanges to deployed personnel. By emphasizing physical performance and providing these for purchase, the military leadership, perhaps unknowingly, endorses the use of these products. Cardiovascular symptoms represent one of the leading nontraumatic causes of aeromedical evacuation from a combat zone. Whether the use of supplements is associated with a differential presentation to cardiovascular complaint is unknown. Methods : Retrospective review using the US Department of Defense Military Health System data, we identified patients evaluated for cardiovascular complaints of syncope or palpitations while deployed to Iraq and Afghanistan. Results : There were 905 US military personnel who presented with complaint of syncope or palpitations (mean age 31 ± 10 years, 77% male). There were 83 (9.2%) who self‐reported taking an ergogenic supplement. The incidence of reported use of supplements among males was 10.8%, which was significantly higher than its use among females at 3.8% (P = 0.001). In those >30 years, those on supplements had a higher resting pulse (90 ± 28 vs 79 ± 24 beats/min, P = 0.032), and the incidence of resting tachycardia was three‐fold higher (35.0% vs 11.4%, P = 0.008). Supplement use was seen in 12.3% of those who presented with palpitations, which was significantly higher than those who presented without palpitations (7.8%, P = 0.043). In those taking supplements, symptoms were more likely during exertion (26.5% vs 15.0%, P < 0.001), and immediately postexertional (13.2% vs 4.6%, P < 0.001). An electrocardiogram was suggestive of diagnosis in 103 (16.3%), while head computed tomography, treadmill, and echocardiogram had no diagnostic utility in this patient population. Discussion : In a healthy population serving within a combat zone, there exists a differential expression of disease in those taking supplements. Further study of a prospective nature to determine the impact of supplement use in this environment may allow for a more refined policy toward use and medical evaluation. (PACE 2010; 33:286–289)