胸痹病因病机历史沿革

胸痹病位在心，与肺、脾、肾三脏关系密切，最早见于《灵枢·本脏》篇，又称“心痛”、“心痹”，病因病机乃寒邪侵袭、热邪犯心、饮食不节、七情内伤、痰瘀阻滞、他脏病变及心；张仲景在《金匮要略》中首创胸痹辩证论治，提出胸痹纲脉：“夫脉当取太过不及，阳微阴弦，即胸痹而痛，所以然者，责其极虚也。今阳虚知在上焦，所以胸痹、心痛者，以其阴弦故也”；皇甫谧《针灸甲乙经》首次明确指出瘀血可致胸膈满痛（即胸痹），“胸中瘀血，胸胁槽满，膈痛”；隋·巢元方《诸病源候论》认为“寒气客于五脏六腑，因虚而发，上冲胸间，则胸痹”，更强调寒邪为患；宋金元时期出现易水学派，有“不通则痛”和“不荣则痛”，张元素《医学启源》认为“心虚则恐悸多惊，忧思不乐，胸腹中苦痛”，李东垣指出“夫饮食入胃，阳气上行，津液与气，贯于肺，充实皮毛，散于百脉”；明清时代对胸痹心痛病的认识趋于完善，《冯氏锦囊秘录·方脉·q．2脾病合参》云：“因于怵惕思虑，伤神涸血，于是清阳不升，浊阴不降，以致食饮风冷热悸虫疰之九种，乘虚侵凌也”，高奉先《医宗释疑·胸痛》日：“胸者，锁骨之下，两乳中间膻中是也。膻中为气海，心肺所居之地，清阳升降之路也，稍有阻碍，胸痛生焉”。

The Historical Development of the Etiology and Pathogenesis of Chest Discomfort

Chest discomfort occurs in the heart and has a close relation with the visceral organs of lung, spleen and kidney. The word ＂chest discomfort＂ first appeared in the book Ling Shu- Ben Zang. The etiology and pathogenesis of chest discomfort are the invasion of heart caused by pathogenic cold and pathogenic heat, improper diet, the internal injury caused by excess of seven emotions, the stasis of sputum and blood or pathological changes of other internal organs. Zhang zhongjing, the writer of Synopsis of Golden Chamber, for the first time presented the syndrome differentiation and treatment and proposed the synopsis of chest discomfort pulse feeling, ＂two main types of pulse should be differentiated, namely, the excess type of pulse and the deficient type of pulse, which can differentiate the pathogenic factors and healthy Qi, and the deficiency and excess. If cun pulse is weak and chi pulse is tight, the chest discomfort will occur subsequently. The causes are the deficiency of Yang Qi in the chest and the excess of lower energizer and Yin pathogenic factors.＂ Chao Yuanfang, who lived in Sui dynasty, pointed out in the book General Treatise on the Cause and Symptoms of Diseases that ＂heart pain is caused by pathogenic wind and pathogenic cold which injuried the heart.＂ He also emphasized that pathogenic cold is the vital factor for the disease. Yishui school, appeared in the period of Song dynasty, Jin dynasty, and Yuan dynasty, believed that ＂obstruction causes pains＂ and ＂nourishment deficiency causes pains＂ . In the book Medicine Origin, Zhang Yuansu said that ＂heart Qi deficiency causes scare, fear, depression and thoracoabdominal pain.＂ Li Dongyuan pointed out that, ＂after food gets into the stomach, Yang Qi will rise and at the same time Jin Ye and Qi will spread throughout the whole body with the help of the lung to protect and nourish the body.＂ The understanding about the chest discomfort and heartache tended to be more perfect in Ming and Qing dynasty. The book ＂Von＇ s Kits And Secret Records＂ mentioned that ＂fearing and thinking a lot will cause mind and blood lesion, then the Yang Qi won＇ t go up and the pest won＇ t go down. The factors as diet, six external excess, pests and infectious diseases will result in the invasion of heart.＂