胸痹(冠心病)证候演变规律的临床研究

对482例胸痹(冠心病)病人进行临床跟踪,调查证候的分布、组合形式及证候的动态变化,结果发现:胸痹证候分布广泛,临床以心气虚、心阳虚、痰浊、血瘀为多,分别占初诊的42.74%、39.42%、85.27%、74.69%,证候常相兼出现,可单见1证,也有6证并见,初诊平均3证以上并见,虚、痰、瘀、郁、滞在胸痹的发病过程中经常发生,并且互化.证候也是动态变化的,治疗后4周、8周,2证组合迅速增多,由13.28%增加到20.90%;3证、4证保持恒定;5证组合明显减少,由14.73%降到4.96%,说明临床病情复杂,证候错杂多见.随着治疗,病情得以缓解,证候组合逐渐简单化,本质矛盾逐渐显露.2证组合和3证组合常反映其证候复杂性的实质,多为阳虚血瘀证,阳虚痰阻证,阳虚痰阻血瘀证.证明心阳虚证、痰浊证、血瘀证等证候一经出现,往往贯穿疾病的始终,是胸痹主要证候,而寒凝证、气滞证、热郁证等为继发证候,构成了胸痹辨证施治的具体内容.

The study on the distribution and evolution of the syndromes of thoracic obstruction(CHD)

Through the clinical research on 482 cases of the patients of thoracic obstruction(CHD),study the distribution,combination and evolution of the syndromes.The result is :The distribution is general.There are more syndromes of deficiency of heart-energy,deficiency of heart-yang,sputum,and blood stasis.It contains 42.74%,39.42%,85.27% and 74.69% separately in the preliminary diagnosis.The syndromes often appear simultaneously,there is one syndromes and six syndromes.There are more three syndromes averagely in the preliminary diagnosis.The combination of 2 syndromes increase quickly from 13.28% to 20.90% through the treatment of 4 weeks and 8weeks.The combination of 3 and 4 syndromes keep constant.The combination of 5 syndromes decrease from 14.73% to 4.96% .It means that the pathogenetic condition is complicated.There are more combinations of the syndromes.they become simple after the treatment and the essential contradict appear.The combination of 2 syndrome and 3 syndrome often reflect the essence of pathogenesis.They are yang asthenia-blood stasis,yang asthenia-sputum and yang asthenia-sputum-blood stasis.It certifies that the syndromes of deficiency of heart-yang,sputum and blood stasis often exist constantly after appearance,and they are the essence of the pathogenesis.The syndromes of cold coagulation,Qi-stagnation and heat accumulation are secondum pathogenesis and the rest are the aggravated and evoked pathogenesis.They constitute the concrete differentiation of syndromes of thoracic obsturction.