On the Discourse of Clinical Usage for Cardiovascular Diseases from Classic Formulae Text

經方金匱原典對治心病證候

10.6516/TJTCM.202403_27(1).0005

Serena Jui-Ying Chu(瞿瑞瑩)

Chin Gui Yao Lue ； Chest Impediment, Heart Pain, and Shortness of Breath Chapter ； Clinical Usage ； Heart Disease ； Classical Formulae ； 《金匱》 ； 胸痺心痛短氣篇 ； 臨床 ； 心病證候 ； 經方

中醫藥研究論叢

27卷1期（2024 / 03 / 30）

53 - 62

英文;繁體中文

Background: the ancient classical formulae text Essential Prescriptions of the Golden Cabinet (Chin Gui Yao Lue, CGYL) is one of four Chinese medicine canons which are widely studied and used by clinical medicine practitioners. It was written by Chang Chung-Ching[張仲景] during the post Han dynasty. It was also called " miscellaneous diseases"[雜病], basically a catch-all phrase for many internal conditions. This text is characterized as containing both diagnostic guidelines and etiological reasoning in addition to instructions for the treatment with herbal formulae. Material and methods: in this classical text, there is a chapter specific to heart disease, which is "Chest Impediment, Heart Pain, and Shortness of Breath"[胸痹 心痛 短氣篇]. Heart disease is the leading cause of death in Taiwan and northern America. One person dies every 176 seconds in the Taiwan from cardiovascular disease. By meta-analysis and comparative study of texts, this study shows the clinical usage and evidence for treating cardiovascular disease. Results: the therapeutic goal of treating heart disease is to extend the patient's lifespan by delaying the progression of serious complications and reducing cardiovascular events. In addition, an increasing number of patients with heart disease have resorted to the use of Chinese medicine (CM) as an alternative or integrated treatment model from Taiwan National Health Insurance records. The efficacy and advantage of CM have been demonstrated in many clinical trials. Gwa Lou Xie Bai Ban Shia Tang can decrease the frequency of angina pectoris attacks and improve ECG; Zhi Shih Xie Bai Gui Zhi Tang integrated with west medicine can significantly improve angina attacks, EKG, blood lipid level, and the number of adverse events. Zhi Gan Tsao Tang combined with conventional western medicine in the treatment of chronic heart failure. Meta-analysis results show that integrated Zhi Gang Tsao Tang and conventional western medicine have better therapeutic effects and safety than only using conventional medicine. Discussion: this paper aims to present the clinical application of "Chest Impediment, Heart Pain, and Shortness of Breath" from CGYL in modern clinical practice for treating heart diseases and reducing risk factors for cardiovascular disease. Based on its patho-mechanisms of Chest Impediment, Yang Wei Yin Shian, the treatment principles for dispelling excess and strengthening deficiency along with main classic herbal prescriptions for heart diseases will be discussed; the associated evidence for tonify Heart Yang, strengthening Qi, invigorating blood stasis, dispel dampness herbal prescriptions will be presented.

背景：本文以後漢張仲景論著經方書《金匱要略》之篇章為例，探討中醫藥論治心病證候。材料與方法：傳世3種版本《金匱要略》以及PubMED網路資源與漢籍資料庫系統性文獻回顧。結果：以《金匱要略》胸痹心痛短氣內容分析，加上系統性文獻回顧得出瓜簍薤白半夏湯、枳實薤白桂枝湯湯、炙甘草湯等方藥，可確治心病證候。並有特定病生理模型可解析。討論：陽微陰弦的病理模型狀態，在胸痹心痛短氣證候的治療，透過增強心陽、益氣、通血、排濕，可確治心病證候。