孔金莉 刘红旭 佘靖

摘要 总结佘靖老师治疗心律失常的临床经验。复习文献、跟师侍诊、总结归纳佘靖老师的临证经验。佘靖老师治疗心律失常重视八纲及脏腑辨证，临证分“三虚三实”;治疗擅用经方，谨守病机;用药精到，灵活加减。佘靖老师治疗心律失常具有独到的学术思想、治疗经验及用药特点。

关键词 心律失常;心悸;经方;辨证论治;中医药治疗; @ 佘靖

Abstract To summarize the clinical experience of Teacher SHE Jing in treating arrhythmia.The author reviewed the literature， following up with teachers with visual diagnosis， and summarizing the clinical experience of Teacher SHE Jing.Teacher SHE Jing attached great importance to the 8 principles and syndrome differentiation of zang-fu viscera for the treatment of arrhythmia， and divided the syndromes into “3 deficiency and 3 excess”; SHE Jing was good at using classical prescriptions and was good at using classical prescriptions， and the pathogenesis， using the essence of medicine and modifying it flexibly according to the patients′ symptoms.Teacher SHE Jing had unique academic thoughts， treatment experience and medication characteristics in the treatment of arrhythmia.

Keywords Arrhythmia; Palpitation; Clinical prescriptions; Syndrome differentiation and Medication characteristics; Traditional Chinese medicine treatment; @ SHE Jing

佘靖，首都医科大学附属北京中医医院心内科主任医师、世界中医药学会联合会创会主席、北京中医药大学研究生导师。从事中医内科临床工作40年，对中医药治疗心血管疾病、脾胃病、糖尿病等疾病颇有心得，疗效显著。我有幸随佘老临诊，现将其治疗心律失常的经验整理如下。

1 佘老论心律失常

1.1 定义及临床表现 心律失常是指心脏冲动的起源部位、频率、节律、传导速度与激动次序等的异常。临床表现多样，轻者可无症状或有心悸、胸闷、胸痛、憋气、头晕、乏力等，严重者甚至出现晕厥、猝死[1]。心律失常见于各种器质性心脏病、植物神经功能紊乱、电解质紊乱、内分泌失调、药物作用，甚至基本健康者也可出现[2]。心律失常属中医“心悸”“惊悸”“怔忡”等范畴，本文就“心悸”进行论述。

1.2 心悸的历史沿革 心悸是指患者自觉心中悸动，惊惕不安，甚则不能自主的一种病证。《黄帝内经》中虽无心悸病名，但已有对心悸症状的记载：如“心掣”“心下鼓”“心如悬”“心澹澹大动”“心惕惕如人将捕之”等;《伤寒杂病论》中首提心悸之……