李凤　程晓昱

【摘要】 经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）后大血管已通，但心绞痛再发，中医根据PCI术后心绞痛的症状特点、临床表现，将其纳入中医“胸痹”范畴。本文主要介绍程晓昱教授治疗PCI术后心绞痛气虚血瘀、气滞血瘀证的临证经验，认为PCI术后心绞痛以本虚标实、虚实错杂为病理基础，辨证关键在于正气不足或气机郁滞，血运无力则瘀结于胸中，提出以补气理气、活血祛瘀法论治，采用补气药配合理气药，以使正气足且运行于胸中，气行血行，通则不痛。

【关键词】 冠心病 PCI术后心绞痛 程晓昱 临证经验

doi：10.14033/j.cnki.cfmr.2020.16.045 文献标识码 B 文章编号 1674-6805（2020）16-0-03

Clinical Experience of Professor Cheng Xiaoyu in Treating Angina Pectoris after Coronary Heart Disease Stent Implantation/LI Feng， CHENG Xiaoyu. //Chinese and Foreign Medical Research， 2020， 18（16）： -114

[Abstract] After percutaneous coronary intervention （PCI）， the large blood vessels have been opened， but angina recurs. According to the symptoms and clinical manifestations of angina pectoris after PCI， TCM has included it into the category of “thoracic paralysis” in TCM. This article mainly introduces the clinical experience of Professor Cheng Xiaoyu in treating angina pectoris with qi deficiency and blood stasis， and qi stagnation and blood stasis syndrome. The author believes that the pathological basis for angina pectoris after PCI is based on asthenia in origin and asthenia in superficiality， intermingled deficiency and excess. The key of syndrome differentiation is deficiency of vital qi or stagnation of qi engine， weak blood flow can be stasis in the chest， put forward the method of tonifying qi and activating blood circulation and removing blood stasis， use gas tonic medicine with gas control medicine， in order to make zhengqi sufficient and run in the chest， qi line blood line， generally no pain.

[Key words] Coronary heart disease Angina pectoris after PCI Cheng Xiaoyu Clinical experience

First-authors address： Anhui University of Chinese Medicine， Hefei 230038， China

冠狀动脉粥样硬化性心脏病，简称冠心病（coronary artery heart disease，CHD），是指各种原因导致血管内管腔狭窄甚至堵塞，从而出现心肌缺血、缺氧、坏死的表现，属于心脏病中最为常见的一种[1-4]。据相关报道，我国每年约有1 100万冠心病新发病例，危害严重。PCI是目前临床上最为常用的恢复冠心病患者血供的手段，可快速改善冠脉血流，挽救缺血心肌，然而20%～34% PCI术后患者，主要血管狭窄已解决，按常规西药治疗，仍反复发作心绞痛，影响患者的心理健康、生活质量及预后[5-6]。

在中医学中，本没有冠心病病名，根据临床表现，可以将其划为“胸痹”范畴，也成为了临床中采用中医药治疗的优势病种[7]。中医药在改善和缓解冠心病心绞痛患者的临床症状、提高患者生活质量和预防术后危险因素等方面有显著优势[8]。导师程晓昱教授出身中医世家，师从新安医学流派，从事中医临床研究30余年，被评为全国首届百名杰出女中医，善用中医理论、中西医结合诊疗手段辩治心血管系统疾病，为后人积累了宝贵的经验。……