2021年胸痹心痛中医诊疗规范.pdf
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1、胸痹心痛【定义】胸痹心痛指因胸阳不足,阴寒、痰浊留踞胸廓,或心气不足,鼓动乏力,使气血痹阻,心失血养所致。以胸闷及发作性心胸疼痛为主要表现的内脏痹病类疾病。【诊断要点】1 膻中及左胸膺部突发憋闷而痛,疼痛性质有闷痛,灼痛,绞痛,刺痛,隐痛等不同。疼痛可涉及肩背,前臂,咽喉,胃脘部等,甚至可沿手少阴,手厥阴经循行部位至中指或小指,呈发作性或持续不解常伴心悸气短,自汗,甚至喘息不得卧。2 突然发作,时作时止,反复发作,轻者几秒至数十分钟,经休息或服用芳香温通药物可迅速缓解。3 多见于中年以上,常因情绪波动,寒冷刺激,饱餐之后,劳累过度而诱发。4 静息 ECG,Holter,运动试验,冠脉造影可明确
2、诊断,血脂,血糖,心肌酶谱测定检查可有助于诊断。【类病鉴别】1 真心痛:为胸痹心痛重症,由于心脉闭塞。猝然大痛,四肢不温,面白唇紫,大汗淋漓,脉微欲绝,经芳香温通药物不能缓解,疼痛可持续几小时至几天不能缓解。2 胃脘痛:二者疼痛部位可相近,但胃脘痛多伴嗳气,精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 1 页,共 11 页呃逆,呕吐,泛酸,腹胀等胃系症状。【辨证论治】1寒凝心脉症候:猝然胸痛如绞,形寒,四肢不温,冷汗自出,心悸气短,或心痛彻背,背痛彻心,感寒痛甚。舌象:淡红,苔白。脉象:沉紧或促。治法:祛寒活血、宣痹通阳方药:当归四逆汤加减:桂枝、红花、当归、芍药、通草、甘
3、草、大枣、丹参、檀香。针灸:主穴选厥阴腧、膻中,备穴选百会、涌泉、足三里,平补平泻。中药穴位敷贴:心绞痛膏(肉桂、檀香、川芎)敷心腧、足三里、膻中。耳针:心、小肠、皮质下、交感、肝。2 气滞心胸主症:心胸满闷,隐痛陈发,痛无定处,时欲太息,遇情志不遂时容易诱发或加重,或兼有脘胀闷,得嗳气或矢气则舒。舌象:苔薄或薄腻。脉象:细弦。治法:疏调气机,和血舒脉。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 2 页,共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A
4、3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文
5、档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ
6、6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L
7、10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10
8、HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T
9、2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1
10、ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4方药:柴胡疏肝散加减:柴胡、枳壳、香附、川芎、陈皮、白芍、郁金、元胡、丹参、甘草。针灸:主穴选厥阴腧、膻中、内关,备穴选百会、合谷、足三里,平补平泻。中药穴位敷贴:心绞痛膏敷心腧、足三里、膻中。耳针:心、小肠、皮质下、交感、肝。3 痰浊闭阻证候:胸闷重而心痛轻微,肥胖体沉,痰多气短,遇阴雨天而易发作或加重,伴倦怠乏力,纳呆便
11、溏,口粘,恶心,咯吐痰涎。舌象:舌质淡,或紫暗,苔白腻或白滑。脉象:滑。治法:通阳泄浊、豁痰开结方药:瓜萎薤白半夏汤加减:栝蒌、薤白、半夏。针灸:主穴选厥阴腧、膻中,备穴选百会、涌泉、足三里,平补平泻。中药穴位敷贴:心绞痛膏敷心腧、足三里、膻中。耳针:心、小肠、皮质下、交感、脾。4 心血瘀阻证候:心胸疼痛剧烈,如剌如绞,痛有定处,甚则心痛彻背,背痛彻心,或痛引肩背,伴有胸闷,日久不愈,可因暴怒而加重。精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 3 页,共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L
12、10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10
13、HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T
14、2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1
15、ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A
16、3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文
17、档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ
18、6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4舌象:舌质暗红,或紫暗,有瘀斑,舌下瘀筋,苔薄脉象:弦涩或结、代、促治法:活血化瘀、通脉止痛方药:血府逐瘀汤加减:当归、川芎、赤芍、桃仁、红花、生地、牛膝、桔梗、柴胡、枳壳、甘草。针灸:主穴选厥阴腧、膻中,备穴选百会、涌泉、足三里,平补平泻。中药穴位敷贴:心绞痛膏(肉桂、檀香、
19、川芎)敷心腧、足三里、膻中。耳针:心、小肠、皮质下、交感、神门、胸。5 气虚血瘀证候:胸闷,心痛如刺,心悸,气短神疲,活动后加重。舌象:暗淡或有斑点。脉象:弱或涩。治法:补益心气,活血化瘀方药:生脉散合丹参饮加减:人参、麦冬、五味子、丹参、檀香、砂仁。针灸:主穴选厥阴腧、膻中、内关,备穴选百会、合谷、足三里,平补平泻。中药穴位敷贴:心绞痛膏敷心腧、足三里、膻中。耳针:心、小肠、皮质下、交感、脾、肝。6 气阴两虚精品w o r d 学习资料 可编辑资料-精心整理-欢迎下载-第 4 页,共 11 页文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6
20、M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L1
21、0C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 H
22、P4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2
23、E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 Z
24、O7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3
25、W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档编码:CZ6M6J2L10C10 HP4Y5T2E2K1 ZO7Z9A3W4T4文档
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