培训课件-心律失常社区讲座.ppt

阴虚火旺证 主症：心悸不宁、心烦少寐 兼症：头晕目眩、手足心热、耳鸣腰酸 苔脉：舌质红少苔、脉细数 治法：滋阴清火，养心安神 主方：天王补心丹 用药：生地、玄参、麦冬、天冬、当归、丹参、人参、茯神、远志、枣仁、柏子仁、五味子、桔梗 心阳不振证 主症：心悸不安、胸闷气短 兼症：面色苍白，形寒肢冷 苔脉：舌质淡白、脉虚弱或沉细而数 治法：温补心阳，安神定悸 主方：桂枝甘草龙骨牡蛎汤 用药：桂枝、甘草、龙骨、牡蛎 水饮凌心证 主症：心悸眩晕、胸脘痞满 兼症：形寒肢冷、小便短少，或下肢浮肿，渴不欲饮、恶心吐涎 苔脉：苔白滑、脉象弦滑 治法：振奋心阳，化气行水 主方：苓桂术甘汤 用药：茯苓、桂枝、甘草、白术 心血瘀阻证 主症：心悸不安、胸闷不舒，心痛时作 兼症：唇甲青紫 苔脉：舌质紫暗或有瘀斑、脉涩或结代 治法：活血化瘀，理气通络 主方：桃仁红花煎 用药：桃仁、红花、丹参、赤芍、川芎、延胡索、青皮、生地、当归 运用络病理论探讨心律失常中医病机 以生脉散（人参、麦冬、五味子）为基础方 金元·张元素《医学启源》 “一补， 一清， 一敛，养气之道备也，名曰生脉。” 《医方考》 人参 补益心气 麦冬 养阴清心除烦 五味子 敛气生津 益气生津，敛阴复脉之功 现代研究：改善心肌细胞代谢、降低心肌细胞自律性、调节植物神经功能。 吸取金元名医张元素经验 吸取金元名医张元素经验 参松养心组方分析-吸取金元名医张元素的经验 益气养阴 荣养气络 Like automaticity, triggered activity involves the leakage of positive ions into a cell, resulting in new action potentials. However, unlike automaticity, Triggered Activity is not consistently spontaneous. It may be either a single or repetitive firing of a myocardial cell, or group of cells, caused by re-excitation. Ion leakages that occur late in Phase 3 or early in Phase 4 after cell recovery has begun are called afterdepolarizations, or late potentials. Afterdepolarizations can be the ‘trigger’ that cause ventricular tachyarrhythmias. For reentry to occur, the following events must take place: A premature impulse occurs in the reentrant circuit at a time when Pathway A with the short refractory period is ready to accept the impulse, and Pathway B with the long refractory period is still repolarizing from the previous depolarization. The impulse slowly travels through Pathway A and reaches Pathway B just as Pathway B completes it repolarization and is no longer refractory, which means it is ready to accept a stimulus. The impulse travels through Pathway B in a retrograde direction and reenters Pathway A. The impulse is conducted antegrade through Pathway A, and the circuit continues. Reentry does not display a “warm up” or “cool down” period. Atrial fibrillation can also result from the rapid discharge of impulses from one or