人参芍药散加减治疗心肌炎临证体会

Clinical Experience with Ginseng and Peony Powder Modified in the Treatment of Myocarditis

摘要: 心肌炎是由感染或非感染因素引起的心肌炎症性疾病，临床以心律失常、心功能不全为主要表现，目前西医缺乏特效疗法。本研究旨在探讨人参芍药散加减治疗心肌炎的临床疗效及作用机制，基于中医“心脾同治”理论，结合文献研究与临床案例分析，系统阐述人参芍药散的组方原理及其“益气养阴、调和气血”的核心功效。通过现代药理学研究揭示其活性成分的心肌保护作用，并结合典型医案分析该方针对气阴两虚、热毒未清等不同证型的加减策略及用药规律。人参芍药散通过补脾益气以充心血、养阴柔肝以畅血行，契合心肌炎“正气亏虚、气阴两伤”的核心病机。药理学研究证实，其组分可抗炎、抗氧化、改善心肌代谢，并抑制纤维化。临床观察显示，加减应用后患者心悸、胸闷等症状显著改善。人参芍药散通过多靶点、多途径发挥心肌保护作用，临床疗效显著，体现了中医“辨证论治”与“整体调节”的独特优势。其以脾胃为枢纽调和气血的治法，为心肌炎提供了“标本兼顾”的治疗新思路。

Abstract: Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious factors, with clinical manifestations primarily including arrhythmias and cardiac dysfunction. Currently, Western medicine lacks specific therapeutic approaches. This study aims to explore the clinical efficacy and mechanism of Ginseng and Peony Powder (GPP) modified in treating myocarditis. Based on the traditional Chinese medicine (TCM) theory of “simultaneous treatment of heart and spleen” and combined with literature research and clinical case analysis, we systematically elucidate the composition principle and core efficacy of GPP, which is characterized by “tonifying qi and nourishing yin, harmonizing qi and blood”. Modern pharmacological studies reveal the myocardial protective effects of its active components. Through typical medical case analysis, we discuss the modification strategies and medication rules of GPP for different syndromes such as qi-yin deficiency and unresolved heat-toxin. GPP tonifies the spleen to replenish qi for nourishing heart blood and nourishes yin to soften the liver for smooth blood circulation, aligning with the core pathogenesis of myocarditis—“deficiency of vital qi and injury to both qi and yin”. Pharmacological research confirms that its components exert anti-inflammatory, antioxidant, myocardial metabolic improvement, and anti-fibrotic effects. Clinical observations show significant improvement in symptoms such as palpitations and chest tightness after modified application. GPP achieves myocardial protection through multi-target and multi-pathway mechanisms, demonstrating remarkable clinical efficacy and reflecting the unique advantages of TCM in “syndrome differentiation and treatment” and “holistic regulation”. Its therapeutic approach, which takes the spleen and stomach as the pivot to harmonize qi and blood, provides a new “symptomatic and root-causing” treatment strategy for myocarditis.