針灸診治心臟疾病探討

Review of Acupuncture Theory in Diagnosis and Treatment of Acupuncture of Heart Diseases

心為君主之官，主宰人體生理與精神一切活動，文獻指出無症狀心肌梗塞（silent myocardial ischemia）為心肌梗塞過世的主因。西醫使用精密儀器與檢測來監控心臟狀態，當疾病症狀出現時加以治療。《靈樞‧本臟》云：「視其外應，以知其內藏，則知所病矣。」本文將論述如何藉由望診及經絡系統進行診察，及早發現心臟疾病的先兆以進行事先預防和治療，達到中醫治未病的概念，以減少或減緩突發心肌梗塞之憾事。關於心臟疾病的中醫治療，病性多屬氣血阻滯，以《靈樞‧九針十二原》：「宛陳則除之」原則，使用拔罐、放血療法使氣血循環通暢；病位上心肌梗塞常見反射區域與心、小腸經循行部位、通經系統延伸相應部位相疊，包含頸肩胸背腋各部。治療時審因辨證論治，兼顧病性與病位，才能讓疾病問題根除，透過中醫四診診察心臟疾病先兆，衛教病人減少繁重工作、注意保暖、重視身體警訊，進而提早預防心臟疾病為首要工作。心臟是個精密的器官，一生跳動數十億次，適切的預防和治療讓其機能更長久是醫師與病人共同努力的方向。

Heart is a speechless organ. If we always ignore its impaired, it should be unfortunately to become a tragedy. At present, silent myocardial ischemia is the major factor of lethal myocardial ischemia. In western medicine (WM), various precise instruments are used for monitoring the heart conditions, and corresponding treatments will be delivered when the diseases occur. However, traditional Chinese medicine (TCM) emphasizes the prevention of disease. As Inner Canon of Huangdi (Huangdi Neijing) says, ＂The observation of external manifestations of viscera can reveal the physical conditions inside the body, so as to identify the diseases that may occur.＂ The prevention and treatment will be launched timely if the heart disease can be detected by the inspection of four-meridian-collateral system which includes twelve meridians, twelve meridian divergences, meridian sinew (Jingjin), as well as collaterals (table 1). In the view point of TCM, heart disease is due to qi stagnation and blood stasis, therefore, both cupping and blood-letting therapy can be applied for promoting the circulation of qi and blood. Besides, not only heart meridian and small-intestine meridian, but also other corresponding locations related to the extension of both meridians mentioned above are the common reflexion areas of myocardial infarction (table 2). As a result, the treatment should focus on the nature and location of the disease. The prevention of heart diseases should be considered as the foremost task, via TCM four diagnostic methods for detecting heart diseases, as well as hygiene education for reminding patients, such as reducing workload, keeping warm and paying attention to signs of the body. The heart is a delicate organ with billions of beats during the whole life, which is worthy of being attached great importance by every single person.