厥心痛

所謂「心肌梗塞」是指供應心臟的血管，因某種原因阻塞，導致血管供應心臟肌肉因血流量不足導致壞死，而心臟又是供應全身血流的重要源頭，若有損傷會導致心律不整、心臟衰竭，甚至生命危險。

根據資料顯示，心肌梗塞患者在發作六小時內就醫的死亡率為百分之六，八小時內的死亡率為百分之七，十二小時內就醫的死亡率為百分之八，發作超過十二小時以後才就醫，死亡率達百分之十六，所以急性心肌梗塞發作時，務必立即就醫。

為何會發生心肌梗塞，可能是現在的民眾交際應酬眾多，吃的好及攝取過多的營養並有吸菸習慣，容易造成高膽固醇、高血脂、高血壓、糖尿病，這些病症卻是引起血管硬化，導致心臟冠狀動脈狹窄的危險因子

當血管部分閉塞的時候，人體中需要這些血管來輸送營養的那些部位所得到的供應便會減少。細胞就會 “發出求救的呼聲”——這反應到我們的肢體上，就是身體感到疼痛了。例如心絞痛，那是由於被輸送到心肌的氧氣不能滿足心肌正常運作的需要；又例如周邊動脈 阻塞疾病——間歇性跛行(intermittent claudication) ，這是細胞缺氧而導致疼痛的結果。

當血管完全閉塞的時候，靠氧氣供應而生存的細胞將會死亡(Necrosis)，身體的那一部分功能便會暫停。如果同樣的事情發生在心臟，那就會出現心臟病。如果同樣的事情發生在腦部，那就會有中風。

 

Case Study:

陳老師周二(13/11/2012)凌晨在家中心肌梗塞突發心肌梗塞住院，目前仍在加護病房；才五十一歲就罹患心血管疾病，推測是平時忙於工作，疏於運動的關係。陳老師每天工作超過十小時，早上七點就開外科會議，一直到晚上六、七點才開始巡房；身兼行政職還要指導醫院評鑑.

依據中醫學的理論: 

厥心痛指因胸陽虛損，或氣陰不足，或瘀痰阻痺，心脈閉塞所致。以心胸劇痛，甚至持續不解，伴有汗出肢冷、面白唇青、脈微欲絕為主要表現的痛病類疾病。
本病相當於西醫學所說的急性心肌梗塞。

人體六陰六陽十二經絡電位盛衰、強弱、高低電位從出生後之每個時辰、每日、每月、廿四節氣、四季及每年、每十年、每六十年隨天干甲、乙、丙、丁、 戊、己、庚、辛、壬、癸、地支子、丑、寅、卯、辰、巳、午、未、申、酉、戌、亥陰陽經絡循環卦現象，此為中醫生理學之主題經絡的循環變化稱為易經，經絡周而復始的循環變化稱為周易.

按中醫理論，雖然經氣在身體循環不息地流動，但在不同的時間，經氣的流動均有盛衰

·         五十一歲至六十歲 --- 手厥陰心包、足肝經氣所行

·         二十四節氣：11月7/8日 立冬交十月，小雪地封嚴； 十月（亥）立冬小雪張; 立冬之日水始冰，又五日地始凍，又五日雉入大水為蜃。

·         凌晨: 「子午流注」十二經脈 氣血流注最盛的時間

1.      11pm- 1am(子時) 足少陽 膽經  復卦，一陽復起，陽剛始生

2.      1am- 3am(丑時) 足厥陰 肝經

五臟六腑的搭配症狀 身體五行

心(火)與腎(水)

1.       水火陰陽相互為用。

2.       心陽不振─水寒不化而反上凌心，心悸、水腫等〝水氣凌心〞（胃經常跳動，多飲則甚，頭眩，嘔吐，小便不利）證。

3.       腎陰不足─心陽獨亢，心悸、怔忡（持續性發作心悸不寧）、心煩、失眠。

4.       水火交戰，心臟無力，先天性心臟病，無元氣，貧血，低血壓

厥陰病

消渴，氣上撞心，心中疼熱（上熱證），飢而不欲食，食則吐蚘（下寒證）。

弦數或弦緊

淡黃

有寒熱錯雜或厥熱勝復證

心屬火。王於夏。逆夏長之氣。則傷心矣, 立冬節氣寒疫傷陽，水旺於子時來克火，是時行之病，陽不歸原。是根氣已損。至冬時寒水當令。無陽熱溫配。故冬時為病。甚危險也, 下焦所出之陰。與上焦所逆之陽。陰陽相搏。而為寒熱之陰瘧也。

[辨證論治]
    1．寒滯心脈證：心痛劇烈，胸悶短氣，心悸，惡寒肢冷，面色蒼白，唇紫，舌淡紫，苔白，脈弦緊或沉伏，或結代。溫通血脈。
    2．心脈瘀阻證：心痛如刺，劇烈難忍，胸悶心悸，面唇青紫，舌暗或有瘀點，脈弦澀或結代。化瘀寬心。
    3．痰熱擾心證：胸悶如窒，心痛不休，口苦口乾，或體胖痰多而稠，舌紅，苔黃膩，脈弦滑。清熱化痰寬胸.
    4．心氣陰兩虛證：胸悶心痛，短氣，神疲乏力，心煩失眠，眩暈，汗出，便結，舌紅少苔，脈細數無力或促或代。補益心氣、滋補心陰。
    5．心陽虛脫證：胸痛劇烈，胸悶氣短，面色蒼灰，焦慮不安，四肢厥冷，冷汗不止，口唇青紫，舌質紫暗，苔白滑，脈微細或結代。回陽固脫。

臟腑辨證湯證訣*心、小腸
心氣不足宜養心，心陽不振加附溫，心血不足多怔忡，四物合入酸棗仁。
心陰不足補心丹，心火亢盛使瀉心，痰迷心竅神志呆，導痰菖蒲和郁金。
痰火擾心多狂妄，礞石滾痰可寧神，心血瘀阻胸窒悶，薤白失笑四物尋。
飲遏心陽多頭暈，苓桂術甘溫化飲，心脾兩虛歸脾湯，黃連阿膠交心腎。
心火小腸導赤散，小腸虛寒茱萸跟，氣痛天臺烏藥親。

臟腑辨證湯證訣*肝、膽
肝氣鬱結須疏肝，肝火上炎使龍膽，陽亢天麻鉤藤飲，肝風羚羊鉤藤攀。
肝血不足四物湯，寒凝疝痛暖肝煎，肝陰虧虛用一貫，虛陽上亢使鎮肝。
肝腎陰虛杞菊丸，肝火犯肺黛蛤散，肝膽不寧酸棗仁，肝脾不和逍遙丸。
心肝火旺煩不寐，瀉青瀉心自能眠，膽熱蒿芩清膽湯，虛熱溫膽驚自安。

養生原則

立冬過後的起居調養應以“養藏”為原則。

早睡早起，日出而作，保證充足的睡眠，有利於陽氣潛藏，陰精蓄積。此外，立冬節氣還應注重養腎。因為中醫認為腎含真陰和真陽，五臟之陰非腎陰不能滋，五臟之陽非腎陽不能養，“冬不藏經，春必病瘟”

逆春氣則少陽不生。肝氣內變。少陽主春生之氣。春氣逆則少陽不生。致肝氣鬱而內變矣。

逆夏氣則太陽不長。 心氣內洞。心為陽中之太陽。故太陽不長。而心氣內虛。

春夏之時。陽盛於外。而虛於內。秋冬 之時。陰盛於外。而虛於內。

春天養生養好了，對夏天心臟心陽的旺盛，就是有助於心陽的旺盛，如果春養生不當，夏季心陽之氣也不能生，又會產生其他病。

內關穴

【適應症】冠心病、心絞痛、胸痛、心悸、胸悶，兼頭暈、肢麻等。

【釋義】內關穴為手厥陰心包經之絡穴，心包經與心臟關係密切。《靈樞‧經脈》記載：手厥陰絡脈從內關處上行「繫於心包，絡心系」，其病「實則心痛，虛則煩心」。內關穴又通於陰維脈，而「陰維有病，苦心痛」，可知本穴與「心」有特殊的關係，故被歷代醫家所推崇是治療心病的要穴

針刺內關穴對心臟功能有調整作用，而且是一種良性雙向性作用。可使病理狀態下心功能趨於正常，使失調變平衡。

太冲穴

足厥陰肝經的俞穴，也是肝經的原穴, 可以治療咽喉的毛病以及心臟病，由於肝經主筋，所以它還能治兩足走路不方便。也可以治療眼目似雲朦，就是眼睛前面朦朦的，好像蓋了個東西似的。它又能夠治療腰痛，而且還“針下有神功”。

心臟病類 中醫常用主要湯方:

• 血府遂瘀湯
• 五味活血湯
• 六味回陽飲
• 六味地黃湯
• 歸脾飲
• 人參湯
• 龍胆瀉肝湯

TCM Practitioners for Chinese with Mental Health

 

   

To promote the fact that mental health is affected by many things, including migration to New Zealand, a partnership between the Mental Health Foundation and the health promoters must be established. A public health education programme advertising the many and varied facets of mental illness must be demonstrated to the population as a whole, so as to reduce discrimination and stigmatization and increase acknowledgement that migration may have adverse effects on mental health. It is envisaged that a television media campaign will be utilized to do this. Examples of televised advertisements could be a series showing an ordinary Chinese migrant speaking in English with Chinese subtitles explaining the mental health issues that he or she dealt with after arriving in New Zealand. This would show that many migrants experience mental illness and that it is not something that should be shameful. The way in which this person overcame their mental health problems could also be documented to demonstrate that it is possible to address these issues and potential ways of doing so. This sort of public health education campaign would allow the population as a whole to understand how migration can affect mental health and that it is something that the general population should be aware of.

To educate the Chinese community more specifically, a more targeted approach should be taken. Although many Chinese migrants are proficient in English, it cannot be assumed that it is universally understood. Therefore, the use of the Chinese language, especially via written media, is vitally important.  There are several factors which must be considered including, the de-stigmatization of mental illness by acknowledging that it is normal,  addressing that it is not something to be ashamed of, and also that there are services available.

Methods that health promoters could utilize to disseminate educational material is diverse. For example, posters and print advertisements could be displayed in Asian supermarkets, Chinese newspapers, churches, temples and cinemas.  Print advertisements could explain the importance of mental health, the fact that migration can affect mental health adversely and that there are services available to help. This would be a series of many different advertisements with contact details for mental health services catering to Chinese people in New Zealand included.  It is hoped that these advertisements would bring to the fore, the issue of mental health within the Chinese community, so that a dialogue can be started.  A major issue for mental health in the Chinese community is social stigma, and the tendency for those in need to remain silent.  For health promotion in church and temple, it is especially important to engage leaders as these individuals are respected by their community and can convey the message to a large segment of the community. They must be shown the importance of mental health so that they can be a source of support to congregation and community members. Individuals must feel safe to reach out to community leaders and be confident that that these community leaders are able to help them.

To ensure adequate community mental health services. The health promoters will identify the mental health organizations available, finding where these organizations are located and what kinds of services they provide. These services will then be evaluated to determine if they feel that they require further resources to meet the needs of the community. Fundamentally, the health promoters will be assessing the current service provision available to the community. This goal being to provide the details of relevant services to community members and encourage them to seek assistance. The approach taken here is a networking approach whereby the resources of several organizations are exchanged so each can benefit independently. In this case, the community service providers are exchanging information with health promoters to better understand the community and to assist in the broader goal of addressing mental health issues.  

  

Improving the mental health of the Chinese community in New Zealand through reducing stigma, and building the capacity of community organizations.  Mental health was identified as key determinant of health for the community as it affects whole families, as well as ability to work, and function within society.  Stigma is a major problem, both through racism and culture, thus the key goal of improving awareness of mental health.  Current mental health services were assessed to be inadequate and inappropriate for the Chinese community, thus it was determined that a collaborative policy network could identify ways to improve available services.  This is because the Chinese community has been underserved by mental health services, and engaging all stakeholders to work together on the problem is a sustainable method of addressing the communities' needs.

 The role of Traditional Chinese Medicine must be included in the stock take of community services, as many people rely on these practitioners to provide holistic services including mental health.  Having western mental health providers communicate with Chinese Medicine Practitioners could help share information and improve cultural competency of western providers, particularly for the Chinese community.