首页|浅谈《伤寒》利水法在慢性心力衰竭治疗中的应用

浅谈《伤寒》利水法在慢性心力衰竭治疗中的应用

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水肿是慢性心力衰竭(CHF)常见的临床症状,利尿在现代医学治疗CHF过程中占据重要地位,然而利尿剂的长期使用会导致机体电解质的紊乱,甚至产生利尿剂抵抗,而CHF患者也时常出现反复水肿的情况,针对这一情况,在传统医学对水肿认识的基础上,着重以对《伤寒》条文及古今部分医家临床经验及研究进行浅述,从《伤寒》原文的层面探讨经方治疗CHF患者水肿症状的可行性,从而更加有效治疗不同病机的CHF患者,达到消除水肿症状、减少水肿复发的目的.通过研究,得到以下结论:对于以"咳喘"为主症的(寒饮伏肺型)CHF患者可辨证使用小青龙汤加减;因"脾阳不足,土不制水"可运用苓桂术甘汤加减治疗;因"肾阳不足,阳虚水泛"可运用真武汤加减治疗;因"三焦气机水道不利"可选用五苓散加减治疗;因"水热互结下焦出现小便不利或利尿剂抵抗"可选用猪苓汤加减治疗.
A Brief Discussion on the Application of "Treatise on Febrile Diseases" in the Treatment of Chronic Heart Failure
Edema is a common clinical symptom of chronic heart failure(CHF).Diuresis plays an important role in the modern medical treatment of CHF.However,long-term use of diuretics can lead to electrolyte disorders in the body and even diuretic resistance,and CHF patients often Recurrent edema occurs.In view of this situation,based on the understanding of edema in traditional medicine,we focus on a brief description of the provisions of"Shanghai"and the clinical experience and research of some ancient and modern doctors,and explore the prescriptions from the original text of"Shanghan"The feasibility of treating edema symptoms in CHF patients,thereby more effectively treating CHF patients with different pathogenesis,and achieving the purpose of eliminating edema symptoms and reducing edema re-currence.Through research,the following conclusions have been drawn:For CHF patients with"cough and asthma"as the main symptom(cold drink and lung type),Xiaoqinglong decoction can be used for syndrome differentiation;because"the spleen yang is insufficient and the soil cannot control water",Linggui Shugan can be used Treatment with addi-tion and subtraction of decoction;due to"insufficient kidney yang,Yang deficiency and excessive water"can be treated with addition and subtraction of Zhenwu decoction;due to"unfavorable water passages of the triple burner Qi mecha-nism"can be treated with addition and subtraction of Wuling powder;due to"the mutual accumulation of water and heat in the lower burner,difficulty in urination or"Diuretic resistance"can be treated with modified Zhuling decoction.

Treatise on Febrile Diseasesdiuresis methodchronic heart failure(CHF)

栾金水、黄斌

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湖北中医药大学 湖北武汉 430065

湖北中医药大学附属十堰市中医医院 湖北十堰 442012

伤寒论 利水法 慢性心力衰竭

2024

中医药临床杂志
中华中医药学会

中医药临床杂志

影响因子:0.636
ISSN:1672-7134
年,卷(期):2024.36(1)
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