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从水、虚、瘀论述射血分数保留的心力衰竭治疗三法

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  • 国家科技期刊平台
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基于中医理论研究与临床经验，结合心力衰竭前期(pre-heart failure)、心力衰竭症状期(symptomatic heart failure)、心力衰竭晚期(advanced heart failure)临床特征，探讨不同阶段射血分数保留的心力衰竭的主要病机及证候演变规律。本文总结提炼水、虚、瘀 3 个核心证候要素，认为水饮贯穿三期始终，随着病情推进，心阳由郁转虚，饮邪逐渐深入，血瘀日益突显，病位由上焦向中下焦动态发展。提出射血分数保留的心力衰竭治疗三法:即心力衰竭前期主要病机为肺气不利、水饮内停，治以利气宣肺、利水化饮法，代表方茯苓杏仁甘草汤;心力衰竭症状期主要病机为阳气虚损、水饮内动，治以升阳益气、温阳化饮法，代表方升陷汤合苓桂术甘汤;心力衰竭晚期主要病机为阳虚血瘀、水饮上凌，治以温阳活血、利水逐邪法，代表方真武葶苈汤。临证时可根据患者兼症灵活加减，并注重患者日常调护。本文从水、虚、瘀探析射血分数保留的心力衰竭分期证治规律，以期为分期论治射血分数保留的心力衰竭提供中医临床借鉴与参考。
Three methods for treating heart failure with preserved ejection fraction from water,deficiency and blood stasis
This study investigated the primary pathogenesis and syndrome evolution of different heart failure with preserved ejection fraction(HFpEF)stages based on the classical and clinical experience of traditional Chinese medicine(TCM),combined with the clinical characteristics of pre-heart failure,symptomatic heart failure,and advanced heart failure.This study summarizes and refines the three core syndrome factors:water,deficiency and blood stasis.Water-fluid retention was observed throughout these three stages,from the beginning to the end.With the advancement of the disease,the heart yang changes from stagnation to deficiency,water-fluid retention gradually increases,blood stasis becomes increasingly prominent,and the disease location develops dynamically from the upper to the middle and lower jiao.This study proposes three methods of treating HFpEF.The main pathogenesis of pre-heart failure is lung qi dysfunction-induced water retention,which can be treated by dispersing lung qi and transforming water retention using Fuling Xingren Gancao Decoction.The primary pathogenesis of symptomatic heart failure is yang and qi deficiency-induced water retention,which can be treated with tonifying yang,supplementing qi,and transforming water retention using Shengxian Decoction combined with Linggui Zhugan Decoction.The primary pathogenesis of advanced heart failure is yang deficiency with blood stasis and water retention affecting the heart,which can be treated with tonifying yang,circulating blood,and expelling water retention using Zhenwu Tingli Decoction.Chinese medicine can be flexibly added or subtracted according to the patients'concurrent patterns.However,the daily care of patients should be considered.This study explores the staging treatment of HFpEF from water,deficiency and blood stasis to provide a TCM clinical reference for treating HFpEF.

heart failure with preserved ejection fractionwater-fluidyang deficiencyqi deficiencyblood stasisstaging treatment

赵欣、何庆勇、王阶、贾裕智、尤雅萍、卢欣宇、吴海芳

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中国中医科学院广安门医院心血管科 北京 100053

北京中医药大学

中国中医科学院中国医史文献研究所

射血分数保留的心力衰竭 水饮 阳虚 气虚 血瘀 分期论治

中国中医科学院科技创新工程重大攻关项目北京中医药大学教育科学研究课题首都临床特色诊疗技术研究及转化应用项目

CI2021A00101XJY21100Z221100007422081

2024

10.3969/j.issn.1006-2157.2024.06.002

北京中医药大学学报
北京中医药大学

北京中医药大学学报

CSTPCD北大核心
影响因子：1.568
ISSN：1006-2157
年,卷(期)：2024.47(6)