首页|基于"四位一体"及"三焦气化"理论探析茯苓桂枝白术甘草汤治疗慢性心力衰竭的机制

基于"四位一体"及"三焦气化"理论探析茯苓桂枝白术甘草汤治疗慢性心力衰竭的机制

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"四位一体"是基于"性、位、势、证"四维角度的研究思路,有助于多维度、立体化地辨识分析经方.慢性心力衰竭(CHF)病机为心气心阳亏虚、三焦气化失司日久,后期由虚向实进展可见虚实夹杂.茯苓桂枝白术甘草汤(简称"苓桂术甘汤")通过"性、位、势、证"四位发挥作用:方性为辛甘而温,淡甘兼苦,辛甘温以化气利水、扶阳涤饮,淡苦以渗水燥湿、通利水道;方位为心、脾、三焦,可鼓舞心阳、健脾蠲饮、通调三焦水道;方势为上下并行、内外兼修、通上利下、宣外补内,则三焦水道借势通达;方证为心阳亏虚、水饮泛滥痰饮证,治疗水气上冲性心脏病应用为多.三焦失司与CHF反复发作互为因果,苓桂术甘汤可暖三焦气化之火、通三焦气化之道,针对CHF的全身性水液潴留发挥作用;其药理作用有抗炎、抗血小板聚集、调节心肌细胞膜离子通道、抗缺血再灌注损伤、调控血管舒缩等.从"四位一体"的角度解构苓桂术甘汤,并结合"三焦气化"理论探讨苓桂术甘汤治疗CHF机制,对重新焕发经方生命力及精准有效应用经方具有重要意义.
Mechanism of Fuling Guizhi Baizhu Gancao Decoction(Linggui Zhugan Decoction)against chronic heart failure based on the thought of"Four in One"with the theory of"Qi transformation in triple energizer"
The"four-in-one"approach is based on the four-dimensional perspective of"property,position,tendency and syndrome",which helps to identify and analyze classical prescriptions in a multi-dimensional and three-dimensional way.The early pathogenesis of chronic heart failure(CHF)is deficiency of heart Qi and heart Yang and disorder in Qi transformation in triple energizer,while in the later stage of the disease,it progresses from deficiency to excess,with simultaneous occurrence of deficiency and excess syndromes.Fuling Guizhi Baizhu Gancao Decoction(Linggui Zhugan Decoction)plays its role in treating chronic heart failure by the four elements of"property,position,tendency and syndrome".Property—Linggui Zhugan Decoction is pungent,sweet,slight sweet and bitter in flavor,but warm in property.The sweet is able to tonify deficiency;the pungent is responsible for dispersing Yang,promoting Qi and draining water retention;the warm nourishes the spleen,raises Yang Qi and resolves phlegm;the bitter could excrete diuresis and dry dampness to guarantee the smooth operation of three energizer.Position-Linggui Zhugan Decoction acts on the heart,spleen and triple energizer.It can stimulate heart Yang,strengthen the spleen,resolve phlegm,and regulate the waterways to promote the Qi transformation in triple energizer.Tendency-The tendency of Linggui Zhugan Decoction is upward and downward in parallel,both internal and external.Warming up and promoting diuresis,raising Yang up and tonifying deficiency,it is conducive to the Yang Qi transformation in triple energizer.Syndrome-Linggui Zhugan Decoction is indicated for the syndrome of heart Yang deficiency and water-fluid retention,which begins with the upper abdomen swelling,Qi rushes against the chest.It is widely used in the treatment of water-vapor impulse heart disease.The disorder of Qi transformation in triple energizer is the main mechanism of recurrent CHF.Linggui Zhugan Decoction can not only warm the fire of Qi transformation in triple energizer,but also smooth the pathway of Qi transformation in triple energizer,which is compatible with the treatment of systemic fluid retention in chronic heart failure.Its pharmacological mechanisms include anti-inflammation,anti-platelet aggregation,regulation of cardiomyocyte cell membrane ion channels,protection against ischemia-reperfusion injury and modulation of vasodilation,etc.Deconstructing Linggui Zhugan Decoction with"four-in-one"approach and discussing its mechanism for treating CHF in combination with the theory of"Qi transformation in triple energizer",have great significance to rejuvenate the vitality of classical prescriptions and to apply them accurately and effectively.

Heart failureFour in oneQi transformation in triple energizerFuling Guizhi Baizhu Gancao DecoctionFamous classical formulas

王鑫、王超、巩祥贺、董莹、段刚峰、雷杰

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湖北中医药大学第一临床学院,武汉 430060

武汉市中西医结合医院心血管内科,武汉 430030

心力衰竭 四位一体 三焦气化 茯苓桂枝白术甘草汤 经典名方

湖北省科技计划项目

2017CFB739

2024

国际中医中药杂志
中华医学会,中国中医科学院中医药信息研究所

国际中医中药杂志

CSTPCD
影响因子:0.411
ISSN:1673-4246
年,卷(期):2024.46(1)
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