首页|心力衰竭的中医认识与经方治疗策略

心力衰竭的中医认识与经方治疗策略

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我国心血管病患病率呈现持续上升态势,其中心力衰竭(以下简称"心衰")患者约890万例,给公共卫生健康带来了沉重负担.虽然现代医学在心衰的病理机制与临床治疗上不断取得进展,然而患者仍然存在喘憋反复发作,需反复入院,利尿剂抵抗,长期使用利尿剂导致肌酐升高、预后不佳等临床关键问题.在中医学中,心衰属于"心水"范畴.由于现代疾病谱变化,古今体质差异,西医抗心衰药物干预,改变了心衰的病理进程,掩盖了部分患者的证候表现,导致其病因病机已发生较大变化.研究发现,在病因上,包括外邪侵袭、情志内伤、过度劳伤、药物损伤、饮食失节、水湿浸渍、禀赋不足等,这与现代医学中的感染加重心衰、双心疾病、心脏容量负荷增加等因素密切相关.在病机上,包括急性期的阳虚水泛、水饮化热,缓解期的肝郁气滞、心气不足、肾阳亏虚、肺脾气虚、痰饮内停、瘀血内阻等证型.在经方治疗策略上,阳虚水泛推荐真武汤,水饮化热推荐木防己汤,肝气郁滞推荐柴胡加龙骨牡蛎汤,心气不足推荐桂枝汤,肾阳亏虚推荐肾气丸、右归丸,肺脾气虚推荐玉屏风散、理中汤、补中益气汤、归脾汤,痰饮内停推荐防己黄芪汤、五苓散、苓桂术甘汤、葶苈大枣泻肺汤,瘀血内停推荐桂枝茯苓丸、当归芍药散.在临床治疗上,进一步提出"病机结合病理,药性结合药理"的治疗原则,中医药膏方补虚的"二级预防"观念,最终达到提高患者生活质量,减少入院次数与利尿剂抵抗,改善终点事件.
Heart failure:innovative understanding from traditional Chinese medicine (TCM) and treatment with classic TCM formulas
The prevalence of cardiovascular diseases in China has shown a rising trend.With the patient number of about 8.9 million,heart failure has brought a heavy burden to public health and wellness.Despite the modern medical research progress in the pathogenesis and clinical treatment of heart failure,the patients with heart failure still suffer from recurrent episodes of dyspnea (requiring repeated hospital admissions),diuretic resistance,elevated creatinine levels due to prolonged diuretic use,and poor prognosis,among other major clinical and scientific issues.In traditional Chinese medicine (TCM),heart failure belongs to the category of "heart water".The research team has found that because of the changes in the modern disease spectrum,the differences between ancient and modern physical constitutions,and the use of anti-heart failure drugs in modern medicine,the pathological process of heart failure has been altered,and the symptoms of some patients have become unobvious.As a result,the etiology and pathogenesis of heart failure have undergone major changes.The disease causes include external pathogen attack,emotional disorders,excessive labor injury,medication-induced damage,dietary disorders,water-dampness stagnation,and endowment insufficiency.These causes are closely related to the infection aggravation-induced heart failure,cardiac and psychological diseases,and heart volume overload in modern medicine.The pathogeneses of heart failure include edema due to Yang deficiency and water retention turning into heat in the acute stage and liver depression and Qi stagnation,heart Qi deficiency,kidney Yang deficiency,Qi deficiency in lung and spleen,phlegm and water retention,and internal obstruction due to blood stasis in the remission stage.The corresponding treatment strategies were recommended as follows:Zhenwu Decoction for edema due to Yang deficiency,Mufangji Decoction for water retention turning into heat,Chaihu Longgu Muli Decoction for liver depression and Qi stagnation,Guizhi Decoction for heart Qi insufficiency,Shenqi Pills and Yougui Pills for kidney Yang deficiency,Yupingfeng Powder,Lizhong Decoction,Buzhong Yiqi Decoction,and Guipi Decoction for Qi deficiency in lung and spleen,Fangji Huangqi Decoction,Wuling Powder,Linggui Zhugan Decoction,and Tingli Dazao Xiefei Decoction for internal obstruction due to phlegm and water retention,Guizhi Fuling Pills and Danggui Shaoyao Powder for internal obstruction due to blood stasis.The clinical treatment should follow the principle of considering both pathogenesis and pathology as well as both medicine nature and mechanism.The TCM concept of secondary prevention with TCM formulas for replenishing deficiency should be adopted.The treatment based on the principle and concept above will improve the patients′ quality of life,reduce the number of hospital admissions,ameliorate diuretic resistance,and improve the clinical outcomes.

heart failureclassic traditional Chinese medicine formulacorrespondence between formula and syndrometraditional Chinese medicine

蓝宇、罗富锟、于悦、王小雅、王朋倩、熊兴江

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中国中医科学院广安门医院,北京 100053

中国中医科学院中药研究所,北京 100700

心力衰竭 经方 方证对应 中医药

2024

中国中药杂志
中国药学会

中国中药杂志

CSTPCD北大核心
影响因子:1.718
ISSN:1001-5302
年,卷(期):2024.49(23)