基于三焦气化学说分消走泄法治疗心力衰竭利尿剂抵抗探析  

An analysis of treating diuretic resistance in heart failure with the Fenxiao Zouxie method based on the Sanjiao gasification theory

作　　者：张晓华[1] 刘淑荣[1] ZHANG Xiaohua;LIU Shurong

机构地区：[1]吉林省中医药科学院第一临床医院,吉林长春130021

出　　处：《中医临床研究》2021年第36期57-60,共4页Clinical Journal Of Chinese Medicine

基　　金：吉林省自然科学基金(20160101196JC)。

摘　　要：中医理论认为人体的体液代谢与三焦气化密切相关,尿液的生成、输布、排泄涉及上、中、下三焦,肺、脾、肾多脏。若三焦气化失常,则水道不畅,人体敷布、运行、调节水液功能难以实现。分消走泄是叶桂(字天士)提出的治疗湿热类温病——“邪留三焦气分证”的治法,通过宣上、畅中、渗下,展气机、畅三焦、祛邪出。后世医家对此理论进行了更加深入、细致的论述及应用,指出分消走泄法是在三焦气化理论指导下治疗水湿为患疾病的根本大法,无论是外感湿热病,还是内伤杂病湿热证均可以分消走泄法则拟方用药。心力衰竭患者长期、大量应用利尿剂后耐药出现“利尿剂抵抗”,导致利尿效果不佳,水肿难以消退,属于水湿为患类疾病。“心为君主之官”,心气气化与三焦气化密不可分。心气是通过心包络与三焦相表里,三焦布气于心包络来实现“君主”之权的。故通过调畅三焦气化功能,分消走泄(芳香化湿,开宣上焦;苦温燥湿调畅中焦;淡渗利湿通达下焦),并顾护正气,舒展气机,通畅阳气,可改善利尿剂抵抗的状态,提高临床疗效。The theory of TCM holds that the body fluid metabolism is closely related to Sanjiao(三焦)gasification.The generation,distribution and excretion of urine involve the upper,middle and lower Jiao(焦),namely,Sanjiao,and multiple organs of the lung,spleen,and kidney.If Sanjiao gasification is abnormal,the waterway is not smooth,and it is difficult for human body to apply,run and adjust the functions of water and liquid.The method of Fenxiao Zouxie(分消走泻)is proposed by Ye Tianshi in the treatment of dampness-heat seasonal febrile diseases based on“syndrome differentiation of pathogenic retention of Sanjiao Qi(气)”.Through regulating Sanjiao,the evil is dispelled.Medical experts of later generations have carried on a more in-depth and detailed discussion and application of this theory,pointing out that the method of Fenxiao Zouxie,namely,elimination and drainage,is the fundamental method to treat diseases caused by water and moisture under the guidance of the theory of Sanjiao gasification,Whether it is exogenous damp heat disease,or internal injury of miscellaneous disease with damp heat syndrome,Fenxiao Zouxie can be used.Diuretic resistance appears in patients with heart failure after long-term and massive application of diuretics,resulting in poor diuretic effect and difficult edema regression,which belongs to water-wet diseases.“Heart is the official monarch”,heart gasification and Sanjiao gasification are inseparable.The heart is managed through the relationship between the cardiac envelope and the Sanjiao.Therefore,by adjusting the Sanjiao gasification function,Fenxiao Zouxie(to open the upper Jiao,to adjust the middle Jiao and to reach the lower Jiao)protects healthy Qi,regulates Qi’s movement and thoroughfares Yang(阳)Qi.It can improve the state of diuretic resistance and promote the clinical efficacy.

关 键 词：三焦气化 分消走泄 心力衰竭 利尿剂抵抗 

分 类 号：R69[医药卫生—泌尿科学]