基于“毒邪学说”探讨炎症在慢性心力衰竭发展中的作用  

Role of Inflammation in Development of Chronic Heart Failure:Based on"Toxic Pathogen Theory"

作　　者：黄淑敏 王梓仪 张倩[1] 廖晓倩 胡思远[1] 胡志希[1] HUANG Shumin;WANG Ziyi;ZHANG Qian;LIAO Xiaoqian;HU Siyuan;HU Zhixi(Hunan University of Chinese Medicine,Changsha 410208,China)

机构地区：[1]湖南中医药大学,长沙410208

出　　处：《中国实验方剂学杂志》2022年第18期198-204,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81774208);广东省重点领域研发项目(2020B1111100001);湖南省自然科学基金项目(2020JJ4062,2020JJ5408,2019JJ50447);湖南省研究生科研创新项目(CX20200784);湖南省学位与研究生教育改革研究项目(JG2016B068,2020JGZX012)。

摘　　要：慢性心力衰竭是以呼吸困难、活动耐量受限等为主要临床表现的一种严重的心脏疾病。炎症系统的激活可显著刺激心脏纤维化和重塑,促进心力衰竭的进展,在疾病发展过程中起着关键的作用,研究证实炎症参与了不同阶段心力衰竭的发展和过程。“毒邪学说”是中医学阐释疾病发生的重要基础理论,总结发现中医毒邪与炎症状态的关联性主要体现在5个方面:①观念相对应;②病位范围相对应;③病因相对应;④辨证相对应;⑤临床特点相对应。在慢性心力衰竭中痰浊、瘀血、水饮等毒邪为患,痹阻心脉是发病的主要病理因素,而坏死心肌细胞产生的炎症因子则是这些毒邪痹阻心脉的微观体现。基于此,该文拟用“毒邪学说”为切入点,从宏观及微观角度来阐明炎症在慢性心力衰竭发展中的作用,提出在心力衰竭初期,血瘀尚未化毒,不可过用清热解毒之品;在心力衰竭发展期有化毒趋势时,应辨证施治,酌情运用解毒中药,以求达到“祛毒不伤正”的目的;在心力衰竭后期,蕴毒已成,当及时应用解毒药,祛除毒邪的治疗方法,以期为用中医理论阐述炎症在慢性心力衰竭发展作用的现代研究奠定基础,为慢性心力衰竭的诊断及治疗提供新的理论指导。Chronic heart failure is a serious heart disease with dyspnea and limited activity tolerance as the main clinical manifestations.Activation of the inflammatory system can significantly stimulate cardiac fibrosis and remodeling and promote the progression of heart failure,playing a key role in the development of the disease.Studies have confirmed that inflammation is involved in the development of different types of heart failure."Toxic pathogen theory"is an important basic theory of traditional Chinese medicine(TCM)to explain the occurrence of diseases.We concluded the similarities between TCM toxic pathogens and inflammation in concept,disease location,etiology,syndrome differentiation,and clinical characteristics.Chronic heart failure is manifested by the toxic pathogens of turbid phlegm,stagnated blood,and accumulated fluid.Heart vessel obstruction is the main pathological factor,and the inflammatory factors produced by necrotic cardiomyocytes are the microscopic manifestations of the obstruction.Therefore,based on the"toxic pathogen theory",this study aimed to clarify the role of inflammation in the development of chronic heart failure from both macroscopic and microscopic perspectives.Moreover,this paper proposed that the stagnated blood has not been transformed into toxin in the early stage of the disease and thus the products of clearing heat and detoxification should not be used.At the development stage of the disease when the transformation tends to begin,treatment should be based on syndrome differentiation,and detoxifying Chinese medicine should be used in order to achieve the goal of"removing toxin without harming the healthy Qi".At the late stage of heart failure,toxins have been accumulated and detoxifying medicines and therapies should be applied to eliminate the toxic pathogens.This study is expected to lay a foundation for the modern research on the role of inflammation in the development of chronic heart failure with TCM theory and guide the diagnosis and treatment of this disease.

关 键 词：毒邪学说 炎症反应 慢性心力衰竭 

分 类 号：R242[医药卫生—中医临床基础] R856.5[医药卫生—中医学] R541