茯苓四逆汤治疗慢性心力衰竭的研究进展  

A review on Fuling Sini decoction in treating chronic heart failure

作　　者：霍宏磊 邵静[2] 李肇基 曹灿 刘笑迎 HUO Honglei;SHAO Jing;LI Zhaoji;CAO Can;LIU Xiaoying

机构地区：[1]河南中医药大学,河南郑州450000 [2]河南中医药大学第一附属医院,河南郑州450000

出　　处：《中医临床研究》2023年第36期60-64,共5页Clinical Journal Of Chinese Medicine

基　　金：国家自然科学基金(81641147)。

摘　　要：慢性心力衰竭(Chronic Heart Failure,CHF)是心血管疾病的终末期表现和最主要死因,是21世纪心血管领域的两大挑战之一。茯苓四逆汤出自《伤寒论》第69条:“发汗,若下之,病仍不解,烦躁者,茯苓四逆汤主之。”该方由茯苓、人参、附子、干姜、甘草等5味中药组成,临床运用具有显著的温阳利水功效,是治疗CHF的常用方剂。临床研究发现茯苓四逆汤对CHF疗效确切,用药安全,远期疗效好,能显著改善患者心功能,提高生活质量,减少不良事件发生等。实验研究发现,茯苓四逆汤可通过调节神经-体液因子,增强心肌收缩力,改善心室舒张功能,亦可调节免疫炎症反应,抑制免疫炎症因子肿瘤坏死因子(Tumor Necrosis Factor,TNF)-α、白细胞介素(Interleukin,IL)-6等释放,保护受损心肌,改善心功能。研究发现,该方中各中药有效成分可通过抑制核因子κB(Nuclear Factor Kappa-B,NF-κB)通路减少炎症因子生成;影响血流动力学并抑制肾素-血管紧张素-醛固酮系统,减少神经-体液因子的释放,减轻心脏的前后负荷,延缓心室重构;下调促凋亡蛋白表达,上调抑制凋亡蛋白表达,减少心肌细胞凋亡等多靶点、多通路治疗心力衰竭。作者通过查阅近十年有关茯苓四逆汤及其加减在治疗CHF方面的相关文献,对茯苓四逆汤及其加减治疗CHF的临床研究和药理机制研究进行综述,以期为茯苓四逆汤的进一步研究提供更加广阔的思路。Chronic heart failure(CHF)is the end-stage manifestation of cardiovascular disease and the leading cause of death,and is one of the two major challenges in the cardiovascular field in the 21st century.Fuling Sini decoction(茯苓四逆汤)comes from the article 69 of Shanghan Lun(《伤寒论》)“:If sweating occurs,the disease is still insoluble and irritability occurs,Fuling Sini decoction could be prescribed.”This prescription is composed of 5 traditional Chinese medicines,including Fuling(Tuckahoe),Renshen(Ginseng),Fuzi(Aconitum),Ganjiang(Dried ginger)and Gancao(Licorice).It has significant effects of warming Yang(阳)and relieving retained fluid in clinical application,and is a commonly used prescription for treating CHF.Clinical studies have found that Fuling Sini decoction has definite curative effects on CHF,it is of safe medication,with good long-term curative effects,and can significantly improve the patients’heart function,promote the quality of life,and reduce adverse events.The experimental study shows that Fuling Sini decoction could enhance myocardial contractility and improve ventricular diastolic function by regulating neurohumoral factors to regulating immune inflammatory response,inhibit the release of immune inflammatory factors such as TNF-αand IL-6,protect damaged myocardium,and improve cardiac function.Studies have shown that the effective components of Chinese medicinal materials in this decoction can reduce the production of inflammatory factors by inhibiting NF-κB pathway,affect hemodynamics and inhibit RAAS system to reduce the release of neurohumoral factors,so as to reduce the front and back load of the heart to delay ventricular remodeling,and down-regulate the expression of pro-apoptotic protein and up-regulate the expression of anti-apoptotic protein so as to reduce myocardial cell apoptosis for the purpose of multi-target,multi-pathway treatment of heart failure.The author reviews the clinical research and pharmacological mechanism of Fuling Sini decoction and its addition

关 键 词：茯苓四逆汤 慢性心力衰竭 研究进展 

分 类 号：R256.2[医药卫生—中医内科学]