顾仁樾教授辨证治疗射血分数保留性心力衰竭的经验  

Professor Gu Renyue's Experience in Treatment of Heart Failure with Preserved E-jection 1 Fraction Based on Syndrome Differentiation

作　　者：侯文艳 丁利建 陈冉 顾仁樾[1] 章怡祎[1] HOU Wen-yan;DING Li-jian;CHEN Ran;GU Ren-yue;ZHANG Yi-yi(Intensive Care Unit of Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032)

机构地区：[1]上海中医药大学附属龙华医院重症监护室,上海200032

出　　处：《世界中西医结合杂志》2024年第7期1339-1342,共4页World Journal of Integrated Traditional and Western Medicine

基　　金：顾仁樾上海市名老中医学术经验研究工作室(SHGZS-202243)。

摘　　要：顾仁樾教授临证论治射血分数保留性心力衰竭,认为其病位在心脾,又关乎五脏,病机为本虚标实,本虚以心脾亏虚为先,心脾气虚为主,又以气虚为导,逐渐演变为气虚损阳,标实以水饮、血瘀为甚。并根据病情阶段变化形成病机演变,发病之初,以心脾气虚为主,水饮兼瘀;进展期逐渐演变为脾阳亏虚、心阳不振,水饮血瘀并重;后期气阴两虚,阴阳俱损。故治疗当标本兼顾,分阶段分别运用运脾、益心、利水、化瘀等治法。治疗过程中应当兼顾他脏,温阳恰当,并注重病证结合。Professor Gu Renyue′s approach to the diagnosis and treatment of heart failure with preserved ejection fraction(HFpEF)emphasizes that the disease is primarily located in the heart and spleen,but also involves five internal organs.The pathogenesis is characterized by asthenia in origin and sthenia in superficiality.The asthenia in origin begins with the depletion of the heart and spleen,primarily manifesting as qi deficiency in these organs,and then progressively leads to qi deficiency damaging yang.The sthenia in superficiality is mainly due to water retention and blood stasis.Professor Gu identifies the disease progression and pathogenesis changes according to the stage of the illness.In the initial stage,heart and spleen qi deficiency predominates,accompanied by water retention and blood stasis.During the progression stage,it evolves into spleen yang deficiency and weakened heart yang,with both water retention and blood stasis becoming significant.In the later stages,there is a deficiency of both qi and yin,leading to damage of both yin and yang.Therefore,treatment should consider both the origin and superficiality and vary according to the stage of the disease.Therapeutic principles include activating the spleen,benefiting the heart,promoting water metabolism,and resolving blood stasis.Throughout the treatment process,it is crucial to also consider the other organs,appropriately warm yang,and integrate modern pharmacological research findings with traditional syndrome differentiation and treatment.

关 键 词：中医药疗法 射血分数保留性心力衰竭 顾仁樾 名医经验 医案 

分 类 号：R541.6[医药卫生—心血管疾病]