基于“以证统病”探讨慢性心力衰竭与糖尿病共病证治  

Syndrome Treatment of Chronic Heart Failure and Diabetes Mellitus omorbidity Based on"Syndrome-based Treatment of Disease"

作　　者：孟骊冲 廉坤 李欣春[1] 卢聪 胡志希[1] MENG Lichong;LIAN Kun;LI Xinchun;LU Cong;HU Zhixi(Hunan University of Chinese Medicine,Changsha 410208,China;Capital Medical University,Beijing 100069,China)

机构地区：[1]湖南中医药大学,长沙410208 [2]首都医科大学,北京100069

出　　处：《中国实验方剂学杂志》2024年第24期233-242,共10页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82274412,82305092);湖南省自然科学基金项目(2023JJ30453);国家中医药管理局高水平中医药重点学科建设项目(zyyzdxk-2023147)。

摘　　要：慢性心力衰竭(CHF)与糖尿病(DM)共病,症状纷繁、病机错综复杂,传统“以病统证”的诊疗模式在临床实践中往往力不从心。“以证统病”理念,根植于中医辨证论治的核心思维,着重强调以证候为纲,将诸类疾病归结于其相应证候范畴内进行探究,秉持从证出发、先证后病的原则,展现了中医整体观与辨证论治的优势。CHF病机在于气阴两虚,血行瘀滞,累及肺、脾、肾等脏腑,影响津液之输布与代谢。津液功能失司,停滞体内,化生痰浊等病理产物,加重阴虚火旺之证。随着阴虚燥热不断加剧及津液耗损持续进行,患者DM症状渐趋严重,从而导致或加重共病。遵循“以证统病”的诊断思路,针对CHF和DM共病的中医诊疗,应紧扣“虚气留滞”的核心病机。笔者将CHF和DM共病分为4个阶段:A期(共病风险期)、B期(共病前期)、C期(共病中期)及D期(共病晚期),并针对不同阶段提出了相应的中医证型。在治疗方面,遵循“补虚通滞”的治疗原则,益气扶正、养阴生津,活血行气、利水解毒的具体治法,笔者综述了近年来关于CHF合并DM的中药复方研究进展,以期实现两种疾病的精准治疗,为中医药在防治CHF和DM共病应用提供了科学依据。Chronic heart failure(CHF)and diabetes mellitus(DM)comorbidity presents a myriad of symptoms and a complex pathogenesis,making the traditional diagnostic and treatment model of"using disease to treat syndrome"often inadequate in clinical practice.The concept of"syndrome-based treatment of disease"is rooted in the core thinking of traditional Chinese medicine(TCM)syndrome differentiation and treatment,emphasizing the importance of syndrome as the guiding principle.This approach categorizes various diseases according to their corresponding syndrome categories for exploration,adhering to the principle of starting from the syndrome and addressing the disease thereafter,which highlights the advantages of TCM holistic view and syndrome differentiation and treatment.The pathogenesis of CHF is characterized by deficiency of both Qi and Yin,along with blood stasis,affecting organs such as the lung,spleen,and kidney,which in turn impacts the distribution and metabolism of body fluids.Dysfunction in body fluid regulation leads to stagnation,resulting in pathological products like phlegm and turbidity,which exacerbates syndromes of Yin deficiency and excessive heat.As the conditions of Yin deficiency and dryness-heat intensify,and as body fluid depletion continues,the patient's DM symptoms worsen,contributing to or aggravating the comorbidity.Following the diagnostic approach of"syndrome-based treatment of disease",TCM diagnosis and treatment of CHF and DM comorbidity should focus on the core pathogenesis of"deficient Qi retention".This study categorized CHF and DM comorbidity into four stages:A(comorbid risk period),B(precomorbid period),C(intermediate stage of comorbidity),and D(advanced comorbidity),proposing corresponding TCM syndrome types for each stage.In terms of treatment,adhering to the principle of"tonifying deficiency and relieving stagnation",the specific methods included invigorating Qi and strengthening the body,nourishing Yin and generating body fluids,activating blood circulation and Qi,and promoting diuresi

关 键 词：以证统病 慢性心力衰竭 糖尿病 共病 

分 类 号：R259[医药卫生—中西医结合]