心力衰竭的中医认识与经方治疗策略  

Heart failure:innovative understanding from traditional Chinese medicine(TCM)and treatment with classic TCM formulas

作　　者：蓝宇 罗富锟 于悦 王小雅 王朋倩[2] 熊兴江[1] LAN Yu;LUO Fu-kun;YU Yue;WANG Xiao-ya;WANG Peng-qian;XIONG Xing-jiang(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Institute of Chinese Materia Medica,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]中国中医科学院中药研究所,北京100700

出　　处：《中国中药杂志》2024年第23期6521-6532,共12页China Journal of Chinese Materia Medica

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目(HLCMHPP2023081);临床科研一体化人才专项(CZ30981);京津冀基础研究合作专项(J230037);中国中医药科技发展中心(国家中医药管理局人才交流中心)联合攻关项目(CXZH202301);中国中医科学院科技创新工程项目(CI2021A03804);中国中医科学院中药研究所启航人才项目(ZXKT21017);中国中医科学院中药研究所国家自然科学基金培育专项(ZXKT23015)。

摘　　要：我国心血管病患病率呈现持续上升态势,其中心力衰竭(以下简称“心衰”)患者约890万例,给公共卫生健康带来了沉重负担。虽然现代医学在心衰的病理机制与临床治疗上不断取得进展,然而患者仍然存在喘憋反复发作,需反复入院,利尿剂抵抗,长期使用利尿剂导致肌酐升高、预后不佳等临床关键问题。在中医学中,心衰属于“心水”范畴。由于现代疾病谱变化,古今体质差异,西医抗心衰药物干预,改变了心衰的病理进程,掩盖了部分患者的证候表现,导致其病因病机已发生较大变化。研究发现,在病因上,包括外邪侵袭、情志内伤、过度劳伤、药物损伤、饮食失节、水湿浸渍、禀赋不足等,这与现代医学中的感染加重心衰、双心疾病、心脏容量负荷增加等因素密切相关。在病机上,包括急性期的阳虚水泛、水饮化热,缓解期的肝郁气滞、心气不足、肾阳亏虚、肺脾气虚、痰饮内停、瘀血内阻等证型。在经方治疗策略上,阳虚水泛推荐真武汤,水饮化热推荐木防己汤,肝气郁滞推荐柴胡加龙骨牡蛎汤,心气不足推荐桂枝汤,肾阳亏虚推荐肾气丸、右归丸,肺脾气虚推荐玉屏风散、理中汤、补中益气汤、归脾汤,痰饮内停推荐防己黄芪汤、五苓散、苓桂术甘汤、葶苈大枣泻肺汤,瘀血内停推荐桂枝茯苓丸、当归芍药散。在临床治疗上,进一步提出“病机结合病理,药性结合药理”的治疗原则,中医药膏方补虚的“二级预防”观念,最终达到提高患者生活质量,减少入院次数与利尿剂抵抗,改善终点事件。The prevalence of cardiovascular diseases in China has shown a rising trend.With the patient number of about 8.9 million,heart failure has brought a heavy burden to public health and wellness.Despite the modern medical research progress in the pathogenesis and clinical treatment of heart failure,the patients with heart failure still suffer from recur rent episodes of dyspnea(requiring repeated hospital admissions),diuretic resistance,elevated creatinine levels due to prolonged diuretic use,and poor prognosis,among other major clinical and scientific issues.In traditional Chinese medicine(TCM),heart failure belongs to the category of"heart water".The research team has found that because of the changes in the modern disease spectrum,the differences between ancient and modern physical constitutions,and the use of anti-heart failure drugs in modern medicine,the pathological process of heart failure has been altered,and the symptoms of some patients have become unobvious.As a result,the etiology and pathogenesis of heart failure have undergone major changes.The disease causes include external pathogen attack,emotional disorders,excessive labor injury,medication-induced damage,dietary disorders,water-dampness stagnation, and endowment insufficiency. These causes are closely related to the infection aggravation -induced heart failure, cardiac and psychological diseases, and heart volume overload in modern medicine. The pathogenesesof heart failure include edema due to Yang deficiency and water retention turning into heat in the acute stage and liverdepression and Qi stagnation, heart Qi deficiency, kidney Yang deficiency, Qi deficiency in lung and spleen, phlegm andwater retention, and internal obstruction due to blood stasis in the remission stage. The corresponding treatment strategieswere recommended as follows: Zhenwu Decoction for edema due to Yang deficiency, Mufangji Decoction for water retentionturning into heat, Chaihu Longgu Muli Decoction for liver depression and Qi stagnation, Guizhi Decoction for heart Qiin

关 键 词：心力衰竭 经方 方证对应 中医药 

分 类 号：R259[医药卫生—中西医结合]