从《伤寒杂病论》“心水”与“虚劳”探讨老年慢性心力衰竭合并肌少症的辨治  

Discussion on the Syndrome Differentiation and Treatment of Senile Chronic Heart Failure Complicated with Sarcopenia from Heart Water and Consumptive Disease in the Treatise on Exogenous Febrile and Miscellaneous Diseases

作　　者：李新梅 林晓忠 LI Xinmei;LIN Xiaozhong(General Dept.Ⅱof Guangdong Provincial Hospital of Chinese Medicine,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广州中医药大学第二附属医院,广东省中医院综合二科,广东广州510120

出　　处：《广州中医药大学学报》2025年第1期237-242,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家重点研发计划项目(编号:2020YFC2005605);广东省重点领域研发计划项目(编号:2020B1111100004);广东省中医药局资助项目(编号:2022KT1279,2022KT1140);广东省中医药局课题(编号:20232057);广东省基础与应用研究省企联合基金项目(编号:2022A1515220016)。

摘　　要：老年慢性心力衰竭(简称慢性心衰)合并肌少症可使患者生活质量进一步下降,导致跌倒、失能和死亡率增加。目前西医防治肌少症措施主要包括营养支持、运动疗法等,但仍处于探索阶段。中医治病具有整体观及辨证论治的独特优势,中医疗法治疗老年慢性心衰合并肌少症值得进一步挖掘研究。该文通过对《伤寒杂病论》相关条文进行梳理,认为老年心衰合并肌少症的临床表现与《伤寒杂病论》的“心水”“虚劳”证候表现较一致,《伤寒杂病论》对于老年心衰合并肌少症的病因病机、诊断治疗具有一定的指导意义。通过对“心水”“虚劳”的心脾肾虚、五劳七伤、水气凌心、瘀血内停病机的分析,提出心脾肾阳虚、水瘀互结为老年心衰合并肌少症的核心病机。经方如苓桂术甘汤、真武汤、四逆汤、肾气丸、建中汤、五苓散等可辨证化裁或合用以治疗老年心衰合并肌少症。老年心衰合并肌少症患者的先后天之本皆虚,辨证论治基础上加强健脾益肾,可能获良效。Senile chronic heart failure(CHF)complicated with sarcopenia can further degrade patientsquality of life,and increase the occurrence of falls,disability and mortality.Currently,western medicine preventive and treatment for sarcopenia mainly depend on nutritional support and exercise therapy,but their efficacy remained uncertain.Traditional Chinese medicine(TCM)therapy has the advantages of holism and syndrome differentiation and treatment,and its application in senile CHF complicated with sarcopenia is worthy of further exploration.This paper sorted out the relevant statements in the Treatise on Exogenous Febrile and Miscellaneous Diseases,and concluded that the clinical manifestations of senile CHF complicated with sarcopenia are similar to those of heart water and consumptive disease in the Treatise on Exogenous Febrile and Miscellaneous Diseases.The statements in Treatise on Exogenous Febrile and Miscellaneous Diseases will guide the identification of etiology and pathogenesis as well as the diagnosis and treatment for senile CHF complicated with sarcopenia.The analysis of the pathogenesis indicated that heart water and consumptive disease were induced by deficiency of heart and spleen and kidney,five kinds of overstrain and seven types of impairment,water pathogen insulting heart,and internal stagnation of blood stasis.Therefore,it is proposed that the core pathogenesis of senile CHF complicated with sarcopenia is due to the deficiency of heart,spleen and kidney yang,and water blended with blood stasis.The classical prescriptions such as Ling Gui Zhu Gan Tang,Zhenwu Tang,Sini Tang,Shenqi Pills,Jianzhong Tang and Wuling Powder can be used by modification or combination based on syndrome differentiation in treating senile CHF complicated with sarcopenia.For both of the congenital and acquired origin(spleen and kidney)of elderly patients with CHF complicated with sarcopenia are deficient,the utilization of herbs for invigorating spleen and boosting kidney on the basis of syndrome differentiation may achieve good

关 键 词：《伤寒杂病论》 心水 虚劳 老年慢性心力衰竭 肌少症 苓桂术甘汤 真武汤 四逆汤 经方 

分 类 号：R256.2[医药卫生—中医内科学]