从“气血水”理论探讨慢性心衰合并焦虑抑郁辨治思路  

Discussion on the Treatment of Chronic Heart Failure Combined with Anxiety and Depression Based on the Theory of“Qi,Blood and Water”

作　　者：张依奇 张明雪[2] ZHANG Yiqi;ZHANG Mingxue(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《辽宁中医药大学学报》2025年第5期109-112,共4页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81273698);国家重点研发计划项目(2017YFC1700401);国家中医药管理局全国名老中医药专家传承工作室项目(国中医药人教函[2022]75号);辽宁省特聘教授滚动支持项目(辽教函[2018]35号)。

摘　　要：慢性心衰合并焦虑抑郁是临床常见双心疾病,其发病率呈逐年增高趋势,慢性心衰作为多种心血管疾病发展的终末阶段,病情易反复且治疗过程漫长,导致患者常伴有不同程度焦虑抑郁症状,而焦虑抑郁是其不良预后的独立危险因素。中医学认为本病病位主要在心,与肝、脾、肾相关,病性总属本虚标实,以心气亏虚为本,瘀血、水饮、痰浊为标,临床治疗此类疾病常以“形神共调”“双心同治”为基础。“气血水”理论起源于汉代,发展于金元时期,逐渐丰富于明代,最终完善于清代。该文以“气血水”理论为切入点,认为心气亏虚是慢性心衰合并焦虑抑郁发病的根本原因,且心气、心阳亏虚贯穿病程始终,疾病进展表现为由气病引发血病,“血不利则为水”,水病累及气血,致使血水同病的复杂病理过程,其不断围绕“气、血、水”三因素发展,三者互为因果,恶性循环。故临证之时当以补气安神、温阳益心、活血利水等为主要治法,兼以行气解郁、涤痰清热、通阳泄浊等。该文基于“气血水”理论,探讨慢性心衰合并焦虑抑郁的辨证论治思路,以期为该病临床诊疗提供参考。Chronic heart failure combined with anxiety and depression is a common clinical psycho-cardiological disease,and its incidence is increasing year by year.As the end stage of the development of various cardiovascular diseases,chronic heart failure is easy to relapse and the treatment process is long,resulting in patients often accompanied by different degrees of anxiety and depression symptoms,and anxiety and depression are independent risk factors for poor prognosis.Traditional Chinese medicine believes that the disease is mainly located in the heart,which is related to the liver,spleen and kidney.The nature of the disease is always deficiency in origin and excess in superficiality.The deficiency of heart Qi is the root,and blood stasis,water retention and phlegm turbidity are the superficiality.Clinical treatment of such diseases is often based on“body and spirit co-regulation”and“dual heart therapy”.The theory of“Qi,blood and water”was originated in the Han Dynasty,developed in the Jin and Yuan Dynasties,enriched in the Ming Dynasty,and improved in the Qing Dynasty.This article takes the theory of“Qi,blood and water”as the entry point,and believes that the deficiency of heart Qi is the root cause of chronic heart failure with anxiety and depression,and the deficiency of heart Qi and heart Yang runs through the course of the disease.The progress of the disease is manifested as blood disease caused by Qi disease,“blood is water”,and water disease involves Qi and blood,resulting in the complex pathological process of“blood and water disease”.It continues to develop around the three factors of“Qi,blood and water”.The three are reciprocal causation and vicious circle.Therefore,in clinical practice,the main treatment methods are tonifying Qi and tranquilizing mind,warming Yang and benefiting heart,activating blood and promoting diuresis,as well as promoting Qi and relieving depression,eliminating phlegm and clearing heat,dredging Yang and relieving turbidity.Based on the theory of“Qi,blo

关 键 词：气血水 慢性心衰 焦虑抑郁 双心疾病 

分 类 号：R256.2[医药卫生—中医内科学] R277.7[医药卫生—中医学]