从“诸湿肿满,皆属于脾”探讨射血分数保留的心力衰竭的辨治

Treatment of Heart Failure with Preserved Ejection Fraction Based on Concept of"All Swelling and Edema Relating to Spleen"

射血分数保留的心力衰竭关键病机是“诸湿肿满,皆属于脾”。五脏脏气相通,传变有次,心受脾逆传而来的病气,即子病传母,而后又传心所克之肺,将病邪留止在生己之肝脏,终于己所不克之肾脏,即“脾病”导致“心病”。射血分数保留的心力衰竭发病早期,心脏舒张功能减退,导致脾肺气虚、痰浊内生,治应健脾益肺、祛痰消肿,可选参苓白术散肺脾同治;发病中期,随着肺循环瘀血的加重,导致肝脾不和、瘀血内停,治应理脾疏肝、散瘀行血,可选四逆散调脾疏肝;发病晚期,肺循环和体循环瘀血同时存在,导致脾肾阳虚、水饮泛滥,治应温脾暖肾、温阳化饮,可选真武汤温脾暖肾。

The key pathogenesis of Heart failure with preserved ejection fraction is"all Dampness and swelling relating to Spleen".The Qi of the Five Zang are interconnected,and there are times when the Heart is affected by the disease Qi transmitted from the Spleen,that is,the child′s disease is transmitted to the mother,and then to the Lungs that Heart conqueres,leaving the disease in the Liver that produces it,and finally to the Kidney that it cannot conquer.This is called"Spleen disease",which leads to"Heart disease".In the early stage of Heart failure with preserved ejection fraction,the diastolic function of the Heart decreases,leading to Spleen and Lung Qi deficiency and Phlegm Turbidity.The treatment should strengthen the Spleen and benefit the Lung,dispeling Phlegm and reducing swelling.It is optional to treat both the Lung and Spleen with Shenling Baizhu Powder.In the middle stage of the disease,as the congestion in the pulmonary circulation worsens,it leads to disharmony between the Liver and Spleen as well as the stagnation of blood stasis.The treatment should be based on regulating the Spleen and Liver,dispersing blood stasis and promoting blood circulation.The option is to use Sini Powder to regulate the Spleen and Liver.In the late stage of the disease,both pulmonary and systemic circulation with blood stasis leading to spleen and Kidney Yang deficiency and excessive Water.The treatment should be warming the Spleen and Kidney,namely,warming the Yang and transforming the Yin.Zhenwu Decoction can be used to achieve the purpose.