从三焦论治心力衰竭

Treating Cardiac Failure from the Respective of Sanjiao

慢性心力衰竭以心气亏虚为本,血瘀、痰浊、水饮互结为标,虚实夹杂,标实为主。心力衰竭与水液代谢密切相关,心力衰竭病变循三焦水道,由上到下分别影响心、肺、脾、肾、肝的功能,故心力衰竭治疗应采用三焦论治,根据三焦症状的不同,分别采用泻肺利水,健脾疏肝法治疗,并根据临床症状的不同各有侧重。治上焦喘咳,常选用葶苈大枣泻肺汤以泻肺逐饮,治中焦心悸乏力,则选用苓桂术甘汤健脾化湿,治下焦水肿尿少,则选用木防己汤或真武汤温阳利水,并在具体方剂中加入川芎、陈皮、赤芍等疏肝行气之药以疏导瘀滞之气,促进水与血的运行。

The root of chronic cardiac failure is heart qi deficiency,and its tips include blood stasis,phlegm turbidity,accumulated fluid retention,intermingled deficiency and excess,and tip excess is the major tip. Chronic cardiac failure has a close relationship with fluid metabolism,its pathological changes go along waterway of sanjiao,affecting the functions of the heart,lung and spleen,kidney and liver function from top to bottom,so treating it should begin from the respective of sanjiao. According to the different symptoms of sanjiao,purging the heat accumulated in the lung and removing water retention by purgation,invigorating spleen and soothing liver can be used respectively. Different emphasis is focused on according to different clinical symptoms. For asthma and cough in upper jiao,Lepidium and Jujube Lung-Draining Decoction is often used to purge the heat accumulated in the lung and remove water retention by purgation. For palpitation and fatigue in middle jiao,Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction is often used to invigorate spleen and remove damp. For edema and oliguria,Costus Root and Stephania Root Decoction,or True Warrior Decoction can be used to warm yang and promote dieresis; Besides,drugs for soothing the liver and promoting qi circulation such as Chuanxiong（ Rhizoma Chuanxiong）,Chenpi（ Pericarpium Citri Reticulatae）,Chishao（ Radix Paeoniae Rubra） can be added in specific prescription to dredge stagnated qi,promote water and blood circulation.