从水湿论慢性心力衰竭不同分期的发病

Pathogenesis of Chronic Heart Failure at Different Stages from Water Dampness Theory

根据慢性心力衰竭发展的不同阶段及不同证候特点,探析其各分期病因病机与水湿的关系。认为慢性心力衰竭在早期为气虚血瘀证,表现为气虚导致脾虚,运化水饮失司;气虚导致血瘀,血不利则为水;水停加重血瘀,血瘀又加重气虚。在中期为气阴两虚证,表现为气阴两虚,瘀水内停;瘀水互结,更伤气阴。在晚期为阳虚水泛证,表现为肾失温煦,水饮停积;津停日久,加重血瘀。根据水湿在慢性心力衰竭病程中的关键地位,提出临床可通过"治水"论治该病。

According to the different stages and characteristics of different syndromes of development of chronic heart failure,the relationship between etiology,pathogenesis and water-dampness was analyzed. It is considered that chronic heart failure is Qi deficiency and blood stasis syndrome in the early stage,manifested as deficiency of Qi leading to spleen deficiency and loss of transportation and transformation of water; Qi deficiency leads to blood stasis. If the blood does not circulate freely,it will transform into water. The stop of water movement aggravates blood stasis,and blood stasis aggravates Qi deficiency. In the mid-term stage,the deficiency of Qi and Yin was manifested as the deficiency of both Qi and Yin,and the internal retention of blood stasis and water. Binding of blood stasis and water will more damage Qi Yin. In the late stage,Yang deficiency and water diffusion syndrome was manifested as the kidney lacks of warming,retention and stagnation of water. Fluid stopped for a long time,increasing blood stasis. It explained the key role of water-dampness in the course of chronic heart failure,and proposed that clinical treatment of the disease can be achieved through ＂treating water＂.