大气下陷理论在慢性心衰治疗中的指导意义

Guidance of the qi sinking theory in the treatment of chronic heart failure

大气下陷是指因大气虚衰、升举无力而出现以下陷为主要特征的一种病理状态,大气下陷证乃多种心肺疾病常见证型之一,大气下陷与现代医学心肺功能下降关系密切。慢性心衰是多种心肺疾病迁延日久的结果,久患心病必将损肺,久患肺病亦损及心,心肺同病,损及宗气,大气无力托举心肺而呈现下降之势甚则下降太过,最终必然引起大气下陷,变生一系列证候。益气升陷是治疗慢性心衰之大法,以张锡纯所创升陷汤为其治疗之基础方。在慢性心衰发病过程中,大气下陷包括了虚、陷、散三个病理阶段,并且在不同阶段可出现瘀血、水饮、痰浊等病理产物,不同阶段正虚、邪实程度不同,并且兼挟不同的病理产物,故在使用益气升陷法时当结合疾病的临床分期和病情缓急,或重补虚、或重升陷、或重收敛,并且注意扶正与祛邪的关系,重视阴阳互化及血水相关。

Qi sinking is a kind of pathological state due to qi weakness and the failure of qi to raise. Qi sinking syndrome is one of the common disorders of heart and lung diseases and it is closely related to the dysfunction of heart and lung functions in modern medicine. Chronic heart failure results from persistent heart and lung disease. The disorders of heart and lung are interacted with each other,which damages the pectoral qi and fails to elevate the heart and lung. Finally,a series of symptoms of qi sinking happen. Benefiting and elevating qi is the major principle in the treatment of chronic heart failure. Shengxian decoction invented by Zhang Xichun is the basic formula. In the occurrence and development of chronic heart failure,qi sinking includes three pathological stages,named deficiency,sinking and dispersing. The different pathological products are generated,including stasis,dilute harmful fluid and turbid phlegm. The strengths of the deficiency and excess are different at different stages. The treatment should be given in stages and based on the conditions of sickness. Additionally,the relationship of strengthening the antipathogenic qi and eliminating the pathogens,the inter-transformation of yin and yang and of blood and water should be emphasized.