基于脾主运化水湿理论探讨慢性心衰的发病机制

Etiology and Pathology of Chronic Heart Failure Based on Spleen Governing Transportation and Transformation Theory

随人口老龄化及城镇化进程的加速,以及生活习惯和饮食结构的改变,慢性心衰的发病率呈逐年上升的趋势,因其发病率高、预后差、病死率高,已成为重大公共卫生问题,因此,探讨慢性心衰的发病及论治具有重要的意义。慢性心衰属于中医学＂心痹＂＂心胀＂＂心水＂等范畴,其病性当属本虚标实、虚实夹杂之证,本虚为阳虚、气虚,标实乃血瘀、痰饮、水湿。＂五脏皆致心衰,非独心也＂,肺、肝、脾、肾之病变均可导致慢性心衰的发病;其中,心为脾之母,脾为心之子,脾与心衰的发生密切相关。本文旨在探析慢性心衰的病因病机与脾主运化水湿的关系。在发病因素方面,从五大病因探讨慢性心衰的发病,认为外邪侵袭,久客经络,脾虚损阳,痰饮内生,发为心衰;饮食不节,损伤脾胃,脾不运湿,心脉不畅,发为心衰;情志失调,损伤脾胃,化血无力,心失所养,发为心衰;劳倦内伤,耗伤脾胃,脾虚湿停,心脉痹阻,发为心衰;失治误治,耗伤脾阳,痰湿积聚,上凌于心,发为心衰。在致病机理环节,从＂气＂＂水＂＂血＂三个方面探讨慢性心衰的发病,从＂气＂,认为脾气虚弱,气血匮乏,心失所养,气阳两虚,发为心衰;从＂水＂,认为脾失健运,化生痰饮,困遏心阳,水饮上犯,发为心衰;从＂血＂,认为脾气不足,化湿无力,血行不畅,血瘀于脉,发为心衰。为临床从脾从痰湿论治慢性心衰提供重要的辨证思路及理论依据。

Objective： With the aging of the population and the accelerating process of urbanization,as well as the change of living habits and diet structure,the incidence of chronic heart failure is increasing year by year. Because of its high incidence,poor prognosis and high mortality,it has become a major public health problem. Therefore,it is of great significance to explore the pathogenesis and treatment of chronic heart failure.Chronic heart failure belongs to the range of ‘heart attack＇,‘heart swelling＇,and ‘heart moisture＇in traditional Chinese medicine. The nature of the disease is asthenia in origin and asthenia in superficiality as well as intermingled deficiency and excess. Asthenia in origin refers to Yang deficiency and Qi deficiency; asthenia in superficiality refers to blood stasis,water,dampness and phlegm retention. ‘All five internal organs（ heart,liver,spleen,lungs and kidneys）,but not only heart,can lead to heart failure. ＇The pathological changes of lung,liver,spleen and kidney can lead to chronic heart failure. Among them,the heart is the mother of the spleen,the spleen is the son of the heart,so the spleen is closely related to the occurrence of chronic heart failure. This paper discussed the relationship between the etiology and the pathology of chronic heart failure and spleen governing transportation and transformation. In the etiology,the invasion of exogenous pathogenic factors lead to deficiency of both spleen and Yang Qi. The disorders of diet leads to the spleen failing to transport and transform water and moisture. Poor mood leads to the injury of the spleen and weakness in activating blood circulation. Over exertion leads to the weakness of the spleen and retaining dampness. Loss of treatment leads to the injury of Yang Qi in the spleen and accumulation of phlegm dampness. All of these would cause heart failure. In the pathology,we discussed the pathogenesis of chronic heart failure from three aspects ‘Qi＇,‘water＇and ‘blood＇. Deficiency of Qi in the spleen leads to lack of Qi and blood,which can not maintain the heart,and finally leads to deficiency of both Qi and Yin. From water aspect,dysfunction of spleen leads to formation of water and moisture,which can block Qi and blood,and finally leads to the obstruction of Yang Qi in the heart. From blood,insufficient Qi in the spleen leads to formation of water and moisture,which can cause poor circulation of blood,and finally leads to obstruction of blood stasis. The etiology and pathology above could cause the heart failure. This paper provides an important theoretical basis for clinical treatment of chronic heart failure by the method of spleen governing transportation and transformation.