从“三焦气化-玄府开阖”论治慢性心力衰竭探析

Exploration and Analysis on Treatment of Chronic Heart Failure from“Qi Transformation in Sanjiao-Opening and Closing of Xuanfu”

慢性心力衰竭(CHF)是气血水代谢异常而致一种复杂的临床综合征,是因脏腑阳虚动能不足,蒸腾气化无力,不能制化阴津,遂凝滞而成水饮、血瘀等阴邪渣浊之物,积于玄府,着而不去,造成水瘀互结为患。阳化气不足,阴成形太过是CHF形成的重要发病机理,水饮和瘀血是主要的病理产物。结合CHF不同阶段的症候特点及病程演变规律,以"阳化气,阴成形"及"气液宣通"理论为指导,依据邪结不同部位及相应脏腑阴阳的多寡,确立"气化三焦-开通玄府-气液宣通"三位一体的治疗法则,三焦气化不利,当时时扶阳,适时消阴以纠正"阳化气"之动能不足,病邪繁杂胶着于玄府,当开宣玄府以利官窍。

Chronic heart failure(CHF)is a complex clinical syndrome caused by abnormal metabolism of qi,blood and water.It is caused by insufficient kinetic energy of viscera and yang deficiency,weakness in transpiration and qi transformation,and inability to suppress yin and fluid,and then stagnates into water,blood stasis and other yin and evil dregs,which accumulate in the Xuanfu,and will not go away,causing the formation of water and stasis.Insufficient yang transforming qi and excessive yin shaping up body are the important pathogenesis of CHF formation,and fluid retention and blood stasis are the main pathological products.Combining the symptom characteristics of different stages of CHF and the evolution of the disease course,guided by the theory of“yang transforming qi,yin shaping up body”and“circulation of qi-liquid”theory,according to the different parts of the evil knot and the corresponding amount of yin and yang in the viscera,the treatment principle of“Qi transformation in Sanjiao-Opening Xuanfu-Circulation of qi-liquid”is established.To reduce the disadvantages of qi transformation in Sanjiao,the yang is strengthened,and the yin is eliminated at the right time to correct the insufficient kinetic energy of the yang transforming qi,and Xuanfu is opened to release the evil pathogenic factors.