健脾活血利水法在慢性心力衰竭中的探析

Analysis of Invigorating Spleen,Promoting Blood Circulation and Diuresis Method for Treating Chronic Heart Failure

慢性心力衰竭是由于各种原因的初始心肌损害引起心脏结构和/或功能的异常改变,是各种心脏疾病发展的终末期。临床上常以外感、劳累、情志因素为诱因,心悸、气喘、浮肿为主要临床症状,具有反复发作、病死率高的特点。病位在心,病机主要责之于气血阴阳虚衰,脏腑功能失调,瘀血、痰浊、水饮滞而为病。在漫长的医学历史进展中,中医药治疗慢性心衰已积累了丰富的辨证论治内容,包括脏腑辨证、六经辨证、三焦辨证、气血津液辨证等,中医经典与西医创新相结合已被实践并逐渐成为有效改善心衰患者临床症状和预后的大趋势。其中,脏腑辨证尤为重要。该文结合现代医学特点,创新辨治思路,基于“五脏相关”理论指导,以脾胃为切入点,综合慢性心力衰竭患者临床表现及古今文献研究,认为心脾两虚、水瘀互结是慢性心衰的重要发病基础,健脾活血利水是治疗慢性心衰的基本治法。

Chronic heart failure(CHF)is an abnormal change in the structure and/or function of the heart caused by the initial myocardial damage of various reasons,and is the end stage of the development of various heart diseases.Clinically,external diseases,fatigue and emotion are triggers,and palpitations,asthma and edema are the main symptoms,which are characterized by recurrent attacks and high mortality.The disease is in the heart,and the pathogenesis is mainly due to the deficiency of Qi and blood,Yin and Yang,dysfunction of Zang-Fu organs,blood stasis,turbid phlegm,and stagnant drinking water.In the long medical history,TCM treatment of CHF has accumulated rich content of syndrome differentiation,including Zang-Fu organs syndrome differentiation,six meridians syndrome differentiation,triple-Jiao syndrome differentiation,and Qi-blood-body fluid syndrome differentiation.Combining the classics of TCM with western medicine innovations has been practiced and has gradually become a major trend in effectively improving the clinical symptoms and prognosis of CHF patients.Particularly,the Zang-Fu organs syndrome differentiation is particularly important.In this article,we combined the characteristics of modern medicine and innovative ideas for syndrome differentiation and treatment.Based on the theory of“five Zang organs being related”,with the spleen and stomach as the entry point,we also comprehensively combined the clinical manifestations of patients with CHF and ancient and modern literature studies.It is believed that the deficiency of both heart and spleen and the mutual accumulation of water and blood stasis are the important pathogenesis of CHF.