基于心肝相关理论探讨心力衰竭辨治

Study on the Differentiation and Treatment of Heart Failure Based on the Heart-Liver Related Theory

心力衰竭总属本虚标实之证,以心阳虚为本,气滞、痰饮、瘀血等病理因素相互搏结为标。肝为心之母,母病及子当先治其母,故辨治心力衰竭时可在温阳利水基础上加疏肝活血、理气化浊药物。高血压是导致心力衰竭的主要原因,也是其最常见的并发症之一,心力衰竭患者更应注意对血压的控制,可在治疗基础上加平肝熄风、清心泻火药物。高血压病程日久者,可见肝肾不足,阴阳两虚之证,需心肝同治,在温阳利水基础上兼滋水涵木、滋阴利水。心力衰竭患者多伴有情志异常,而情志异常与心肝脾密切相关,故在治疗上,应合理运用疏肝理气、解郁安神药物,一则舒畅肝郁,调达气机,助利水药通调水道,助温阳药升阳有道;二则解心神思绪,防诸气凝郁,水道不通,病情反复。

Heart failure is generally a syndrome of deficient root causes and excessive manifestations.The heart-yang deficiency is the root cause,while the pathological factors such as qi stagnation,phlegm and blood stasis fighting each other are the major manifestations.The liver is the mother of the heart,and the mother disease.If mother′s disease affects the child,then the mother should be treated first.Therefore,when treating heart failure,drugs for soothing the liver and activating blood circulation,regulating qi and removing turbidity can be added on the basis of the ones for warming yang and promoting urination.Hypertension is the main cause of heart failure and one of its most common complications.Patients with heart failure should pay more attention to the control of blood pressure,and drugs for calming the liver and eliminating wind,clearing the heart and purging fire can be add on the basis of the above treatment.For patients with hypertension with a long course of disease,liver-kidney deficiency,yin-yang insufficiency can be seen,and complicated with heart failure,simultaneous treatment of heart and liver is needed for warming yang and promoting urination,nourishing the kidney and liver,nourish yin and promoting urination.Heart failure patients are often accompanied by emotional abnormalities,which are closely related to the the heart,liver and spleen.Therefore,in the treatment,drugs for soothing the liver and regulating qi,relieving depression and calming the mind should be reasonably used.On the one hand,it is for relieving liver depression,regulating qi movement,helping diuretic drugs to regulate water channels,and drugs for warming yang to raise yang.On the other hand it is for relieving the mind and preventing the stagnation of qi,blocked water channel and repeated illness.