基于证素辨证的心力衰竭精准辨证模式探析

Analysis of Accurate Syndrome Differentiation Mode of Heart FailureBased on Syndrome Differentiation of Syndrome Elements

心力衰竭的中医辨证与其他内科疾病相比发展滞后,亟须统一的辨证标准。目前气阴两虚证、气虚血瘀证、阳虚水泛证是较公认的三种临床证型。临床证素研究提示,除此三种证型,病性证素痰浊与病位证素肺也是心衰的病机关键。以心功能分级分阶段的证素研究提示,心衰是从气虚发展至全身阳虚、气虚、血瘀、阴虚、痰浊、水湿共同为主要证素的病理过程。由于心衰的临床辨证与标准的不统一,本研究提出心力衰竭“病-证素-证”结合分期精准辨证模式:通过现代诊疗手段获取微观病情,通过证素辨证获取宏观症状,宏观与微观相结合,得出阶段性中医证型。此模式的精准性在于,不同的病理阶段,相同的证型可能出现不同的中医治疗方案,从而提高中医治疗的疗效,实现真正意义上的个体化。此模式能弥补现有心衰辨证分型的不足,为心力衰竭的中医诊治提供了一种新策略,以期为心力衰竭中医病证结合治疗的实际运用与完善提供参考。

The identification of heart failure in Chinese medicine is lagging behind other internal diseases,and there is an urgent need for a unified identification standard.At present,the three clinical evidence types are Qi-Yin deficiency,Qi deficiency and blood stasis,and Yang deficiency and water flooding.Clinical evidence studies suggest that in addition to these three types of evidence,the pathogenic evidence of phlegm and the pathogenic evidence of lung are also key to the pathogenesis of heart failure.The study of graded heart function suggests that heart failure progresses from Qi deficiency to systemic Yang deficiency,Qi deficiency,blood stasis,Yin deficiency,phlegm and water-dampness as the main pathological elements.Due to the inconsistency of clinical evidence and criteria for heart failure,this study proposes a stage-by-stage accurate evidence model for heart failure:microscopic conditions are obtained through modern diagnostic methods,macroscopic symptoms are obtained through evidence-based evidence,and macroscopic and microscopic symptoms are combined to arrive at a stage-by-stage TCM evidence pattern.The accuracy of this model lies in the fact that different pathological stages and the same pattern may have different TCM treatment plans,thus improving the efficacy of TCM treatment and realizing the true sense of individualization.This model can make up for the deficiencies of existing heart failure typing and provide a new strategy for the diagnosis and treatment of heart failure in Chinese medicine,with the aim of providing a reference for the practical application and improvement of the combined Chinese medicine evidence-based treatment of heart failure.