黄芪、葶苈子、防己“强心利水三味”治疗慢性心力衰竭的应用

The application of Huangqi,Tinglizi,and Fangji“three medicinals of strengthening heart and regulating water”,in the treatment of chronic heart failure

心力衰竭作为大多数心血管疾病加重的最终归宿,是以心悸、气喘、乏力、水肿为主要临床表现的一组复杂综合征,中医属“心水”范畴,本虚标实,其中水饮是本病症状表现的关键因素,也是疾病进展过程中导致临床症状体征最为显著的因素,其上扰于心则悸,停于肺则喘,停于胃则纳差、乏力,溢于肌肤则肿。而中医在改善疾病进展及缓解症状上一直具有其独特的优势,随着中医对该疾病认识的加深,临床越来越多的治法及方剂得到应用并起到良好的疗效。其中方剂中黄芪、葶苈子、防己“强心利水三味”是常用的核心药物组,古今医家广泛应用。文章主要从八纲、脏腑、三焦辨证,认识心力衰竭病机及从药物功效、性味及归经等不同角度分析黄芪、葶苈子、防己这三味具有强心利水功效的药物在治疗心力衰竭中的配伍应用并借助临床观察及现代药理学研究进展分析其效果。随着药理研究的不断深入,中药的药效物质基础和药物协同作用的机制更加清楚,能够拓展其临床应用范围,更加需要我们挖掘中医经典方剂或复方中核心配伍药物的协同作用,以期进一步借助现代药理学研究其临床应用价值,发挥中医药防治心力衰竭优势。

Heart failure,as the ultimate result of aggravation of most cardiovascular diseases,is a group of complex syndroms with palpitation,asthma,fatigue and edema as the main clinical manifestations.In traditional Chinese medicine,it belongs to the category of“heart water”,which is characterized by deficiency in origin and excess in superficiality,among which water retention is a key factor in the symptoms and manifestations of this disease,and it also leads to the most significant clinical symptoms and signs in the course of disease progression.If it disturbs the heart,it will cause palpitations;if it stops in the lungs,it will cause asthma;if it stops in the stomach,it will cause malaise and fatigue;if it overflows the skin,it will cause edema.TCM has always had its unique advantages in relieving disease progression and alleviating symptoms.With the deepening of understanding of the disease in TCM,more and more clinical treatment methods and prescriptions have been applied and show a good curative effect.In the prescription,Huangqi(Astragalus membranaceus),Tinglizi(Draba nemorosa),Fangji(Stephania tetrandra),“three medicinals of strengthening heart and regulating water”,are commonly used core drug groups,which are widely used by doctors in ancient and modern times.This article mainly analyzes the pathogenesis of heart failure from the perspective of the eight principles,Zang-fu(脏腑),three Jiao(三焦)syndrome differentiation.The compatibility of Huangqi,Tinglizi and Fangji in the treatment of heart failure is analyzed from the perspectives of drug efficacy,property and taste,and meridian returning.Its effect is analyzed by clinical observation and modern pharmacological research progress.With the deepening of pharmacological research,the pharmacodynamic material basis of TCM medicine and the mechanism of drug synergy are more clear,which can expand its clinical application scope.It is more necessary for us to explore the synergistic effect of core compatible drugs in traditional Chinese medicine classic prescriptions or compounds,so as to further study their clinical application value with the help of modern pharmacology,and give full play to the advantages of traditional Chinese medicine in preventing and treating heart failure.