基于“虚、瘀、水、毒”理论探讨慢性心力衰竭的分期论治

Discussion on the staged treatment of chronic heart failure based on the theory of"deficiency,blood stasis,water and toxin"

虚、瘀、水、毒在慢性心力衰竭(CHF)的发生发展和病理演变过程中具有重要意义。基于"虚、瘀、水、毒"探讨CHF发展过程中的病机演变及治疗,认为虚是起病之本,瘀、水、毒为疾病发展之标。其中,虚:心气亏虚、心阳不足;瘀:血瘀是中心病理环节,也是加重疾病、造成恶性循环的重要机制;水:痰饮、水湿是根本病理产物;毒:热毒、水毒、瘀毒是病情进展、产物堆积的最终结果。治疗上,CHF可分为早、中、晚、末4期。早期补气调心治本、活血行水治标;中期益气养阴扶正、化瘀泄浊祛邪;晚期化瘀解毒为主、温阳利水为辅;末期救逆固脱敛阳、生津益气补阴。在分期论治的同时要注意坚持整体观念、辨证论治;注重把握时机、灵活用药;采取中西并用、融会贯通。

Deficiency,stasis,water and toxin are of great significance in the pathogenesis and pathologic evolution of chronic heart failure(CHF).Based on"deficiency,blood stasis,water and toxin",the pathogenesis and treatment of CHF were discussed in this article.It was found that in the pathogenesis,deficiency--deficiency of heart qi and deficiency of heart yang were the origin of the disease,and blood stasis,water and toxin were the markers of the disease.Among them,blood stasis was the central pathological link,and also an important mechanism that could aggravate the disease and cause a vicious cycle;water-phlegm and water dampness were the basic pathological products;toxin-heat toxin,water toxin,and stasis toxin were the final results of disease progress and product accumulation.In terms of treatment,CHF can be divided into four stages:early,middle,late and end.In the early stage,tonifying qi and regulating heart can be used for the treatment of root cause,and promoting blood circulation and water can be used for the treatment of symptoms;tonifying qi and yin and reinforcing the healthy qi,reducing blood stasis,purging turbid,and eliminating pathogenic factors can be used in the middle stage;reducing blood stasis and removing toxic materials should be used in the late stage,supplemented with warming yang and increasing urine excretion;astringing yang,generating body fluids,tonifying qi and yang should be used in the end stage.At the same time of treating by stages,attention should be paid to adhering to a holistic concept and dialectical treatment;pay attention to timing and flexible medication;adopting a combination of Chinese and Western approaches and integrating them.