基于心肾相交理论从肾论治心胀

Treating heart distension from kidney based on the theory of intersection of heart and kidney

扩张型心肌病是一种以心腔扩大为主要特征的遗传异质性心肌病,也是导致终末期心力衰竭患者进行心脏移植的主要疾病之一,治疗难度较大。心胀是中医胀病的一种,胀病是脏器形体体积增大的一类疾病的总称,心胀的相关表述与现代医学中扩张型心肌病的临床表现有诸多契合,故研究立足于心胀理论从中医角度对扩张型心肌病进行早期防治。从中医角度看,心胀的证治不可离肾。中医对心肾关系阐发详实,将心肾关系囊括于心肾相交理论体系之中。心肾相交是中医五脏一体观的核心内涵之一,即心肾二脏虽各有其独特作用,但并非在结构与功能上彼此孤立,而是通过经脉气血,在生理病理上相互协调、互相影响。目前中医治疗扩张型心肌病多参考心胀论治,但缺乏系统辨证思路,文献报道多以名家经验和临床观察为主。文章以心肾相交理论为指导,梳理了心肾相交理论的发展及演变,探讨心肾相交的理论内涵。依据心胀的病程演变规律,从肾分早中晚三期分期论治心胀,以早期交通心肾、中期温补肾阳、晚期标本兼顾为治法治则,浅析心胀证治,以期为扩张型心肌病的中医诊疗提供新思路、新策略。

Dilated cardiomyopathy is a kind of genetically heterogeneous cardiomyopathy characterized by enlarged heart cavity,and it is also one of the major diseases leading to heart transplantation in patients with end-stage heart failure.Heart distension is a kind of dilatation disease of TCM,and dilatation is a general term for a class of diseases that increase the volume of organs.The relevant expressions of Heart distension are in good agreement with the clinical manifestations of dilatation cardiomyopathy in modern medicine.Therefore,the study is based on the Heart distension theory to conduct early prevention and treatment of dilatation cardiomyopathy from the perspective of TCM.From the point of view of TCM,the treatment of heart distension cannot be separated from the kidney.Traditional Chinese medicine elaborates the relationship between heart and kidney in detail and includes it in the theoretical system of heart-kidney intersection.The intersection of the heart and kidney is one of the core contents of the TCM view of the five viscera,although the heart and kidney have their own unique functions.They are not isolated from each other in structure and function,but coordinate and influence each other in physiology and pathology through the meridians,Qi(气)and blood.At present,the treatment of dilated cardiomyopathy in TCM mostly refers to the treatment of dilated cardiomyopathy,but there is a lack of systematic syndrome differentiation.Guided by the theory of heart-kidney intersection,this paper reviews the development and evolution of the theory,and probes into the theoretical connotation of heart-kidney intersection.According to the law of the evolution of the course of heart distension,this paper discusses the treatment of heart distension by three stages:early,middle and late.It takes early heart-kidney circulation,middle warm-tonifying kidny-Yang(阳)and late specimens as the treatment principles,and analyzes the treatment of heart distension syndrome,in order to provide newe ideas and new strategies for the diagnosis and treatment of dilated cardiomyopathy.