辨治慢性心力衰竭经验摭拾

Summary of experience in the diagnosis and treatment of chronic heart failure

文章介绍冯晓敬教授辨治慢性心力衰竭的经验。慢性心力衰竭是心病科常见的一种以心室充盈和(或)射血功能受损导致心脏排血量不足为主的临床综合征,多为各种心血管疾病发展的终末阶段,病死率和再住院率仍居高不下,严重影响患者的生活质量。近年来中医药对慢性心力衰竭在改善患者临床症状、减轻心脏负荷、增强活动耐量方面发挥了显著的作用。冯晓敬教授是山东省名中医,从事中医内科临床、教学、科研工作30余年,具有扎实的中医理论和现代医学理论知识基础,擅长运用中医辨证理论体系治疗心血管疾病。冯晓敬教授认为慢性心力衰竭为本虚标实之证,心气虚、心阳虚为发病之根本,血瘀为核心环节,水湿、痰饮为主要病理产物。针对其病机特点,冯教授提出将“活血化瘀法”贯彻于治疗始终,临证中结合心力衰竭各个阶段气血阴阳的盛衰、痰饮水湿等邪实的偏重,针对不同分期不同证型灵活选用补气活血法、祛痰泄浊活血法、益气养阴活血法、温补阳气活血法等治疗本病,促使机体气足血通,痰化瘀消水去,从而改善患者症状,延缓疾病的发展。经大量临床实践证明,冯教授随证创制的不同组方疗效显著,对于临床治疗慢性心力衰竭有着良好的指导意义。附验案1则以佐证。

This paper summarizes the clinical experience of Professor FENG Xiaojing in the diagnosis and treatment of chronic heart failure.Chronic heart failure is a common clinical syndrome in the department of cardiology,which is characterized by insufficient cardiac output caused by ventricular filling and/or impaired ejection function.It is mostly the end stage of the development of various cardiovascular diseases.The mortality and rehospitalization rate are still high,which seriously affects the quality of life of patients.In recent years,traditional Chinese medicine has played a significant role in relieving clinical symptoms,reducing cardiac load and enhancing activity tolerance in patients with chronic heart failure.Professor FENG Xiaojing is a famous doctor of traditional Chinese medicine in Shandong Province,has been engaged in clinical teaching and scientific research of traditional Chinese medicine for more than 30 years.The professor has a solid foundation of traditional Chinese medicine theory and modern medical theory knowledge,and is good at using the theoretical system of TCM syndrome differentiation to treat cardiovascular diseases.Professor FENG Xiaojing believes that chronic heart failure is a syndrome of deficiency in origin and excess in superficiality.Heart Qi(气)deficiency and heart Yang(阳)deficiency are the root causes of the disease,blood stasis is the core link,and water dampness and phlegm are the main pathological products.In view of the characteristics of its pathogenesis,Professor FENG proposes to implement the promoting blood circulation and removing blood stasis method throughout the treatment.In clinical practice,combined with the rise and fall of Qi,blood,Yin(阴)and Yang in each stage of heart failure,and the emphasis of pathogenic factors such as phlegm,fluid and dampness,Professor FENG flexibly selects the methods of tonifying Qi and activating blood circulation,eliminating phlegm and turbidity and activating blood circulation,tonifying Qi and nourishing Yin and activating blood circulation,warming and tonifying Yang and activating blood circulation for different stages and different syndromes,which promote the body’s Qi and blood circulation,resolve phlegm and blood stasis to eliminate water,thereby relieving the symptoms of patients and delaying the development of the disease.A large number of clinical practices have proved that the curative effect of different prescriptions prescribed by Professor FENG based on the syndrome is remarkable,which has a good guiding significance for the clinical treatment of chronic heart failure.One test case is attached to prove it.