《道德经》与心力衰竭治疗发微

Thoughts on Tao Te Ching and the treatment of heart failure

《道德经》是中国古代文化和哲学的代表,其中很多哲学观点与中医理论交织。《道德经》中主张“道法自然”“人法地,地法天,天法道,道法自然”,提到的与医学相关的理念主要包括道法自然、天人合一,阴阳失衡疾病乃生和淡泊守静身心俱治。老子关于“万物负阴而抱阳”的阴阳总纲为中医所吸收,后续许多医家逐渐贯彻深入,建立了阴阳辨证施治的原则。治病就是调理阴阳。医家遣方用药,无不奉此为圭臬。本文结合慢性心力衰竭本虚标实的中医病机特点,以及现代医学对心力衰竭的认识和治疗的变革,师古不泥,守正创新,在《道德经》的思想和文化的指引下提出如下思考:①《道德经》通篇强调“柔弱”思想的重要性,体现崇阴尚柔之精神,故益气养阴作为心力衰竭病的基础治疗,符合心力衰竭病的病机特点,对病情的预后具有长远的意义。临症之时,心力衰竭患者以阴虚证型居多,益气养阴方药可提高心力衰竭患者的治疗效果,改善利尿剂抵抗,减少心律失常的发生,养心安神。②反者道之动,弱者道之用,循环往复是道的动向,弱化演变是道的起作用方式,故对于终末期心力衰竭患者,不能一味的益气养阴,“瘀、毒”是其独特的病机特点,应注重化瘀解毒之效。终末期心力衰竭患者瘀毒瘀滞,加重心肌纤维化,严重者出现肝肾功能异常。解瘀去毒的方药可起到更好的临床疗效。

Tao Te Ching is a representative of ancient Chinese culture and philosophy,in which many philosophical views are intertwined with the theory of traditional Chinese medicine.Tao Te Ching advocates that“For I am from the world,the world is from the nature,the nature from the way,and the way from what is beneath abstraction”.The ideas mentioned in relation to medicine mainly include that Tao is a natural combination of nature and man,the imbalance of Yin(阴)and Yang(阳)is cause of disease,and when one is indifferent and quiet,the physical and mental health is achieved.Lao Zi’s general principle of Yin and Yang,“All things are governed by Yin and Yang”,is absorbed by traditional Chinese medicine,subsequently many doctors gradually carried it out and established the principle of Yin and Yang diffientiation and treatment.Treatment is to regulate Yin and Yang.All doctors regard this as the major principle in the treatment.Combined with the pathogenesis characteristics of chronic heart failure in traditional Chinese medicine,as well as the changes in modern medicine’s understanding and treatment of heart failure,this paper puts forward the following thoughts under the guidance of Tao Te Ching’s thought and culture:①Tao Te Ching emphasizes the importance of the thought“Soft attitude towards life”,reflecting the spirit of respecting Yin and soft.Therefore,invigorating Qi(气)and nourishing Yin is taken as the basic treatment of heart failure,which has long-term significance for the prognosis of the disease.In clinical practice,the majority of heart failure patients are of Yin deficiency syndrome types,prescriptions for supplementing Qi and nourishing Yin can improve the therapeutic effect of heart failure patients by relieving diuretic resistance,reducing the occurrence rate of arrhythmia,nourishing the heart and calming the mind.②The movement of Qi flow is in a cycle,the use of flow is acceptance,the cycle is the trend of the way,and the weakening of the evolution is the mode of action of the Tao.So end-stage heart failure patients can not blindly apply supplementing Qi and nourishing Yin therapy,since“stasis-toxic”is its unique pathogenesis characteristics,attention should be paid to the effect of removing blood stasis and detoxification.Patients with end-stage heart failure oftern suffer from blood stasis and toxin cohesion,which increases myocardial fibrosis,and severe cases may experience liver and kidney dysfunction.Prescriptions for resolving blood stasis and removing toxins can achieve better clinical efficacy.