基于“阴阳水火”论心力衰竭合并失眠中医病机及治疗思路

Discussion of the Pathogenesis and Treatment of Heart Failure Complicated with Insomnia in TCM Based on the Theory of“Yin-Yang-Water-Fire”

失眠是心力衰竭患者常见伴发症状,且常可相互为患。作者基于“阴阳水火”理论,提出该病以阴阳疲怠为启病之本、阴阳失和为变病之著、阴阳失济为助病之澜、阴阳待决为重病之末。临证时应以“恢复人体阴阳水火”为本,初以气血同调,尤重参芪之用;病进为虚火燔灼时,每予寒热并用、阴中求阳,并配肉桂引火归元、黄连驱火下交于肾,但应注意中病即止,勿削元气;待病以阴水肆虐为患,则应于阳中求阴,以姜附与熟地黄、山药、麦冬等阴药相配,且不可妄用峻下逐水之法。此外,治病之时还应遵从四时阴阳节律、掌握病情顺逆规律,如夏时重于利水,冬时重于温补,阴水泛溢之时避免刺络、点滴等,通过尽早纠正阴阳失衡之势以阻止病进。从“阴阳水火”切入重新审度心力衰竭合并失眠之因机证治,可化繁为简,返璞归真。

Insomnia is a common symptom in patients with heart failure(HF).Insomnia and heart failure can often affect each other.Based on the theory of“Yin-Yang-water-fire”,this paper puts forward that the weakness of“Yin-Yang”is the basis of disease evolution,and the disharmony of“Yin-Yang”is the basis of disease aggravation.Furthermore,the disorder of harmonization of“water-fire”is a promoting factor leading to disease progression,and the separation of“Yin-Yang”is the cause of serious illness.Thus,restoring“Yin-Yang-water-fire”should be the foundation of treating diseases.At the beginning of onset,Qi and blood should be recuperated at the same time.Especially pay attention to the use of Renshen(Ginseng Radix Et Rhizoma)and Huangqi(Astragali Radix).When deficiency fire is the main pathogenesis,cold drugs and hot drugs should be used at the same time,and the drug compatibility method of“reinforcing Yang from Yin”theory should be used.Rougui(Cinnamomi Cortex)can be used to restore the fire,and Huanglian(Coptidis Rhizoma)can be used to communicate with the heart and kidney.However,it should be noted that after the therapeutic effect is achieved,it is necessary to stop using this powerful drug and not to damage the vitality.When Yin water is the main pathogenesis,the drug compatibility method of“reinforcing Yin from Yang”theory should be used.Ganjiang(Rhizoma Zingiberis)and Fuzi(Radix Aconiti carmichaeli),Shudihuang(Rehmanniae Radix Praeparata),Shanyao(Dioscoreae Rhizoma),Maidong(Ophiopogonis Radix)and other Yin-nourishing drugs can be used.Meanwhile,the method of driving water from the steep ground in large quantities is forbidden.In addition,when treating a disease,we should follow the rhythm of“Yin-Yang”of the four seasons and day-night,and master the law of the condition.For example,in the course of treatment,we can focus on driving water in summer and warming in winter.When there is too much Yin in the body,avoid intravenous drip of drugs by puncturing blood vessels.In this way,the imbalance between“Yin-Yang”can be corrected as soon as possible to prevent the disease from progressing.Re-differentiation the syndrome of HF complicated with insomnia from“Yin-Yang-water-fire”theory can simplify the pathogenesis and treatment,and return to the original.