基于“肝-血-心-脉”整体观探析慢性心力衰竭的辨治规律

The Differentiation And Treatment of Chronic Heart Failure Based on The Holistic View of"Liver,Blood,Heart and Pulse"

慢性心力衰竭(chronic heart failure, CHF)是由于各种病因导致心脏功能和(或)结构异常,致使心脏收缩或舒张功能受损的心脏疾病的终末期表现。慢性心力衰竭5年生存率与恶性肿瘤相当,患者一旦患有慢性心衰,不但严重影响生存质量,且与其家庭经济关联巨大。慢性心力衰竭的临床主要表现为呼吸困难、水液潴留、活动受限等。慢性衰竭在中医学中属于“喘证”“心悸”“水肿”等疾病范畴。中医治疗多以“心病治心”的思想为主,常忽略与之关系密切的肝及血脉的预防诊疗。文章基于肝、血、心、脉的生理联系,即“肝心相连,和合为用”“心主血脉,营润周身”“肝血心脉,相互为用”与病理联系,即“肝气阻络,发为心衰”“血虚脉滞,心气不行”“肝心不合,心衰日甚”“神魄失养,加重心衰”及其相互之间的作用关系,阐述“肝-血-心-脉”一体观理论与慢性心力衰竭的相关性,从“肝-血-心-脉”整体观浅谈慢性心力衰竭的辨治规律。

Chronic heart failure is the end-stage manifestation of heart disease caused by various causes of cardiac function and/or structural abnormalities,resulting in impaired systolic or diastolic function of the heart.The 5-year survival rate of chronic heart failure is comparable to that of malignant tumors.Once patients suffer from chronic heart failure,it not only seriously affects the quality of life of the patients themselves,but also has a great relationship with their family economic life.The main clinical manifestations of chronic heart failure are dyspnea,fluid retention and limited activity.In traditional Chinese medicine,it belongs to"asthmatic syndrome","palpitation","edema"and other diseases.In the treatment of traditional Chinese medicine,the idea of"treating heart disease"is the main one,and the prevention and treatment of liver and blood vessels,which are closely related to it,are often ignored.The article is based on the physiological connection of liver,blood,heart and pulse:"Liver and heart are connected,and harmony is used","heart governs blood,Ying moistens the whole body","liver blood and heart pulse are used for each other"and the pathological relationship is"liver qi obstructs collaterality,causes heart failure","blood deficiency pulse stagnation,heart Qi is not good","liver heart is not good,heart failure is very bad","soul loss,aggravates heart failure"and the relationship between them.This paper expounds the correlation between the theory of"liver-blood-heart-pulse"and chronic heart failure,and discusses the rule of differentiation and treatment of chronic heart failure from the holistic view of"liver-blood-heart-pulse".