Ⅱ型心肾综合征中医病机演变规律初探

Exploration for Evolution of TCM Pathogenesis of Type Ⅱ Cardiorenal Syndrome

目前对Ⅱ型心肾综合征(cardiorenal syndrome,CRS)病机认识尚不统一,主要有心肾不交、心肾阳虚和血不利为水3种,这些观点从不同层面反映了疾病发展阶段的病理特征。Ⅱ型CRS是心病及肾、心肾同病的状态,其发展多呈慢性经过,每一阶段有其不同的病理特点,分析其动态变化,探讨其病机演变规律,对开展疾病早期防治具有重要意义。本文基于文献研究和临床观察,提出Ⅱ型CRS病机演变规律主要经历4个阶段,即早期为心气不足、初期为阴虚火旺、中期为血瘀水停、后期为阳虚水泛,以期更有效指导临床辨证施治,减少疾病发生,延缓病情进展。

The understanding of TCM pathogenesis of typeⅡcardiorenal syndrome(TⅡCRS)is still not uniform at present.It mainly includes three viewpoints:disharmony between heart and kidney,yang deficiency of heart and kidney,and the unfavorable blood transform into water,which reflect the pathological features of the disease at different stages from different aspects.TⅡCRS is the stage of heart disease affecting kidney,and the condition of simultaneous occurrence of both heart and kidney disease.Besides,the development of TⅡCRS is usually chronic and each stage has different pathological features.Furthermore,to analyze its dynamic changes and explore its evolution mechanism will be of great significance for carrying out early disease prevention and treatment.Based on the literature studies and clinical observations,this article proposed that the evolution of TCM pathogenesis of TⅡCRS mainly has four stages:deficiency of heart qi syndrome at stage 1,hyperactivity of fire due to yin deficiency syndrome at stage 2,blood stasis and water diffusion syndrome at stage 3 and water overflowing due to yang deficiency syndrome at the last stage,with the purpose to guide clinical syndrome differentiation in clinic,reduce the incidence of the disease and delay the progression of the disease.