Lan Yu, Luo Fu-Kun, Yu Yue, Wang Xiao-Ya, Wang Peng-Qian, Xiong Xing-Jiang
Guang'anmen Hospital, China Academy of Chinese Medical Sciences Beijing 100053, China.
Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences Beijing 100700, China.
Zhongguo Zhong Yao Za Zhi. 2024 Dec;49(23):6521-6532. doi: 10.19540/j.cnki.cjcmm.20240814.501.
The prevalence of cardiovascular diseases in China has shown a rising trend. With the patient number of about 8.9 million, heart failure has brought a heavy burden to public health and wellness. Despite the modern medical research progress in the pathogenesis and clinical treatment of heart failure, the patients with heart failure still suffer from recurrent episodes of dyspnea(requiring repeated hospital admissions), diuretic resistance, elevated creatinine levels due to prolonged diuretic use, and poor prognosis, among other major clinical and scientific issues. In traditional Chinese medicine(TCM), heart failure belongs to the category of "heart water". The research team has found that because of the changes in the modern disease spectrum, the differences between ancient and modern physical constitutions, and the use of anti-heart failure drugs in modern medicine, the pathological process of heart failure has been altered, and the symptoms of some patients have become unobvious. As a result, the etiology and pathogenesis of heart failure have undergone major changes. The disease causes include external pathogen attack, emotional disorders, excessive labor injury, medication-induced damage, dietary disorders, water-dampness stagnation, and endowment insufficiency. These causes are closely related to the infection aggravation-induced heart failure, cardiac and psychological diseases, and heart volume overload in modern medicine. The pathogeneses of heart failure include edema due to Yang deficiency and water retention turning into heat in the acute stage and liver depression and Qi stagnation, heart Qi deficiency, kidney Yang deficiency, Qi deficiency in lung and spleen, phlegm and water retention, and internal obstruction due to blood stasis in the remission stage. The corresponding treatment strategies were recommended as follows: Zhenwu Decoction for edema due to Yang deficiency, Mufangji Decoction for water retention turning into heat, Chaihu Longgu Muli Decoction for liver depression and Qi stagnation, Guizhi Decoction for heart Qi insufficiency, Shenqi Pills and Yougui Pills for kidney Yang deficiency, Yupingfeng Powder, Lizhong Decoction, Buzhong Yiqi Decoction, and Guipi Decoction for Qi deficiency in lung and spleen, Fangji Huangqi Decoction, Wuling Powder, Linggui Zhugan Decoction, and Tingli Dazao Xiefei Decoction for internal obstruction due to phlegm and water retention, Guizhi Fuling Pills and Danggui Shaoyao Powder for internal obstruction due to blood stasis. The clinical treatment should follow the principle of considering both pathogenesis and pathology as well as both medicine nature and mechanism. The TCM concept of secondary prevention with TCM formulas for replenishing deficiency should be adopted. The treatment based on the principle and concept above will improve the patients' quality of life, reduce the number of hospital admissions, ameliorate diuretic resistance, and improve the clinical outcomes.
中国心血管疾病的患病率呈上升趋势。心力衰竭患者人数约890万，给公众健康带来了沉重负担。尽管现代医学在心力衰竭的发病机制和临床治疗方面取得了研究进展，但心力衰竭患者仍面临呼吸困难反复发作（需要反复住院）、利尿剂抵抗、长期使用利尿剂导致肌酐水平升高以及预后不良等主要临床和科学问题。在中医中，心力衰竭属于“心水”范畴。研究团队发现，由于现代疾病谱的变化、古今体质差异以及现代医学中抗心力衰竭药物的使用，心力衰竭的病理过程发生了改变，部分患者症状变得不明显。因此，心力衰竭的病因病机发生了重大变化。病因包括外感邪气、情志失调、过度劳累损伤、药物损伤、饮食失调、水湿停滞和禀赋不足。这些病因与现代医学中感染加重诱发的心力衰竭、心脏和心理疾病以及心脏容量超负荷密切相关。心力衰竭的病机包括急性期阳虚水泛、水饮化热，缓解期肝郁气滞、心气亏虚、肾阳亏虚、肺脾气虚、痰饮水湿内停、瘀血内阻。相应的治疗策略如下：阳虚水泛用真武汤，水饮化热用木防己汤，肝郁气滞用柴胡龙骨牡蛎汤，心气不足用桂枝汤，肾阳亏虚用肾气丸和右归丸，肺脾气虚用玉屏风散、理中汤、补中益气汤和归脾汤，痰饮水湿内停用防己黄芪汤、五苓散、苓桂术甘汤和葶苈大枣泻肺汤，瘀血内阻用桂枝茯苓丸和当归芍药散。临床治疗应遵循辨病与辨证相结合、药性与药理相结合的原则。应采用中医补虚方剂二级预防的理念。基于上述原则和理念进行治疗将提高患者的生活质量，减少住院次数，改善利尿剂抵抗，并改善临床结局。
