心衰从肾阳虚论治探析
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摘要
基于中医基础理论探析心衰中医治疗思路,笔者认为心衰与肾、心关系密切,病因病机为肾阳虚不仅导致心阳虚,亦致脾、肺、肝功能失调,气血津液得不到正常运化,产生血瘀、痰浊、水湿耗减气血津液,肾阳失其气血津液补充而亏竭,心阳失其肾阳温煦亦亏竭,肾与心在病理上相互作用,互相影响以致恶性循环,引发心衰发生发展。肾阳虚为本虚,血瘀、痰浊、水湿为标实。肾阳虚为因,心衰为果。治疗应当温补肾阳为主,以温通心阳为辅,兼顾化瘀、祛痰、利水为标之法。只要辨证准确,用药恰当,心衰从肾阳虚论治临床疗效显著。
Based on the theory of traditional Chinese medicine,the treatment of heart failure is investigated and a close relationship is present between heart failure and kidney. The etiology and pathogenesis are that kidneyYang deficiency not only results in heart-yang deficiency,but also leads to the disorder of functions of spleen,lung and liver. Then the non-normal transportion and transformation of Qi-blood and body fluid will lead to blood stasis,phlegm turbidity,water dampness,and depletion of Qi-blood and body fluid eventually. Finally,kidney-Yang exhausts for lack of Qi-blood and body fluid,as well as heart-yang deficiency without the kidney-Yang warming. The above pathological interaction and influence of kidney and heart gives rise to the occurrence and development of heart failure. The kidney is root deficiency,while blood stasis,phlegm turbidity and water dampness shows branch excess,suggesting kidney-Yang can result in heart failure. The treatment should adopt the dominant role of warming kidney-Yang and the subsidiary role of sweating heart-yang by warmth and acridity,as well as the absorbing clots and diuresis function. With the accurate syndrome differ treatment and appropriate medication,the heart failure therapy from the kidney-Yang deficiency treatment of clinical efficacy is significant.
Based on the theory of traditional Chinese medicine,the treatment of heart failure is investigated and a close relationship is present between heart failure and kidney. The etiology and pathogenesis are that kidneyYang deficiency not only results in heart-yang deficiency,but also leads to the disorder of functions of spleen,lung and liver. Then the non-normal transportion and transformation of Qi-blood and body fluid will lead to blood stasis,phlegm turbidity,water dampness,and depletion of Qi-blood and body fluid eventually. Finally,kidney-Yang exhausts for lack of Qi-blood and body fluid,as well as heart-yang deficiency without the kidney-Yang warming. The above pathological interaction and influence of kidney and heart gives rise to the occurrence and development of heart failure. The kidney is root deficiency,while blood stasis,phlegm turbidity and water dampness shows branch excess,suggesting kidney-Yang can result in heart failure. The treatment should adopt the dominant role of warming kidney-Yang and the subsidiary role of sweating heart-yang by warmth and acridity,as well as the absorbing clots and diuresis function. With the accurate syndrome differ treatment and appropriate medication,the heart failure therapy from the kidney-Yang deficiency treatment of clinical efficacy is significant.
引文
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[3]中国中西医结合学会心血管疾病专业委员会:中国医师协会中西医结合医师分会心血管疾病专业委员会.慢性心力衰竭中西医结合诊疗专家共识[J].心脑血管病防治,2016,16(5):340-347.
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[5]陈可冀,吴宗贵,朱明军,等.慢性心力衰竭中西医结合诊疗专家共识[J].心脑血管病防治,2016,10(16):340-347.
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[10]刘超,王阶.从补肾对血脉的影响探讨其在冠心病治疗中的应用与研究[J].中华中医药杂志,2018,3(33):841-843.
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[12]郦旦明,蒋蓝英,付仲颖.右归丸对合并亚临床甲状腺功能减退老年慢性心力衰竭患者的影响[J].中华中医药杂志,2010,18(5):1108-1110.
[13]周晓靓,樊赛军,黄海舟,等.使用低营养小鼠模型评价中药右归丸的补益功效[J].中国中医基础医学杂志,2014,20(9):1285-1287.
[14]于化新,王德山,单德红.右归丸对慢性肾衰大鼠肾保护作用的实验研究[J].吉林中医药,2009,29(5):443-444.
[15]耿振平,陈阳春.真武汤加减对心肾阳虚型慢性心力衰竭细胞黏附分子表达及其对心脏结构和功能的影响[J].世界中医药,2018,13(4):893-896.
[16]彭志林,卢健棋,温志浩,等.真武汤治疗心肾阳虚型慢性心力衰竭临床疗效的系统评价[J].中华中医药学刊,2017,32(12):3101-3106.
[17]卢崇汉.扶阳讲记[M].北京:中国中医药出版社,2007:53.
[18]王吉均.医学衷中参西录中药解读[M].河北:河北科学技术出版社,2007:104.
[19]清·叶天士.临证指南医案[M].北京:中国中医药出版社,2008:415.
[20]将梅先.改善心肾阳气互资是治疗慢性心力衰竭的关键[J].中国中西医结合杂志,2008,28(12):1067-1068.
[21]Xian SX,Yang ZQ,Ren PH,et al.Effect of yangxin-kang tables on chronic heart failure:A multi-center randomized double-blind placebo-controlled trial[J].Chin J Integr Med,2015,21(10):733-742.
[22]赵永华.中西医结合救治重度心力衰竭的探讨[J].中国中西医结合急救杂志,2003,1(10):64-65.
[23]孟庆春.内科疑难病中医治疗学[M].北京:中国中医药出版社,2002:87-98.
[24]吴赛,张珊珊.固本助阳方治疗心肾阳虚型慢性心力衰竭[J].吉林中医药,2015,35(12):1224-1227.
[25]礼海,马金,张洋,等.中药复方联合运动疗法对CHF大鼠MMP-2及胶原蛋白的影响[J].中医学报,2018,33(3):440-444.
[26]张金国,高东升,魏广和,等.黄芪注射液对急性心肌梗塞早期患者左室重构及心功能的影响[J].中国中西医结合杂志,2003,23(5):346-348.
[2]Varma C,Cammm AJ.Pace for heat failure[J].Lancet,2001,357(9264):1277-1283.
[3]中国中西医结合学会心血管疾病专业委员会:中国医师协会中西医结合医师分会心血管疾病专业委员会.慢性心力衰竭中西医结合诊疗专家共识[J].心脑血管病防治,2016,16(5):340-347.
[4]孙许涛,姜德友,陈飞,等.中医药治疗慢性心力衰竭研究进展[J].中医学报,2018,33(3):496-499.
[5]陈可冀,吴宗贵,朱明军,等.慢性心力衰竭中西医结合诊疗专家共识[J].心脑血管病防治,2016,10(16):340-347.
[6]郑钦安.郑钦安医学三书[M].山西:山西科学技术出版社,2007:62-63.
[7]Braam B,Joles JA,Danishwar AH,et al.Cardiorenal syndrome-current understanding and future perspestives[J].Nat Rev Nephrol,2014,10(1):48-55.
[8]Schefold JC,Filipatos G,Hasefuss G,et al.Heart failure and kidney dysfunction:mechanisms and management[J].Nat Rev Nephrol,2016,12(10):610-623.
[9]张鹏,陈婵,王娟,等.基于两种研究结果的冠心病心力衰竭症状、证和证素分布特点的比较研究[J].中华中医药杂志,2016,31(12):4969-4973.
[10]刘超,王阶.从补肾对血脉的影响探讨其在冠心病治疗中的应用与研究[J].中华中医药杂志,2018,3(33):841-843.
[11]游茂,贺柯庆.益气温阳汤治疗心肾阳虚型慢性心力衰竭的临床研究[J].长春中医药大学学报,2011,27(2):175-176.
[12]郦旦明,蒋蓝英,付仲颖.右归丸对合并亚临床甲状腺功能减退老年慢性心力衰竭患者的影响[J].中华中医药杂志,2010,18(5):1108-1110.
[13]周晓靓,樊赛军,黄海舟,等.使用低营养小鼠模型评价中药右归丸的补益功效[J].中国中医基础医学杂志,2014,20(9):1285-1287.
[14]于化新,王德山,单德红.右归丸对慢性肾衰大鼠肾保护作用的实验研究[J].吉林中医药,2009,29(5):443-444.
[15]耿振平,陈阳春.真武汤加减对心肾阳虚型慢性心力衰竭细胞黏附分子表达及其对心脏结构和功能的影响[J].世界中医药,2018,13(4):893-896.
[16]彭志林,卢健棋,温志浩,等.真武汤治疗心肾阳虚型慢性心力衰竭临床疗效的系统评价[J].中华中医药学刊,2017,32(12):3101-3106.
[17]卢崇汉.扶阳讲记[M].北京:中国中医药出版社,2007:53.
[18]王吉均.医学衷中参西录中药解读[M].河北:河北科学技术出版社,2007:104.
[19]清·叶天士.临证指南医案[M].北京:中国中医药出版社,2008:415.
[20]将梅先.改善心肾阳气互资是治疗慢性心力衰竭的关键[J].中国中西医结合杂志,2008,28(12):1067-1068.
[21]Xian SX,Yang ZQ,Ren PH,et al.Effect of yangxin-kang tables on chronic heart failure:A multi-center randomized double-blind placebo-controlled trial[J].Chin J Integr Med,2015,21(10):733-742.
[22]赵永华.中西医结合救治重度心力衰竭的探讨[J].中国中西医结合急救杂志,2003,1(10):64-65.
[23]孟庆春.内科疑难病中医治疗学[M].北京:中国中医药出版社,2002:87-98.
[24]吴赛,张珊珊.固本助阳方治疗心肾阳虚型慢性心力衰竭[J].吉林中医药,2015,35(12):1224-1227.
[25]礼海,马金,张洋,等.中药复方联合运动疗法对CHF大鼠MMP-2及胶原蛋白的影响[J].中医学报,2018,33(3):440-444.
[26]张金国,高东升,魏广和,等.黄芪注射液对急性心肌梗塞早期患者左室重构及心功能的影响[J].中国中西医结合杂志,2003,23(5):346-348.