彭丽琪 邓旭 蔡虎志 陈新宇

〔摘要〕 國家级名中医陈新宇认为慢性心力衰竭（chronic heart failure， CHF）是心脏阴阳互损的终末状态，病因病机多责于阴阳失调、气血失常。陈教授从“阴阳”辨治CHF，按病程轻重缓急进行分期分型辨治，兼顾五脏施治和病机论治。缓解期分为“肺肾两虚，脾虚湿盛证”“肝肾阴虚，心阴耗伤证”和“心肺气虚，心神不宁证”，急性发作期常见证型为“阴寒凝聚，气虚血瘀证”“心肾亏损，阳虚水泛证”和“心阳不足，水凌心肺证”，危重期以“热陷心包，痰蒙心窍证”和“阴竭阳脱，元气暴亡证”居多。针对CHF不同分期、不同证型，施以阴阳同治、温补肺肾、平肝潜阳、回阳救逆等治法。并将中医“治未病”思想贯穿于CHF防治的各个阶段。

〔关键词〕 慢性心力衰竭;分期分型辨治;阴阳;治未病;陈新宇

〔中图分类号〕R256.2       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.10.025

TCM Understanding and Prevention of Chronic Heart Failure： Research on Chen

Xinyus Academic Thought and Clinical Experience

PENG Liqi1， DENG Xu2， CAI Huzhi2， CHEN Xinyu2*

（1. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China; 2. The First Affiliated

Hospital of Hunan University of Chinese Medicine， Changsha， Hunan 410007， China）

〔Abstract〕 Professor Chen Xinyu believes that chronic heart failure （CHF） is the terminal state of mutual loss of Yin and Yang of the heart， the etiology and pathogenesis are mostly responsible for the imbalance of Yin and Yang， Qi and blood disorders. Professor Chen advocates the differentiation and treatment of CHF from "Yin and Yang"， and thinks that differentiation and treatment of CHF should according to the severity of the disease stage， taking into account the treatment of the five Zang organs and the pathogenesis. Remission stage is divided into "deficiency of lung and kidney， spleen deficiency and dampness excess syndrome"， the "liver and kidney Yin deficiency， heart Yin consumption injury syndrome" and "syndrome of heart and lung Qi deficiency and restlessness of mind"; acute phase often witness type as "Yin cold coagulation， Qi deficiency and blood stasis syndrome" and "heart and kidney loss， Yang deficiency and water flooding syndrome" and "deficiency of heart Yang， water touching heart and lung syndrome"; critical period， most of them are "phlegm heat defect pericardium， phlegm covering the heart orifices syndrome" and "Yin exhaustion and Yang loss， Yuan Qi sudden death". In the view of different stages and syndrome types of CHF， the treatment of Yin and Yang， warming and tonifying lung and kidney， calming liver and activating Yang， and restoring Yang to save adverse conditions are carried out. The idea of "preventive treatment of disease" runs through all stages of CHF prevention and treatment.

〔Keywords〕 chronic heart failure; syndrome differentiation and treatment according to period and syndrome type; Yin and Yang; preventive treatment of disease; Chen Xinyu

慢性心力衰竭（chronic heart failure， CHF）是全球医学领域难以攻克的挑战，人群死亡率普遍偏高。据统计，我国现有CHF患者450万（患病率达0.9%），发病率具有明显区域、性别、年龄等差异[1-2]。CHF是一种不可逆、递进性疾病，早期预防、药物治疗和合理干预能延缓病程。目前，药物是CHF治疗的基石，心脏移植、心脏再同步化治疗、心室辅助装置等[3]能改善预后。与强心剂、利尿剂等西药对比，中药能避免神經内分泌过度激活，延缓心室重构[4]，减轻心脏负荷，改善患者症状。第六批全国老中医药专家学术经验继承工作指导老师、湖南省名中医陈新宇教授熟谙经典，通彻医理，在治疑难、起沉疴、救危急等方面善用经方，匠心独运，屡屡获效。……