基于“大气下陷”理论浅析慢性心力衰竭性水肿的治疗

Analysis of the Treatment of Chronic Heart Failure Edema Based on the Theory of “Atmospheric Subsidence”

摘要: 慢性心力衰竭是心血管疾病常见类型之一，好发生于老年，但近些年的研究显示，慢性心衰的患者逐渐开始年轻化，青年的发病率正在逐年上升。心衰属于中医学“胸痹”、“喘证”、“水肿”范畴。本病由多种原因诱导，其初期多表现为心悸，胸闷，短气等症状，后随着病情的不断发展，严重者常出现心脏结构及功能的异常改变，主要表现为呼吸困难、乏力和全身性水肿。传统医家认为其发病多因久病或年老体衰，气血阴阳虚损有关，故采用张锡纯的“大气下陷”理论论治本病，临床上常用升陷汤治疗，以补益通利之法，用补益通利之品去实而愈重病，使正气得补，气机通利，水液代谢畅达，诸病得除。但临床上治疗此病主要以汤剂为主，本文通过分析张锡纯的“大气下陷”理论，阴阳五行的制化以及现代医家运用针灸补益通利的方法，以期为临床治疗慢性心力衰竭性水肿提供更加广阔的思路。

Abstract: Chronic heart failure is one of the common types of cardiovascular disease, which occurs in old age, but studies in recent years have shown that patients with chronic heart failure are gradually starting to get younger, and the incidence of young people is increasing year by year. Heart failure belongs to the categories of “chest paralysis”, “wheezing” and “edema” in traditional Chinese medicine. The disease is induced by a variety of reasons, the initial stage of the disease is mostly manifested as palpitations, shortness of breath, chest tightness and other symptoms, with the progression of the disease, severe cases often appear with abnormal changes in heart structure and function, mainly manifested as dyspnea, fatigue and systemic edema. Traditional physicians believe that its onset is mostly related to long-term illness or old age and physical decline, qi and blood yin and yang deficiency, so Zhang Xichun’s theory of “atmospheric depression” is used to treat the disease, and clinically commonly used Shengxi soup treatment, with the method of tongli, using tonic tongli products to achieve reality and become more serious, so that the right qi can be replenished, the qi machine is smooth, the water metabolism is smooth, and the diseases can be eliminated. However, the clinical treatment of this disease is mainly based on decoctions, and this article analyzes Zhang Xichun’s theory of “atmospheric subsidence”, the systemization of the five elements of yin and yang, and the method of modern doctors using acupuncture to supplement tongli, in order to provide new ideas for the clinical treatment of chronic heart failure edema.