基于气血理论探讨炙甘草防治房颤心肌纤维化
Exploring the Prevention and Treatment of Atrial Fibrillation-Induced Myocardial Fibrosis with Zhigancao Decoction Based on the Theory of Qi and Blood
DOI: 10.12677/tcm.2025.141058, PDF,   
作者: 马雪宁*, 石开虎#：南京中医药大学附属中西医结合医院，江苏 南京
关键词: 气血理论；炙甘草汤；心房颤动；心肌纤维化；Qi and Blood Theory； Zhigancao Decoction； Atrial Fibrillation； Myocardial Fibrosis
摘要: 心房颤动是临床实践中常见的心律失常，其发病机理错综复杂。心肌纤维化作为房颤的主要病理基础，与房颤可互相促进，进而导致疾病的加重。基于房颤心肌纤维化的临症表现，中医可将其归于“心悸”范畴来诊治。本文从气血理论出发，结合现代药理学及临床研究，讨论气血失和与房颤心肌纤维化的相关性，探讨炙甘草汤对房颤心肌纤维化的治疗作用。研究发现，炙甘草汤诸药合用，益气养阴，补血复脉，具有保护心肌、延缓心肌重构等多重功效，能有效改善心肌纤维化状况，从而防治心房颤动。
Abstract: Atrial fibrillation (AF) is a common arrhythmia in clinical practice, characterized by a complex pathogenesis. Myocardial fibrosis, serving as a primary pathological substrate of AF, can mutually exacerbate AF, leading to disease progression. Based on the clinical manifestations of AF-related myocardial fibrosis, traditional Chinese medicine categorizes it under the diagnosis and treatment framework of “palpitations”. This paper, grounded in the theory of qi and blood, integrates modern pharmacology and clinical research to discuss the correlation between qi-blood disharmony and AF-related myocardial fibrosis, as well as to explore the therapeutic effects of Zhigancao Decoction on AF-related myocardial fibrosis. The study reveals that Zhigancao Decoction, through the combined actions of its constituents, tonifies qi and nourishes yin, replenishes blood, and restores the pulse. It exhibits multiple benefits including myocardial protection and delay of myocardial remodeling, thereby effectively ameliorating myocardial fibrosis and preventing AF.
文章引用：马雪宁, 石开虎. 基于气血理论探讨炙甘草防治房颤心肌纤维化[J]. 中医学, 2025, 14(1): 375-380. https://doi.org/10.12677/tcm.2025.141058

参考文献

[1] Chen, P., Chen, L.S., Fishbein, M.C., Lin, S. and Nattel, S. (2014) Role of the Autonomic Nervous System in Atrial Fibrillation. Circulation Research, 114, 1500-1515. [Google Scholar] [CrossRef] [PubMed]
[2] Denham, N.C., Pearman, C.M., Caldwell, J.L., Madders, G.W.P., Eisner, D.A., Trafford, A.W., et al. (2018) Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure. Frontiers in Physiology, 9, Article 1380. [Google Scholar] [CrossRef] [PubMed]
[3] Verheule, S., Sato, T., Everett, T., Engle, S.K., Otten, D., Rubart-von der Lohe, M., et al. (2004) Increased Vulnerability to Atrial Fibrillation in Transgenic Mice with Selective Atrial Fibrosis Caused by Overexpression of TGF-β1. Circulation Research, 94, 1458-1465. [Google Scholar] [CrossRef] [PubMed]
[4] 李贝金. 基于数据挖掘技术的李平教授辨治心房颤动经验研究[D]: [硕士学位论文]. 北京: 北京中医药大学, 2023.
[5] 娜几娜∙吾格提, 艾力曼∙马合木提, 王坤, 等. 炙甘草汤减缓兔右心房颤所致心肌纤维化作用[J]. 中国实验诊断学, 2014, 18(11): 1754-1758.
[6] 颜德馨. 中医气血证治学[M]. 北京: 中国中医药出版社, 2015: 732.
[7] 王茹, 王培利, 王承龙. 房颤的中医研究进展[J]. 辽宁中医杂志, 2020, 47(6): 213-216.
[8] Gyöngyösi, M., Winkler, J., Ramos, I., Do, Q., Firat, H., McDonald, K., et al. (2017) Myocardial Fibrosis: Biomedical Research from Bench to Bedside. European Journal of Heart Failure, 19, 177-191. [Google Scholar] [CrossRef] [PubMed]
[9] Li, C., Zhang, J., Hu, W. and Li, S. (2020) Atrial Fibrosis Underlying Atrial Fibrillation (Review). International Journal of Molecular Medicine, 47, Article No. 9. [Google Scholar] [CrossRef] [PubMed]
[10] Liu, M., López de Juan Abad, B. and Cheng, K. (2021) Cardiac Fibrosis: Myofibroblast-Mediated Pathological Regulation and Drug Delivery Strategies. Advanced Drug Delivery Reviews, 173, 504-519. [Google Scholar] [CrossRef] [PubMed]
[11] 吴正波, 吴旸, 谢连娣, 等. 基于气血理论探讨心肌纤维化与气虚血瘀水停证的关系[J]. 中西医结合心脑血管病杂志, 2023, 21(16): 3071-3074.
[12] 刘果果, 张明, 石磊, 等. 胡希恕治疗心悸的经方使用规律[J]. 中医药导报, 2021, 27(9): 176-179.
[13] 高翔, 于美丽, 李金根, 等. 徐浩教授从“虚”“瘀”“风”论治阵发性房颤经验浅析[J]. 中西医结合心脑血管病杂志, 2016, 14(15): 1813-1815.
[14] 李哲山, 刘聪. 心房颤动中医证候及用药规律文献研究[J]. 中国卫生标准管理, 2019, 10(15): 94-97.
[15] 杨璇妹, 陈晓虎. 房颤发病机制的中西医研究[J]. 浙江中西医结合杂志, 2017, 27(8): 732-735.
[16] 李渊芳, 谢盈彧, 徐士欣, 等. 浅析气血同治法在冠脉微循环障碍中的应用[J]. 辽宁中医杂志, 2019, 46(9): 1855-1858.
[17] (清)王清任, 撰. 李天德, 张学文, 整理. 医林改错[M]. 北京: 人民卫生出版社, 2005: 62.
[18] 夏菲菲, 刘震超, 周明爱, 等. 近十年营卫学说研究进展[J]. 中华中医药杂志, 2018, 33(4): 1474-1477.
[19] 贾波, 主编, 王璞, 韩彬, 吴建红, 等, 副主编. 方剂学[M]. 北京: 中国中医药出版社, 2016: 205.
[20] 李潇潇, 司廷林. 炙甘草汤方证临床医案浅析[J]. 中国中医药现代远程教育, 2024, 22(17): 63-66.
[21] 张效科, 丁纪茹. 从经方中感悟仲景治疗心系病证用药智慧[J]. 陕西中医药大学学报, 2020, 43(1): 30-33.
[22] 谢瑞强, 王长福. 炙甘草化学成分和药理作用研究进展[J]. 中医药信息, 2023, 40(4): 84-89.
[23] 刘燕, 邹远荣, 黄建萍, 等. UPLC-TOF-MS、GC-MS结合网络药理学探讨炙甘草抗心律失常的作用机理[J]. 陕西中医药大学学报, 2023, 46(4): 84-93.
[24] Zhang, Y., Zhang, L., Zhang, Y., Xu, J., Sun, L. and Li, S. (2016) The Protective Role of Liquiritin in High Fructose-Induced Myocardial Fibrosis via Inhibiting Nf-κb and MAPK Signaling Pathway. Biomedicine & Pharmacotherapy, 84, 1337-1349. [Google Scholar] [CrossRef] [PubMed]
[25] 张晶芳, 沈晓旭, 李颖, 等. 炙甘草汤对比西医治疗心房颤动临床疗效的Meta分析[J]. 中国中医急症, 2021, 30(4): 584-589.
[26] 谢冰昕, 李树斌, 马丽华, 等. 炙甘草汤加减方治疗心房颤动随机对照试验的Meta分析[J]. 世界中医药, 2017, 12(9): 2219-2222.
[27] 刘长猛. 炙甘草汤治疗心房颤动患者的效果及对炎症因子水平的影响[J]. 中国医学创新, 2022, 19(18): 44-48.
[28] Guo, S., Xue, Y., Zhu, X., Yang, B. and Zhou, C. (2022) Effects and Pharmacological Mechanism of Zhigancao Decoction on Electrical and Structural Remodeling of the Atrium of Rabbits Induced by Rapid Atrial Pacing. Journal of Interventional Cardiac Electrophysiology, 66, 597-609. [Google Scholar] [CrossRef] [PubMed]
[29] 熊兴江. 基于现代病理生理及CCU急危重症病例的炙甘草汤方证溯源及其复律、转窦、止血、升血小板、补虚临床运用[J]. 中国中药杂志, 2019, 44(18): 3842-3860.
[30] 孙子雯, 卢笑晖. 炙甘草汤调节免疫细胞自噬干预房颤的生物信息机制探讨[J]. 中国中医药现代远程教育, 2023, 21(12): 140-142.
[31] 白雪峰, 万晓燕, 惠彩霞. 炙甘草汤对异丙肾上腺素诱导的心肌纤维化大鼠心肌NF-κB信号通路的调节作用研究[J]. 现代中西医结合杂志, 2021, 30(31): 3440-3446.
[32] Wijesurendra, R.S. and Casadei, B. (2019) Mechanisms of Atrial Fibrillation. Heart, 105, 1860-1867. [Google Scholar] [CrossRef] [PubMed]