基于“阳气化行”理论探析心肌梗死后心力衰竭的诊治思路

Post-Myocardial Infarction Heart Failure: Diagnostic and Therapeutic Insights from the Perspective of Yang Qi Transformation and Circulation Theory

摘要: 急性心肌梗死后心力衰竭(心梗后心衰)是急性心肌梗死患者最常见且严重的并发症之一，且发病率高、预后差，严重威胁患者生命安全。“阳气化行”理论源于《周易》乾坤学说，承《内经》“阳气者，若天与日”之旨，经张仲景扶阳思想发展，至郑钦安而集大成。本文旨在构建基于“阳气化行”理论的心梗后心衰中医病机理论框架，为临床辨证论治提供系统性指导。心梗后心衰的发生发展与“阳气化行”理论密切相关，阳气卫外失司，营卫不和，腠理疏松，外邪乘虚而入，损伤心体，此为发病之始动因素；阳气推动无力，血行瘀滞，津液输布失常，痰瘀胶结，阻滞心络，此为发病之关键病理环节；心阳亏虚，一身阳气失其根本，日久累计脾肾，脾失温煦而运化失司，肾失资助而气化不行，水湿痰浊内生，此为发病之根本。本文以“阳气化行”理论为指导，秉承“未病先防”、“既病防变”理念，以益气温阳为主要治法，兼以调和营卫、活血通络、化饮利水，从根本上恢复阳气化行功能，达到“阳气化行，阴邪即灭”之治疗目标。

Abstract: Post-myocardial infarction heart failure (post-MI heart failure) is one of the most common and severe complications in patients with acute myocardial infarction, characterized by high incidence and poor prognosis, posing a serious threat to patients’ life safety. The theory of “Yang Qi transformation and circulation” originated from the Qian-Kun doctrine in the Book of Changes (I Ching), inherited the essence of “Yang Qi is like heaven and sun” from the Neijing (Inner Canon), developed through Zhang Zhongjing’s Yang-supporting theory, and reached its culmination with Zheng Qin’an. The occurrence and development of post-MI heart failure are closely related to the theory of “Yang Qi transformation and circulation.” The dysfunction of Yang Qi’s defensive function leads to disharmony between nutrient Qi and defensive Qi, loose interstices, and external pathogens invading due to deficiency, thereby damaging the heart substance—this constitutes the initiating factor of pathogenesis. The weakened propelling function of Yang Qi results in blood stasis, abnormal distribution of body fluid, phlegm-stasis binding, and blockage of heart collaterals—this represents the key pathological process of pathogenesis. Heart Yang deficiency causes the loss of the root of whole-body Yang Qi, which gradually affects the spleen and kidney over time: the spleen loses warmth and fails in transportation, while the kidney loses support and fails in Qi transformation, leading to internal generation of water-dampness and phlegm-turbidity—this constitutes the fundamental pathogenesis. This article, guided by the theory of “Yang Qi transformation and circulation” and adhering to the concepts of “preventing disease before onset” and “preventing transmission after onset,” employs supplementing Qi and warming Yang as the primary therapeutic method, combined with harmonizing nutrient and defensive Qi, activating blood and unblocking collaterals, and resolving fluid retention and promoting urination. The treatment aims to fundamentally restore the function of Yang Qi transformation and circulation, achieving the therapeutic goal of “when Yang Qi transforms and circulates, pathogenic Yin is eliminated”.