基于“湿浊痰饮”探讨心力衰竭的治疗

Exploring the Treatment of Heart Failure Based on the Theory of “Damp-Turbidity Phlegm-Fluid”

摘要: 心力衰竭(Heart Failure，心衰)是由多种原因引起的以心室充盈、心脏功能受损或心脏结构失代偿为特点的一组复杂临床综合征，是大部分心血管疾病的最终归宿，严重影响患者的预后和生活质量。中医学理论认为，心衰的发生发展与水湿、痰饮、瘀血等因素关系密切。“湿浊痰饮”理论为中医治疗心衰提供了新的视角，文章基于该学术思想，从水湿、痰饮、瘀血的角度探讨了心力衰竭的治疗思路。肺、脾、肾三脏与“湿浊痰饮”密切相关，脾为生痰之源，肺为贮痰之器，肾为痰饮之根。一旦三脏功能失调，则会导致人体内正常的津液代谢失常，水湿痰饮积聚，从而进一步促进心衰的发生与发展。同时，心衰的发病及演变过程离不开“瘀血”这个重要因素，因此在使用温阳利水法、益气健脾法、化痰开窍法的基础上，结合患者舌脉灵活运用活血化瘀法可获得更好的疗效反馈。临证当标本兼治，以提升治疗效果，改善患者生活质量，为中医辨治心衰提供理论依据和实践参考。

Abstract: Heart failure (HF) is a complex clinical syndrome characterized by impaired ventricular filling, compromised cardiac function, or structural decompensation due to various causes. It represents the final common pathway for most cardiovascular diseases, severely impacting patient prognosis and quality of life. Traditional Chinese Medicine (TCM) theory posits that the development and progression of heart failure are closely related to factors such as water-dampness, phlegm-fluid, and blood stasis. The “Damp-Turbidity Phlegm-Fluid” theory provides a novel perspective for TCM in treating HF. Based on this academic concept, this paper discusses the treatment approach for heart failure from the perspectives of water-dampness, phlegm-fluid, and blood stasis. The lungs, spleen, and kidneys are intimately connected with the formation of “Damp-Turbidity Phlegm-Fluid”, wherein the spleen is the source of phlegm production, the lungs are the reservoir, and the kidneys are the root. Dysfunction of these three organs disrupts normal body fluid metabolism, leading to the accumulation of dampness, phlegm, and fluid, which in turn promotes the onset and progression of heart failure. Concurrently, the pathogenesis and evolution of heart failure invariably involve the critical factor of blood stasis. Therefore, integrating the method of activating blood circulation and resolving stasis, tailored to the patient’s tongue and pulse manifestations, with core therapeutic principles—such as warming Yang to promote diuresis, boosting Qi to fortify the spleen, and resolving phlegm to open the orifices—can yield superior therapeutic outcomes. Clinical practice should address both root cause and branch manifestations to enhance treatment efficacy, improve patient quality of life, and provide theoretical foundations and practical references for TCM-based pattern differentiation and treatment of heart failure.