基于“脾邪干心”理论探讨慢性心力衰竭合并肥胖症代谢紊乱机制及中医药应用
Exploring Metabolic Mechanisms and Traditional Chinese Medicine Interventions in Chronic Heart Failure with Obesity: A Perspective Based on the “Spleen Problems Affecting Heart” Theory
DOI: 10.12677/md.2026.165064, PDF,   
作者: 王雅婷*：黑龙江中医药大学研究生院，黑龙江 哈尔滨；郭丹丹#：黑龙江中医药大学附属第二医院心血管内科，黑龙江 哈尔滨
关键词: “脾邪干心”；慢性心力衰竭；肥胖症；脂肪因子；心外膜脂肪组织；“Spleen Problems Affecting Heart”； Chronic Heart Failure； Obesity； Adipokines； Epicardial Adipose Tissue
摘要: 心血管疾病已进入心脏代谢医学时代。慢性心力衰竭(Chronic Heart Failure, CHF)的临床治疗核心正从单一干预心功能，转向慢性共病的长期管理。肥胖症是CHF最常见的代谢共病之一。脂肪因子、胰岛素抵抗、心外膜脂肪组织所引起的代谢紊乱是其共病的核心病理环节。“脾邪干心”指脾失健运所产生的痰湿、脂浊等病理产物干犯心宫，与代谢紊乱引起的CHF合并肥胖症的病理机制相契合。文章在“脾邪干心”理论的视角下，从脂肪因子紊乱、胰岛素抵抗、心外膜脂肪组织异常三个代谢层面，系统阐释“脾失健运致脾邪内生，循经干心，耗散心气，损及心体”的动态疾病演变过程，并总结相关中医药的应用，为相关科学研究与临床实践提供新的思路与框架。
Abstract: Cardiovascular disease has entered the era of cardiometabolic medicine. The clinical treatment of chronic heart failure (CHF) is shifting from a sole focus on targeting cardiac function towards long-term management of chronic comorbidities. Obesity stands as one of the most prevalent metabolic comorbidities associated with CHF. The core pathological mechanisms underpinning this comorbidity involve metabolic disturbances triggered by adipokines, insulin resistance, and epicardial adipose tissue. The concept of “Spleen Problems Affecting Heart” describes pathological products such as phlegm-dampness and lipid turbidity arising from impaired spleen function invading the heart. This aligns with the pathomechanism of obesity coexisting with CHF induced by metabolic disorders. This paper, framed by the “Spleen Problems Affecting Heart” theory, systematically elucidates the dynamic disease progression—where impaired spleen function generates pathogenic factors that invade the heart via meridians, dissipating heart qi and damaging heart substance—across three metabolic dimensions: adipokine dysregulation, insulin resistance, and epicardial adipose tissue abnormalities. It further summarises relevant applications of Traditional Chinese Medicine, offering novel perspectives and frameworks for related scientific research and clinical practice.
文章引用：王雅婷, 郭丹丹. 基于“脾邪干心”理论探讨慢性心力衰竭合并肥胖症代谢紊乱机制及中医药应用[J]. 医学诊断, 2026, 16(5): 490-499. https://doi.org/10.12677/md.2026.165064

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