中西医结合治疗心房颤动的研究现状

Current Research Status of Integrated Traditional Chinese and Western Medicine in the Treatment of Atrial Fibrillation

摘要: 心房颤动是临床最常见的持续性心律失常，发病率随年龄增长显著上升，与脑卒中、心力衰竭及死亡风险增加密切相关。西医以抗凝、节律控制、心室率控制及导管消融为核心手段，但长期药物不良反应与术后复发问题仍制约疗效。中医将房颤归属于心悸、怔忡范畴，辨治体系历经《内经》奠基、张仲景立论、后世充实，至现代形成本虚标实的核心病机认识，并衍生出络风内动、火郁发之、从脾胃论治等创新学说。近年来，中西医结合方案在房颤的治疗中的优势逐渐突出，凭借西医规范干预与中医药多靶点调控的协同优势，有效弥补了单纯西医在延缓左房结构重构、降低长期复发率等方面的局限。本文系统梳理房颤的中医理论源流、辨证分型规律、西医机制进展及中西医结合干预证据，指出当前证候标准化缺失、高质量循证不足、机制研究薄弱等瓶颈，提出未来应在标准化、循证化与机制化三维协同推进，以期为推进中西医有机结合与深度协同发展提供借鉴。

Abstract: Atrial fibrillation is the most common sustained arrhythmia in clinical practice. Its incidence rises significantly with age and is closely associated with increased risks of stroke, heart failure, and death. Western medicine takes anticoagulation, rhythm control, ventricular rate control, and catheter ablation as core strategies, but long-term adverse drug reactions and postoperative recurrence still restrict the efficacy. Traditional Chinese Medicine (TCM) classifies atrial fibrillation into the categories of “Xinji” (palpitation) and “Zhengchong” (severe palpitation). The system of syndrome differentiation and treatment was founded in the Inner Canon of the Yellow Emperor (Neijing), established by Zhang Zhongjing, and enriched by later generations. In modern times, it has formed the core pathogenesis understanding of “Ben-Xu-Biao-Shi” (deficiency in the root and excess in the manifestation), and derived innovative theories such as “collateral wind stirring internally” (luo feng nei dong), “fire stagnation needing dispersion” (huo yu fa zhi), and “treatment from the spleen and stomach”. In recent years, the advantages of integrated TCM and Western medicine regimens in the treatment of atrial fibrillation have become increasingly prominent. By virtue of the synergistic advantages of standardized Western medical intervention and multi-target regulation of TCM, they effectively compensate for the limitations of Western medicine alone in delaying left atrial structural remodeling and reducing long-term recurrence rates. This paper systematically reviews the TCM theoretical origins of atrial fibrillation, syndrome differentiation patterns, progress in Western medical mechanisms, and evidence of integrated interventions. It points out current bottlenecks such as the lack of syndrome standardization, insufficient high-quality evidence, and weak mechanistic research. It proposes that future research should advance synergistically in three dimensions: standardization, evidence-based medicine, and mechanistic exploration, in order to provide a reference for promoting the organic combination and deep collaborative development of Chinese and Western medicine.