基于“宗气贯心脉”理论探讨心肌能量代谢与慢性心力衰竭

Exploring Myocardial Energy Metabolism and Chronic Heart Failure Based on the Theory of “Zong Qi Penetrating the Heart Vessels”

摘要: 慢性心力衰竭(CHF)是多种心脏疾病的终末阶段。心肌能量代谢障碍是CHF的核心病理环节，主要表现为线粒体氧化磷酸化受损、ATP生成不足。中医学CHF病机总属本虚标实，以“宗气不足”为导引。现有研究提示“宗气”与线粒体能量代谢存在关联，但尚未回答宗气的哪一具体功能环节与线粒体氧化磷酸化相对应。本文以“贯心脉”为逻辑枢纽，提出“宗气贯心脉–线粒体氧化磷酸化”理论假说，构建从宗气功能到能量代谢的因果递进链条，并据此探讨“升补宗气”治则的应用。文章结合临床证据分析假说的契合性，主动讨论其局限性与替代解释，提出可检验的预测，为中医药干预CHF提供理论参考。

Abstract: Chronic heart failure (CHF) is the terminal stage of various heart diseases. Myocardial energy metabolism disorder is a core pathological link of CHF, mainly manifested as impaired mitochondrial oxidative phosphorylation and insufficient ATP production. In traditional Chinese medicine (TCM), the pathogenesis of CHF is generally characterized by deficiency in origin and excess in manifestation, with “zong qi deficiency” as the leading factor. Existing studies suggest an association between “zong qi” and mitochondrial energy metabolism, but have not answered which specific functional link of zong qi corresponds to mitochondrial oxidative phosphorylation. This paper takes “penetrating the heart vessels” as the logical pivot, proposes the theoretical hypothesis of “zong qi penetrating the heart vessels—mitochondrial oxidative phosphorylation”, constructs a causal progressive chain from zong qi function to energy metabolism, and accordingly explores the application of the therapeutic principle of “tonifying and elevating zong qi”. Combined with clinical evidence, the paper analyzes the consistency of the hypothesis, proactively discusses its limitations and alternative explanations, and proposes testable predictions, providing a theoretical reference for TCM intervention in CHF.