基于"上下交损,治其中"辨治缓慢性心律失常OA

The core pathogenesis of bradyarrhythmia(BA)lies in the dysfunction of the middle energizer(including the spleen and stomach),which leads to disorder of the three functional axes:"heart-spleen-intestine,""heart-spleen-liver,"and"heart-spleen-kid-ney."This dysregulation subsequently induces insufficiency of heart-yang,deficiency of kidney-yang,and impairment of qi and blood circulation.As the root cause is invariably the dysfunction of the spleen and stomach resulting in the disruption of the clear and the tur-bid,the therapeutic principle should prioritize regulating the middle energizer,combined with targeted treatments addressing the distinct pathological characteristics of each axis.For disorders of the"heart-spleen-intestine"axis manifesting as qi and blood deficiency and in-testinal stagnation,the treatment should focus on supplementing qi,nourishing blood,fortifying the spleen,and regulating the intestines.Formulas such as Four Gentlemen Decoction to boost qi and invigorate the spleen,and Modified Spleen-Restoring Decoction to boost qi,invigorate the spleen,nourish blood,and calm the spirit can be used.For disorders of the"heart-spleen-liver"axis characterized by liver qi stagnation and counterflow of qi movement,the treatment should focus on regulating the liver and spleen simultaneous,and banking up earth and suppressing wood.Formulas like Free Wanderer Powder)and Bupleurum Liver-Soothing Powder are employed.For disorders of the"heart-spleen-kidney"axis presenting as heart-kidney disharmony and imbalance of yin and yang,the treatment should focus on warming and tonifying the spleen and kidney,and to restore communication between the heart and kidney to harmonize yin and yang.Formulas such as Ephedra and Aconite and Asarum Decoction to warm yang,dispel cold,and invigorate the yang of the heart and kid-ney,and Modified True Warrior Decoction to warm yang and promote diuresis to resolve fluid retention can be used.In cases of pro-longed illness invading the collaterals,where phlegm and blood stasis intertwine,both being pathological products and etiological fac-tors,the treatment should aim to activate blood circulation,resolve stasis,dissolve phlegm,and unblock the collaterals.Therefore,Blood Mansion Stasis-Expelling Decoction combined with Modified Two Matured Substances Decoction can be adopted.