从"瘀-毒-虚"病机的时空演变探讨心肌梗死后心力衰竭的发生发展与中医诊疗思路OA

This study systematically explored a traditional Chinese medicine(TCM)diagnostic and therapeutic strategy for heart failure(HF)post-myocardial infarction(MI)through the spatio-temporal progression of the"blood stasis-toxicity-deficiency"pathogenesis.We propose an evolutionary model of"blood stasis leading to toxin,and toxin leading to deficiency,"dividing the occurrence and progression of HF post-MI into three stages:the local stagnation stage characterized by blood stasis obstructing heart vessels,which corresponds to the acute onset of MI correlating with thrombosis/microcirculatory dysfunction;the subacute-to-chronic toxin-damage on heart and kidney stage marked by blood stasis-toxin interplay driving post-MI ventricular remodeling and HF progression,which is associated with inflammation/oxidative stress;and the systemic deficiency stage in which HF worsens,defined by blood toxin-induced qi-blood depletion causing multi-organ deficiency,which involves energy metabolism dysregulation/neuroendocrine activation.Each stage is predominantly characterized by blood stasis,toxin,and deficiency,respectively;however,these stages are not entirely independent and may intertwine.Stage-specific therapies include promoting blood circulation and resolving blood stasis to improve perfusion during the local stagnation stage;detoxifying and promoting diuresis to inhibit remodeling during the toxin-damage on heart and kidney stage;and strengthening and consolidating body resistance to alleviate symptoms during the systemic deficiency stage.Future research should elucidate the material basis of the pathogenesis,establish dynamic syndrome mapping,and advance a precision TCM framework integrating staging,syndrome differentiation,and grading;establish a synergistic intergrated TCM and Western medicine treatment plan.