心肾同治法治疗心力衰竭合并利尿剂抵抗OA

The core pathogenesis of chronic heart failure complicated with diuretic resistance is decline of heart and kidney yang qi,dis-order of qi and blood,and interbinding of water and blood stasis,presenting a syndrome of root deficiency and branch excess with mixed deficiency and excess.Treatment should focus on simultaneous regulation of the heart and kidney,addressing both root and branch.In the early stage,qi deficiency and blood stasis predominate.Treatment should focus on warming and tonifying the heart and kidney,invig-orating blood to resolve stasis.Fuzi(Radix Aconiti Lateralis Preparata)and Guizhi(Ramulus Cinnamomi)can be used to assist yang with their acrid-warm properties,with Huangqi(Radix Scutellariae)and Dangshen(Radix Codonopsis)are combined to tonify qi with sweet-warm propertiess,forming a synergistic effect of"minor fire generating qi."True Warrior Decoction,Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction are adopted in combination with blood-activating and stasis-resolving medicinals.In the middle stage,yang deficiency leads to flooding of water,with symptoms such as aversion to cold,cold limbs,edema,and dyspnea,and obvious intermingled stasis and water.On the basis of warming and tonifying the heart and kidney,treatment should focus on promo-ting urination and regulating qi,adding medicinals such as Tinglizi(Semen Descurainiae seu Lepidii),Sangbaipi(Cortex Mori),Yimucao(Herba Leonuri),Zhuling(Polyporus),Dafupi(Pericarpium Arecae),and Zexie(Rhizoma Alismatis).In the late stage,deficiency,sta-sis,and water interbind,with severe depletion of heart and kidney yang qi and dual deficiency of qi and blood.Treatment should supple-ment both yin and yang and regulate qi and yin simultaneously.Yin-nourishing medicinals are combined with warming-yang formulas,which not only nourish kidney yin to support heart yang,but also moderate the drying and intense properties of Fuzi(Radix Aconiti Late-ralis Preparata).Non-pharmacological therapies such as electroacupuncture,heat-sensitive moxibustion,and acupoint application are al-so combined to stimulate yang qi,regulate water metabolism,and enhance therapeutic efficacy.