周宜轩从"虚气留滞"论治射血分数轻度降低型心力衰竭经验OA

Heart failure is a complex clinical syndrome caused by abnormal changes in the structure and/or function of the heart resulting from a variety of etiologies,causing ventricular systolic and/or diastolic dysfunction,which is the final result of various cardiovascular events and the cumulative effect of various cardiac abnormalities,with a poor prognosis and a high risk of death.Heart failure with mildly reduced ejection fraction refers to heart failure with a left ventricular ejection fraction of 41％to 49％.Based on the theory of stagnation of deficient Qi(气),Professor ZHOU Yixuan holds that the root causes of the disease lie in the insufficiency of Zong Qi(宗气),middle Qi and Yuan Qi(元气),while the superficial causes are the retention of pathogenic factors such as static blood,phlegm-dampness and fluid retention.The professor innovatively proposed that the core pathogenesis of this disease is three types of deficiency leading to three types of stagnation.Insufficiency of Zong Qi results in weakness in blood circulation,manifested as shortness of breath and dyspnea,which corresponds to myocardial energy metabolism disorders.Insufficiency of middle Qi gives rise to internal generation of phlegm-dampness,presenting with poor appetite,abdominal distension,limb edema and loose stools,which corresponds to gastrointestinal hypoperfusion and intestinal flora imbalance.Insufficiency of Yuan Qi leads to failure in fluid transformation,marked by aversion to cold,cold limbs and frequent nocturia,which is associated with the long-term excessive activation of the renin-angiotensin-aldosterone system(RAAS)and sympathetic nervous system(SNS).Collectively,these three types of deficiency give rise to the excessive superficial pathogenesis characterized by static blood obstructing the collaterals,phlegm-dampness impairing the spleen,and fluid retention attacking the heart.Based on this,Professor ZHOU Yixuan established the therapeutic principle of tonifying deficiency and unblocking stagnation,and implemented treatment differentiated by the three energizers(Sanjiao).For tonifying the upper energizer,the modified Shengmai Huoxue Tang(生脉活血汤)is commonly used to regulate Qi movement,unblock the vessels,promote blood circulation and resolve blood stasis.For strengthening the middle energizer,the combined modified Linggui Zhugan Tang(苓桂术甘汤)and Tingli Dazao Xiefei Tang(葶苈大枣泻肺汤)are usually adopted to dry dampness and resolve phlegm,as well as promote blood circulation and unblock the vessels.For warming the lower energizer,the combined modified Zhenwu Tang(真武汤)and Linggui Zhugan Tang are frequently prescribed to tonify the Yuan Qi,warm Yang,dispel cold and unblock the vessels.The core of this treatment lies in applying treatment in accordance with the Qi movement characteristics of the different Zang-Fu organs in the upper,middle and lower energizers.All these treatments are based on tonifying Qi,with the method of promoting blood circulation and unblocking vessels integrated throughout the therapies such as Qi-tonifying,phlegm-resolving and Yang-warming,thus forming a diagnostic and therapeutic approach characterized by integrating disease diagnosis with syndrome differentiation and treating both the root cause and superficial symptoms.