基于络病理论下气络-血络协同视角的慢性心力衰竭络病链式演变与辨治规律OA

Chronic heart failure(CHF)is a clinical syndrome characterized by ventricular filling and/or ejection disorders caused by abnormalities in cardiac structure or function,with pathological features of a protracted and recurrent course as well as an interweaving of deficiency and excess.The collateral disease theory provides innovative insights for the theoretical research and clinical practice of CHF.This article reviews the developmental context of the collateral disease theory and proposes a dual-dimensional system of qi collaterals and blood collaterals to systematically capture the pathological changes of the heart.It points out that the etiology of CHF lies in the constitutional vulnerability of qi collaterals and blood collaterals:Deficiency of heart qi,decline of pectoral qi,and dysfunction of the five zang-organs lead to reduced permeation and perfusion of collaterals.The occurrence and progression of CHF follow the pathogenesis law of"impairment of qi collaterals,stasis of blood collaterals,and collateral stagnation leading to mass accumulation",which is associated with the processes such as cardiac energy metabolism disorders,insufficient microcirculatory perfusion,ventricular remodeling,and hyperactivation of the neurohumoral axis.Based on the pathogenic chain model of synergistic imbalance between qi collaterals and blood collaterals,a staged syndrome differentiation and treatment system is constructed:collateral deficiency stage,collateral stasis stage,and collateral stagnation stage.The therapeutic principles are as follows:replenish qi and unblock collaterals in the early stage,resolve stasis and eliminate phlegm in the middle stage,and warm yang and promote diuresis in the advanced stage.This theoretical framework not only deepens the understanding of the pathogenesis of CHF but also provides a theoretical basis and practical approach for constructing a staged prevention and treatment strategy of integrated traditional Chinese and Western medicine.