基于"大气一转,其气乃散"论治射血分数保留型心力衰竭OA

Jingui Yaolue(《金匮要略》)states,"Once Yin(阴)and Yang(阳)are in harmony,the Qi(气)flows;once the pectoral Qi circulates freely,all stagnant Qi will disperse".Based on this theory,this paper explores the pathogenesis and treatment strategy of heart failure with preserved ejection fraction(HFpEF)from a traditional Chinese medicine(TCM)perspective,proposing that the core pathogenesis of HFpEF is"pectoral Qi does not turn,resulting in the accumulation of turbid and stagnant Qi in the organs."HFpEF is a common type of heart failure characterized by a normal left ventricular ejection fraction.Its pathological essence lies in diastolic dysfunction and increased myocardial stiffness.Current treatments mainly focus on symptom relief and improving quality of life,with no clearly targeted therapies available.In TCM theory,"pectoral Qi"governs the circulation of the body's Vital Qi and is the central hub for the rise and fall of Qi.In a physiological state,the circulation of pectoral Qi harmonizes Yin and Yang.In a pathological state,when pectoral Qi fails to circulate,Qi stagnates,fluids accumulate,phlegm and blood stasis form,and turbid toxins accumulate,ultimately leading to the weakening of the organs.The pathogenesis of HFpEF evolves three stages dynamically:In the early stage,"pectoral Qi begins to stagnate,and the pivotal Qi is blocked",leading to symptoms such as chest tightness,shortness of breath,and abdominal distension.In the middle stage,"pectoral Qi stagnates for a long time,and turbid blood and phlegm congeal",causing exertional dyspnea and lower limb edema;In the later stage,"stagnation leads to deficiency,and pectoral Qi becomes debilitated",with heart and kidney Yang deficiency and excessive accumulation of water and fluids.In terms of clinical manifestations,"Qi does not disperse,"resulting in the mutual accumulation of phlegm,blood stasis,and water retention,forming a complex pattern of both excess and deficiency.To address this pathogenesis,this study proposes a staged treatment strategy of"regulating Qi to adjust its pivotal function,and nourishing the deficiency while eliminating turbid accumulation".In the early stage,the focus is on"regulating Qi to adjust its pivotal function",to harmonize the middle Jiao(焦),smooth the Qi flow,and clear turbid accumulation,restoring the circulation of pectoral Qi;in the middle stage,both supplementation and clearing are used,with a focus on Qi-regulating,blood-activating,and promoting circulation with the addition of insect-based remedies;in the later stage,the focus shifts to warming Yang and strengthening the foundation,with the use of formulas to warm the kidneys,strengthen the spleen,resolve phlegm,and promote diuresis;during the acute phase,"eliminating turbid accumulation"is prioritized,using comprehensive methods to activate blood,promote diuresis,resolve phlegm,and promote circulation to quickly eliminate stagnation and toxins,reducing the burden on the heart.This treatment approach integrates the principles of"regulating Qi to adjust the pivot"and"nourishing the deficiency while eliminating turbid accumulation",balancing the smooth flow of Qi,blood,and fluids,and aiming to achieve the goal of"once the pectoral Qi circulates freely,all stagnant Qi will disperse".This strategy provides new theoretical insights and treatment guidelines for the staged differentiation and treatment of HFpEF in TCM.However,it still requires large-scale clinical validation and individualized treatment studies,along with the integration of modern medical technologies,to explore more precise therapeutic strategies.