“血不利则为水”理论辨治慢性心力衰竭思路

The approach to the diagnosis and treatment of chronic heart failure based on the theory of "stagnant blood leads to fluid retention"

关键词:  慢性心力衰竭  血不利则为水  中医药  辨治

Key words:  chronic heart failure  blood stasis leads to water retention  traditional Chinese medicine  diagnosis and treatment based on syndrome differentiation

摘要:

慢性心力衰竭是多种心脏疾病发展的终末阶段，最典型的临床表现是呼吸困难（喘）和外周水肿，可见“喘”“肿”等症，而这些症状的出现均与中医之“血不利则为水”理论有密切关联。“血不利”贯穿于慢性心力衰竭发生发展始终，基于中医“血不利则为水”理论，慢性心力衰竭呈现出“气虚不行，血脉瘀滞”“血行不畅，化而为水”“瘀水化热，耗伤气阴”等病机特点，临证时当谨守病机，抓住虚、瘀、水三者之间因果关联，以“益气为本”“活血为要”“利水为常”为治法，做到扶正不留邪，祛邪不伤正，标本同治，达到气行则瘀血不生、血行则水湿自利、水去则肿消喘平之效。

Abstract:

Chronic heart failure is the end stage of various heart diseases. The most typical clinical symptoms are dyspnea(wheezing) and peripheral edema, with visible signs such as wheezing and swelling. The onset of these symptoms is closely linked to the traditional Chinese medical theory that"blood stasis leads to water retention". "blood stasis "permeates the onset and progression of chronic heart failure. Based on the theory that "blood stasis leads to water retention", chronic heart failure exhibits disease mechanisms such as "qi deficiency preventing effective circulation, leading to blood stasis", "impaired blood flow, leading to fluid retention", and"stagnant fluid transforming into heat, depleting qi and yin", In clinical practice, it is essential to strictly adhere to the underlying pathology, grasp the causal relationship between qi deficiency, blood stasis, and fluid retention, and adopt therapeutic strategies based on the principles of "nourishing qi", "promoting blood circulation" and "promoting fluid excretion"to achieve the goal of supporting the body's vital energy without retaining pathogenic factors, eliminating pathogenic factors without harming the body's vital energy, and addressing both symptoms and root causes, thereby achieving the effects of promoting qi circulation to prevent blood stasis, promoting blood circulation to facilitate self-resolution of fluid retention, and eliminating fluid retention to relieve swelling and asthma.