摘要
心功能损伤的病理过程中,伴有一系列能量代谢的改变,心肌底物代谢发生重构,脂肪酸、葡萄糖等能量底物的选择与利用出现转移,持续的底物代谢紊乱将恶化能量供应、促进心力衰竭的发生发展。底物代谢重构实际上是脏腑功能下降与病理产物积聚之间的层次递进、相兼为患、双向因果,“虚气留滞”是核心病机的概括。“虚气”(心气虚损、能量不足)是发病之本,作为始动因素并贯穿疾病始终;“留滞”(痰瘀水邪、脂毒性产物与乳酸等)是发病之标,是病情恶化进展的进一步表现;“虚气”与“留滞”相互交织、互为因果,反复叠加构成螺旋式的恶性循环,概括为因虚致实、虚实夹杂之证。以扶正补虚、疏通祛邪作为治疗原则,初期治以扶正补虚(益气)为主,酌情兼用疏通祛邪(活血)之法;中期和晚期治以扶正补虚(益气温阳)与疏通祛邪(活血、化瘀、利水)并重。遵守病机特点运用中药干预,可以促进脂肪酸、葡萄糖等底物的有效利用,减少底物代谢重构衍生的毒性产物堆积,标本兼顾从而优化心肌能量代谢,改善心功能。
In the case of cardiac dysfunction,energy metabolism changes and the metabolism of myocardial substrates is reconstructed,as manifested by variation in the selection and utilization of energy substrates such as fatty acids and glucose.Persistent metabolic disorders of substrates will decrease energy supply,thus resulting in the occurrence and development of heart failure.Metabolic remodeling of substrate is resulted from the decline of visceral function and the accumulation of pathological products.Deficient Qi stagnation is the core pathogenesis.Deficient Qi(heart Qi deficiency,insufficient energy)is the root cause,which exists in the whole disease course.Stagnation(phlegm,blood stasis,fluid,lipid toxic products,lactic acid,etc.)is the symptom,which evidences the aggravation of the disease.Deficient Qi and stagnation are intertwined and causal,which form a spiral vicious circle.The typical syndrome is excess resulted from deficiency and deficiency-excess in complexity.The treatment principle is reinforcing healthy Qi and tonifying deficiency,dredging and removing pathogen.At the early stage,the method of reinforcing healthy Qi and tonifying deficiency(benefiting Qi)should be used,and the method of dredging and removing pathogen(activating blood)can be applied according to the conditions of patients.At the middle and late stages,both reinforcing healthy Qi and tonifying deficiency(benefiting Qi and warming Yang)and dredging and removing pathogen(activating blood,resolving stasis,and excreting water)should be emphasized.Chinese medicine can be applied according to the pathogenesis,thereby promoting the utilization of fatty acids,glucose,and other substrates and reducing the accumulation of toxic products derived from metabolic remodeling of substrate.Thus,both the root cause and symptoms can be alleviated,further improving cardiac energy metabolism and heart function.
作者
李静
钟森杰
匡慧芳
杨漾
刘祎
黄舒淳
郭志华
张秋雁
LI Jing;ZHONG Senjie;KUANG Huifang;YANG Yang;LIU Yi;HUANG ShuchunGUO Zhihua;ZHANG Qiuyan(Hunan University of Chinese Medicine,Changsha 410208,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2023年第17期195-202,共8页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(82174343)
湖南省自然科学基金项目(2020JJ4471)
湖南省教育厅重点项目(21A0253)
湖南省研究生科研创新项目(CX20210687)
湖南中医药大学校级科研基金项目(2020XJJJ018)。
关键词
心力衰竭
底物代谢重构
脂肪酸代谢
葡萄糖代谢
虚气留滞
中药
heart failure
substrate metabolic remodeling
fatty acid metabolism
glucose metabolism
deficiency Qi stagnation
Chinese medicine
