摘要
慢性心力衰竭(简称慢性心衰)是由心室功能不全引起的复杂临床综合征,线粒体能量代谢紊乱是其病情发展的重要因素,心阳虚作为慢性心衰核心病机贯穿疾病始终。心阳不振,推动温煦功能下降,痰饮、血瘀、水湿积聚,终致气滞痰阻、血瘀水停,循环进展、螺旋加重,促进病情发生发展演变。笔者以扶阳学说为切入点,根据国医大师唐祖宣慢性心衰心阳虚证临床经验及现代分子生物研究,创新性提出“中医辨证分期-线粒体代谢机制-扶阳方药干预”的中西医结合研究框架。将心阳虚分为轻证(Ⅰ~Ⅱ级)、重证(Ⅲ级)、危证(Ⅳ级),从理论内涵、发病机制、治疗用药、现代研究等方面阐述揭示各期病机与线粒体代谢紊乱的精准对应关系及扶阳中药干预效果,轻证以“生物发生受阻-燃供失衡”为特征,对应心阳不足、痰饮停聚,苓桂术甘汤等方可显著改善线粒体生物发生中的过氧化物酶体增殖物激活受体γ辅激活因子-1α/沉默信息调节因子1(PGC-1α/SIRT1)表达及三磷酸腺苷(ATP)酶活性;重证以“氧化应激-结构损伤”为核心,体现阳虚水泛、痰瘀互结,真武汤和强心汤等方能有效减轻氧化应激损伤,提高ATP含量,修复线粒体结构;危证则因“钙超载-线粒体崩解”引发阴阳离决,茯苓四逆汤和芪苈强心胶囊等回阳救逆剂可抑制线粒体通透性转换孔(MPTP)异常开放,降低心肌细胞凋亡率,保护线粒体功能。归纳慢性心衰不同阶段线粒体能量代谢紊乱特点,探讨扶阳理论在慢性心衰心阳虚证中的应用,为慢性心衰的临床诊断和治疗提供新的思考。
Chronic heart failure(CHF)is a complex clinical syndrome caused by ventricular dysfunction,with mitochondrial energy metabolism disorder being a critical factor in disease progression.Heart-Yang deficiency syndrome,as the core pathogenesis of CHF,persists throughout the disease course.Insufficiency of heart-Yang leads to weakened warming and propelling functions,resulting in the accumulation of phlegm-fluid,blood stasis,and dampness.This eventually causes Qi stagnation with phlegm obstruction and blood stasis with water retention,forming a vicious cycle that exacerbates disease progression.According to the theory of reinforcing Yang,the clinical experience of the traditional Chinese medicine(TCM)master Tang Zuxuan in treating CHF with heart-Yang deficiency syndrome,and achievements from molecular biological studies,this study innovatively proposes an integrated research framework of"TCM syndrome differentiation and staging-mitochondrial metabolism mechanisms-intervention with Yang-reinforcing prescriptions"which is characterized by the integration of traditional Chinese and Western medicine.Heart-Yang deficiency syndrome is classified into mild(StageⅠ-Ⅱ),severe(StageⅢ),and critical(StageⅣ)stages.The study elucidates the precise correlations between the pathogenesis of each stage and mitochondrial metabolism disorders from theoretical,pathophysiological,and therapeutic perspectives.The mild stage is characterized by impaired biogenesis and substrate-utilization imbalance,corresponding to heart-Yang deficiency and phlegm-fluid aggregation.Linggui Zhugantang and similar prescriptions can significantly improve the expression of peroxisome proliferator-activated receptor gamma co-activator-1α(PGC-1α)/silent information regulator 2 homolog 1(SIRT1)and ATPase activity.The severe stage centers on oxidative stress and structural damage,reflecting Yang deficiency with water overflow and phlegm-blood stasis intermingling.At this stage,Zhenwu Tang and Qiangxin Tang can effectively mitigate oxidative stress damage,increase adenosine triphosphate(ATP)content,and repair mitochondrial structure.The critical stage arises from calcium overload and mitochondrial disintegration,leading to the collapse of Yin-Yang equilibrium.At this stage,Yang-restoring and crisis-resolving prescriptions such as Fuling Sini Tang and Qili Qiangxin capsules can inhibit abnormal opening of the mitochondrial permeability transition pore(MPTP),reduce cardiomyocyte apoptosis rate,and protect mitochondrial function.By summarizing the characteristics of mitochondrial energy metabolism disorders at different stages of CHF,this study explores the application of the theory of reinforcing Yang in treating heart-Yang deficiency syndrome and provides new insights for the clinical diagnosis and treatment of CHF.
作者
吴子政
陈杏
孟骊冲
张垚
罗鹏
叶嘉豪
廉坤
胡思远
胡志希
WU Zizheng;CHEN Xing;MENG Lichong;ZHANG Yao;LUO Peng;YE Jiahao;LIAN Kun;HU Siyuan;HU Zhixi(Hunan Provincial Key Laboratory of Traditional Chinese Medicine Diagnostics,Hunan University of Chinese Medicine,Changsha 410208,China)
出处
《中国实验方剂学杂志》
北大核心
2026年第5期129-138,共10页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(82274412)。
关键词
扶阳理论
线粒体能量代谢
慢性心力衰竭
分期论治
方药干预
theory of reinforcing Yang
mitochondrial energy metabolism
chronic heart failure
staged treatment
prescription intervention
