基于文献分析探讨“辨病-辨证-辨病机”在心衰病的应用

Exploring the application of disease-pattern-pathogenesis differentiation in heart failure based on the analysis of classical Chinese medicine literature

摘要

目的 探析“辨病-辨证-辨病机”在心衰病治疗中的应用。方法 本文通过检索Pubmed及中国知网中有关经方治疗心衰病的文献，筛选出运用频次较高的经方，溯源经方在《伤寒杂病论》原文对于的病证与病机，窥探心衰病的病机，再通过药理学研究证实经方治疗心衰病的机制，从而探讨“辨病-辨证-辨病机”在心衰病的应用。结果 经过文献检索及筛选，得到符合标准的文献562篇。其中运用频次前四位的经方，包括真武汤（146篇）、苓桂术甘汤（58篇）、五苓散（45篇）、葶苈大枣泻肺汤（27篇）。真武汤证、苓桂术甘汤证、五苓散证及葶苈大枣泻肺汤证的基本病机为水饮内停；研究也证实心衰病的基本病理机制为水液潴留。通过联系“病机”与“病理机制”，从而贯通中医“病-证-病机”与西医学“病-症-病理机制”，探讨“辨病-辨证-辨病机”，基于此临床思维辨治心衰病。结论 “辨病-辨证-辨病机”治疗心衰病，即从病出发，整体把握，抓住主证（症），据证析机，其核心在于辨病机，按机立法，依法遣方，以治愈疾病为最终目的。

Abstract

Objective To explore the disease-pattern-pathogenesis differentiation in treating heart failure (HF). Methods We searched for literature on the treatment of HF with classic prescriptions in Pubmed and China National Knowledge Infrastructure (CNKI), and selected the most frequently used classic prescriptions. Then we traced the disease patterns and mechanisms of the classic prescriptions in the original text of Shanghan Zabing Lun (Treatise on Cold Pathogenic and Miscellaneous Diseases), and explores the pathogenesis of HF. Further modern pharmacological research was conducted to confirm the mechanism of using classic prescriptions to treat HF, to explore the application of disease-pattern-pathogenesis differentiation in HF. Results After literature search and screening, 562 articles were obtained that met the standards. Among them, the top four formulas with the highest frequency of use include Zhenwu Decoction (True Warrior Decoction, n=146), Linggui Zhugan Decoction (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction, n=58), Wuling Powder (Five Substances Powder with Poria, n=45), and Tingli Dazao Xiefei Decoction (Lepidium/Descurainiae and Jujube Lung-Draining Decoction, n=27). The basic pathogenesis of patterns of the four prescriptions are internal retention of fluid. Modern research has also proved that the basic pathological mechanism of HF is water retention. By connecting the pattern and pathological mechanism, we can connect the disease-pattern-pathogenesis of TCM with the disease-syndrome-pathological mechanism of modern medicine, and explore the disease-pattern-pathogenesis differentiation. Conclusion The treatment of HF via differentiation-pattern-pathogenesis differentiation involves starting from the disease itself, holistically grasping the condition, identifying the main pattern (symptom), and analyzing the underlying mechanism based on the pattern. Its core lies in differentiating the pathogenesis. The treatment principle is then established according to this mechanism, and formulas are prescribed accordingly, with the ultimate goal of curing the disease.

关键词

经方 / 心衰病 / 辨病 / 辨证 / 辨病机

Key words

classic prescriptions / heart failure / disease differentiation / pattern differentiation / pathogenesis differentiation

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基金资助

上海市卫生健康委员会科研项目(202340158)

国家自然科学基金项目(81973611)

安徽省卫生健康科研项目(AHWJ2023A20461)

安徽省中医药传承创新项目(2024CCCX122)

安徽省高校科研项目(2024AH050989)