从“强心方”浅析罗铨辨治慢性心力衰竭思路

韦章进1，吴玉涛 2，万启南 1

1.云南省中医医院，云南 昆明 650021；2.云南中医学院临床医学院，云南 昆明 650011摘要：全国名老中医罗铨教授认为气（阳）虚、瘀血内阻、水泛饮停是慢性心力衰竭病机之关键环节，采用益气温阳、活血化瘀、利水蠲饮为治法，据此创制的“强心方”效验显著。本文浅析强心方组方用药之要义，隅举罗老临床运用该方经验，以期对本病的辨证论治有所助益。关键词：名医经验；罗铨；慢性心力衰竭；强心方

DOI：10.3969/j.issn.1005-5304.2017.10.022

中图分类号：R259.416.1 文献标识码：A 文章编号：1005-5304(2017)10-0094-03

Preliminary Analysis on Syndrome Differentiation and Treatment of Chronic Heart Failure Based on Qiangxin Prescription of Professor LUO Quan

WEI Zhang-jin1, WU Yu-tao2, WAN Qi-nan1 (1. Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650021, China; 2. Clinical Medical College of Yunnan University of Traditional Chinese Medicine, Kunming 650011, China)

Abstract: The national famous TCM doctor, Professor LUO Quan considers that the key pathogeny of chronic heart failure (CHF) is deficiency of yang qi, blood blocking and liquid stagnation, and should be treated with the method of tonifying qi and warming yang, activating blood and expelling stasis and inducing diuresis to alleviate edema. Qiangxin Prescription was created based on the above treatments, with obvious efficacy. This article conducted a preliminary analysis on the essence of medication of Qiangxin Prescription, took some example of Professor LUO Quan’s experiences in using this prescription, with a purpose to be helpful to the treatment of syndrome differentiation and treatment of CHF.

Key words: experience of famous doctors; LUO Quan; chronic heart failure; Qiangxin Prescription

云南省中医医院主任医师罗铨教授是第二、三批全国老中医药专家学术经验传承工作指导老师，操歧黄业五十余载，擅治多种疾病，尤以心脑血管疾病见长。

慢性心力衰竭（以下简称“慢性心衰”）是心血管疾病的终末期表现和最主要的死因[1]。根据临床表现，本病可归属中医学“心水”“喘证”“水肿”“痰饮”等范畴。罗老认为，本虚标实、虚实夹杂是其基本证候特征。本虚主要责之于气虚、阳虚、阴虚，而以气虚为根本；标实则以瘀血、水湿、痰饮为紧要。慢性心衰病程冗长，随着病情进展或失治、误治，气虚日久必致阳虚，所谓“气虚为阳虚之渐，阳虚为气

基金项目：国家中医药管理局全国名老中医药专家传承工作室

建设项目(2014年)；云南省应用基础研究计划项目（2016FD101）通讯作者：万启南，E-mail：wanqinan@sina.com 虚之甚”；气阳亏虚，则温煦失职，推动乏力，导致血失温运，脉失温通，血行艰涩而成瘀，故《医林改错•论小儿抽风不是风》说：“元气既虚，必不能达于血管，血管无气，必停留而瘀。”又《金匮要略•水气病脉证并治》有“血不利则为水”，瘀血内停，阻碍气机运行，三焦水道不利，致水液代谢失常，水津不归正化则变生水湿、痰饮，故《血证论》云“血积既久，亦能化为痰水”，且“须知痰水之壅，由瘀血使然”，表明瘀阻心脉，水湿上壅，痰饮凌心，又复耗伤心气、损伤心体，诱发或加重心力衰竭。可见，瘀血、水湿、痰饮不仅为慢性心衰的病理产物、标实之主，也是诱发或加重本病的原因，其中尤以瘀血阻脉为关键。因此，罗老认为治疗慢性心衰当以益气温阳、活血化瘀、利水蠲饮为法，创制强心方，经临床应用多年，疗效满意。兹将其组方特色解析如下，以就正于同道。