北京中医药大学学报2026，Vol.49Issue(3)：392-400,9.DOI:10.3969.jssn.1006-2157.2026.03.011
从"瘀-毒-虚"病机的时空演变探讨心肌梗死后心力衰竭的发生发展与中医诊疗思路
Temporal-spatial evolution of"blood stasis-toxicity-deficiency"pathogenesis in the development of heart failure post-myocardial infarction and diagnostic and therapeutic approaches in traditional Chinese medicine
摘要
Abstract
This study systematically explored a traditional Chinese medicine(TCM)diagnostic and therapeutic strategy for heart failure(HF)post-myocardial infarction(MI)through the spatio-temporal progression of the"blood stasis-toxicity-deficiency"pathogenesis.We propose an evolutionary model of"blood stasis leading to toxin,and toxin leading to deficiency,"dividing the occurrence and progression of HF post-MI into three stages:the local stagnation stage characterized by blood stasis obstructing heart vessels,which corresponds to the acute onset of MI correlating with thrombosis/microcirculatory dysfunction;the subacute-to-chronic toxin-damage on heart and kidney stage marked by blood stasis-toxin interplay driving post-MI ventricular remodeling and HF progression,which is associated with inflammation/oxidative stress;and the systemic deficiency stage in which HF worsens,defined by blood toxin-induced qi-blood depletion causing multi-organ deficiency,which involves energy metabolism dysregulation/neuroendocrine activation.Each stage is predominantly characterized by blood stasis,toxin,and deficiency,respectively;however,these stages are not entirely independent and may intertwine.Stage-specific therapies include promoting blood circulation and resolving blood stasis to improve perfusion during the local stagnation stage;detoxifying and promoting diuresis to inhibit remodeling during the toxin-damage on heart and kidney stage;and strengthening and consolidating body resistance to alleviate symptoms during the systemic deficiency stage.Future research should elucidate the material basis of the pathogenesis,establish dynamic syndrome mapping,and advance a precision TCM framework integrating staging,syndrome differentiation,and grading;establish a synergistic intergrated TCM and Western medicine treatment plan.关键词
心肌梗死/心力衰竭/瘀-毒-虚/分期论治/心室重塑Key words
myocardial infarction/heart failure/blood stasis-toxicity-deficiency/stage-specific treatment/ventricular remodeling分类
医药卫生引用本文复制引用
张淑欣,李欣仪,陈淑芬,谢荣坚,靳俊涛,刘思琳..从"瘀-毒-虚"病机的时空演变探讨心肌梗死后心力衰竭的发生发展与中医诊疗思路[J].北京中医药大学学报,2026,49(3):392-400,9.基金项目
国家中医药传承创新中心科研项目(No.2023QN03) （No.2023QN03）
广州市科技计划项目2025年度基础与应用基础研究专题(No.2025A04J3793) （No.2025A04J3793）
广东省医学科研基金(No.B2024046) National Center for Inheritance and Innovation of Traditional Chinese Medicine Research Project(No.2023QN03) （No.B2024046）
