从心肾相交浅析慢性肾脏病并发心血管疾病

慢性肾脏病并发心血管疾病为本虚标实之证。本虚指肾的气血阴阳亏虚、脏腑功能失职而致心之气血阴阳逆乱。标实证则以痰湿、浊毒、瘀血为主。肾元亏损、脾气衰败,气机升降失调,极易发生肾水不升、心火不降,肾精亏虚、心血及心神失养,甚则心肾阴阳亏虚、虚阳浮越等心肾不交之证。痰湿、浊毒、瘀血内生,痹阻心脉,从而产生"胸痹、心痛、心悸"等心系病证。痰湿、浊毒、瘀血又常相互影响,瘀血阻滞脉络,可致水液内停;痰湿亦可阻滞脉络,而使瘀血内生;浊毒耗伤正气,而致气虚水停;浊毒又常与瘀血、湿热并行,并行后若上窜入心入脑,易蒙蔽心窍,发为危候。故临床上化痰利湿、活血祛瘀、泄浊解毒常常相兼而用。另外,外感风、寒、湿等邪亦会加重病情。故治疗上当以心肾同治、补虚泄实为法。同时脾为中州,助力于心火与肾水之升降交济,且肾与脾分别为先后天之本,相互滋生,故治疗上亦需兼顾实脾。

An Analysis of Chronic Kidney Disease Combined with Cardiovascular Disease from Heart-Kidney Intersection

Chronic kidney disease combined with cardiovascular disease has syndrome of primary deficiency and secondary excess.Primary deficiency refers to the deficiency of qi and blood,yin and yang in the kidney,and the failure of viscera function causing the disorder of qi and blood,yin and yang in the heart.Syndrome of secondary excess is mainly characterized by phlegm dampness,turbid toxin,and blood stasis.Deficiency of kidney,decline of spleen qi,disorder of qi movement in ascending and descending easily lead to heart-kidney interaction manifested as kidney water failing to rise,heart fire failing to descend,deficiency of kidney essence,nutrition loss of heart blood and heart mind,even deficiency of heart-kidney yin and yang,upward floating of yang in deficiency condition.Phlegm dampness,turbid toxin,and blood stasis can block heart vessel causing "heart vessel obstruction,angina,palpitation" and other syndromes of heart system disease.Phlegm dampness,turbid toxin,and blood stasis often affect each other.Blood stasis can block meridians,which can cause fluid retention.Phlegm dampness can also block meridians,,which can cause blood stasis to grow inside the body.Turbid toxin consumes healthy qi,which causes fluid retention due to qi deficiency.Turbid toxin is often combined with blood stasis and damp heat,invading into the heart and brain,hurting heart orifice,causing emergency.Therefore,in clinical practice,resolving phlegm and dampness,promoting blood circulation and removing blood stasis,relieving turbidity and detoxification are often used together.In addition,exogenous pathogenic factors such as wind,cold and dampness will aggravate the disease.Therefore,the treatment should focus on treating heart and kidney together,tonifying deficiency and purging excess.At the same time,the spleen is in the body center,can help the heart fire fall and the kidney water rise.The kidney is the foundation of congenital(prenatal) constitution,while the spleen is the foundation of acquired(postnatal) constitution,which nourishes each other,so the treatment should also take strengthening spleen into account.