【摘要】 慢性心力衰竭（CHF）是指原始心肌损伤引起心脏功能或结构改变，导致心脏泵血和（或）充盈功能减退的临床综合征。近年来，中医药治疗CHF的作用机制、通路和靶点不断被证实，而运用中医理论指导CHF的辨证分型和精准施治是当前的研究热点。李灿东教授在中医辨证论治的基础上，创新性提出中医“五辨”思维模式，即辨病、辨证、辨机、辨症与辨人。该文从“五辨”思维探讨CHF的临床诊疗，强调全面辨证、客观分析、动态评估与个体化治疗。诊断方面，首先，辨别CHF的病名、病因、病位、病势和病型，确定疾病的分型与分型演变，明确虚实传变过程。其次，辨别CHF证候的真假、轻重、主次、缓急与兼杂等，为辨证论治提供科学指导。第三，以标本、虚实为指导，从气、血、阴、阳、虚、瘀、痰、水和毒等角度，辨别CHF的核心病机。第四，从宏观、中观和微观等层面，仔细辨别证的有无、轻重、真假与偏全，指导CHF的诊疗过程。最后，根据患者的性别、年龄、体质和生活习惯，促进CHF的个性化用药。在治疗方面，基于“五辨”思维，笔者提出CHF的治疗应当病证结合、明确病机、精准施治；以人为本、分期分型、随症加减。该诊疗思路立足于整体观念和辨证论治，又结合三因制宜，以期为CHF的诊疗提供新思路和新见解。更多还原

【Abstract】 Chronic heart failure(CHF) refers to a clinical syndrome in which the function or structure of the heart is changed due to damage to the original myocardium, resulting in reduced pumping and/or filling functions of the heart. In recent years, the mechanisms, pathways, and targets of traditional Chinese medicine(TCM) in the treatment of CHF have been continuously confirmed, and the application of TCM theories in guiding the syndrome differentiation and precise treatment of CHF is currently a research hotspot. On the basis of the syndrome differentiation and treatment in TCM, Professor LI Candong innovatively proposed the thinking of five differentiation: Disease differentiation, syndrome differentiation, pathogenesis differentiation, symptom differentiation, and individual differentiation. This article explores the clinical diagnosis and treatment of CHF from this thinking, emphasizing comprehensive syndrome differentiation, objective analysis, dynamic assessment, and individualized treatment. In terms of diagnosis, the first is to identify the disease name, cause, location, severity, and type of CHF, determine the type and its evolution, and clarify the process of transmission and transformation between deficiency and excess. Secondly, it is necessary to distinguish the authenticity, severity, primary and secondary, urgency and complexity of CHF syndromes, providing scientific guidance for syndrome differentiation and treatment. Thirdly, according to the symptoms and the principles of deficiency and excess, the physician should identify the core pathogenesis of CHF from the perspectives of Qi, blood, Yin, Yang, deficiency, stasis, phlegm, water, and toxins. Fourthly, from the macro, meso and micro levels, the physician should carefully distinguish the presence or absence, severity, authenticity, and completeness of the symptoms to guide the diagnosis and treatment process of CHF. Finally, personalized medication for CHF should be promoted based on the patient’s gender, age, constitution, and living habits. In terms of treatment, based on the thinking of five differentiation, we propose that the treatment of CHF should integrate the disease and syndrome, clarify the pathogenesis, and apply precise treatment. The treatment should be people-oriented, staged, and typed, and the medication should be adjusted according to symptoms. This diagnostic and therapeutic approach is based on the holistic concept and syndrome differentiation and treatment, and combines the three causes for appropriate treatment, providing new ideas and insights for the diagnosis and treatment of CHF.更多还原