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Avances en la investigación clínica y mecanicista del tratamiento de la insuficiencia cardíaca crónica con fórmulas clásicas de la medicina tradicional china

  • role： First author第一作者
  • Affiliation：

    Liaoning University of Traditional Chinese Medicine （TCM）， Shenyang 110847， China

  • Email：2433602163@qq.com
  • Introduction：杨过，在读硕士，从事中西医结合心血管疾病研究，E-mail：2433602163@qq.com
YANG Guo1,  
  • role： Corresponding author通信作者
  • Affiliation：

    The Affiliated Hospital of Liaoning University of TCM， Shenyang 110000， China

  • Email：yuanziyang2021@163.com
  • Introduction：张艳，博士，博士生导师，从事中西结合心血管研究，Tel：024-82961295，E-mail：yuanziyang2021@163.com
ZHANG Yan2*,  
  • Affiliation：

    Liaoning University of Traditional Chinese Medicine （TCM）， Shenyang 110847， China

YUAN Ziyang1

resumen

La insuficiencia cardíaca crónica (ICC) es un conjunto de síndromes clínicos causados por la disfunción cardíaca que conduce a una disminución de la capacidad de eyección, siendo la etapa terminal de la mayoría de las enfermedades cardíacas. Debido a su prevalencia en aumento y al gran impacto en la calidad de vida de los pacientes, se ha convertido en un problema de salud pública global. Actualmente, la medicina occidental trata principalmente mediante el uso oral del "nuevo cuádruple" y diuréticos. Aunque se han logrado avances significativos en investigaciones patológicas y tratamientos clínicos, persisten problemas como importantes efectos adversos, resistencia al tratamiento y marcadas diferencias individuales en la eficacia terapéutica. Por lo tanto, explorar y aprovechar las ventajas de la medicina tradicional china (MTC) en el tratamiento de la ICC se ha convertido en un tema urgente y crucial. La MTC cuenta con miles de años de experiencia en la prevención y tratamiento de la insuficiencia cardíaca (IC) y ha acumulado una rica experiencia. Gracias a sus características de múltiples componentes y múltiples objetivos, puede regular de manera integral las funciones de múltiples sistemas del cuerpo, intervenir en la progresión de la IC y tiene una gran importancia clínica en su tratamiento. A través de métodos como calentar yang, eliminar agua, tonificar qi, nutrir yin y activar la circulación sanguínea, mejora eficazmente la fibrosis miocárdica, inhibe el estrés oxidativo, fortalece la contractilidad miocárdica y mejora la remodelación ventricular. Los medicamentos patentados modernos derivados de fórmulas clásicas, basados en la teoría tradicional, no solo tienen buena eficacia clínica, sino que también poseen ventajas significativas en conveniencia, estabilidad y seguridad. Este artículo revisa sistemáticamente los efectos notables de las fórmulas clásicas de la MTC en el tratamiento de la ICC y sus mecanismos de acción, y expone el panorama clínico de los medicamentos modernos, con el objetivo de proporcionar nuevas estrategias para el diagnóstico y tratamiento clínico de la ICC.

palabra clave

fórmulas clásicas;insuficiencia cardíaca crónica;avances en la investigación;mecanismo de acción;investigación clínica

References

  1. 1.
    ZHU M J，ZHANG J，MAO J Y.Expert consensus on the diagnosis and treatment of heart failure with preserved ejection fraction（HFpEF） by integrated Chinese and western medicine［J］.J Tradit Chin Med，2025，66（8）：860-872.
  2. 2.
    SCHWINGER R H G.Pathophysiology of heart failure［J］.Cardiovasc Diagn Ther，2021，11（1）：263-276.
  3. 3.
    National Center for Cardiovascular Diseases，The Writing Committee of the Report on Cardiovascular Health and Diseases in China.Report on cardiovascular health and diseases in China 2023：An updated summary［J］.Chin Circ J，2024，39（7）：625-660.
  4. 4.
    GE J B，HUO Y，YANG J F，et al.Expert consensus on decision-making pathway for quadruple pharmacotherapy management of chronic heart failure［J］.Chin Circ J，2022，37（8）：769-781.
  5. 5.
    WANG F，LIAN K，HU Z X，et al.Mechanism of ferroptosis in chronic heart failure based on theory of "harmful hyperactivity and responding inhibition"［J］.China J Chin Mater Med，2023，48（17）：4803-4811.
  6. 6.
    CHEN Y，LIU Y，ZHANG Y.Etiology and pathology of chronic heart failure based on spleen governing transportation and transformation theory［J］.Chin J Exp Tradit Med Form，2018，24（20）：229-234.
  7. 7.
    QU P Y，HU J，LIU L C，et al.Role of aquaporins in heart failure from theory of cardiac and renal coordination［J］.Chin J Exp Tradit Med Form，2023，29（10）：216-223.
  8. 8.
    ZHANG Q Q，SONG F F.Clinical study on the adjunctive use of Zhenwu decoction for treating chronic heart failure with Yang deficiency and fluid retention［J］.J Pract Tradit Chin Med，2024，40（12）：2499-2501.
  9. 9.
    WANG H X，HAN L H，ZHANG H C，et al.Clinical Study on Zhenwu decoction combined with conventional western medicine in treating chronic heart failure［J］.Henan Tradit Chin Med，2023，43（9）：1307-1311.
  10. 10.
    MA X S，ZHANG D，MA J，et al.Clinical effects of Zhenwu decoction combined with Danshen drink on patients with chronic heart failure［J］.Chin Tradit Pat Med，2024，46（11）：3651-3654.
  11. 11.
    CHENG C F，CHENG B L，SHI Y X，et al.Effect of Jiawei Zhenwu decoction on chronic heart failure patients with slow arrhythmia and its effect on hemodynamics［J］.World J Integr Tradit West Med，2024，19（3）：601-605.
  12. 12.
    LIN M L，WANG S，JIANG Z S，et al.Clinical effects of Zhenwu decoction combined with Baduanjin Qigong on the cardiopulmonary function and quality of life in older adults with coronary heart disease［J］.Guangzhou Med J，2024，55（12）：1470-1475.
  13. 13.
    GAN X Q，LIU H，SHI X Y.Effect of Zhenwu decoction Combined with umbilical moxibustion on chronic heart failure［J］.Syst Med，2024，9（19）：186-189.
  14. 14.
    LIAO J H，WANG X，WANG X L，et al.Study on the effect of Zhenwu Tang on PINK1/Parkin mediated mitochondrial autophagy in rats with chronic heart failure［J］.J Basic Chin Med，2025，31（1）：43-48.
  15. 15.
    WANG M N，XU S Q，QIN Y M，et al.Action mechanism of Zhenwu decoction on regulating mitochondrial energy metabolism and improving myocardial cell damage in chronic heart failure based on the PPARα/ASCL1 signaling pathway［J］.J Basic Chin Med，2025，31（5）：812-818.
  16. 16.
    WANG X L，ZHANG Q，TIAN X，et al.Exploring effect of Zhenwu decoction on structural remodeling-electrical remodeling of cardiomyocytes in heart failure based on p38-MAPK pathway［J］.Chin Arch Tradit Chin Med，2024，42（4）：130-137，290-292.
  17. 17.
    WANG H，LUO Y H，WANG Y，et al.Effects of modified Linggui Zhugan decoction on TGF-β1，TNF-α，NT-proBNP and ventricular remodeling in patients with chronic heart failure of Yang deficiency and water stagnation syndrome［J］.J Basic Chin Med，2024，30（5）：853-856.
  18. 18.
    LU Q，NAN Y L，GUO X P，et al.Clinical observation of Linggui Zhugan decoction combined with sacubitril valsartan in the treatment of chronic heart failure［J］.World Clin Drug，2024，45（11）：1155-1160，1211.
  19. 19.
    NAN Y L，SUN D H，ZHANG X L，et al.Efficacy of Linggui Zhugan decoction combined with Sacubitril Valsartan Sodium in the treatment of CHF with Yang deficiency and water flooding and its prognostic factors［J］.Chin J Integr Med Cardio-Cerebrovasc Dis，2024，22（11）：2008-2013.
  20. 20.
    WANG Z P，KUANG Z D.Linggui Zhugan decoction in the treatment of chronic heart failure with atrial fibrillation in 60 cases［J］.Zhejiang J Tradit Chin Med，2023，58（7）：508-509.
  21. 21.
    ZHUANG H C，HAN T X，SHI H.Therapeutic effect of Linggui Zhugan decoction combined with warm acupuncture in the treatment of chronic heart failure and its effect on cardiac function and vascular endothelial function［J］.Hainan Med J，2022，33（17）：2181-2184.
  22. 22.
    YAO J，DING R，LI X Y，et al.Effect of Linggui Zhugantang on mitochondrial fusion-fission and Sirt3/AMPK signaling pathway in chronic heart failure rats after myocardial infarction［J］.Chin J Exp Tradit Med Form，2024，30（3）：1-9.
  23. 23.
    MU L，FAN Y W，HU Y L，et al.Effect of Linggui Zhugan decoction on cognitive function in rats with chronic heart failure by regulating AQP4［J］.J Chin Med Mater，2023，46（8）：2057-2061.
  24. 24.
    WANG X，MO J J，TANG T J，et al.Effect of Linggui Zhugan decoction on myocardial infarction induced heart failure in rats based on Nrf2/BNIP3 pathway and its mechanism［J］.Chin Pharmacol Bull，2023，39（12）：2390-2397.
  25. 25.
    SUN Q.Effect of modified Buyang Huanwu decoction combined with Western medicine on chronic heart failure and its influence on plasma homocysteine level［J］.China Prescr Drug，2020，18（4）：125-126.
  26. 26.
    WU X B，TAN Y Q，TIAN P P，et al.Systematic review and sequential analysis on efficacy of modified Buyang Huanwu Tang in treatment of chronic heart failure［J］.Chin J Exp Tradit Med Form，2021，27（1）：188-195.
  27. 27.
    QIAO L J，LI B，PENG G C，et al.Yiqi Huoxue recipe and its disassembled recipes in the treatment of coronary heart disease and heart failure in Qi deficiency and blood stasis syndrome：A double-blind randomized controlled trial［J］.China J Tradit Chin Med Pharm，2023，38（2）：881-886.
  28. 28.
    SUN J.Clinical effect of Jiawei Buyang Huanwu decoction on chronic heart failure complicated with rapid atrial fibrillation［J］.World J Complex Med，2019，5（3）：119-121.
  29. 29.
    WENG J Q，LI J B，YUAN M F，et al.Effects of Buyang Huanwu decoction on intestinal barrier，intestinal flora，and trimethylamine oxide in rats with heart failure［J］.Chin J Integr Med，2023，29（2）：155-161.
  30. 30.
    PAN Q J，ZENG J B，WAN C J，et al.A randomized controlled study of Buyang Huanwu decoction modified acupoint application in the treatment of chronic heart failure of Qi deficiency and blood stasis［J］.Chin J Integr Med Cardio-Cerebrovascr Dis，2021，19（10）：1614-1616，1626.
  31. 31.
    WANG Z，LI J B，DONG X，et al.Effect of Buyang Huanwu Tang on myocardial mitochondrial energy metabolism and AMPK/PPARα signaling pathway in rats with diastolic heart failure［J］.Chin J Exp Tradit Med Form，2019，25（9）：12-17.
  32. 32.
    HUANG X N，HUANG L，LUO H B，Intervention of Buyang Huanwu decoction on myocardial remodeling in rats with heart failure based on TGF-β1/Smads pathway［J］.Pharmacol Clin Chin Mater Med，2019，35（5）：15-20.
  33. 33.
    SHI Z J，LU W T，ZHANG J P，et al.Study on the mechanism of Buyang Huanwu decoction in the treatment of heart failure based on transcriptomics and network pharmacology［J］.Chin Tradit Pat Med，2022，44（10）：3354-3360.
  34. 34.
    ZHANG C，DU Z L，LI Z L，et al.Clinical effect of Jiawei Shengxian decoction on patients with chronic heart failure of Qi deficiency and water retention type［J］.Chin Tradit Pat Med，2023，45（2）：690-692.
  35. 35.
    GU X J，ZOU W Q，ZOU J C，Effects of modified Shengjin decoction combined with conventional treatment on cardiac function and serum Hcy and hsTnT in patients with chronic heart failure［J］.Clin J Tradit Chin Med，2024，36（6）：1124-1128.
  36. 36.
    YAO L，BAI Y H，LU W J，et al.Clinical efficacy evaluation and drug safety study of Shengxian decoction in patients with chronic left heart failure［J］.J Chin Med Mater，2020，43（2）：478-481.
  37. 37.
    GAO H，YANG Z Q，GAO F，et al.Protective effect of Shengxiantang on myocardial microvascular injury in rats withchronic heart failure［J］.Chin J Exp Tradit Med Form，2025，31（7）：35-42.
  38. 38.
    WANG M Z，FU D Y，YAO L，et al.Study on the mechanism of Shengxian decoction in the treatment of heart failure based on network pharmacology［J］.Chin Tradit Pat Med，2021，43（1）：228-234.
  39. 39.
    QU Y，DAN W C，LIU J L，et al.Study on the mechanism of Shengxian decoction in treating heart failure based on network pharmacology［J］.Mod Tradit Chin Med Mater Med-World Sci Technol，2020，22（10）：3583-3593.
  40. 40.
    YANG Y D，WANG M L，ZHAO J，et al.Evaluation of clinical efficacy of Shengmaisan granules in inhibiting myocardial fibrosis in patients with chronic heart failure with Qi-Yin deficiency syndrome based on CMR［J］.Chin J Exp Tradit Med Form，2023，29（23）：89-97.
  41. 41.
    YANG Y B，ZHANG X T，JIANG H P，et al.Clinical study on Huangqi Shengmai powder in the treatment of chronic heart failure （Qi and Yin deficiency type）［J］.J Sichuan Tradit Chin Med，2022，40（5）：92-95.
  42. 42.
    HAN Y，LIU Y，JIA Y X，et al.Effects of modified Shengmai powder on serum GDF-15 and soluble ST2 in patients with acute exacerbation of chronic heart failure［J］.Chin J Integr Med Cardio-Cerebrovasc Dis，2022，20（5）：893-897.
  43. 43.
    ZHANG Q F，WANG Y S.The investigation on the clinical efficacy and safety of Jiawei Shengmaisan in the auxiliary treatment of elderly chronic pulmonary heart disease complicated with heart failure［J］.J Math Med，2022，35（4）：585-587.
  44. 44.
    ZHOU L J，YANG S，JIANG G J，et al.Clinical study of Shengmai powder plus modified Wuling powder combined with tolvaptan for the treatment of chronic heart failure accompanied by diuretic resistance［J］.J Guangzhou Univ Tradit Chin Med，2023，40（2）：316-321.
  45. 45.
    ZHENG M H.Analysis of the effect of Shengmai powder combined with sacubitril valsartan sodium tablets in the treatment of chronic heart failure with decreased ejection fraction of Qi and Yin deficiency syndrome［J］.Prev Treat Cardiovasc Dis，2021，11（22）：12-14.
  46. 46.
    SONG Y W，ZHANG Z Y，JIA Z Z，et al.Effects of optimized New Shengmai powder in modulating β1-AR/cAMP/PKA/CREB signaling pathway on myocardial fibrosis in rats with heart failure［J］.Chin J Inf Tradit Chin Med，2024，31（3）：78-84.
  47. 47.
    ZHAO Y T.Based on calcium regulation，the effect and mechanism of Shengmaisan on heart failure mice with deficiency of both qi and yin were studied［D］.Shijiazhuang：Hebei University of Chinese Medicine，2023.
  48. 48.
    HAN Y X.Mechanism of optimized new Shengmaisan on inhibitingcardiomyocyte apoptosis in heart failure through NMDAR pathway［D］Tianjin：Tianjin University of Traditional Chinese Medicine.，2022.
  49. 49.
    ZAHO Q F，PENG G C，WANG X，et al.LMeta-analysis of efficacy and safety of modified Zhigancao decoction combined with conventional medical therapy in the treatment of chronic heart failure［J］.Tradit Chin Drug Res Clin Pharmacol，2021，32（8）：1197-1205.
  50. 50.
    SONG C X.The influence of Zhigancao decoction combined with western medicine on hemodynamics and myocardial enzymes in the elderly patients with chronic heart failure［J］.Chin J Integr Med Cardio-Cerebrovasc Dis，2019，17（24）：3981-3985.
  51. 51.
    WANG Y.Clinical observation on Zhigancao decoction combined with conventional western medicine in the treatment of chronic heart failure with depression［J］.J Hunan Univ Chin Med，2019，39（12）：1512-1516.
  52. 52.
    YIN Z S.Observation on the therapeutic effect of electroacupuncture combined with Zhigancao decoction in the recovery period of chronic heart failure［J］.China Med Device Inf，2020，26（12）：151-152.
  53. 53.
    YANG J W，XU Y F.YAN Q Y.Study on the energy metabolism of Zhigancao decoction intervened rats myocardial damage caused by adriamycin［J］.Zhejiang J Tradit Chin Med，2021，56（4）：258-260.
  54. 54.
    BAI X F，WAN X Y，HUI C X.Study on regulation of Zhigancao decoction on myocardial NF-κB signal pathway in rats with myocardial fibrosis induced by isoproterenol［J］.Mod J Integr Tradit Chin West Med，2021，30（31）：3440-3446.
  55. 55.
    WANG S J.Animal experiments and network pharmacology study on the protective effect of Zhigancao decoction against doxorubicin-induced cardiotoxicity in rats［D］.Beijing：China Academy of Chinese Medical Sciences，2024.
  56. 56.
    MA X Z，WANG M R，LI Q Y.System evaluation on the clinical curative effect of Baoyuan decoction in the treatment of chronic heart failure caused by Qi deficiency and blood stasis［J］.Guangming J Chin Med，2022，37（16）：2868-2874.
  57. 57.
    QIU L F，LI Y，XIE H，et al.Clinical effect of furosemide combined with Baoyuan decoction in the treatment of chronic heart failure［J］.Chin J Clin Ration Drug Use，2021，14（33）：104-106.
  58. 58.
    ZHANG Y，LI Z J.Efficacy observation of modified Baoyuan decoction and thumb-tack needle for subcutaneous embedding on heart failure with preserved ejection fraction［J］.Shanxi J Tradit Chin Med，2025，41（1）：11-13.
  59. 59.
    ZHANG Y，AI K R.Efficacy of Xinshuai Baoyuan decoction in the treatment of heart failure with preserved ejection fraction after PCI and its effect on serum Gal-3 and sST2［J］.Shaanxi J Tradit Chin Med，2025，46（1）：51-55.
  60. 60.
    LIU X T，LU L H，DONG J X，et al.Therapeutic effect of Baoyuan decoction on ISO-induced chronic heart failure in rats based on network pharmacology and experimental validation［J］.Chin J Hosp Pharm，2024，44（19）：2205-2214，2222.
  61. 61.
    DIAO Y Y，LIU Z D，ZHANG Y H，et al.To explore the mechanism of Baoyuan decoction in the treatment of chronic heart failure based on network pharmacology and molecular docking［J］.Chin J Gerontol，2022，42（10）：2309-2315.
  62. 62.
    YUAN X Y，GAO Z R.Improving effect of Baoyuan decoction on myocardial injury and effects of PERK/eIF2α/CHOP signaling pathway in adriamycin indcued rats［J］.China J Tradit Chin Med Pharm，2022，37（6）：3549-3553.
  63. 63.
    MENG H，WANG Q X，LU W J，et al.Mechanism of Baoyuan decoction on improving myocardial fibrosis and treating heart failure via regulating AT1/p38 MAPK/TGF-β pathway［J］.China J Tradit Chin Med Pharm，2019，34（5）：2292-2297.
  64. 64.
    CHEN H Y，WANG Z Y，WANG C，et al.Evaluation of Tingli Dazao Xiefei decoction on Yang deficiency and blood stasis type of heart failure by cardiac ultrasound［J］.Chin Arch Tradit Chin Med，2024，42（11）：71-74.
  65. 65.
    AN G H，YANG Z Q，WEN Y X，et al.Clinical study on Tingli Dazao Xiefei Tang combined with enalapril for congestive heart failure［J］.New Chin Med，2022，54（20）：1-4.
  66. 66.
    YANG J J.Observation of the clinical efficacy of Tinglizi Dazao Xiefei decoction combined with Xinhuosu in patients with chronic heart failure［J］.Pract Clin J Integr Tradit Chin West Med，2024，24（17）：99-102.
  67. 67.
    YUAN Z J，HAO X X，LI B，et al.Effects of Tingli Dazao Xiefei decoction on ventricular remodeling in model rats［J］.China Pharm，2023，34（2）：161-167.
  68. 68.
    LI J W，LI B，HAO X X，et al.Mechanism of Tingli Dazao Xiefei decoction regulating myocardial contractility protein in rats with heart failure after myocardial infarction through ACE2-Ang-（1-7）-Mas axis［J］.China J Tradit Chin Med Pharm，2023，38（7）：3103-3108.
  69. 69.
    HAO X X，XIE S Y，WANG Y P，et al.Study on diuretic effect of Tingli Dazao Xiefei decoction on heart failure rats after myocardial infarction［J］.Lishizhen Med Mater Med Res，2022，33（12）：2882-2885.
  70. 70.
    HAO X X，XIE S Y，WANG Y P，et al.Effects of Tingli Dazao Xiefei decoction on myocardial fibrosis in rats after myocardial infarction［J］.China J Tradit Chin Med Pharm，2020，35（5）：2649-2652.
  71. 71.
    HAN S J.Based on the VEGF-C / VEGFR-3 pathway of cardiac lymphatic vessels，the clinical study of Nuanxin Capsule on ischemic heart failure of Yang deficiency type was discussed［D］.Guangzhou：Guangzhou University of Chinese Medicine，2022.
  72. 72.
    DONG H X，GAO X H，LI X Y，et al.Effect of Qili Qiangxin capsule on chronic heart failure and its influence on levels of cTNI，Hcy，NT-proBNP and hs-CRP［J］.Chin Arch Tradit Chin Med，2025，43（12）：149-152.
  73. 73.
    PENG G C，ZHU M J，WANG J R，et al.Systematic evaluation of Naoxintong capsule in the treatment of chronic heart failure［J］.Pharmacol Clin Chin Mater Med，2020，36（2）：221-226.
  74. 74.
    WANG J X.Clinical study of Yangxinshi tablet combined with bisoprolol in the treatment of coronary heart disease and heart failure［J］.Syst Med，2022，7（16）：133-136.
  75. 75.
    MA Q F，ZHANG T，WANG L.Clinical study on Yixinshu capsules combined with sacubitril valsartan in treatment of chronic heart failure［J］.Drugs Clin，2024，39（8）：2028-2032.

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