中医杂志

总结基于育心软坚理念辨治非梗阻性肥厚型心肌病（HCM）的临证经验。认为HCM属于“心积”范畴，脾肾亏虚为发病之本，痰瘀积聚、气阴耗伤为发病之标。脾肾亏虚，化生痰瘀，痰瘀积聚心体；痰瘀结聚日久，耗伤心之气阴，导致心体失养，久之则表现为心之体用俱损。据此提出育心软坚法治疗非梗阻性HCM，强调软坚散结贯穿治疗全程，常用四味软坚方加减；症状明显期以益气养阴、软坚散结为主要治法，方用自拟育心软坚方加减；病情稳定期以益肾健脾、软坚散结为主要治法，方用自拟脾肾同治方加减。

This article summarized clinical experience in differentiating and treating non-obstructive hypertrophic cardiomyopathy(HCM) based on the concept of nourishing the heart and softening the hardness. It is considered that HCM belongs to the category of "heart accumulation", with the fundamental cause being depletion of the spleen and kidney, and phlegm-stasis accumulation, as well as qi-yin exhaustion, serving as the manifestations. Spleen and kidney depletion leads to the transformation of phlegm and stasis, which accumulate in the heart; over time, this phlegm-stasis accumulation consumes heart qi and yin, resulting in the heart being deprived of nourishment, which eventually leads to the damage to both the function and structure of heart. Therefore, the method of nourishing the heart and softening the hardness is proposed for the treatment of non-obstructive HCM. Emphasis is placed on softening hardness and dissipating masses throughout the entire treatment process, often using Modified Siwei Ruanjian Formula （四味软坚方加减）. During periods with prominent symptoms, the main treatment is boosting qi and nourish-ing yin to soften hardness and dissipate masses with self-made Yuxin Ruanjian Formula （自拟育心软坚方） in modifica-tions; in stable periods, the main treatment is boosting kidney and fortifying spleen to soften hardness and dissipate masses with self-made Pishen Tongzhi Formula （脾肾同治方） in modifications.