Exploring the Etiology, Pathogenesis, Syndrome Differentiation, and Treatment of Chronic Heart Failure Based on the Theory of “Water Depression, Drain It”

Chronic heart failure (CHF) is a cardiac disease characterized by reduced cardiac output due to impaired ventricular filling or pumping function. Western medical treatments for CHF are associated with adverse effects and low patient compliance, whereas Traditional Chinese Medicine (TCM) offers advantages such as multi-target effects and fewer side effects. In TCM, CHF falls within the categories of “heart failure” and “edema”. Its fundamental pathogenesis involves a deficiency in the root cause and an excess in the manifestations, with “water depression” (Shui Yu) running through the entire disease course and serving as a critical factor in disease progression. This paper interprets the pathogenesis of CHF through the theory of “Water Depression, Drain It” (Shui Yu Zhe Zhi). It posits that insufficiency of heart-yang leading to water depression and blood stasis forms the pathological foundation. The key links in disease progression involve impaired diffusion and descent of lung-qi, impaired transportation and transformation by the spleen, and failure of kidney-qi transformation, all contributing to water depression. Based on this analysis, four therapeutic approaches for “draining the depression” are proposed: Warming Yang to Promote Diuresis, Activating Blood Circulation to Promote Diuresis, Diffusing the Lung to Promote Diuresis, and Fortifying the Spleen to Promote Diuresis. This framework aims to provide insights and methodologies for the syndrome differentiation and treatment of CHF.