Syndrome treatment of chronic heart failure complicated with sarcopenia from the perspective of "circular flow of primordial qi"

Sarcopenia is a common comorbidity of chronic heart failure and serves as an independent risk factor for chronic heart failure, which can exacerbate disease progression and lead to poor prognosis. Current Western medical treatment primarily focuses on reversing ventricular remodeling, providing nutritional support, and intervention, however, it has limited efficacy and poor patient compliance. Traditional Chinese medicine (TCM), based on the holistic concept, harmonizes zang-fu organs and has unique advantages in treatment. This article, based on the theory of "circular flow of primordial", suggests that the initial stage of chronic heart failure combined with sarcopenia is characterized by the decline of the middle earth (spleen) and the failure of qi regulation, making smooth "qi" circulation challenging. Liver and lung stagnation and dysfunction of qi movement may occur as the diseases progresses, leading to the disconnection between the heart and kidney, as well as the separation of yin and yang in the advanced stage. Therefore, the therapeutic principle is fundamentally rooted in fortifying the middle earth and regulating qi dynamics. The primary formula, Huangya Decoction, is employed to restore the pivotal function of the middle earth. During the disease progression phase, if liver wood stagnation is present, Dayu Decoction is used in modified form to soothe the liver and disperse constraint. If lung metal fails to descend, Xiaqi Decoction is applied in modified form to clear and direct lung qi downward. In the advanced stage, when non-interaction between the heart and kidney, as well as yin-yang disharmony, are commonly observed, Tianhun Decoction should be administered in modified form to restore heart-kidney communication and harmonize yin and yang. In cases of severe yang qi depletion and critical conditions, Sini Decoction or Shenfu Decoction must be urgently prescribed to rescue yang from collapse, secure desertion, and reverse the critical state. The middle earth is invigorated, the four elements are rotated through the staged differentiation and treatment of chronic heart failure combined with sarcopenia, thus, the heart yang is invigorated and the muscles are replenished. This study provides novel insight for TCM diagnosis and treatment of CHF complicated with sarcopenia.