Temporal-spatial evolution of "blood stasis-toxicity-deficiency" pathogenesis in the development of heart failure post-myocardial infarction and diagnostic and therapeutic approaches in traditional Chinese medicine

This study systematically explored a traditional Chinese medicine (TCM) diagnostic and therapeutic strategy for heart failure (HF) post-myocardial infarction (MI) through the spatio-temporal progression of the "blood stasis-toxicity-deficiency" pathogenesis. We propose an evolutionary model of "blood stasis leading to toxin, and toxin leading to deficiency," dividing the occurrence and progression of HF post-MI into three stages: the local stagnation stage characterized by blood stasis obstructing heart vessels, which corresponds to the acute onset of MI correlating with thrombosis/microcirculatory dysfunction; the subacute-to-chronic toxin-damage on heart and kidney stage marked by blood stasis-toxin interplay driving post-MI ventricular remodeling and HF progression, which is associated with inflammation/oxidative stress; and the systemic deficiency stage in which HF worsens, defined by blood toxin-induced qi-blood depletion causing multi-organ deficiency, which involves energy metabolism dysregulation/neuroendocrine activation. Each stage is predominantly characterized by blood stasis, toxin, and deficiency, respectively; however, these stages are not entirely independent and may intertwine. Stage-specific therapies include promoting blood circulation and resolving blood stasis to improve perfusion during the local stagnation stage; detoxifying and promoting diuresis to inhibit remodeling during the toxin-damage on heart and kidney stage; and strengthening and consolidating body resistance to alleviate symptoms during the systemic deficiency stage. Future research should elucidate the material basis of the pathogenesis, establish dynamic syndrome mapping, and advance a precision TCM framework integrating staging, syndrome differentiation, and grading; establish a synergistic intergrated TCM and Western medicine treatment plan.