老年慢性心力衰竭（简称慢性心衰）合并肌少症可使患者生活质量进一步下降，导致跌倒、失能和死亡率增加。目前 西医防治肌少症措施主要包括营养支持、运动疗法等，但仍处于探索阶段。中医治病具有整体观及辨证论治的独特优势， 中医疗法治疗老年慢性心衰合并肌少症值得进一步挖掘研究。该文通过对 《伤寒杂病论》 相关条文进行梳理，认为老年心 衰合并肌少症的临床表现与 《伤寒杂病论》 的“心水”“虚劳”证候表现较一致，《伤寒杂病论》 对于老年心衰合并肌少症 的病因病机、诊断治疗具有一定的指导意义。通过对“心水”“虚劳”的心脾肾虚、五劳七伤、水气凌心、瘀血内停病机的 分析，提出心脾肾阳虚、水瘀互结为老年心衰合并肌少症的核心病机。经方如苓桂术甘汤、真武汤、四逆汤、肾气丸、建 中汤、五苓散等可辨证化裁或合用以治疗老年心衰合并肌少症。老年心衰合并肌少症患者的先后天之本皆虚，辨证论治基 础上加强健脾益肾，可能获良效。

Senile chronic heart failure（CHF）complicated with sarcopenia can further degrade patients􀆳 quality of life，and increase the occurrence of falls，disability and mortality. Currently，western medicine preventive and treatment for sarcopenia mainly depend on nutritional support and exercise therapy，but their efficacy remained uncertain. Traditional Chinese medicine（TCM）therapy has the advantages of holism and syndrome differentiation and treatment，and its application in senile CHF complicated with sarcopenia is worthy of further exploration. This paper sorted out the relevant statements in the Treatise on Exogenous Febrile and Miscellaneous Diseases， and concluded that the clinical manifestations of senile CHF complicated with sarcopenia are similar to those of heart water and consumptive disease in the Treatise on Exogenous Febrile and Miscellaneous Diseases. The statements in Treatise on Exogenous Febrile and Miscellaneous Diseases will guide the identification of etiology and pathogenesis as well as the diagnosis and treatment for senile CHF complicated with sarcopenia. The analysis of the pathogenesis indicated that heart water and consumptive disease were induced by deficiency of heart and spleen and kidney， five kinds of overstrain and seven types of impairment，water pathogen insulting heart，and internal stagnation of blood stasis. Therefore，it is proposed that the core pathogenesis of senile CHF complicated with sarcopenia is due to the deficiency of heart， spleen and kidney yang， and water blended with blood stasis. The classical prescriptions such as Ling Gui Zhu Gan Tang，Zhenwu Tang，Sini Tang，Shenqi Pills，Jianzhong Tang and Wuling Powder can be used by modification or combination based on syndrome differentiation in treating senile CHF complicated with sarcopenia. For both of the congenital and acquired origin（spleen and kidney）of elderly patients with CHF complicated with sarcopenia are deficient，the utilization of herbs for invigorating spleen and boosting kidney on the basis of syndrome differentiation may achieve good efficacy.

R256.2

国家重点研发计划项目（编号：2020YFC2005605）；广东省重点领域研发计划项目（编号：2020B1111100004）；广东省中医药局 资助项目（编号：2022KT1279，2022KT1140）；广东省基础与应用研究省企联合基金项目（编号：2022A1515220016)；广东省中医药局课题 （编号：20232057）