[Traditional Chinese medicine understanding and treatment strategies for diuretic resistance]

Diuretic resistance(DR) is more common in patients with heart failure(especially acute decompensated heart failure), renal dysfunction, and cardiorenal syndrome. DR can accelerate the damage to heart and kidney organ functions, prolong hospitalization time, increase mortality rate, and bring a heavy burden to public health. It has become a major global public health problem. Although there are currently many treatment methods for DR, the complex pathophysiological mechanisms and limited clinical efficacy have led to unsatisfactory relief of heart failure and renal failure. Moreover, some DR patients are prone to adverse reactions such as electrolyte imbalance, hypotension, and worsening infection during the treatment process. Traditional Chinese medicine(TCM) treatment has the characteristics of reducing diuretic resistance while exerting fewer side effects, so some patients have started seeking help from TCM. In TCM, DR falls under the categories of "heart-water disease" and "edema". In terms of etiology, it is mainly associated with aging and chronic illness, innate deficiency, invasion of external pathogens, dietary irregularities, emotional imbalances, and improper work-rest balance. In terms of pathogenesis, it includes water overflow due to Yang deficiency, fluid retention turning into heat, and kidney Yang deficiency. In TCM treatment strategies, for water overflow due to Yang deficiency syndrome, Zhenwu Decoction is recommended; for fluid retention turning into heat syndrome, Mufangji Decoction is recommended; and for kidney Yang deficiency syndrome, Shenqi Pill is recommended. In clinical treatment, based on the principles of "formula-syndrome correspondence" and "integrating disease mechanisms with pathology, and herbal properties with pharmacology", the combined use of TCM and western medicine can help alleviate DR, increase urine output, and improve the quality of life for patients with DR.