运动能力下降是心血管疾病（cardiovascular disease，CVD）患者预后不良的独立危险因素。针对CVD引发以心功能不全为核心的恶性循环累及肺通气/氧合、骨骼肌代谢及骨骼力学功能，共同导致运动能力衰竭，提出“心-肺-肌-骨”功能轴协同理论，并以此为基础系统阐述中药干预通过改善心功能与血管功能、提升肺通气与氧合能力、增强肌肉质量与代谢功能、维持骨骼质量与力学功能等多重机制，发挥多靶点、整体调节优势以协同逆转运动能力下降的作用。临床证据整体质量总体偏低，但已形成以运动耐量为核心、覆盖功能轴各子系统的多维度证据体系，证实中药复方对功能轴核心指标的一致改善作用。该功能轴理论为阐释CVD患者运动能力下降的多系统深层机制，解析中药整体调节优势并优化干预策略提供了创新框架，体现了中医药在心脏康复领域的独特价值。

Impaired exercise capacity is an independent risk factor for poor prognosis in patients with cardiovascular disease (CVD). The vicious cycle triggered by CVD, centered on cardiac dysfunction, progressively compromises pulmonary ventilation/gas exchange, skeletal muscle metabolism, and skeletal function, collectively leading to exercise intolerance. The “cardio-pulmonary-muscular-skeletal” functional axis theory is proposed to elucidate this multisystem deterioration. Within the framework, this review systematically discusses the mechanisms by which traditional Chinese medicine (TCM) interventions synergistically reverse exercise intolerance. These mechanisms include improving cardiac and vascular function, enhancing pulmonary ventilation and oxygenation, increasing muscle mass and metabolic function, and maintaining bone quality and mechanical function, thereby leveraging the multi-targeted and holistic regulatory advantages of TCM. Although the overall quality of clinical evidence remains moderate, a multidimensional evidence system centered on exercise tolerance has been established. This evidence confirms the consistent benefits of TCM formulas on core indicators across the functional axis. The functional axis theory provides an innovative framework for understanding the multisystemic underlying mechanisms of exercise capacity decline in CVD patients and for guiding holistic TCM-based interventions, highlighting the unique value of TCM in cardiac rehabilitation.

R285

国家科技重大专项子项目（2024ZD0528303）