洪善貽辨治青中年高血壓合并代謝紊亂經驗

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摘要：本文介紹洪善貽教授診療青中年高血壓伴代謝紊亂的經驗。洪教授認為，青中年高血壓最常見肝火上炎，痰濕內阻，與不良生活方式有關，因此健康生活方式是控制高血壓的基礎;臨證應辨證與辨病相結合，以辨證為主，從肝脾腎論治，從血脈論治，發揮中醫整體調理和個體化的優勢，逆轉高血壓發展。

關鍵詞：名醫經驗;洪善貽;青中年高血壓;代謝紊亂;中醫藥療法

中圖分類號：R259.441????文獻標識碼：A ???文章編號：1005-5304（2019）09-0126-03

Experience of HONG Shanyi in Treating Young and Middle-aged HypertensionComplicated with Metabolic Disorders

WU Li

Ningbo Hospital of Traditional Chinese Medicine，?Zhejiang University of Chinese Medicine， Ningbo 315010， China

????Abstract：?This article introduced Professor HONG Shanyis experience in treating young and middle-aged hypertension complicated with metabolic disorders. Professor HONG believes that the young and middle-aged hypertension is the most common in liver-fire exuberance syndrome and phlegm moisture hindering syndrome which is closely related to unhealthy lifestyle， so the modern way of life is the basis for the control of hypertension. The clinical treatment is directed by the combination of the differentiation of disease and the differentiation of syndrome， and is mainly with the differentiation of syndrome. The treatment should be discussed from liver， spleen， kidney， blood and meridians， giving full play to the advantages of overall conditioning and individualization of TCM， and reversing the development of hypertension.

???Keywords：?experience of famous doctors; HONG Shanyi; young and middle-aged hypertension; metabolic disorders;?TCM therapy

本院洪善貽教授是第三批全國名老中醫藥專家學術經驗繼承工作指導老師，從醫50余載，對高血壓、高脂血癥、糖尿病等具有豐富的臨床經驗。筆者有幸隨侍洪教授左右，受益匪淺，現將洪教授辨治青中年高血壓合并代謝紊亂經驗介紹如下。

1 ?病因病機

1.1 ?肝火上炎

由于工作及生活壓力大，青中年人精神常處于高度緊張狀態。研究表明，不良情緒及焦慮均與高血壓的發生有關^[1]。中醫認為，肝為剛臟，主疏泄，體陰而用陽，喜調達舒暢，在體合筋;若七情不和，五志過極，首先傷肝，引動肝火，肝失疏泄則氣滯，日久化火，或肝木升發太過，肝火過旺，火性炎上，上擾清竅，致頭脹頭痛，血壓升高。

1.2 ?痰濁內阻

嗜食膏粱厚味、煙酒，少動及熬夜等不良生活習慣，傷及脾胃，致運化失常，痰濕內生，濕濁內蘊，或痰食互結，醞釀而成濁脂。郁久化熱，痰熱互結;壅滯經絡，上蒙清竅，引起頭暈，血壓上升。洪教授認為，痰瘀互結，濁脂內生，壅塞經絡，與現代醫學的高脂血癥、高黏血癥、脂質代謝紊亂、動脈粥樣硬化的機理相吻合。

2 ?辨證論治

臨床上，青中年高血壓以肝火上炎、痰濕內阻常見，以實證為主，也可見肝陽上亢、痰瘀壅滯證^[2]。

2.1 ?肝火上炎

以頭暈頭痛、面紅目赤、口干口苦、便秘、易激動緊張等內火熾盛癥狀為辨證要點，方選龍膽瀉肝湯加減。方中龍膽、黃芩清肝經實火;澤瀉、車前子清利濕熱，引火從小便而出;生地黃滋陰養肝;當歸活血疏肝;柴胡舒暢肝膽，主要解除頭痛、目赤、腫痛等表證。同時兼顧“治血”“治脈”，所謂“治血”，即化濁降脂，改善血液黏稠度，可選用葛根、決明子、山楂、萊菔子、黃連調脂化濁、化瘀祛痰，珍珠母、首烏藤鎮心安神;“治脈”即活血化瘀，改善血管內皮功能，軟化血管，可選丹參、三七、赤芍、牛膝、益母草等。