中国中药杂志

2020, v.45(12) 2752-2759

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初发高血压病、青年高血压病的中医认识及天麻钩藤饮的临床治疗体会
Traditional Chinese medicine insights of newly-diagnosed and young hypertension and clinical practice of Tianma Gouteng Decoction for hypertension treatment

孟醒;熊兴江;
MENG Xing;XIONG Xing-jiang;Guang′anmen Hospital, China Academy of Chinese Medical Sciences;Lugouqiao Community Health Service Center Fengtai District;

摘要(Abstract):

高血压病已经成为全球重大公共卫生问题,针对初发高血压病、青年高血压病的早期干预与及时阻断尤为关键。天麻钩藤饮出自胡光慈《杂病证治新义》,可以平肝息风,清热活血,滋补肝肾,主治肝阳偏亢,风阳上扰证。众所周知,天麻钩藤饮为治疗高血压病的经典名方。然而,由于历史条件限制,古今关于天麻钩藤饮的医案与研究均存在诊断不明确,降压疗效与疗程不具体,天麻钩藤饮能不能降压,具体能下降多少收缩压与舒张压,服药多长时间能降压,同时在服的西药能不能减或者停等均充满了不确定与未知,此类共性问题严重影响经典传承。因此明确其方证指征、疗效、疗程等关键点对于指导临床至关重要。研究发现,①既往认为高血压病属于肝阳上亢、肝风内动,从肝论治高血压病能够取效,然而,长期服用降压西药后,不仅能阻断疾病进展,使升高的血压得以迅速控制,更使中医病机证候发生变化,使肝阳上亢证等"火证"出现的几率大大减少,从而更主要表现为"饮证"和"虚证",使高血压病的病因病机朝虚实夹杂的复杂病变阶段转化,因此在高血压病的"肝风"与"肝阳"实证阶段做到及早干预尤为关键;②初发高血压病、青年高血压病因其初发,且大多未经降压西药干预,其中医病机与证候尚未受西药干预影响,尚保留高血压病的本源状态,与肝阳上亢证高度吻合;③初发高血压病、青年高血压病在其病理机制上主要表现为交感神经系统活性亢进、肾素-血管紧张素-醛固酮系统激活、血管平滑肌细胞舒缩变化、内皮细胞功能紊乱等机制;④天麻钩藤饮方证包括:在现代医学疾病方面,该方广泛应用于高血压病初期或未经西药干预的早期治疗,其中尤以初发高血压病、青年高血压病为主,还可用于3级高血压病、高血压病危象、高血压病急症的治疗;在症状方面,天麻钩藤饮可用于头痛,头晕,头胀,言语不利;面红目赤,视物昏花;烦躁不安,躁动,焦虑,心悸,失眠,精神障碍,身体发热感;口干口苦,汗出;四肢酸软无力,腰痛,腰膝酸软;小便黄,小便灼热感,大便或干或稀;舌红,脉滑数,脉弦数有力,弦直而长,脉过寸口;⑤服用天麻钩藤饮3~6个月,不仅能降压、改善症状,更能减少西药用量,甚至停用西药;⑥近年来,研究发现,因天麻钩藤饮中首乌藤具有一定的肝毒性,长期服用该方存在安全风险,然而,在定期复查生化指标监测下,笔者发现长期服用(3~6个月)首乌藤(3~10 g·d~(-1))未发现肝功能损害;⑦天麻钩藤饮的药性与药理契合初发高血压病、青年高血压病的病机与病理,可视为初发高血压病、青年高血压病的"专病专方"。深化对天麻钩藤饮的临床疗效、安全性与分子机制研究有望在中药降压及高血压病的治疗上取得突破。
Hypertension is a global major public health problem. Early intervention and timely blocking are necessary for newly-diagnosed hypertensive and young hypertensive patients. Tianma Gouteng Decoction recorded in Zabing Zhengzhi Xinyi written by HU Guangci has the major functions in treating excess syndrome and wind-Yang disturbance syndrome with effects in calming liver-wind, clearing heat and activating blood, and nourishing liver and kidney. As we known, Tianma Gouteng Decoction is a classical formula for treating hypertension. However, due to the limitation of historical conditions, some problems impede Tianma Gouteng Decoction from being handed down successfully, such as uncertain diagnosis, uncertain antihypertensive efficacy and treatment-course. In this case, we ask whether Tianma Gouteng Decoction can be used as antihypertensive therapy and the exactly decrease of systolic and diastolic blood pressure, and wonder the half-life of Tianma Gouteng Decoction and the relationship with Western medicine. Therefore, defined prescription and syndrome, efficacy, treatment-course are important in clinical practice. According to the findings, ① previously, we thought that hypertension was a liver-Yang hyperactivity and liver-wind stirring syndrome, and the liver-based therapy theory was effective. However, based on our study, long-term treatment with Western medicine could block disease progression, control the increased blood pressure and change the pathogenesis and syndrome of traditional Chinese medicine. Therefore, the frequency of liver-Yang hyperactivity syndrome "fire syndrome" decreased sharply, and the main syndrome was fluid-retention syndrome and deficiency syndrome. The etiology and pathogenesis of hypertension was prone to deficiency syndrome accompanied with excess syndrome. Therefore, it was necessary to intervene hypertension in "liver-wind" and "liver-Yang" excess syndrome stage, and the early intervention and treatment are important. ② The newly-diagnosed hypertensive and young hypertensive patients usually had no Western medicine intervention. Thus, the etiology and pathogenesis of hypertension were free from Western medicine, which maintained the initial stage of hypertension in line with the liver-Yang hyperactivity syndrome. ③ The pathological mechanisms of newly-diagnosed and young hypertension were mainly increase in sympathetic activity, active renin-angiotensin-aldosterone system, change in morphology of vascular smooth muscle cells and endothelial cell dysfunction. ④ According to the syndrome of Tianma Gouteng Decoction, in modern medicine, Tianma Gouteng Decoction was widely used to treat the early-stage hypertension and the early-intervention of hypertension without Western medicine, particularly newly-diagnosed, young hypertension, Ⅲ hypertension, hypertensive crisis and hypertensive emergency. Tianma Gouteng Decoction can treat such symptoms as headache, dizziness, fullness of head, slurring of speech; facial flushing, conjunctival congestion and blurred vision; dysphoria, anxiety, palpitation, insomnia, mental disorder and hot flushes; dry-mouth with bitter taste and sweeting; myasthenia of limbs and lassitude in loin and legs; brown urine with burning sensation during urination; a solid or liquid stool consistency; red tongue, slippery and rapid pulse, wiry and rapid pulse over to Cunkou. ⑤ After treatment with Tianma Gouteng Decoction for three to six months, the blood pressure was decreased, and the symptoms were improved with reduction or even discontinuance of Western medicine. ⑥ According to recent studies, Caul is Polygoni Multiflori of Tianma Gouteng Decoction induced certain hepatotoxicity and increased the risk of long-term treatment. However, with the regular monitoring of biomedical index, long-term treatment with Caulis Polygoni Multiflori(3-10 g·d~(-1) for 3 to 6 months) didn′t show hepatic dysfunction. ⑦ The pharmacological activity of Tianma Gouteng Decoction coincided with the pathology and disease mechanism of newly-diagnosed and young hypertension. Therefore, Tianma Gouteng Decoction was the specific recipe for newly-diagnosed and young hypertension. Therefore, further studies of efficacy, safety and molecular mechanism of Tianma Gouteng Decoction may make a medical breakthrough for hypertension treatment.

关键词(KeyWords): 初发高血压病;青年高血压病;天麻钩藤饮;经典名方
newly-diagnosed hypertension;young hypertension;Tianma Gouteng Decoction;classical formula

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(81403375,81603479,81804084);; 中国科协青年人才托举工程项目(2017QNRC001);; 国家重点研发计划项目(2018YFC17044901);; 北京市自然科学基金项目(7194277);; 中国中医科学院育苗基金培育专项(ZZ11-073);中国中医科学院优秀青年科技人才项目(ZZ13-YQ-018)

作者(Author): 孟醒;熊兴江;
MENG Xing;XIONG Xing-jiang;Guang′anmen Hospital, China Academy of Chinese Medical Sciences;Lugouqiao Community Health Service Center Fengtai District;

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