近代医家刘民叔辨治高血压的学术经验

Modern Physicians LIU Min-Shu's academic Experience in the Treatment of Hypertension

探讨近代巴蜀医家刘民叔辨治和预防高血压的学术经验。刘民叔根据高血压的病理、症状与转归,辨其为中医之“气血厥逆”。认为高血压病位在心与血脉,与肝相关,核心病机是营卫运行失常,心气热是根本,风是暴发诱因,营卫留止是病机结果。心气热则营卫运行时速失常,痰瘀内结,留止于血脉,引起血压升高,常隐匿起病,发为无症状性高血压。在此基础上,若火动生风,风火相煽则病势暴速,形成高血压急症,血压急剧升高(收缩压≥220 mmHg,和/或舒张压≥140 mmHg),伴/不伴靶器官损害症状。刘民叔以养藏为防治原则,自制凌霄抵当汤,从心气热、营卫留止、风煽火烈3个病机节点恢复营卫运行常度,以降压、救急和保护靶器官损害,治疗高血压久病乃至脑出血者。预防方面认为,未厥当养藏,重节欲保精;已病慎始,早治防传,填精善后防复,力求断病绝根,防止二次卒中。

To explore the academic experience of LIU Min-shu,a modern Bashu healer of TCM,on the differentiation,treatment and prevention of hypertension.According to hypertension's pathology,clinical symptoms and outcome,LIU Min-shu named it as"qi and blood reverse".He thought hypertension was located in the heart and blood vessel,related to the liver,its the core pathogenesis was the abnormal often and speed of run of construction and defense,the foundation was the heart qi heat,the outbreak precipitating factor was the wind,and the pathogenesis result was the detention of construction and defense.The heart qi heat led the abnormal often and speed of the run of construction and defense,phlegm and static blood binding together and stayed in blood vessel,all these caused blood pressure to rise,and it was often to be the asymptomatic hypertension because the process was very hidden.On this basis,if fire engenders wind,fire and wind assisted each other could cause a stormily hypertension-hypertension emergency,which the blood pressure increased sharply(systolic blood pressure≥220 mmHg,and/or diastolic blood pressure≥140mmHg),with/without symptoms of target organ damage.According to the principle of nourishing store,Liu Minshu self-created Lingxiao Didang decoction to restore the normal run habitus of construction and defense by intervening the three pathogenesis nodes of heart qi heat,detention of construction and defense,and vigorous fire with wind fanning.It had effects of lowering blood pressure,emergency rescue and protecting target organs damage in treating patients with chronic hypertension and even cerebral hemorrhage.In the aspect of prevention,he thought we should store essence by continence when we weren't a patient of hypertension.So if we have been sick in it,we should be treatment in early to check erroneous ideas at the outset,and replenish essence in the state of recover to prevent recurrence,that in order to get a radical cure as much as possible and avoid stroke again.