基于从肝论治的高血压病舌象的临床试验研究

Clinical Trials of Tongue Image of Hypertension Based on Treatment from Liver

目的:通过比较中青年原发性高血压患者中肝火上炎证与肝气郁结证辨证治疗后舌象变化的规律,初步探讨肝藏血主疏泄生理功能对人体微循环系统的调节作用。方法:选取天津中医药大学第二附属医院2014年12月—2015年3月期间在心内科住院或门诊就诊的原发性高血压患者共25例,其中肝火上炎证13例,肝气郁结证12例,分别对其进行辨证治疗28 d,治疗药物分别为三草芍甘汤和柴胡疏肝散颗粒剂,2次/d,1袋/次。基线期及治疗期结束时对所有患者进行舌象数据采集。结果:中药干预前肝气郁结组最大瘀斑面积明显大于肝火上炎组(P<0.05);中药干预后有舌瘀斑患者较前明显减少(P<0.05),且最大瘀斑面积较前显著减小(P<0.05);两组间苔色比较,肝火上炎组黄苔显著多于肝气郁结组(P<0.05);肝火上炎组中药干预后苔质由厚腻转薄,且差异有统计学意义(P<0.05);舌下络脉两组间比较及组内前后比较均无显著性差异(P>0.05)。结论:原发性高血压患者呈现不同程度的循环障碍和内分泌代谢紊乱。肝火上炎证以微循环充血表现为主,肝气郁结证以微循环淤血表现为主。肝主疏泄功能失常时局部为微循环淤滞状态,血管受到一定程度的损伤,可能释放某些血管活性物质,血液出现特定的病理变化。

Objective： By comparing the tongue image of treatment from liver for young and middle-aged essential hypertension（ EH） patients who were up-flaming liver fire syndrome and liver qi stagnation syndrome to explore the physiological functions of liver adjusting human body blood microcirculation system. Methods： A total of 25 young and middle-aged essential hypertension patients from the Second Affiliated Hospital of TCM from December 2014 to March 2015 included 13 up-flaming liver fire patients and 12 liver qi stagnation patients. Treat them based on syndrome differentiation for 28 days and detect the tongue image. Chinese medicine prescriptions including Sancao Saogan Decoction and Chaihu Shugan Powder were taken,a bag at a time and twice a day. At the end of the baseline period and treatment,we evaluated all patients＇ tongue image. Results： The biggest bruises area of liver qi stagnation group was significantly greater than the other group＇s before the intervention of Chinese medicine（ P〈0. 05）. The number of patients with tongue ecchymosis was obviously reduced after the intervention（ P〈0. 05） and the largest bruises area significantly decreased（ P〈0. 05）. Tongue coating color comparison between the two groups： yellow coating in up-flaming liver fire patients was significantly more than the other group＇s（ P〈0. 05）. After the intervention,the up-flaming liver fire patients＇ tongue coating turned to be greasy and thin（ P〈0. 05）. There was no significant difference of two groups＇ sublingual collateral（ P〉0. 05）. Conclusion： EH has different degrees of circulatory disturbance and endocrine metabolic disorders. Up-flaming liver fire patients mainly performs microcirculation congestion and the liver qi stagnation patients performs local microcirculation congestion. The blood vessel is damaged,which may release some vascular active substances and particular pathological changes.