张钟爱教授治疗老年高血压病的经验

Experience of Zhang Zhong'ai in the treatment of hypertension in the elderly

张钟爱教授认为老年高血压病是由多种因素相互作用导致脏腑功能失调,气机逆乱所致,其中肾肝脾三脏最为关键。肾乃先天之本,肾阴是人体阴液之本,肾精不足、阴液亏虚、肝木失养是老年高血压病的发病基础;肝主疏泄,调达全身气机,条畅气血平和。肝用不稳,疏泄失司,脏腑气血升降失衡是老年高血压病的病机关键;脾主运化,主升清,运化失常,痰浊内生,清阳不升是老年高血压病发生的重要环节;肾肝脾三脏相互作用,相互影响。痰、瘀作为重要病理因素,既是脏腑功能失调的产物,又可进一步影响脏腑的功能,导致疾病进展。老年高血压病病性乃本虚标实,其中本虚以脾虚、肾虚为主,疾病早期以阴虚为主,中期表现为气阴两虚,后期出现阴损及阳,乃至阴阳两虚之候。标实乃肝阳、痰、火、瘀血为患。治疗方面张钟爱教授提出滋肾柔肝健脾、潜阳化痰祛瘀的治则,并分为肝肾阴虚型、风阳(火)上扰型、痰浊中阻型、气虚血瘀型。辨证选方用药方面,以六味地黄丸为主方加减化裁滋补肝肾,桑蒺温胆汤加减平肝化痰,提出活血通络应贯穿于治疗的始终,强调腑气通畅的重要性,并指出规律服药、健康饮食、乐观的心态对稳定血压至关重要。

Professor Zhang Zhong'ai holds that hypertension in the elderly is caused by the disorder of viscera function and Qi according to the traditional Chinese medicine(TCM)theory.The kidney,liver and spleen are the most critical organs involved in the pathogenesis of hypertension.In detail,the deficiency of kidney essence and Yin fluid is the initiating factor.The deregulatory function of liver and spleen is the key promoter.The phlegm and blood stasis are the main pathological products and deteriorating factors.The pathogenesis is empty of essence.Empty of spleen and kidney essence is the major reason.Liver yang,phlegm,fire and blood stasis are outer phenomena.In the early phase,yin deficiency is the main mechanism.Deficiency of Qi and Yin is the key mechanism in the middle phase.At last,hypertension is characterized by Yin deficiency affecting yang which results in deficiency of both Yin and Yang(阴阳).Prof.Zhang establishes the principles of nourishing the kidney,softening the liver,strengthening the spleen,removing phlegm and blood stasis.Differentiation syndrome can be divided into yin deficiency of liver and kidney,disturbance in wind yang,stagnation of phlegm,and Qi deficiency and blood stasis.Prof.Zhang applies Liuwei Dihuang pills(六味地黄丸)and Sangji Wendan decoction(桑蒺温胆汤)as the basic formula to nourish liver-kidney and reduce phlegm.Therapy of promoting blood circulation to remove meridian obstruction should be performed throughout the disease.She also stresses that regular medication,a healthy diet and a positive outlook are crucial to stabilizing blood pressure.