从“数”到“证-靶”——高血压中医药治疗理念与策略研究述评

From"Numerical Value"to"Syndrome and Target":A Review of the Concept and Strategy of Hypertension Treatment in Chinese Medicine

围绕高血压中医药治疗从重视血压数值到重视证和靶器官终点事件的理念转变,从“血压值达标”到“越早达标越好”的策略转变,以及在继承拓展病机理论、科学阐释证候内涵、创新优化遣方用药、阐明药效靶点机制等方面的进展,对近年来高血压中医药治疗的理念、策略、方法及机制进行简要总结。针对“病初即可及靶”的认识和继承不够、创新不足、证据薄弱等问题,提出“数-证-靶”结合的高血压中医药防治与疗效评价研究策略,探讨与西药治疗“差异化、互补化、比较优势”的研究定位及以“终”(心脑肾终点)为“始”(研究出发点)的研究思路,并在明确自身定位、探索融合之术、守正升华理论、开拓组方思维、积累循证证据、创新评价方法、阐明靶点机制等方面展望了前沿探索方向。

A brief summary of the concepts,strategies,methods and mechanisms of Chinese medicine treatment for hypertension in recent years is presented,focusing on the conceptual shift of endpoint events from emphasizing the numerical value of blood pressure to syndromes and target organs,and the strategic shift from"meeting the blood pressure standard"to"sooner meeting the standard",as well as the progress in inheriting and expanding the pathogenesis theory,scientifically interpreting the connotation of syndrome,innovating and optimizing the use of prescriptions,and elucidating the mechanisms of pharmacological targets.In response to the problems of insufficient understanding and inheritance,short of innovation,and flimsy evidence of"reaching the target at the initial stage",we propose the research strategy of"the combination of numerical value-syndrome-target"for the prevention and treatment of hypertension with Chinese medicine and its efficacy evaluation,with the research orientation of"differentiation,complementation,and comparative advantage"of the western medicine treatment,together with the research idea of"regarding the research starting point as the ending point of heart,brain,and kidney".In addition,we analyze and prospect the frontier exploration directions in terms of clarifying our own positioning,exploring the art of integration,keeping the positive and upgrading development,expanding the formulae thinking,accumulating evidence-based facts,innovating evaluation methods,and elucidating target mechanisms.