基于“下虚上实”病因病机探讨高血压病的防治策略

Prevention and treatment strategy of hypertension based on etiology and pathogenesis of"lower deficiency and upper excess"

高血压病患者病因病机为“下虚上实”,病因以下虚为先,后致上实。下虚表现在肝肾阴虚,临床症状为腰膝酸软、或腰痛、或下肢无力、或全身乏力、或咽干。上实多表现为肝阳上亢,(冲)气逆于上,临床表现为血压超出正常值、头晕、咽干,或口苦、或头痛、或耳鸣耳聋、或心悸、或怔忡、或胸痛、或胃食管反流、或烧心反酸等,属于肝阳上亢、或肝木克脾土、胃失和降等证候。肝肾亏虚导致阴不敛阳,形成肝阳上亢,痰瘀阻滞清窍形成眩晕。高血压病其本在肝肾亏虚,其标在肝阳上亢。因此,从下虚上实发展过程中,采取以补下泻上的治疗准则,滋肝肾阴以敛肝阳,进行高血压的防治和预防,达到标本同治的目的。

The etiology and pathogenesis of patients with hypertension are lower deficiency and upper excess.The deficiency below the etiology comes first,and then leads to upper excess.Lower deficiency is manifested by the yin deficiency of liver and kidney.The clinical symptoms are lumbar and knee weakness,or low back pain,or lower limb weakness,or systemic fatigue,or dry throat.In fact,it is mostly manifested as excess of liver yang,manifesting Qi inversion symptoms of high blood pressure,dizziness,dry throat,or bitter mouth,or headache,or tinnitus and deafness,or palpitations,or chest pain,or gastroesophageal reflux,or heartburn acid reflux,which are also named like hyperactivity of liver yang,liver yang heat,liver defencing spleen,or spleen deficiency leading to phlegm.Deficiency of liver and kidney leads to yin failing to restrain yang,resulting in hyperactivity of liver yang,spleen deficiency generating phlegm,and phlegm blocking orifices.Hypertension is due to deficiency of liver and kidney,and its sign is hyperactivity of liver yang.Therefore,lower deficiency and upper excess process and guides the treatment and prevention of hypertension.In the treatment,with the principle of lower deficiency and upper excess,we can nourish liver and kidney Yin to defence liver Yang for hypertension.