从“气-血-脉络”体系探析儿童青少年高血压的分层防治思路

Prevention and Treatment of Hypertension in Children and Adolescents by Levels from the“Qi-blood-vessels and collaterals”System

基于儿童青少年禀赋于先天、形质未充、脉络娇弱以及变蒸于后天、气血渐盛、阳旺阴长的生理特点,以“气-血-脉络”体系为理论指导,提出儿童青少年高血压是以禀赋不良、脉络失柔为病变基础,以气病不和、阳郁阴伤、气血窜逆为基本病机,并引起痰湿热生、与气相搏,血分稠滞、痰瘀互结,终致脉络受损、久伏而发。基于儿童青少年高血压气分、血分、脉络病三个不同层面,主张以调和气血、通补脉络为治疗总纲,以气分病理气宣郁、调和阴阳,血分病行瘀除痰、活血养血,脉络病通脉涤络、顾护元气为分层防治用药思路,并强调“调其禀赋、补虚纠偏、荣养形脉”应贯穿治疗始终。

In terms of the hysiological characteristics,children and adolescents are endowed with physical insufficiency and delicate vessels and collaterals,but have changes of the acquired constitution when there is gradual exuberant qi and blood,and when yang arises and yin grows.From the“qi-blood-vessels and collaterals”system,this paper discussed and summarized that based on the pathological changes of“poor endowment and unsoftened vessels and collaterals”,and the basic pathogenesis of“qi disease disharmony,yang constraint and yin damage,and scurrying counterflow of qi and blood”,hypertension in children and adolescents occurs when there is“phlegm-dampness producing heat,and having contention with qi”,“blood level thickening,and phlegm and stasis binding”,and thereafter“damaged vessels and collaterals,and long-term accumulation”.It is proposed to treat from three levels of qi,blood,and vessels and collaterals,and take“harmonizing qi and blood,unblocking and supplementing the vessels and colla-terals”as the general principle.It is advised to rectify qi and diffuse constraint,harmonize yin and yang for qi level diseases,move stasis and remove phlegm,activate and nourish blood for blood level diseases,and unblock vessels and collaterals,and protect original qi in terms of vessels and collaterals diseases.Additionally,it is emphasized to“regulate the endowment,nourish deficiency and rectify the abnormal,nourish body and vessels”throughout the treatment.