徐凤芹“病症结合”治疗老年高血压病经验

XU Fengqin's Experience in Treating Hypertension in the Elderly based on the Theory of“Combination of Disease and Symptoms”

总结徐凤芹教授治疗老年高血压病的临证经验。认为老年高血压病以肝肾亏虚为发病基础,以肝阳上亢、脾失健运为病机关键,提出“病症结合”观点,将老年高血压病的四种常见临床症状(晨峰现象、昼夜节律异常之反杓型高血压、餐后低血压及体位性低血压)进行分类辨治,并根据不同症的病机特点组方施药。晨峰现象的病机以肝肾阴虚、肝阳上亢为主,治宜滋肝益肾、平肝潜阳,方用清眩降压汤加减;昼夜节律异常之反杓型高血压的病机以痰湿阻滞、清阳不升为主,治宜化痰祛湿、平肝熄风,方用半夏白术天麻汤合加味红龙夏海汤加减;餐后低血压和体位性低血压的病机均以脾胃亏虚、清阳不升为主,治宜补中益气、升阳举陷,方用补中益气汤或益气聪明汤加减。

This paper summarized the clinical experience of XU Fengqin in the treatment of hypertension in the elderly.It is believed that the basic pathogenesis of hypertension in the elderly is liver and kidney depletion,and the key is ascendant hyperactivity of liver yang and spleen failing to transport.Therefore,the theory of“combination of disease and symptoms”is put forward that the four common clinical symptoms of hypertension in the elderly,including morning hypertension,non-dipper hypertension with abnormal circadian rhythm,postprandial hypotension and orthostatic hypotension,should be differentiated and treated with prescription in accordance with the characteristics of the corresponding pathogenesis.Specifically,the pathogenesis of morning hypertension is mainly liver-kidney yin deficiency and ascendant hyperactivity of liver yang,for which the treatment method of enriching liver and boosting kidney,calming the liver and subduing yang is suggested,and Qingxuan Jiangya Decoction(清眩降压汤)in modifications can be used.For non-dipper hypertension with abnormal circadian rhythm,the pathogenesis is mainly phlegm-dampness obstruction and clear yang failing to ascend,and treatment method should be dissolving phlegm and dispelling dampness,calming the liver and extinguishing wind,with Banxia Baizhu Tianma Decoction and Modified Honglong Xiahai Decoction(半夏白术天麻汤合加味红龙夏海汤)in its modifications.Regarding postprandial hypotension and orthostatic hypotension,the pathogenesis is mainly spleen-stomach depletion and clear yang failing to ascend,and thus the method of supplementing the center and boosting qi,raising yang and lifting the sunken is advised with Buzhong Yiqi Decoction(补中益气汤)or Yiqi Congming Decoction(益气聪明汤)in the modifications.