林谦教授从肝肾论治老年高血压的临床经验

Professor Lin Qian's Clinical Experience in Treating Elderly Hypertension From the Perspective of Liver and Kidney

现代中医学者大多从“眩晕”“头痛”“痰饮”的角度进行辨证论治来探讨高血压病。头为“诸阳之会”“清阳之府”,五脏六腑之精气皆上注于头,若气虚亏虚、阴阳失调、痰浊内阻、瘀血阻滞,致清窍失养,均可发为眩晕。林谦教授认为,本病的病因病机大约有4种:情志过极,忧思恼怒,致肝气郁结气滞化火;饮食不节,损伤脾胃,致湿浊中阻;先天不足或年老体衰致肝肾阴虚,阴不潜阳肝阳上亢;年老体虚或久病失养,损伤脾肾之阳,水湿不运,痰湿泛溢。林谦教授通过大量的临床实践经验,得出肝肾功能失调是老年高血压病的最常见基本病因病机,兼顾心、脾、肾、全身血管,以及情、气、血、瘀、痰等病理因素。治疗上以调肝补肾为主,兼顾“益气”“活血”“通络”“化痰”为辅,林谦教授自拟调肝补肾汤,临证兼顾个体辨证论治,临床治疗效果显著,病案举例2例。

Modern Chinese medicine scholars mostly explore hypertension through syndrome differentiation and treatment from the perspectives of dizziness,headache,and phlegm retention.The head is the"meeting of all Yang"and the"mansion of clearing yang".The essence and qi of the five organs and six organs are all injected into the head.If Qi deficiency,Yin and Yang imbalance,phlegm turbidity internal obstruction,and blood stasis block,resulting in the loss of nourishment in the clear body,dizziness can occur.Professor Lin Qian believes that there are approximately four types of causes and pathogenesis of this disease:excessive emotions,worry and anger,leading to stagnation of liver Qi and stagnation of Qi into fire.Improper diet can damage the spleen and stomach,leading to dampness and turbidity obstruction.Congenital deficiency or aging and physical decline can lead to liver and kidney Yin deficiency,Yin deficiency and liver yang hyperactivity.Old age,physical deficiency,or prolonged illness leading to loss of nourishment,damage to the Yang of the spleen and kidneys,stagnation of water and dampness,and overflow of phlegm and dampness.Professor Lin Qian has gained extensive clinical experience and concluded that liver and kidney dysfunction is the most common underlying cause and pathogenesis of elderly hypertension,taking into account pathological factors such as heart,spleen,kidney,systemic blood vessels,as well as emotions,Qi,blood,stasis,phlegm,etc.In terms of treatment,the main focus is on regulating the liver and tonifying the kidney,while taking into account"tonifying Qi""promoting blood circulation""unblocking collaterals",and"resolving phlegm"as auxiliary measures.Professor Lin Qian has developed his own"Tiaogan Bushen Tang",which combines individual syndrome differentiation and treatment in clinical practice.The clinical treatment effect is significant,with 2 cases of medical records as examples.