基于潜阳活血治则的天芎颗粒治疗高血压病临床体会

Clinical experience of Tianxiong Granules in treatment of hypertension based on treatment principle of supressing Yang and promoting blood circulation

高血压病为临床最常见的慢性疾病,已成为心血管疾病最常见的危险因素,因其高发病率、致残率、病死率备受全球关注。尽管现代医学在新型降血压药物,如microRNA候选药物Zilebesiran、直接肾素抑制剂、肾交感神经阻断术等高血压病的治疗手段上取得进展,但其控制率仍不理想。如何有效防控高血压病,已成为当前亟待解决的临床难题之一。中医药治疗高血压病历史悠久,已积累丰富的经验,包括理论认识、有效单味药、复方、中成药与经典名方。中医学中,高血压病属于“眩晕”“头痛”等范畴。既往文献与临床研究发现,高血压病存在火证、饮证、虚证、瘀证等关键病机。其中,肝阳上亢与血压波动、血压变异、炎症、交感活性兴奋等密切相关;瘀血内阻与高血压病的心、脑、肾等靶器官损害密切相关。因此,肝阳上亢、瘀血内阻这两大关键病机贯穿高血压病的疾病始终。前期研究发现,基于潜阳活血治则治法而形成的有效经验方——天芎颗粒,源于经典名方《御药院方》芎䓖天麻丸,由天麻、川芎、葛根、牛膝、川牛膝组成,在高血压病的治疗中疗效显著。其临床运用指征包括头痛、头晕、头胀,项强,腰腿酸软。同时可伴有言语不利,口渴,大便或正常、或稀溏,腰酸腿软,下肢疼痛,筋脉挛急,行经腹痛,舌暗红,脉弦数有力、或脉过寸口,弦直而长。在合方规律上,可根据高血压病患者所处的不同病机阶段,合方而用,火证阶段常合天麻钩藤饮、柴胡加龙骨牡蛎汤;饮证阶段合半夏白术天麻汤;虚证阶段合六味地黄丸、肾气丸。在剂量加减上,应抓主症,根据血压值调关键药物的剂量,部分药物可足量运用。通过解析天芎颗粒组方配伍、临床运用指征、合方经验及剂量运用体会,为中医药治疗高血压病阳亢血瘀证提供有效治疗方法及更多选择。

Hypertension is the most common chronic disease in clinics and has become the most common risk factor for cardiovascular diseases.Because of its high incidence rate,disability rate,and mortality,it has attracted worldwide attention.Despite continuous progress in modern medicine in the treatment of hypertension with new antihypertensive drugs such as Zilebesiran,a nucleic acid drug that acts on microRNA,direct renin inhibitors,and renal sympathetic blockade,the control rate is still not ideal.How to effectively prevent and control hypertension has become one of the urgent clinical challenges to be solved.Traditional Chinese medicine(TCM)has a long record of treating hypertension and has accumulated rich experience,including theoretical understanding,effective single medicine,compound medicine,traditional Chinese patent medicines,and classic famous prescriptions.In TCM,hypertension belongs to the categories of diseases such as dizziness and headache.Previous literature and clinical studies have found that hypertension has key pathogenesis such as fire syndrome,fluid syndrome,deficiency syndrome,and blood stasis syndrome.Among them,the hyperactivity of liver Yang is closely related to blood pressure fluctuations,blood pressure variability,inflammation,and sympathetic activity stimulation.Internal obstruction by blood stasis is closely related to the damage of target organs such as the heart,brain,and kidneys in hypertension.Therefore,the two key pathogenesis of liver yang hyperactivity and internal obstruction by blood stasis run through the entire process of hypertension.Previous studies have found that the effective empirical formula Tianxiong Granules,based on the principles of suppressing Yang and promoting blood circulation,originated from the classic formula Xiongqiong Tianma Pills in Yu Yao Yuan Fang.It is composed of Gastrodiae Rhizoma,Chuanxiong Rhizoma,Puerariae Lobatae Radix,Achyranthis Bidentatae Radix,and Cyathulae Radix and has significant therapeutic effects in the treatment of hypertension.The clinical indications include headache,dizziness,bloating,strong neck,and weak waist and legs.At the same time,it may be accompanied by poor speech,thirst,normal or loose stools,soreness in the waist and legs,lower limb pain,muscle and pulse spasm,menstrual and abdominal pain,dark red tongue,strong pulse strings,or straight and long pulse strings that pass through the mouth of an inch.In the combination rule,it can be used according to the different pathogenesis stages of hypertension patients.In the fire syndrome stage,it is often combined with Tianma Gouteng Decoction and Chaihu Jia Longgu Muli Decoction.In the fluid syndrome stage,it is often combined with Banxia Baizhu Tianma Decoction.In the deficiency syndrome stage,it is often combined with Liuwei Dihuang Pills and Shenqi Pills.In terms of dosage,it is important to focus on the main symptoms and adjust the dosage of key drugs based on blood pressure values.Some drugs can be used in sufficient quantities.By analyzing the compatibility of Tianxiong Granules,clinical application indications,combined formula experience,and dosage application experience,we provide effective treatment methods and more options for TCM to treat hypertension with Yang hyperactivity and blood stasis syndrome.