基于“土枢四象,一气周流”理论论治高血压病合并失眠

Treating hypertension complicated with insomnia based on the theory of“Normal spleen pivots other four viscera,and Qi circulates around the body”

高血压病是一种以体循环动脉压升高为主要临床表现的心血管综合征,是心、脑、肾等器官功能损害及器质性病变的重要风险因素,近年来,高血压病在我国的发病率逐渐升高,成为影响人们生活的常见慢性疾病。失眠是一种常见的睡眠障碍,发病率也逐渐升高。高血压病与失眠往往相伴相生。清代医家黄元御以《黄帝内经》中的五行理论为基石,总结前人的学术研究与临证思想,并结合自身的医学心得,阐发了脾胃升降在全身气机运转中的核心枢纽作用,提出了著名的“土枢四象,一气周流”理论。研究基于黄氏“土枢四象,一气周流”理论体系,从厥阴风木、太阳寒水、少阴君火、太阴湿土四个方面来论述分析高血压病合并失眠的病机,治疗上侧重于脾土为气机升降的枢纽,采用疏肝健脾、温肾暖水、清火养阴、燥土泻湿等方法,将黄氏思想贯穿于高血压病合并失眠治疗的始终,以期为高血压病合并失眠的临床诊疗提供参考。

Hypertension is a kind of cardiovascular syndrome with increased systemic arterial pressure as the main clinical manifestation,and is an important risk factor for organ function damages of the heart,brain,and kidney,and organic diseases.In recent years,the incidence of hypertension in our country has gradually increased,and slowly has become a common chronic disease that affects people’s life.Insomnia is a common sleep disorder with an increasing incidence.Hypertension is often accompanied by insomnia.Based on the five elements theory in Huangdi Neijing(《黄帝内经》),HUANG Yuanyu,a famous TCM practitioner in the Qing Dynasty,summarized previous academic research and clinical thoughts,integrated his own medical insights,elucidated the pivotal role of spleen and stomach in Qi movement(气机)in the human body,and proposed the famous theory of“Normal spleen pivots other four viscera,and Qi circulates around the body”.Based on HUANG’s theoretical system of“Normal spleen pivots other four viscera,and Qi circulates around the body”,the author discusses and analyzes the pathogenesis of hypertension plus insomnia from the four aspects as follow:Jueyin meridians(厥阴)liver-wind,Taiyang meridians(太阳)cold-water,Shaoyin meridians(少阴)monarch-fire,and Taiyin meridians(太阴)earth-dampness.The treatment focuses on spleen soil as the hub of the rise and fall of Qi movement.The treatment strategies such as soothing liver and fortifying spleen,warming kidneys and water,clearing away heat and nourishing Yin(阴),and drying soil to remove dampness are adopted,and HUANG’s ideas are integrated throughout the treatment of hypertension plus insomnia,in order to provide a reference for the clinical diagnosis and treatment of this disease.