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摘要：本文介紹洪善貽教授診療青中年高血壓伴代謝紊亂的經(jīng)驗(yàn)。洪教授認(rèn)為，青中年高血壓最常見肝火上炎，痰濕內(nèi)阻，與不良生活方式有關(guān)，因此健康生活方式是控制高血壓的基礎(chǔ);臨證應(yīng)辨證與辨病相結(jié)合，以辨證為主，從肝脾腎論治，從血脈論治，發(fā)揮中醫(yī)整體調(diào)理和個(gè)體化的優(yōu)勢(shì)，逆轉(zhuǎn)高血壓發(fā)展。

關(guān)鍵詞：名醫(yī)經(jīng)驗(yàn);洪善貽;青中年高血壓;代謝紊亂;中醫(yī)藥療法

中圖分類號(hào)：R259.441????文獻(xiàn)標(biāo)識(shí)碼：A ???文章編號(hào)：1005-5304（2019）09-0126-03

Experience of HONG Shanyi in Treating Young and Middle-aged HypertensionComplicated with Metabolic Disorders

WU Li

Ningbo Hospital of Traditional Chinese Medicine，?Zhejiang University of Chinese Medicine， Ningbo 315010， China

????Abstract：?This article introduced Professor HONG Shanyis experience in treating young and middle-aged hypertension complicated with metabolic disorders. Professor HONG believes that the young and middle-aged hypertension is the most common in liver-fire exuberance syndrome and phlegm moisture hindering syndrome which is closely related to unhealthy lifestyle， so the modern way of life is the basis for the control of hypertension. The clinical treatment is directed by the combination of the differentiation of disease and the differentiation of syndrome， and is mainly with the differentiation of syndrome. The treatment should be discussed from liver， spleen， kidney， blood and meridians， giving full play to the advantages of overall conditioning and individualization of TCM， and reversing the development of hypertension.

???Keywords：?experience of famous doctors; HONG Shanyi; young and middle-aged hypertension; metabolic disorders;?TCM therapy

本院洪善貽教授是第三批全國名老中醫(yī)藥專家學(xué)術(shù)經(jīng)驗(yàn)繼承工作指導(dǎo)老師，從醫(yī)50余載，對(duì)高血壓、高脂血癥、糖尿病等具有豐富的臨床經(jīng)驗(yàn)。筆者有幸隨侍洪教授左右，受益匪淺，現(xiàn)將洪教授辨治青中年高血壓合并代謝紊亂經(jīng)驗(yàn)介紹如下。

1 ?病因病機(jī)

1.1 ?肝火上炎

由于工作及生活壓力大，青中年人精神常處于高度緊張狀態(tài)。研究表明，不良情緒及焦慮均與高血壓的發(fā)生有關(guān)^[1]。中醫(yī)認(rèn)為，肝為剛臟，主疏泄，體陰而用陽，喜調(diào)達(dá)舒暢，在體合筋;若七情不和，五志過極，首先傷肝，引動(dòng)肝火，肝失疏泄則氣滯，日久化火，或肝木升發(fā)太過，肝火過旺，火性炎上，上擾清竅，致頭脹頭痛，血壓升高。

1.2 ?痰濁內(nèi)阻

嗜食膏粱厚味、煙酒，少動(dòng)及熬夜等不良生活習(xí)慣，傷及脾胃，致運(yùn)化失常，痰濕內(nèi)生，濕濁內(nèi)蘊(yùn)，或痰食互結(jié)，醞釀而成濁脂。郁久化熱，痰熱互結(jié);壅滯經(jīng)絡(luò)，上蒙清竅，引起頭暈，血壓上升。洪教授認(rèn)為，痰瘀互結(jié)，濁脂內(nèi)生，壅塞經(jīng)絡(luò)，與現(xiàn)代醫(yī)學(xué)的高脂血癥、高黏血癥、脂質(zhì)代謝紊亂、動(dòng)脈粥樣硬化的機(jī)理相吻合。

2 ?辨證論治

臨床上，青中年高血壓以肝火上炎、痰濕內(nèi)阻常見，以實(shí)證為主，也可見肝陽上亢、痰瘀壅滯證^[2]。

2.1 ?肝火上炎

以頭暈頭痛、面紅目赤、口干口苦、便秘、易激動(dòng)緊張等內(nèi)火熾盛癥狀為辨證要點(diǎn)，方選龍膽瀉肝湯加減。方中龍膽、黃芩清肝經(jīng)實(shí)火;澤瀉、車前子清利濕熱，引火從小便而出;生地黃滋陰養(yǎng)肝;當(dāng)歸活血疏肝;柴胡舒暢肝膽，主要解除頭痛、目赤、腫痛等表證。同時(shí)兼顧“治血”“治脈”，所謂“治血”，即化濁降脂，改善血液黏稠度，可選用葛根、決明子、山楂、萊菔子、黃連調(diào)脂化濁、化瘀祛痰，珍珠母、首烏藤鎮(zhèn)心安神;“治脈”即活血化瘀，改善血管內(nèi)皮功能，軟化血管，可選丹參、三七、赤芍、牛膝、益母草等。