基于土滞金藏理论从痰论治阻塞性睡眠呼吸暂停综合征相关性高血压  

Discussion on the treatment of obstructive sleep apnea-hypopnea syndrome related hypertension from phlegm based on the theory of Tu Zhi Jin Cang

作　　者：李白雪 曹斌[2] 丛丛[2] 王咏 LI Baixue

机构地区：[1]山东中医药大学,山东济南250000 [2]山东中医药大学附属医院,山东济南250000

出　　处：《中医临床研究》2024年第20期66-71,共6页Clinical Journal Of Chinese Medicine

基　　金：山东省自然科学基金青年项目(ZR2020QH333);山东省老年医学学会2021年科技攻关计划项目(LKJGG2021W107)。

摘　　要：阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea-hypopnea Syndrome,OSAHS)相关性高血压患病率在高血压病患病人群中日益增高,常规西医降压药难以达到良好的降压效果,而近几年研究表明OSAHS是诱发高血压病的危险因素。中医认为,OSAHS相关性高血压的致病因素包括痰湿和气阻两方面,其中痰湿为根本病理因素。OSAHS患者好食肥甘厚味,导致脾失健运、水液输布不均,痰湿内生,损伤血管内皮及发生炎症反应,使血压升高;痰湿存肺,上行沿上呼吸道至咽喉,壅扼咽喉,阻塞呼吸运动,清气无法纳入,浊气无法吐出,加之脾失健运导致的水谷精微不足,宗气不足,无法正常完成主司呼吸运动,推动血脉运行的功能活动失常,血脉瘀滞,导致血压升高。本研究认为,痰湿生成与加重基于土滞金藏理论,脾主津液失常、肺主气机失利,土不运化则滞,金不畅散则藏,津液运行输布失常及气机失调与肺、脾、肾三脏相关。本研究结合OSAHS诱发高血压病的西医机制,分析中医角度下OSAHS从津液运化受阻、气的生成与运行失调等方面促成高血压病的病因病机,相类比西医治疗时患者依从性差、预后不良等缺点,临床治疗OSAHS相关性高血压可基于“土滞金藏”这一理论基础,围绕痰湿这一病理因素,以疏土、顺金、补充元阳为治疗法则,畅通患者气道,改善鼾眠症状,为控制OSAHS相关性高血压病患者血压提供新型中医诊疗思路。The prevalence rate of hypertension associated with obstructive sleep apnea-hypopnea syndrome(OSAHS)is Tincreasing in the population with hypertension,and conventional western medicine antihypertensive drugs are difficult to achieve good effects.Studies in recent years have shown that OSAHS is a risk factor for inducing hypertension.According to traditional Chinese medicine,the pathogenic factors of hypertension caused by OSAHS include phlegm dampness and Qi(气)obstruction,of which phlegm dampness is the fundamental pathological factor.OSAHS patients always have heavy taste eating habits and like greasy,thick flavor food.This habit leads to the decline of spleen function and the endogenous phlegm and dampness,which in turn damages the vascular endothelium and increases blood pressure.In addition,traditional Chinese medicine believes that patients’phlegm dampness,which is stored in the lungs,will rise to the throat,block breathing movement,hinder blood circulation,and then lead to an increase in blood pressure.This article combines the Western medicine mechanism of OSAHS induced hypertension and analyzes the etiology and pathogenesis of hypertension caused by OSAHS from the perspective of traditional Chinese medicine,including obstruction of body fluid circulation and imbalance of Qi generation and operation.Compared with the disadvantages of poor compliance and poor prognosis in Western medicine treatment of patients,clinical treatment of OSAHS related hypertension can be based on the theoretical basis of earth stagnation due to metal bind.This article suggests that the treatment should focus on the factor of phlegm dampness,and follow the principles of protecting the spleen,promoting lung function,and supplementing kidney-Yang Qi to unblock the patient’s airway and relieve the symptoms of OSAHS.

关 键 词：高血压病 阻塞性睡眠呼吸暂停综合征 鼾眠 脾肺失调 痰湿 

分 类 号：R259.441[医药卫生—中西医结合]