高血压病中医新论  

New discussion on hypertension from traditional Chinese medicine

作　　者：侯敬乐 熊兴江[1] HOU Jing-le;XIONG Xing-jiang(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;the First Hospital of Fangshan District,Bejing 102400,China)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]北京市房山区第一医院,北京102400

出　　处：《中国中药杂志》2024年第21期5958-5964,共7页China Journal of Chinese Materia Medica

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目(HLCMHPP2023081);临床科研一体化人才专项(CZ30981);京津冀基础研究合作专项(J230037);中国中医药科技发展中心(国家中医药管理局人才交流中心)联合攻关项目(CXZH202301)。

摘　　要：高血压病作为心脑血管病中最常见、最主要的危险因素,已成为我国面临的重大公共卫生问题,给社会带来了沉重的卫生经济学负担。然而,由于降血压药物的早期、全程干预,导致高血压病的病机规律较前发生了深刻变化,且传统医籍中的眩晕不能完全等同于高血压病,也不局限于肝阳上亢、肝风内动等传统病机认识。因此,亟须重新探索现代病机与临床诊治规律。近年来,中医药因其治疗高血压病具有平稳降血压、缓和降血压的特征而备受关注。该课题组基于20年临床实践,重读经典,结合现代循证医学研究进展,提出高血压病的治疗应遵循“一二三四”原则,即“一个核心,两大机制,三种病机,四个防治目标”。其中,“一个核心”指以降血压为核心,“两大机制”指糖脂代谢与水钠代谢,“三种病机”指高血压病存在火证、饮证、虚证,“四个防治目标”指平稳降血压、逆转危险因素、保护靶器官和减少心血管终点事件。“一二三四”的治疗原则为中医药防治高血压病的临床疗效提供新思路。Hypertension,as the most common and major risk factor in cardiovascular and cerebrovascular diseases,has become a major public health issue facing China,bringing a heavy burden of health economics to the society.However,due to the early and comprehensive intervention with antihypertensive drugs,the pathogenesis of hypertension has undergone profound changes compared with that before.The dizziness in traditional medical texts cannot be completely equated with hypertension,and the understanding of this disease is not limited to traditional pathogeneses such as hyperactivity of liver Yang and internal movement of liver wind.Therefore,it is urgent to explore the modern pathogenesis and clinical treatment rules.In recent years,traditional Chinese medicine(TCM)treatment of hypertension has attracted much attention for its ability to steadily and gently lower blood pressure.On the basis of 20 years of clinical practice and the review of classics and progress of modern evidence-based medicine research,our research group proposes that the treatment of hypertension should follow the principle of"one core,two key mechanisms,three pathogeneses,and four prevention and treatment goals".Among them,"one core"refers to blood pressure reduction;"two mechanisms"refer to glucose and lipid metabolism and water and sodium metabolism;"three pathogeneses"refer to fire syndrome,fluid retention syndrome,and deficiency syndrome;"four prevention and treatment goals"refer to stable blood pressure reduction,reversal of risk factors,protection of target organs,and reduction of cardiovascular endpoint events.This treatment principle provides new ideas for the clinical prevention and treatment of hypertension with TCM.

关 键 词：高血压病 中医药 火证 饮证 虚证 

分 类 号：R259[医药卫生—中西医结合]