基于痰瘀互结理论从肝脾论治H型高血压

Treatment of H-Type Hypertension from Liver-Spleen Theory Based on Phlegm-Blood Stasis Interconnection Theory

摘要: H型高血压是指伴有高同型半胱氨酸血症(hyperhomocysteinemia, HHcy)的高血压，其诊断标准为血同型半胱氨酸(homocysteine, Hcy) ≥ 10 μmol/L，本病致病机制较为复杂，其核心病理环节是高血压和HHcy的协同作用，可显著增加心脑血管疾病(尤其是脑卒中)的患病风险。在我国，由于遗传因素(如基因突变)或饮食习因素导致叶酸缺乏，加之现代人不良的饮食和生活方式及情绪刺激的共同影响，H型高血压患者群体规模庞大，但目前西医针对该病的治疗仍存在局限性。从中医病因病机角度分析，肝脾两脏在生理病理上密切相关，而肝脾失调与痰瘀互结存在内在关联性。基于中医“痰瘀互结”理论，本文从肝脾两脏论治系统探讨H型高血压的辨证论治思路，提出其核心病机为肝脾失调，痰瘀互结，毒损脉络。综上，本病治疗应以调和肝脾为核心，以痰瘀同治为主线，同时注重疏通脉络，从而为临床辨治H型高血压提供新的理论依据和治疗策略。

Abstract: H-type hypertension refers to hypertension accompanied by hyperhomocysteinemia (HHcy), the diagnostic criterion of which is blood homocysteine (Hcy) ≥ 10 μmol/L. The pathogenesis of this disease is complex, and its core pathology is the synergistic effect of hypertension and HHcy, which significantly increases the risk of cardiovascular and cerebrovascular diseases (especially stroke). The core pathology of this disease is the synergistic effect of hypertension and HHcy, which can significantly increase the risk of cardiovascular and cerebrovascular diseases (especially stroke). In China, due to genetic factors (such as gene mutation) or dietary factors leading to folic acid deficiency, coupled with modern people’s poor diet and lifestyle and emotional stimulation of the joint influence, H-type hypertension patients group size is huge, but the current Western medicine for the treatment of this disease still has limitations. From the perspective of etiology and pathogenesis of Chinese medicine, liver and spleen are closely related to each other physiopathologically and pathologically, and there is an intrinsic correlation between liver and spleen disorders and phlegm-stasis interconnection. Based on the theory of “phlegm-stasis interconnection” in Chinese medicine, this article systematically discusses the identification and treatment of H-type hypertension from the perspective of the liver and spleen, and proposes that the core pathogenesis of the disease is liver-spleen imbalance, phlegm-stasis interconnection, and toxicity damage to the veins and collaterals. In conclusion, the treatment of this disease should be centered on harmonizing the liver and spleen, with phlegm and blood stasis as the main line of treatment, and at the same time, focusing on dredging the veins and collaterals, so as to provide a new theoretical basis for the clinical diagnosis and treatment of H-type hypertension and a new strategy for the treatment of the disease.