基于《黄帝内经》“痹症”理论探讨高血压病“脉痹”病机

The Pathogenesis of Hypertension from the Perspective of “Bi Syndrome” in Huang Di Nei Jing: A Discussion on “Mai Bi”

摘要: 高血压病的中医辨治历来多从肝肾立论，对其血管病变本质的揭示尚有不足。本文以《素问·痹论》为据，梳理“脉痹”的病因病机及“脉痹不已，内舍于心”的传变规律，提出以“脉道痹阻、血凝不流”为核心的高血压病“脉痹”病机框架，认为高血压病位在血脉，其病程演变可对应“脉痹–心痹”的传变过程。在此基础上，以温通、活血、祛风、益气、调和五法为框架，探讨从“脉痹”论治高血压的基础方剂组方思路。并回顾以“脉痹”为核心的高血压临床研究及典型医案，进一步印证“脉痹”病机的临床指导价值。从“脉痹”论治可为高血压提供兼顾脉道状态与脏腑功能的辨治思路，与西医降压治疗形成互补，对早期干预血管病变、延缓靶器官损害具有一定参考价值。

Abstract: The TCM differentiation and treatment of hypertension has traditionally focused on the liver and kidney, yet the vascular nature of the disease remains insufficiently explained. Based on Suwen·Bi Lun (Discourse on Impediment), this paper examines the etiology and pathogenesis of “Mai Bi” (vessel obstruction) and the transmission principle that “persistent Mai Bi, when re-attacked by pathogens, lodges in the heart”. A framework centered on “vessel pathway blockage with congealed blood” is proposed, with the disease located in the blood vessels and its progression mapped onto the “Mai Bi-Xin Bi” (heart obstruction) transmission sequence. On this basis, a foundational formula rationale is discussed using the five methods of warming-unblocking, blood-activating, wind-dispelling, qi-tonifying, and harmonizing. Clinical studies and typical medical cases centered on “Mai Bi” are reviewed to further corroborate the clinical value of this pathogenesis framework. Treating from the perspective of “Mai Bi” offers an approach that addresses both vessel condition and organ function, complementing Western antihypertensive therapy, with potential value for early intervention in vascular pathology and delaying target organ damage.