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寒性高血压病不可盲目“降压”

寒性高血压病不可盲目“降压”

一、三个病例的启示

人们认为，对于高血压病采用“降压”方法，是天经地义的，都会接受治疗。然而，我们在临床实践中发现，高血压病有寒热之分，热性高血压可使用“降压”方法，而寒性高血压则不可。请看下面三个病例：1）、张××，男，64岁，湖南锡矿山矿务局职工。因患高血压、左侧脑血栓，后脑痛，手足麻胀，并时时出现“心”部疼痛，类似心绞痛，较为剧烈而持久，可达数小时。发作时，面色苍白，烦躁不安，出冷汗，呼吸困难，心稳不住，有死亡的恐惧。每天须服硝酸甘油3次，且脚跛行动困难。多医治疗无效，于2005年11月8日前来诊治。据患者说，因高血压服降压药，逐渐出现精神紧张心部疼痛。
我们认为，患者脚冷，且全身有畏寒感觉，寒气本下流，不予降压治疗，从痰瘀养心着手，拟如下处方以试探：防风8克 杏仁10克 桃仁8克 土鳖6克 枣仁10克 柏子仁10克 制南星8克 青蒿10克 鳖甲12克 天麻12克 法夏6克 浙贝母6克 当归12克 阿胶10克 全瓜蒌10克 太子参30克 。
11月13日，心窝痛明显减轻，大便可以，因感冒出现干咳，即于上方加麻黄5克、枇杷叶8克。去防风、太子参；减制南星为5克。
11月18日，咳嗽明显减轻，痰已能咳出，未出现心部疼痛，硝酸甘油已完全停止服用。更方如下：羌活3克 独活5克 桑寄生10克 桃仁6克 莪术6克 胆南星8克 阿胶10克 全瓜蒌12克 全虫3克 枣仁8克 柏子仁8克 当归12克 鳖甲12克
12月9日，自感舒适，麻胀感减轻，即于上方加川牛夕12克以降压。服后即心部发痛，急去之；加桂枝8克、升麻5克。12月20日，因天气大变，气温下降，心痛又发作一次。于上方中加附片8克，去全虫。1月13日，心痛缓和，即进补中益气汤加味：生芪15克 党参12克 白术10克 当归12克 升麻3克 柴胡3克 枣仁10克 柏子仁10克 附片6克 桂枝8克 天麻10克 桃仁8克 陈皮6克 炙甘草6克。
从此，心部疼痛再没有发作，且脚行走有力，调理一个月，自行停药。

2）、邹××，女，69岁，冷水江锡矿山矿务局职工医院诊断为高血压（190/100）、气管炎、冠心病、糖尿病，服降压药已一年多，头汗直流，双手冰冷，头晕出气不舒，胸闷，不能费力，腿发颤，从汽车站到“心连心”超市，大约300米远，要走一个小时，每走三步要停下来休息。近20多天来晕倒过四次，且一年来出现过一次大的心绞痛。认为是胃痛，几乎都是由寒引起，大小便通畅。于2006年2月17日前来就诊。
综上所述，诊断为中气下陷。此中气下陷全由过分降压所引起，即主以补中益气汤加味治之：防风8克 生芪15克 太子参30克 当归12克 白芍15克 枣仁10克 柏子仁10克 升麻5克 柴胡5克 天麻12克 川芎15克 白术10克 茯苓12克 丹参18克 郁金10克 炙甘草5克，嘱咐病家陆续减降压药。
2月22日，自觉轻松，能多走几步了。近两天出现咳嗽，一天要咳三次；脚仍然凉。更方如下：
麻黄6克 杏仁10克 枇杷叶8克 法夏5克 浙贝母8克 生芪12克 淮山15克 桃仁6克 枣仁10克 柏子仁10克 全瓜蒌10克 远志8克 白术10克 茯苓12克。
2月27日，已停服降压药，咳嗽缓和，自感轻松多了，又能多走几步了。近来心窝至脐出现不少疮疖小点，不痒，大便不通畅：防风8克 银花8克 连召6克 蒲公英10克 僵虫8克 桃仁6克 鳖甲10克 枣仁8克 柏子仁8克 瓜蒌仁15克 丹参15克 郁金10克 赤芍15克 太子参24克 法夏6克。
3月4日，身感轻松舒畅，行动自如，完全恢复了以前的体力，从汽车站一气可以走到“心连心”超市不用休息了。只大便有些不通畅。嘱咐用胶囊装玄明粉3克，两天后大便通畅，即自行停药。
3）、张××，男，54岁，锡矿山矿务局职工。患高血压、支气管炎，每天早晨干咳很重，声音洪大，往往咳得气接不上来。平素烟抽得多，咳嗽十几年，异常痛苦。曾到外地治疗多年，花了不少钱，不但病不少减，病情反而日益恶化。于2005年10月26日前来诊治。当即主方如下：石菖蒲6克 远志8克 枣仁10克 柏子仁10克 玄参12克 生芪15克 太子参15克 知母10克 丹皮12克 桃仁6克 莪术6克 全瓜蒌12克 葶苈子8克 枸杞12克 鱼腥草12克 嘱其陆续减降压药。
11月5日，吐痰甚多，小便通畅，气接不上来的现象大为减轻，咳也随之减轻，但大便仍每天2~3次。去菖蒲，知母减为8克，太子参加至24克，再服10剂。
12月4日，咳已基本缓和，为了证明疗效，自行停药半月，咳不反弹，然大便仍溏。原方加薤白10克。
12月24日，已完全不咳，大便已转正常，即调理收功。

上述三个病例，均系高血压病，医院均从“降压”处理，可是“降压”的结果，都使病情加重：前三例都因“降压”而并发冠心病，后一例使咳嗽顽固而致无法可治。均为患者造成了极大的痛苦，都有“痛不欲生”的念头。我们认为，这三例高血压病有一个共同的特点：脚冷或全身有畏寒的感觉，属寒性高血压病。为了进一步证明寒性高血压病不可降压之事，我们又记录了一个由高血压病降压而引发心脏病的完整过程：李××，男，54岁，湖南锡矿山矿务局干部。近来患高血压病，检测血压为160/100，服了六天“尼群地平片”降压药，每天一粒，开头降为100/60、110/70，加服半粒，近一、二天血压又增高为160/100，昨晚出现胸部左边有钻痛感，脚凉、双手有畏寒感觉，大便每天2~4次，腹微微痛，痛就要上厕所，左边与后脑有不舒感觉，双手握力不足。显然加重了阳虚，引发了肝脾下陷，我们反其道行之，使用“升压”方法，也就是中医的所谓“提升肝脾”法，此例病情立即好转。此为“寒性高血压”患者，踩出了一条新途径。其所使用的药品为四君子汤与补中益气汤所组成的药物。四君子汤（党参、白术、茯苓、甘草）与补中益气汤（黄芪、人参、白术、炙甘草、当归、陈皮、升麻、柴胡）经实验研究表明均有抗突变及抗肿瘤的作用。

以四君子汤对不同危重杂症的应用，并不是否定辨证。这是因为各种不同的疑难杂症常有一些共同的症状：疲乏无力，面色少华，脘腹不舒，隐隐作痛，腹胀与便溏或泄泻等症状。按照中医辨证都可辨之为脾虚。李东垣说：“推其百病之源，皆因饮食劳倦，而胃气元气散解，不能滋荣百脉，灌溉脏腑，卫护周身之所致也”。所以，以健脾治疗各种疑难杂症是有可靠的理论根据和临床实效支持的。当然，脾虚与气虚关系密切，且常为因果，所以在临床上有“善治气虚者，多从健运脾胃着手”之说。有人用四君子汤对胃癌细胞的细胞毒作用做过实验研究：用二味药、三味药、四味药的不同配伍对胃癌细胞的杀伤作用没有比相应的单味减少，或相等，或有所增加，其最大的杀伤配伍是四君子汤全方，即四药同用。说明四君子汤的配伍方法有其明显的合理性，并提示“茯苓”在本方配伍中有着重要的作用。

通过实验研究，四君子汤与补中益气汤均有显著的抗突变作用，但两者相较，四君子汤的作用不及补中益气汤的作用强，即补中益气汤抑制癌细胞高于四君子汤。

二、高血压病的病理基础—痰瘀互结

痰和瘀的形成，是肝脾虚弱所引起。首先是脾胃受损，使脾不健运、输转失常，则水谷精微之一部分变为浊脂，进入血液而使血脂升高。其次是肝的疏泄功能失常，血中之浊脂不能及时疏泄，留而不去，反过来又阻碍脾胃运化之气机，造成新的浊脂生成，如此互相影响，愈积愈多，不得清化而变为血中之痰浊。血中之痰浊直接阻滞血气的运行，形成瘀血，这是脉管内形成瘀血的主要原因。血中之痰浊是痰与血的混合物，是造成痰瘀互结的初始阶段。这种病理状态持续发展下去，痰借血体，血借痰凝，凝血为瘀，痰瘀相结，着于血脉，血脉上凝着之痰瘀结块使脉管本身受损，局部气血的运行和温煦受阻，日久胶结不解，凝之愈坚，此脑中所谓“高血压”、“脑血栓”等脑部疾病之所由来也。

人的正常生理，有赖于脑之阴阳平衡；人之病理，常出现脑之阴阳失调；人之死亡，乃脑之精气决绝。所以阴阳失调是脑病的基本矛盾。气为阳，血为阴，对脑来说，气为阳气，血为阴精。说明脑病的基本矛盾是阴精阳气失调：阳为阴之主，阴为阳之基；阳气一有郁滞，就会产生气滞，气滞不但津液凝滞而为痰，而且影响血液的运行而成瘀，此脑中痰瘀之所由来也。脑中既生痰瘀，即耗损阴精阳气而虚弱。这就是“提升肝脾”治疗高血压病的病理基础。

以“提升肝脾”来治疗寒性高血压病，为治疗高血压病开闯了一条新的途径，也充分体现了中医药的优越性。

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