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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