升清降浊法在神经源性直立性低血压合并卧位高血压防治中的应用探讨

神经源性直立性低血压(neurogenic orthostatic hypotension, nOH)是直立性低血压(orthostatic hypotension, OH)的亚型,主要见于以α-突触核蛋白异常沉积为特征、与自主神经功能障碍相关的神经变性疾病。临床发病率较高,部分同时伴发卧位高血压(SH)。严重影响患者日常独立生活能力,是疾病不良预后的重要危险因素。根据其临床表现特点,nOH合并SH相当于中医学"眩晕"、"厥证"范畴,以中气升降失常,清浊相干为基本病机。基于整体观念,调整阴阳,燮理中气升降,探讨升清降浊法在nOH合并SH中的应用,为本病防治提供思路和依据。

Discussion on Application of Ascending Clear and Descending Turbid Method in Prevention and Treatment of Neurogenic Orthostatic Hypotension Combined with Supine Hypertension

Neurogenic orthostatic hypotension(nOH) is a subtype of orthostatic hypotension(OH), which mainly presents in neurodegenerative diseases characterized by abnormal deposition of a-synuclein and associated with autonomic nerve dysfunction. The clinical incidence of nOH is high, a part of the patients are accompanied by supine hypertension(SH). The combination of nOH and SH could seriously affect the patients’ ability of daily independent living, and it has been an important risk factor for poor prognosis. In traditional Chinese medicine(TCM), nOH combined with SH is equivalent to dizziness or syncope according to the clinical characteristics. The root cause is the abnormal rise and fall of middle Qi, and the mixture of clear Qi with turbid Qi. Based on the holistic concept, the therapeutic principle is treating disease from the root, adjusting Yin and Yang, regulating middle Qi. This article discussed the application of ascending clear and descending turbid method in the prevention and treatment of nOH combined with SH, aiming to provide ideas and basis for the prevention and treatment of the disease.