한국에 인물이 그렇게 없나? 

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1800만에 풀린 의문

 

지금으로부터 1800 여년전, 즉 서기 200년 경에 중국에 상한(傷寒)이라는 병이 퍼졌다. 이때 장중경(張仲景)이라는 의사가 상한을 치료하면서 자신이 쓴 약방을 체계적으로 정리하고, 그 책 이름을 <상한잡병론>이라고 정했다. 이 책은 기구한 여정을 거쳐 후에 <상한론>과 <금궤요략>이라는 두 책으로 분책되어 세상에 알려졌다.

 

장중경이 활동했던 시기는 우리가 삼국지로 잘 아는 바로 그 시기와 거의 겹친다. 장중경은 사망한 일족의 10분의 7이 상한으로 죽었다고 슬퍼했다. 당시 상한이라는 병이 무엇인지 현대의 학자들 간에 논의가 분분했다. 어떤 이는 상한이니까 글자 그대로 추위에 인체가 노출되었을 때 걸리는 감기 정도의 병이라고 했고, 또 어떤 이는 유행성 출혈열이라고도 했다.

 

그런데 2019년 12월 중국 우한에서 우한 폐렴이 유행하기 시작한 후에, 환자들의 증상을 살펴보니, 모두 장중경이 <상한론>에서 말한 증상과 유사했다. 정말 귀신이 곡할 노릇이었다.

 

장중경이 죽은 뒤 1800년이 지난 뒤에, 현대의 우리는 비로소 장중경이 겪었던 상한이 우한 바이러스와 유사한 역병이었다는 것을 깨닫게 된 것이다. 1800년의 시공을 뛰어넘어 장중경이라는 중국의 한 의사와 우리가 그의 책 속에서 가슴 떨리는 만남을 경험하고 있다. 대단한 사건이다.

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사회주의는 파괴주의이다.

사회주의의 강력한 반대자들조차 사회주의 경제가 자본주의보다 더 합리적이고, 좀 더 정의로운 소득 분배를 보장하며, 역사적 진화가 인간을 불가역적으로 그런 방향으로 인도하고 있다고 믿고 있다.

하지만 사회주의 사상은 자잘한 분노를 거창하게 합리화 한 것일 뿐이다. 그들의 이론은 과학적인 비판에 무너지고, 그들의 논리는 엉터리이다.

사회주의는 수천년의 문명이 쌓아온 것들을 무너뜨리고, 건설하는 대신 파괴한다. 파괴는 그들의 본질이다. 사회주의는 아무 것도 생산하지 않고, 자본주의가 생산한 것들을 소비할 뿐이다.

그런 파괴주의 정책은 자본의 소진을 의미한다.

점진적인 자본의 형성만이 대중의 삶을 향상시키는 유일한 방법이다.

--->파괴주의는 가장 쉽게 볼 수 있는 곳이 쿠바와 북한이다. 그들은 아무 것도 생산하지 못하고, 과거 자본주의 시대의 유물들을 고쳐서 그대로 쓰고 있다. 쿠바의 자동차들은 모두 미국의 5,60년대 차들이다. 

 

Socialist Destructionism

 

Ludwig von Mises

 

To the socialist, the coming of Socialism means a transition from an irrational to a rational economy. Under Socialism, planned management of economic life takes the place of anarchy of production; society, which is conceived as the incarnation of reason, takes the place of the conflicting aims of unreasonable and self-interested individuals. A just distribution replaces an unjust distribution of goods. Want and misery vanish and there is wealth for all. A picture of paradise is unfolded before us, a paradise which—so the laws of historical evolution tell us—we, or at least our heirs, must at length inherit. For all history leads to that promised land, and all that has happened in the past has only prepared the way for our salvation.

 

This is how our contemporaries see Socialism, and they believe in its excellence. It is false to imagine that the socialist ideology dominates only those parties which call themselves socialist or—what is generally intended to mean the same thing—“social.” All present-day political parties are saturated with the leading socialistic ideas.

 

Even the stoutest opponents of Socialism fall within its shadow. They, too, are convinced that the socialist economy is more rational than the capitalist, that it guarantees a more just distribution of income, that historical evolution is driving man inexorably in that direction.

 

When they oppose Socialism they do so with the sense that they are defending selfish private interests and that they are combating a development which from the standpoint of public welfare is desirable and is based upon the only ethically acceptable principle. And in their hearts they are convinced that their resistance is hopeless.

Yet the socialist idea is nothing but a grandiose rationalization of petty resentments. Not one of its theories can withstand scientific criticism and all its deductions are ill-founded. Its conception of the capitalist economy has long been seen to be false; its plan of a future social order proves to be inwardly contradictory, and therefore impracticable.

 

Not only would Socialism fail to make economic life more rational, it would abolish social cooperation outright. That it would bring justice is merely an arbitrary assertion, arising, as we can show, from resentment and the false interpretation of what takes place under Capitalism. And that historical evolution leaves us no alternative but Socialism turns out to be a prophecy which differs from the chiliastic dreams of primitive Christian sectarians only in its claim to the title “science.”

 

In fact Socialism is not in the least what it pretends to be. It is not the pioneer of a better and finer world, but the spoiler of what thousands of years of civilization have created. It does not build; it destroys. For destruction is the essence of it. It produces nothing, it only consumes what the social order based on private ownership in the means of production has created. Since a socialist order of society cannot exist, unless it be as a fragment of Socialism within an economic order resting otherwise on private property, each step leading towards Socialism must exhaust itself in the destruction of what already exists.

 

Such a policy of destructionism means the consumption of capital. There are few who recognize this fact. Capital consumption can be detected statistically and can be conceived intellectually, but it is not obvious to everyone.

 

To see the weakness of a policy which raises the consumption of the masses at the cost of existing capital wealth, and thus sacrifices the future to the present, and to recognize the nature of this policy, requires deeper insight than that vouchsafed to statesmen and politicians or to the masses who have put them into power. As long as the walls of the factory buildings stand, and the trains continue to run, it is supposed that all is well with the world. The increasing difficulties of maintaining the higher standard of living are ascribed to various causes, but never to the fact that a policy of capital consumption is being followed.

 

In the problem of the capital consumption of a destructionist society we find one of the key problems of the socialist economic policy. The danger of capital consumption would be particularly great in the socialist community; the demagogue would achieve success most easily by increasing consumption per head at the cost of the formation of additional capital and to the detriment of existing capital.

 

It is in the nature of capitalist society that new capital is continually being formed. The greater the capital fund becomes, the higher does the marginal productivity of labour rise and the higher, therefore, are wages, absolute and relative. The progressive formation of capital is the only way to increase the quantity of goods which society can consume annually without diminishing production in the future—the only way to increase the workers’ consumption without harm to future generations of workers. Therefore, it has been laid down by Liberalism that progressive capital formation is the only means by which the position of the great masses can be permanently improved.

 

Socialism and destructionism seek to attain this end in a different way. They propose to use up capital so as to achieve present wealth at the expense of the future. The policy of Liberalism is the procedure of the prudent father who saves and builds for himself and his successors. The policy of destructionism is the policy of the spendthrift who dissipates his inheritance regardless of the future.

 

Excerpted from Socialism: An Economic and Sociological Analysis. Published as "The Nature of Destructionism," section 1 of chapter 33, "The Motive Powers of Destructionism."

 

 

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고혈압은 단지 간 때문에 발생하는 게 아니다.

고혈압 치료에 대해 거의 전분야를 언급하고 있는 글이다.

 

你知道麼——高血壓不唯從肝治

 

 

I導讀：「如果對高血壓病抱有肝陽上亢的成見，一味地採用滋水平木的清降方劑，可以斷言，不但無效，而且勢必加劇」。因此，在寒熱虛實、臟腑上下縱橫錯雜之時若求之「六經」辨證可望法廣方眾，左右逢源。

 

一般認為高血壓的發生多由陰虛陽亢、肝風旋動所致。其治療多從滋陰、平肝、潛陽著手。其用方用藥多取寒涼。

 

近年來筆者在研讀《傷寒雜病論》及有關文獻的基礎上，結合臨床實踐，發現高血壓的發生與五臟六腑均有關係，非獨肝也；血壓升高亦非因熱一端，因於虛寒者亦復不少。筆者應用傷寒六經辨證立法診治，收到良好效果。今略陳體會，與諸同道共研討。

 

解肌緩急頭痛可除 利水活血血壓可降

 

《素問·熱論》雲「傷寒一日，巨陽受之，故頭頸痛，腰脊強」。《傷寒論》亦指出「太陽之為病……頭頸強痛……」高血壓患者多見頭痛之症。或痛引眼目，或痛連頸項，或痛掣腰背，頗似太陽經證。既有是證，則當籍桂枝輩以治之。筆者每以桂枝加葛根湯解肌止痙常收良好鎮痛效果。

 

桂枝加葛根湯或葛根湯治療高血壓頭痛同時為眾多國內外學者所重視。日本矢數道明治一高血壓伴重聽、耳鳴、肩頸拘緊如板、頭痛劇烈難忍的患者，血壓180/90mmHg，先投它方二十日無效，後用葛根湯加羌、防，服後頸項靈活自如，頭痛緩解。連服四月重聽好轉，血壓降至150/80mmHg。

 

劉渡舟氏指出「桂枝加葛根湯治療冠心病的胸背作痛，高血壓動脈硬化的後腦部疼痛，用之得當均有療效」。馬有度亦認為「桂枝加葛根湯……如重用白芍、葛根，並酌加赭石、龍骨、牡蠣治療伴有頭項強痛的高血壓患者，常能較為滿意地改善症狀」。《傷寒論方古今臨床》引謝文宗報導雲「葛根湯加減……可治腦血管痙攣、高血壓、腦動脈硬化」。

 

若高血壓伴心悸失眠、烘熱自汗或手足麻木者又當分別投以桂枝加龍牡蠣湯、炙甘草湯，黃芪桂枝五物湯等桂枝湯類方。近代藥理研究證明，桂枝具有擴張血管、調整血液循環、緩解血管和平滑肌痙攣的作用。若與緩急止痛的芍藥，擴張腦血管的葛根相伍則其作用更強。

 

倘若高血壓而見小便短少，頭目脹痛眩暈，或作嘔惡，此乃下焦氣化不利，水濁上泛之故。宜取太陽腑證治法投以五苓散，豬苓湯化氣行水。如果因某些腎病造成腎組織缺血而產生腎素，腎素再與血液中的血管緊張素元結合產生血管緊張素，促使小動脈收縮而使血壓升高。此時又當以活血化瘀法解除小動脈的痙攣，改變血液的濃、粘、聚傾向。可以桃核承氣湯、桂枝茯苓丸、當歸芍藥散等活血通絡，廓清瘀濁。

通過利水活血降低血壓治療巔疾眩暈這已為古今中外醫家所重視。尤其是利水除濕一法已為眾多醫家所習用。《素問·四氣調神大論》雲「陽氣者閉塞，地氣者冒明」。陽氣不振，水濕痰濁上泛，蒙蔽清陽，邪害空竅，多致頭目眩暈脹痛諸證。故仲景有以五苓散治「顛眩」，苓桂術甘湯治「起則頭眩」，以真武湯治「頭眩，身眶動，振振欲擗地」，以澤瀉湯治「心下有支飲，其人苦冒眩」諸法，近代論治更屢見不鮮。

 

如張文高治張xx，女，48歲。患高血壓病7年，眼瞼浮腫，頭暈目眩，口粘納差，舌苔白膩，脈沉細，血壓170/100mmHg。以五苓散合防己茯苓湯加減，三劑後頭暈浮腫明顯減輕，血壓亦降至134/84mmHg。筆者亦常用五苓散、澤瀉湯、真武湯等治療高血壓眩暈多獲滿意療效。

 

國外學者認為，幾乎所有高血壓病人的腎臟排鈉能力都可能有障礙。由於排鈉降低或醛固酮分泌增加使血容量增加，從而加大對血管壁的壓力，致使血壓升高。此時用利尿劑促使液體排泄以減少血容量，便能使血壓下降。

 

可見通過利尿除濕，化痰逐瘀以改變血液的質和量，減少脂質在血管壁的沉著，保護血管彈性以治療高血壓確有一定價值。

 

陽熱亢盛必資白虎 釜底抽薪首推承氣

 

高血壓大多屬上盛下虛、本虛標實之症。但在該病的發展過程中，由於陰陽消長的變化，亦會呈現陽熱亢盛而類似陽明實熱病變。此時血壓往往驟升而出現面紅目赤、頭目脹痛、口乾煩躁、二便不利或吐血衄血等症。

 

治療若只限於一般的「平肝潛陽」，則猶如杯水車薪難消烈焰。唯遵陽明病治法假清下之劑釜底抽薪方能為功。尤其對「心火暴盛」「肝陽上亢」等高血壓患者更宜速撲火勢避免中風發生。若為無形邪熱者以白虎湯、瀉心湯清泄之；若腑氣不通者則以承氣輩攻下之。

 

有實驗表明，大黃、黃芩、黃連組成的瀉心湯有明顯的降壓和降脂作用；大承氣湯有增加游離腸袢血流量、擴張血管、改善胃腸道血液循環而可緩解頭面部的充血性疾病。臨床上往往隨一清一瀉而血壓下降諸證悉減。然此終屬應急之法，不宜常籍，以免犯虛虛之戒。

 

 

筆者77年曾治一李姓45歲男患者，素有高血壓，最高達210/130mmHg。時值炎暑，血壓驟升，鼻衄如注，急入本院五官科作前後鼻孔填塞止血，並加用止血劑、降壓藥無效而延中醫會診。

 

診時血壓170/110mmHg，面色潮紅，頭目脹痛，唇乾口燥，大便五日未行，舌紅苔黃，脈弦數。按陽明熱盛投白虎湯合瀉心湯重用石膏大黃，兩劑便通、熱清、血止。繼用滋陰清熱調理，血壓降至150/90mmHg以下，隨訪一年衄血未發。

 

由於清瀉法對陽亢火熾的高血壓確具療效，故有人將承氣湯、葛根芩連湯、白虎湯、瀉心湯等方列為治療實熱型高血壓的代表方。

 

鬱火上擾頭目暈眩 疏泄少陽當取柴胡

 

經雲「少陽之上，火氣主之」。《傷寒論》亦云「少陽之為病，口苦咽干目眩」。高血壓患者若因鬱火上竄多出現口苦煩躁、眩暈頭痛等類似少陽病之症候。根據《內經》「火郁發之」「木郁達之」「高者抑之」之旨，宜分別施以解郁、泄熱、平逆之法，藉柴胡劑以主治之。

若血壓隨情緒波動而變化，並見胸脅不適或痞悶疼痛等症，可用四逆散或小柴胡湯以暢達之。兼有痰濕者合溫膽湯以化之。若抑鬱或暴怒化火，致胸脅脹滿疼痛，煩躁多怒，便秘溲赤者則用大柴胡湯清泄之。倘若少陽相火挾厥陰風氣上沖而見頭目脹痛眩暈，口苦耳鳴，胸滿煩驚者，宜以柴胡加龍骨牡蠣湯以平之。

 

日本矢數道明治一55歲男性高血壓患者，服其它降壓藥治療兩年，血壓終不能降至150/90mmHg以下，後投大柴胡湯一月後，血壓降到130/80mmHg，且諸症悉平。

 

又治一60歲女性高血壓伴心絞痛患者，以柴胡加龍骨牡蠣湯為主，治療兩月後血壓由175/100mmHg降到140/80mmHg，並使其十年來的胸脅苦滿得以治癒。矢數氏認為，本方可作為老年性高血壓病的首選常服方。

 

日本山本岩氏在「談小柴胡湯的臨床運用」一文中論述到小柴胡湯的變化方如柴胡加龍骨牡蠣湯、大柴胡湯、柴胡勾藤散、柴胡八味丸等都可用於治療高血壓。

 

馬有度氏將柴胡加龍骨牡礪湯中的鉛丹以赭石代之，用治各種循環、精神系統疾病。

 

重慶中醫研究所陳源生老中醫將柴胡加龍骨牡蠣湯中的薑桂等溫燥之品去除加白芍、玉竹等養陰之品，用於治療高血壓等心血管及精神系統疾病。

 

目前認為原發性高血壓的發生多由憂慮、恐懼、持續緊張等精神因素導致大腦皮層機能紊亂，使全身小動脈痙攣而致血壓升高。繼發性高血壓雖其病因不同，但同樣是全身小動脈收縮的結果。由於肝主謀慮，膽主決斷，二者互為表里能疏泄一身之氣機。對情志、精神神經等活功起著重要的調節作用。因而疏泄肝膽對緩解血管痙攣以降低血壓，改善自覺症狀有著一定作用。而調節肝膽氣機又多賴柴胡之劑。

 

然而因懼於柴胡昇陽之用，或恐於繆仲淳柴胡劫陰之說，使醫界鮮見以柴胡劑投之於高血壓者。殊不知柴胡苦平，非溫燥之劑，實為達木解郁、升降氣機之正品。李時珍在《本草綱目》中指出:柴胡「平肝、膽、三焦、包絡相火，及頭痛眩暈目昏……耳聾鳴」諸證。清吳達認為「柴胡性能升降。其升也，舉肝脾之陷；其降也，平肝膽之逆」。

 

郭光偉、孫冀真氏分別在「關於柴胡升散、劫陰等問題的初步探討」，「對柴胡劫肝陰的看法」二文中指出:柴胡用於疏肝達郁方面，當升不升者用之可升，當降不降者用之可降。若配伍得當，用於治肝膽鬱火並無昇陽之害，反能發揮瀉肝泄熱之用。至於劫陰與否，主要決定於方藥是否切中病情，配伍是否合理，劑量是否得當。

 

明薛立齋亦有以柴胡配伍的治肝腎陰虛的「滋陰腎氣丸」、「加味腎氣丸」趙獻可用於滋水達郁的「疏肝益腎湯」也配有柴胡。由此可見若作適當配伍，柴胡劑對於具有肝膽氣逆、鬱火症狀的高血壓是可放膽投用的，實不必狐疑不決。

 

清濁逆亂多緣中焦 協調升降重在脾胃

 

高血壓的發生原因雖繁，而可以一言蔽之者因升降失調而已。而升降失調之由則多緣中焦。脾胃居中，二者一升一降乃成人身氣機升降的樞軸。若中焦運轉正常，則清氣升，濁氣降，如天地交泰，陰陽和順，何痰濁水濕之生?眩暈巔疾之有?世治高血壓多重調肝，筆者竊意尚應注重調中，庶不致清濁逆亂，陰陽反作。

 

大凡太陰脾土不運，斡旋不力，清陽不升則致上氣不足出現「腦為之不滿，頭為之苦傾，耳為之苦鳴，目為之眩」等症。陽不化陰則生濕釀疾，因清陽不升，濁陰反上，陰占陽位致令頭目昏眩，即朱丹溪所謂「無痰不作眩」是也。或痰隨氣竄，火助痰升，壅塞經隧則肢體麻木。痰郁化火，內擾心神每致煩躁失眠。濕滯中焦，胃失和降則嘔惡痞滿，溲便失常。

 

見此類症狀的高血壓，若持所謂「平肝熄風」之論予以清降，是欲安之而反亂之。當遵仲景太陰病「當溫之」之治法，投以四逆輩溫化中焦。首取理中湯、苓桂術甘湯。俾中陽得扶，清升濁降則暈眩可解，血壓可降。

 

若痰濕郁久化熱，可取小陷胸湯、黃連溫膽湯清化之；若寒熱夾雜者則宜半夏瀉心湯類辛開苦降，若風氣夾痰濕上擾頭痛眩暈甚者又當半夏白朮天麻湯祛之化之；若氣虛不升頭昏目暗、氣短乏力者當以建中、補中、益氣聰明湯類補之升之。總在「伏其所主，而先其所因」。若膠柱於高血壓不能升補，便失卻辨證論治之精神。

 

戴慧芬治一楊XX，58歲男性高血壓患者，血壓190/100mmHg。肢腫腹脹，胸悶氣喘，頭眩暈，尿短少，苔厚膩,脈沉，辨證屬脾腎陽虛。以四逆湯加砂半苓、苓桂術甘湯等出入進退治療兩月，症狀消除，血壓下降並穩定於150/80mmHg。

 

筆者亦曾治一張XX，56歲女患者，血壓升高5年，常波動於180～150/110～90mmHg之間，並伴長期胃痛，食少便溏，形浮面晦。每用降壓藥後雖血壓下降但頭眩益增。曾屢進天麻勾藤湯、六味地黃湯之類，非但眩暈不減更覺脘腹脹滿。後按太陰中寒論治投理中湯加砂、半、苓、吳萸、雲母，服十餘劑大便轉干，飲食增進，昏眩消失，血壓亦降至130/90mmHg。

 

醫貴明理，治貴知本。不降血壓而血壓得降，此全在調燮氣機，使升降不悖，清濁不亂，則無下陷之憂，亦無逆上之苦。

 

五臟之傷窮必及腎 上盛下虛治從少陰

 

《素問·五臟生成篇》指出「頭痛巔疾，下虛上實過在足少陰巨陽，甚則入腎」。張景岳亦指出「陽邪之至，害必歸陰，五臟之傷，窮必及腎」。高血壓後期每每損及少陰心腎。由於少陰一主火，一主水，故高血壓一旦累及心腎每有熱化、寒化或水火不濟龍雷浮越等症情。這時應按少陰病論治。

 

經雲「年四十而陰氣自半，起居衰矣」。四十歲以後髒氣依次衰減，陽氣漸消，陰氣漸長。據筆者數年觀察及對近百例高血壓患者初步分型，凡五十歲以上者最多陽虛和陰陽兩虛型。這是否與氣候水土及人的體質因素有關有待研究。

 

若為陽虛寒化者主以四逆輩。其中陽不化陰致濁陰上犯或呈現面浮足腫，或小便不利，或眩暈身重等症者，直投真武湯、附子湯、茯苓四逆湯之類溫陽利水。倘投之得當收效甚著。

 

蒲輔周治一馬XX，70歲女患者，患高血壓三年，血壓在230/118mmHg以上。頭暈頭痛，形豐痰多，畏寒尿頻，飲水則腹脹，脈沉細舌淡苔滑。辨證屬陽虛水逆，投真武湯三診後自覺症狀減輕，血壓維持在200/100mmHg左右。筆者以真武湯類所治高血壓病收效者亦多，然以數見不鮮，茲不贅述。

 

若虛陽浮越，面赤身熱，血壓驟升，昏昏如醉者，急宜白通加豬膽汁湯等攝納浮陽，慎防中風之患。此類高血壓若辨證不確妄投苦寒每致僨事。而放膽投以此方則可冀化險為夷。

 

若是陰虛熱化，水不涵木或水不濟火，症見眩暈頭痛，煩躁失眠者宜賴黃連阿膠湯、復脈湯之類清心滋水柔肝。二方實為育陰清熱之祖方，略事進退便可統治一切陰虛陽亢之高血壓。

 

周次清氏治一水虧火旺的高血壓患者，血壓持續在150/100mmHg左右。頭脹頭暈，心煩失眠，便干溲赤，口乾苦。以涼肝熄風的天麻勾藤飲、鎮肝熄風湯治療三周不見好轉，後投俞根初黃連阿膠湯三劑見效，十二劑症狀消失，血壓恢復正常。

 

另有水火兩不足者，當審二氣不足之多寡以治之，切不可雜亂相投，寄望於亂中取勝。最為穩妥者當推金匱腎氣湯。稍加化裁則無論陰虛陽虛投以小劑量常服，對調節陰陽鞏固療效，穩定症狀頗有作用，老年患者尤為適宜。

 

陰風陽風咸起厥陰 平肝熄風必別陰陽

 

《素問·氣交變大論》雲:「歲木太過，風氣流行……眩冒巔疾」。厥陰為風木之髒，風為陽邪最易化火。若風火相煽則發病突然，變化迅速，多致顛眩頭痛震顫攣急候。故《內經》又雲「諸暴強直皆屬於風」、「諸風掉眩皆屬於肝」。亦如劉河間所說「風大皆陽，陽多兼化，陽主乎動，兩動相搏則為之旋轉」。言高血壓多與肝有關或源於此。

 

厥陰主風，但有陽風陰風之別。陽風之擾則熱，泄其熱則風無所附而自平，白虎、承氣、柴胡劑可使;陰風之竄則寒，散其寒則風得溫，變殺厲而為和順也。吳茱萸湯、當歸四逆湯、四逆輩宜投。

 

萬友生氏治一萬XX，51歲男性高血壓患者，血壓220/140mmHg，久治少效。頭暈，巔頂重痛，頭皮麻木不知痛癢，四肢麻痹乏力，神疲怯寒。受寒即胸脘疼痛，口淡吐涎。舌暗淡滑潤，脈弦勁而遲。投以吳茱萸湯溫肝降逆五劑症減，後改用他方症情反覆，又轉用吳茱萸湯數劑後諸症悉平，血壓下降並穩定於140/80mmHg。

 

高血壓發展到一定階段，由於多臟器的功能紊亂，往往陰陽錯雜，寒熱逆亂，根據《內經》「熱淫於內，治以咸寒，佐以甘苦，以酸收之，以苦發之」，「寒淫於內，治以甘熱，佐以苦辛，以咸瀉之，以辛潤之，以苦堅之」之義，以烏梅丸方最為的對之劑。

 

本方融辛散、酸收、苦降、寒溫於一爐，對寒熱錯雜、升降失調之高血壓證稍事化裁確有較好效果。誠如劉渡舟說「諸藥配合，使寒熱邪去，陰陽協調，柔肝溫脾，安蛔斂沖。龔志賢老中醫根據「諸風掉眩皆屬於肝」的理論，以之治「脾腎陽虛，肝鬱化火之上熱下寒眩暈證」屢獲良效。

 

筆者近來治一徐XX，53歲女性高血壓患者，血壓常波動在200/110mmHg左右。頭痛頭暈，眼球脹痛，口苦嘔惡吞酸，腹痛便溏。舌暗紅，苔淡黃稍膩，脈細弦稍數。先擬半夏瀉心湯4劑，口苦止，嘔惡吞酸減輕，大便稍干，但余症未緩。後改用烏梅丸去蜀椒加代赭石二劑腹痛止，續服十劑諸症平息，血壓下降到160/100mmHg。可見本方對陰陽寒熱交錯的高血壓證的治療作用確實值得探討。

 

結語

 

近代對高血壓的研究資料認為，「高血壓病實際上是一個複雜的疾病，是由多種因素引起的。血壓的變化主要決定於循環系統對血流的阻力及血管內的血流量。血流阻力增加的因素，一方面是血管病變如痙攣、狹窄、硬化；一方面是血液質的改變如粘稠度增加。而血流量的變化，一方面是血容量增加，一方面是血流速度加大。

 

要消除這些因素就必須分別施以清熱解痙、行氣活血、利水化痰、鎮靜降逆諸法，妥善處理整體與局部的關係。若但從「肝風」「肝陽」立論，獨從肝一經一髒論治，或只重降壓不顧全身機能的調整，或謀求一方一藥以達降壓的目的，這是不能應付複雜多變的證情獲得滿意療效的。

 

雖然現代醫學將高血壓分為繼發性和原發性兩種，但無論是哪一種在中醫治療方面其基本原則是一致的。如萬友生所說「中醫臨床治病應該按照其理論體系嚴格進行辨證論治才能提高療效。不能從中西醫病名上隨便對照，以致抱有治療成見……如果對高血壓病抱有肝陽上亢的成見，一味地採用滋水平木的清降方劑，可以斷言，不但無效，而且勢必加劇」。

 

在寒熱虛實、臟腑上下縱橫錯雜之時若求之「六經」辨證可望法廣方眾，左右逢源。無怪乎前人認為傷寒六經不特為外感立法，亦為內傷雜病立法。如柯琴說「夫仲景之六經是分區地面，所賅者廣……凡風寒溫熱，內傷外感，自表及里，有寒有熱，或虛或實無乎不包」。鄭欽安也指出「萬病不出六經」。可見以六經辨證方法診治高血壓是有理論意義和臨床價值的。

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