中醫治療頑固型高血壓病例報告

目的：根據衛生福利部統計，高血壓疾病為國人十大死因之一，其中約有10-15%的病人屬於頑固性高血壓(Resistant Hypertension)。本文旨在說明一位長達36年的頑固性高血壓續發腦出血經住院後仍呈現血壓控制不佳的狀況，增加中醫治療後呈現，血壓趨穩定的案例。臨床病例：61歲男性病例，本態性高血壓服西藥已36年，但是血壓控制不佳，於107/06/28左側腦幹出血，出院時MRS:2，病患目前使用4至5種降壓藥但控制不佳，自107/08/04開始服中藥，治療方藥為健保科學中藥配上診所自製的加味清血消脂茶，並觀察患者臨床症狀的改變。結果：臨床觀察發現，科學中藥配合筆者臨床27年的自擬方清血消脂飲，達到降低頑固性高血壓的功效。病例規律服用該方後，血壓的平均值由八月分初診的165.6±12.0／99.6±8.7降至十月分的140.9±6.9／91.5±3.3，明顯看見血壓數值下降，與患者自覺症狀消失。結論：中醫治療「調理氣血沖和，陰陽平衡」的原理，用「平肝、潛陽、息風」，佐以「清熱、化痰、逐瘀、利水」辯證施治的方式，幫助此一頑固性高血壓患者，合併出血型腦中風，在5種西藥治療仍出現血壓失控的案例，但其治療作用機轉為何，值得更深入的研究和探討。

關鍵字

頑固性高血壓；中醫治療；清血消脂飲

並列摘要

Purpose: According to Ministry of Health and Welfare statistics, hypertension is one of the top ten causes of death in our nation, and about 10-15% of these people have resistant hypertension. This paper presents a clinical case of a patient with a 36-year history of persistent hypertension who also suffered a secondary cerebral hemorrhage and was subsequently hospitalized. Despite Western medicine efforts to get the condition under control, high blood pressure levels remained a problem. However, Chinese medicine therapeutic intervention proved effective in gradually reducing the patient's blood pressure, stabilizing the condition, and improving symptoms. Clinical Case: A 61 y/o male with a history of primary hypertension had received Western medicine drug therapy for the past 36 years, but this treatment proved ineffective in controlling high blood pressure levels. On 06/28/2018, the patient suffered left-sided brainstem hemorrhage. At the time of discharge, MRS: 2, the patient was prescribed 4 to 5 types of antihypertensive drugs without achieving successful results at controlling blood pressure levels. On 08/04/2018, the patient began receiving Chinese medicine medicinal therapy. The patient was prescribed extract powder, which was covered under the National Healthcare Plan, in combination with Qing Xue Xiao Zhi Cha variant, and follow-up examination and treatment continued as the patient's condition was closely monitored. Results: Clinical observations found that the administration of the aforementioned Chinese medicine extract powder in combination with Qing Xue Xiao Zhi Yin, a formula decoction that I personally designed and have been prescribing clinically for the past 27 years, proved effective in lowering the patient's persistent hypertension. Following the continuous administration of this formula, the patient's blood pressure decreased from 165.6±12.0/99.6±8.7 on the initial consultation in August down to 140.9±6.9/91.5±3.3 in October. It was obvious that the patient's blood pressure levels gradually decreased and the patient also noticed that symptoms had resolved. Conclusion: The Chinese medicine therapeutic principle of ＂regulating the harmonious flow of qi and blood＂ was applied. Prescription of ＂liver calming, yang-subduing, and wind-extinguishing＂ medicinals combined with ＂heat-clearing, phlegm-transforming, stasis-expelling, and water-disinhibiting＂ medicinals were chosen based on pattern identification as the basis for determining treatment. This Chinese medicine therapy proved effective in the control and management of persistent hypertension with concomitant hemorrhagic stroke despite unsuccessful attempts made to treat this patient's condition with 5 different types of antihypertensive drugs. These results are worthy of further research and discussion.