中医杂志

总结刘志明教授基于“兰除陈气”理论辨治肥胖相关性高血压的临证经验。认为陈气内积是肥胖相关性高血压的病机本质，水精不散、气浊始生、陈郁三焦为发病始动因素，痰湿壅遏、陈气搏结、蕴热炼津为进展关键步骤，营虚血浊、陈气化瘀、侵蚀脉络为加重主要环节。临证在“施以兰法”的治疗原则指导下，初期、恢复期分别用自拟流气运浊汤、自拟育精化陈汤，进展期用加味二陈汤合甘露饮，加重期用自拟推陈散瘀汤加减治疗。

This paper summarizes Professor LIU Zhiming's clinical experience in the syndrome differentiation and treatment of obesity-related hypertension based on the theory of "eliminating stale qi with the orchid method". It is proposed that the internal accumulation of stale qi constitutes the essential pathogenesis of obesity-related hypertension. The initial triggering factors include failure of water essence to disperse, the generation of turbid qi, and stagnation of stale qi in the sanjiao （三焦）. Key steps in disease progression involve obstruction by phlegm-dampness, the confluence of stale qi, and the accumulation of heat that consumes body fluids, while aggravation is mainly characterized by deficiency of nutritive qi, blood turbidity, transformation of stale qi into blood stasis, and erosion of the vessels and collaterals. In clinical practice, under the therapeutic principle of "applying the orchid method", a self-formulated Liuqi Yunzhuo Decoction （流气运浊汤） is used in the initial stage, a self-formulated Yujing Huachen Decoction （育精化陈汤） in the recovery stage, a modified Erchen Decoction （二陈汤） combined with Ganlu Drink （甘露饮） in the progressive stage, and a self-formulated Tuichen Sanyu Decoction （推陈散瘀汤）, with modifications, in the aggravated stage.