A Small Formula with Seven Herbs - Master Yue Meizhong’s Hypertension Empirical Formula
12. A Small Formula with Seven Herbs - Master Yue Meizhong’s Hypertension Empirical Formula
Pathomechanism
The pathomechanism of liver-stagnation transforming to heat type hypertension is: the liver loses its free flow, qi stagnation over time transforms into fire, pathogenic heat rises along the meridians to disturb the clear orifices; heat consumes liver yin, yin fails to control yang, liver yang rises hyperactively and blood pressure elevates. During the disease course, kidney yin insufficiency is often concurrent, water fails to nourish wood, further aggravating the yang hyperactivity trend. Red tongue without coating, left pulse strong right pulse weak - these are signs of yin-blood insufficiency and liver yang hyperactivity.
Formula Composition
Composition: Lily Bulb 12g, Raw Rehmannia 12g, Chrysanthemum 12g, Cassia Seed 12g, Prunella 12g, White Peony 12g, Mulberry Parasite 9g
Efficacy: Cooling the liver and draining heat, leveling the liver and anchoring yang, nourishing blood and supplementing yin
Indications: Liver-stagnation transforming to heat type hypertension (dizziness and distending pain, palpitations and tinnitus, red tongue without coating, left pulse strong right pulse weak)
In the formula, Chrysanthemum, Cassia Seed, and Prunella - three herbs - clear and drain liver meridian stagnant heat, directly quenching the fire; Lily Bulb and Raw Rehmannia nourish heart-kidney yin, White Peony nourishes blood and softens the liver, three herbs supplementing the insufficiency; Mulberry Parasite supplements liver-kidney, guiding drugs downward. Seven herbs divided into three groups, within draining there is supplementing, within clearing there is nourishing, when liver heat is cleared yang does not rise hyperactively, when yin-blood is filled the liver has what to store.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Clearing the liver | Chrysanthemum 12g, Cassia Seed 12g, Prunella 12g | Chrysanthemum levels the liver and clears heat, Cassia Seed clears the liver and brightens the eyes, Prunella drains liver fire, scatters stagnation. The three herbs used together clear and drain liver meridian stagnant heat, directly quenching the rising-disturbing fire |
| Nourishing yin and nourishing blood | Lily Bulb 12g, Raw Rehmannia 12g, White Peony 12g | Lily Bulb clears the heart and moistens the lungs, Raw Rehmannia nourishes the kidney and cools the blood, White Peony nourishes blood, converges yin, softens the liver. The three herbs supplement yin-blood insufficiency, so the liver has what to store, yang has what to control |
| Supplementing liver and kidney | Mulberry Parasite 9g | Supplements liver-kidney, strengthens sinews and bones, guides drugs downward into the kidney, so the hyperactive rising yang has where to return |
In the formula, six herbs are all used at 12g, equal dosages, neither biased nor leaning; only Mulberry Parasite is slightly reduced at 9g, taking the meaning of supplementing with guiding, guiding without being vigorous. The whole formula has seven herbs, no single heavy-anchoring herb, purely achieves effect through cooling the liver and nourishing yin, the drug properties are mild, suitable for long-term use for conditioning.
Modifications
| Concomitant Pattern | Modified Herbs | Treatment Intent |
|---|---|---|
| Liver yang hyperactivity | Add Raw Dragon Bone 30g, Raw Oyster Shell 30g | Heavy anchoring to suppress yang, converging the floating liver yang |
| Yin deficiency fire exuberance | Add White Caltha 12g | Clearing deficiency heat, cooling the blood to remove vexation |
| Severe dizziness | Add Gastrodia 10g, Uncaria 15g | Leveling the liver and extinguishing wind, stopping vertigo and dizziness |
| Insomnia with many dreams | Add Jujube Seed 15g, Polygonum Multiflorum Vine 15g | Nourishing the heart and settling the spirit, improving sleep |
| Severe headache | Add Chuanxiong 10g, Vitex Fruit 10g | Activating blood and moving qi, dispelling wind to stop pain |
| Constipation | Increase Cassia Seed to 20g, add Hemp Seed 15g | Moistening the intestines and unblocking the bowels, guiding heat downward |
In the original case, Yue Meizhong after three doses showed effect, added White Caltha, Dragon Bone, Oyster Shell among them, after twenty doses all symptoms were completely resolved, blood pressure stabilized. White Caltha clears deficiency heat, Dragon Bone and Oyster Shell heavy anchoring to suppress yang, indicating this formula initially focuses on cooling the liver and nourishing yin, after effect is seen add heavy-anchoring herbs as appropriate to consolidate the therapeutic effect.
Summary
Yue Meizhong Liver-Cooling Decoction uses Chrysanthemum, Cassia Seed, Prunella to clear and drain liver heat, Lily Bulb, Raw Rehmannia, White Peony to nourish yin and nourish blood, Mulberry Parasite to guide drugs into the kidney, seven herbs with clearing and supplementing in parallel, nourishing within draining. The whole formula uses no heavy-anchoring herb, purely establishes the principle through cooling the liver and nourishing yin, suitable for liver-stagnation transforming to heat, yin-blood insufficiency type hypertension; after effect is seen add Dragon Bone and Oyster Shell for heavy anchoring as appropriate to consolidate.
References:
[1] Yue Meizhong. Yue Meizhong Medical Case Collection [M]. Beijing: People’s Medical Publishing House.
[2] Wang Qinghai. Hypertension Integrated Traditional and Western Medicine Research and Clinical [M]. Beijing: People’s Medical Publishing House.
[3] Yue Meizhong Empirical Formulas. Cited from TCM Clinical Empirical Formula Literature Compilation.
12. 七味藥的小方—嶽美中治高血壓經驗方
病機
肝鬱化熱型高血壓的病機為肝失條達，氣鬱日久化火，邪熱循經上擾清竅；熱耗肝陰，陰不制陽，肝陽上亢而血壓升高。病程中常兼腎陰不足，水不涵木，進一步加劇陽亢之勢。舌紅無苔、脈左盛右弱即為陰血不足、肝陽偏亢之徵。
方藥組成
組成：百合 12g、生地黃 12g、菊花 12g、決明子 12g、夏枯草 12g、白芍 12g、桑寄生 9g
功效：涼肝洩熱，平肝潛陽，養血滋陰
主治：肝鬱化熱型高血壓（頭暈脹痛、心悸耳鳴、舌紅無苔、脈左盛右弱）
方中菊花、決明子、夏枯草三味清洩肝經鬱熱，直折其火；百合、生地黃滋心腎之陰，白芍養血柔肝，三味補其不足；桑寄生補益肝腎，引藥下行。七味藥分三組，瀉中有補，清中有養，肝熱得清則陽不上亢，陰血得充則肝有所藏。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 清肝涼肝 | 菊花 12g、決明子 12g、夏枯草 12g | 菊花平肝清熱，決明子清肝明目，夏枯草洩肝火、散鬱結。三藥合用，清洩肝經鬱熱，直折上擾之火 |
| 滋陰養血 | 百合 12g、生地黃 12g、白芍 12g | 百合清心潤肺，生地黃滋腎涼血，白芍養血斂陰柔肝。三藥補陰血之虛，使肝有所藏，陽有所制 |
| 補益肝腎 | 桑寄生 9g | 補肝腎、強筋骨，引藥下行入腎，使上亢之陽有所歸宿 |
方中六味藥均用12g，劑量均等，不偏不倚，唯桑寄生用9g略減，取其補中有引、引而不峻之意。全方七味，無一味重鎮之品，純以涼肝滋陰取效，藥性平和，適於久服調理。
隨證加減
| 兼證 | 加減藥物 | 立法用意 |
|---|---|---|
| 肝陽亢盛 | 加生龍骨 30g、生牡蠣 30g | 重鎮潛陽，收斂上浮之肝陽 |
| 陰虛火旺 | 加白薇 12g | 清退虛熱，涼血除煩 |
| 眩暈甚 | 加天麻 10g、鉤藤 15g | 平肝息風，止眩定暈 |
| 失眠多夢 | 加酸棗仁 15g、夜交藤 15g | 養心安神，改善睡眠 |
| 頭痛甚 | 加川芎 10g、蔓荊子 10g | 活血行氣，祛風止痛 |
| 大便秘結 | 決明子增至 20g，加火麻仁 15g | 潤腸通便，導熱下行 |
原案中嶽美中在三劑取效後，加入白薇、龍骨、牡蠣出入其間，二十劑後諸症悉平，血壓穩定。白薇清退虛熱，龍牡重鎮潛陽，提示本方初服以涼肝滋陰為主，取效後酌加鎮潛之品以鞏固療效。
小結
嶽美中涼肝湯以菊花、決明子、夏枯草清洩肝熱，百合、生地、白芍滋陰養血，桑寄生引藥入腎，七味藥清補並行，瀉中有養。全方不用一味重鎮藥，純以涼肝滋陰立法，適用於肝鬱化熱、陰血不足型高血壓，取效後酌加龍牡鎮潛以鞏固。
參考文獻：
[1] 嶽美中. 嶽美中醫案集[M]. 北京:人民衛生出版社.
[2] 王清海. 高血壓中西醫結合研究與臨床[M]. 北京:人民衛生出版社.
[3] 《嶽美中經驗方》. 引自中醫臨床經驗方文獻整理.