肝木与脾土互资互用，肝主疏泄、脾主运化协同配合是人体维持生命和机能的枢纽。若肝脾功能失调，肝失疏泄， 脾失健运，出现木郁土壅的病理状态，则可影响肠道菌群的稳定性及神经系统的功能，出现脑-肠轴机制异常，从而导致更 年期高血压的发生与发展。宋银枝教授基于多年临证体会，提出木郁土壅可致更年期高血压，并结合现代研究分析其病理 机制，探讨采用疏肝运脾法防治更年期高血压的思路。疏肝运脾之具体措施包括“健运脾土，祛痰化浊”“疏肝解郁，补益 气血”“未病先防，调摄心神”，方药可选六君子汤、半夏白术天麻汤、逍遥散等。通过疏肝运脾，可使肝气调达，情志舒 畅；脾肠健运，肠道菌群保持稳态平衡，膏脂代谢正常，使血压波动在正常范围。治疗更年期高血压可从肝脾入手，疏肝 运脾是调治更年期高血压的切入点和关键所在。

Liver-wood and spleen-earth are in the relation of mutual promotion and mutual restriction. The liver governs the free flow of qi and the spleen governs transportation and transformation，and the coordination of their function serves as the pivot for the human body to maintain life and function well. If the function between the liver and the spleen becomes uncoordinated，the liver will fail to govern the free flow of qi and the spleen will fail to govern transportation and transformation，and then the pathological state of wood constraint and earth congestion appears，which will affect the stability of intestinal flora and the function of the nervous system，and will result in the disordered brain-gut axis mechanism and cause the occurrence and progression of menopausal hypertension. Based on years of clinical experience，Professor SONG Yin-Zhi proposes that wood constraint and earth congestion can cause menopausal hypertension， and puts forward the thoughts for preventing and treating menopausal hypertension with the therapy of soothing the liver and activating the spleen by analyzing the pathological mechanism based on the achievements of modern research. The specific measures for soothing the liver and activating the spleen include method of strengthening and activating the spleen and eliminating phlegm and resolving turbidity，method of soothing the liver and relieving constraint and supplementing qi and blood，and method of prevention before illness and regulating the heart spirit. The prescriptions of Liujunzi Decoction，Banxia Baizhu Tianma Decoction，and Xiaoyao San can be chosen separately. The application of therapy of soothing the liver and activating the spleen will enable the liver qi go smoothly and the emotions be pleased，and then the spleen and intestine function well，which will enable the stable equilibrium of intestinal flora，keep the normal lipid metabolism，and maintain the blood pressure fluctuations in the normal range. It is indicated that the treatment of menopausal hypertension can start from the liver and spleen，and the therapy of soothing the liver and activating the spleen is the starting point and is the key to the treatment of menopausal hypertension.

R259.441

广东省自然科学基金资助项目 （编号：2022A1515010679）