Thuốc cổ truyền phòng, trị bệnh tăng huyết áp

Tren thi trUdng hien nay co nhieu loai thuoc tan duoc co the dung de tri benh t&ng huyet ap, tuy nhien khi suf dung thudng kem theo nhtfng tac dung khong mong muon, anh hudng den sure kh

P G S TS P H A M X U A N SINH

CMiex* c©

raa m m

THUOC CO TRUYEN PHONG, TRIBENH TANG HUYET AP

PGS TS PHAM XUAN SINH

THUOC CO TRUYEN PHONG,

NHA XUAT BAN Y HOC

L0(I NOI DAU

Tang huyet ap la chtfng benh thudng gSp, benh mang trnh tong hap, phat trien cham va tCr tCf; ngay

cang co xu the gia tang, dac biet a cdc nUdc co nen, r, 7, ’ a

kinh te phat trien O chau Au va Bac My, benh tang huyet dp chiem ty le cao, tori 15-20% trong so cac benh

ve tim mach d Hoa Ky nam 1998 co tdi 50 trieu ngi/di,

d Phdp tdi 8 trieu ngUdi bi tSng huyet ap O nUdc ta

trong nhuTng nam gan day, benh tang huyet ap cung

co ty le gia tang dang ke, chiem 11,75% trong so benh tim mach vao nam 1990 Theo so lieu dieu tra cua Vien tim mach Viet Nam, nam 1989, trong so 31,3 trieu ngtfdi tuf 15 tuoi trd len co 2 trieu ngUdi tang huyet

ap chinh thiJc va 2,6 trieu ngUdi tang huyet ap gidi han, chiem ty le 6-12% dan so Giao si/ Pham Khue

va cong sir da tien hanh dieu tra tren 1329 cu tuoi tren 60 tuoi cho thay tan suat tang huyet ap la 9,23% Rieng 364 cu d dong bang, tan suat la 16,7% Ta biet rang benh tang huyet ap se la moi lo ngai neu khong duoc phat hien va dieu tri sdm vdi cac phitong phap thlch hop Vi benh se lam ton thuong cac mach mau, anh hudng xau den hoat dong cua cac co quan nhu tim

co the bi suy, vufa xo mach vanh, nguy co dan den nhoi mau co tim; dau that ngUc hoSc anh hudng true tiep den than, gay suy than cap

O giai doan nang co the gay xuat huyet a nhieu

bo phan nhu xua't huyet vong mac, gay md mat hoac

mu loa, dac biet la xuat huyet mach mau nao, gay liet

nufa ngUdi; de lai nhufng di chufng khong the hoi phuc duoc, anh hudng den sufc khoe va cuoc song Trong trUdng hop qua nSng co the gay nguy hiem den tinh mang Tren thi trUdng hien nay co nhieu loai thuoc tan duoc co the dung de tri benh t&ng huyet ap, tuy nhien khi suf dung thudng kem theo nhtfng tac dung khong mong muon, anh hudng den sure khoe cua ngtfoi benh Chinh vi le do de phong tri benh tSng huyet

ap hien nay tren the gidi; dSc biet cdc nUdc dang phat trien co xu hudng suf dung cac vi thuoc co nguon goc tCr duoc lieu trong thien nhien Dung thuoc co truyen

de phong tri cao huyet ap co nhieu UU diem:

- Nguon duoc lieu phong phu, de kiem, gia thanh ha

- Phuong phap bao che don gian, de dang thuc hi^n ngay ca d nhufng noi co dieu kien kho khan

- Han che duoc nhufng tac dung khong mong muon Sau khi uong thuoc dua lai cam giac de chiu cho ngudi benh

Tuy nhien, tuy theo tinh hinh cu the, co the tien hanh ket hop viec dieu tri benh t&ng huyet ap b&ng thuoc tan duoc va thuoc YHCT cho hop ly

Vdi cuon sach nho nay hy vong giup ban doc tim hieu sau them ve cdc vi thuoc va phi/cfng thuoc co truyen dung phong va tri benh tdng huyet ap

TAC GIA

P han I

MOT SO KHAI NIEM VE BENH• • •

TANG HUYET AP (HA)

I NHLT THE NAO GOI L A B E N H T A N G H U Y E T AP

Cf ngudi khoe manh, co HA toi da (HA tam thu) la

120mmHg vk HA toi thieu (HA tam trUOng) Id 80mmHg

va thudng bieu thi bang chi so 120/80mmHg Neu HA toi da 140mmHg va HA toi thieu 90mmHg duoc coi la t&ng huyet dp Neu HA toi da n&m trong khoang 140- 160mmHg, v& HA toi thieu nfim trong khoang 90-

95mmHg, duoc coi la tang huyet Ap gidfi han Tuy nhien

HA con phu thuoc vao nhieu yeu to khac nhau Vi du vao gioi tinh, o nam HA thudng cao hon nOr Vao luTa tuoi ngUdi gia thudng co HA cao hon ngUcfi tre thudng tif 10- 20mmHg Vao vi tri trong co the; HA toi da d chan thudng cao hon d tay 20mmHg con HA toi thieu thi khong chenh lech NgUdi ta thudng chia benh tang huyet

ap ra lam 2 loai: Loai tang huyet ap thudng xuyen co the lanh tinh va co the ac tinh; loai tang HA con tren

co sd HA binh thudng, co nhOTng con cao vot, nhihig luc ndy thudng gay tai bien

Mac du vay d moi quoc gia, dUa vao dieu kien cu

the, co cac quy dinh rieng ve chi so HA O Trung Quoc c6 luc dUa vdo do tuoi de xac dinh tinh trang tang huyet dp

Do tuoi HA toi da Ket luan

39 < >140 Tang HA 40-49 >150 Tang HA 50-59 >160 T jing HA

> 60 >170 T§ng HA

- j

0 Hoa Ky theo quy dinh cua Vien sure khoe JNC

thi tinh trang HA duoc quy dinh thanh 4 giai doan:

HA toi da

(mmHg)

HA toi thieu mmHg

Tinh trang HA

130< 85< Binh thudng

130-139 85-89 Binh thudng cao

140-159 90-99 Tana HA nhe-aiai doan 1160-179 100-109

Tang HA vua, giai doan 2 180-209 110-119

> 220 > 120 Tang HA nang-giai doan 3

Tang HA rat nanq-qiai doan 4

Theo OMS o ngudi ldn tuoi co HA binh thudng neu

HA toi da dudi 140mmHg va HA to i thieu dudi

90mmHg Neu HA toi da tren 160mmHg va HA toi

thieu tren 95mmHg la tang huyet ap

Nam 1993, cung vdi Hoi tang huyet ap the gidi, OMS da quy dinh lai nhu sau: Tti 140/90 trcr len duoc coi la tang huyet ap

Tang HA nhe, neu HA toi da 140-180mmHg

HA toi thieu 90-105mmHg

Tang HA vira va nSng; HA toi da > 180mmHg

HA toi thieu 105mmHgTheo con so dieu tra cua Vien tim mach Viet Nam

HA binh thirdng cua ngirdi VN la 120/75mmHg a nam

gidi thirdng 122/76mmHg, d nur gidi 119/75mmHg.Tuy nhien doi vdi ngtfdi tang huyet dp, cung co the chi tang HA toi da con HA toi thieu vdn binh thirdng; cung co the chi tang HA toi thieu con HA toi da van binh thirdng; cung co the tang ca HA toi da va HA toi thieu khi hieu so cua HA toi da va HA toi thieu nho, khoang 15-20mmHg; hodc HA toi thieu > 100, luc nay the rat m$t moi va kho chiu cung can noi them rang, doi vdi YHCT khong co khai niem benh tang huyet ap Cac khai niem ve benh tang huyet ap nhu

ta thudng hieu lai ndm trong khai niem ve chufng

"huyen vyfng" cua YHCT Trong nhufng nam gan day cac nha YHCT phirang Dong noi chung va YHCT Viet Nam noi rieng, qua nghien cufu tren thiTc nghiem cung nhi/ tren thiTc ti§n lam sang thay rang chufng huyet viTng cua YHCT noi chung co cac trieu chufng giong vdi cac trieu chufng cua benh tang huyet ap Tuy nhien ve mat phan loai HA va ccf che tac dung cua thuoc lai

co y nghla rieng se phan tlch d phan sau Mac du vay nhufng vi thuoc va phi/cfng thuoc co truyen chufa chufng huyin viTng van diTcfc suf dung vdi tinh chat de chijfa benh tang huyet ap

De xac dinh xem mot ngirdi co bi tang huyet dp hay khong, ngudi ta co the diia vao mot so dau hieu sau day:Benh nhan thudng co cac ccfn dau dau duf doi, cdng dau, hoa mat, chong mat, buon non mat thudng do, mdt do do sung huyet, mat md di Tinh trang ndng hoi thd thudng gap tim dap nhanh; tham chi chan tay

bi co qudp Ve phia YHCT thudng ket hop giufa cdc trieu chufng lam sang vdi viec chan mach de xem xet tinh trang HA

Ve mdt chan mach, YHCT coi mach huyen la loai mach dien hinh cua chufng tang huyet ap; do Id loai

mach dai suot 3 bo (thon quan xich) c6 do trU’cmg life

ldn "cang nhu sai day dan" Tuy nhien dien bien nay cung kha phufc tap, se duoc bdn d muc sau De- co ket luan chinh xac ve tinh trang tang huyet ap cua mot ngi/di, hien nay ngirdi ta thirdng tien hanh kiem tra

HA bang cac may do HA Cong viec kiem tra thi/dng tien hanh do it nhat 2 lan vdi nhufng dieu kien giong nhau, vao gid nhat dinh, thirdng tien hanh vao buoi sang co the tir 8-10 gid Sau do lay gia tri trung binh cua cac lan do Co the dung HA ke kieu dong ho hodc

HA ke thuy ngan Kieu HA ke dong ho tien lcfi, nhanh song do chinh xac doi khi khong cao vi the ngi/di ta khuyen cdo nen 3 thang kiem tra lai bang HA ke thuy ngan mot lan doi vdi nhufng ngirdi bi b<?nh tang huyet

ap Khi tien hanh do HA benh nhan co the ngoi hodc nim de do Can chu y them rdng khi tien hanh kiem tra HA ngirdi benh can d trang thai thoai mai tranh cac hoat dong ndng nhir chay nhay; can nghi ngoi 5-10 phut trUdc khi do va tranh cac thufc an mang tinh kich thich nhir riTOu, bia, ca phe, tranh hut thuoc la hodc uong cdc thuoc chufa hen suyen, tranh nhufng kich thich

ve cam xuc vd cung khong do sau khi dn no

II P H A N L 0 « l CHUNG B E N H T A N G H U Y E T A P

2.1 Y hoc hi$n dai

Theo y hoc hien dai benh tdng huyet dp diroc chia lam 2 loai:

- Nguyen phdt: Loai tdng huyet dp khong rd nguyennhan; co the do bairn sinh, the loai nay chiem ty le cao tori 85-90% trong tong so ngirdi bi tang huyet ap

- Thur phdt: Loai tang huyet ap do sau mot chufng benh nao do Vi du: Viem cau than, viem be than, u than, lao than, benh noi tiet, phi dai thifOng than bam sinh, hep dong mach chu, nhiem doc thai nghen, hodc tinh than cdng thdng

2.2 Y hoc co truyen

Y hoc co truyen coi benh tang huyet dp la benh thuoc chufng huyen viTng, dau thdng, can difcfng thi/ang ci/dng Cdn cur vdo chufng trang benh, ngifdi ta chia 1dm mot so loai hinh nhir sau:

2:2 1 Can nhiet <can dilang thuqng cangi

Cac trieu chufng thudng gap: Dau dau cAng dau, hoa mat, m !t do u tai moi mieng kho, dang, chan tay hay

bi co rut te bi, dau luSi do reu trang hoac hoi vang mat ngu, long ban tay chan nong mach huyen

2.2.2 Dam hoa noi thinh (dam thapj:

The hien mat md dau cang dau d£u nguc stfdn day tufc, mat do, mieng kho dang, dam dinh quanh, reu ludi vang day, dau ludi do hay lam giong buon

non, kem an it ngu; mach huyen hoat The dam thap

thudng gap d nhtfng ngudi co the trang beo co ham liiang cholesterol cao < md mau cao)

2.2.3 Am hit ditang thinh:

Nguyen nhan do phan am trong ca the bi suy yeu, phan am khong du de ufc che hoa: hoa vuong len ma gay

ra benh Bieu hien: Hoa mat, chong mat, dau nang chan biidc khong that, tai u, phien tao de cau gat, chav tay

te bi, chat ludi do reu trang, mong, mach huyen

2.2.4 Can than dm hu:

Cac trieu chufng thudng gap la nhufc dau hoa mat, u tai, hay hoang hot de sa hai, mat hay bi do, mieng kho, chat lU3i do, it reu Lung dau, goi moi, di tinh; khi ngu

hay bi me; mach huyen, te, sac The nay thudng gdp d

nhufng ngudi gia ma dong mach bi xa cufng.

2.2.5 Th$ t&m ty hu.:

Thudng xay ra d ngudi cao tuoi, co kem theo cac

chufng viem loet da day td trang bieu hien hoa m&t, dau dau, da kho, kem fin, kem ngu, phan ndt Reu ludi mong trSng Mach huyen te

2.2.6 T h i dm duang litdng hxl:

Bieu hien chdng m&t dau dau; siCc m&t tr^ng bech, chan tay lanh, mem yeu, cd teo nheo, ti£u d§m nhieu lin , li£t dUdng hoat tinh Ngudi luon c6 cam gidc sd lanh, gid lanh, nUdc lanh NgUdi luon c6 tam trang phien muQn, mieng kho, ludi b6ng hdi hong Mach tram te

III N G U Y E N N H A N DAN D E N T A N G H U Y E T A P

3.1 Nguyen nhan ben trong

3.1.1 Viem than:

Viem than cap tinh hoSc man tinh deu co nguy

cd dan den tang huyet ap Thudng cd nhufng bieu hien ban dau la phu; thudng bSt dau tCf m&t, m&t (ml mat tren)

Thdi ky dau huyet ap t&ng cao va dao dong ldn, thdi

ky sau d§n den huyet ap toi thieu t&ng; co nhufng bieu hien dau lifng, so lanh, chan tay moi, cd mem nhuac Tieu It; nUdc tieu thudng v&ng thSm; doi khi due nhu nude gao ho&c co m&u Kem Sn kem ngu mpt moi

3.1.2 Viem dai than man tinh:

Bieu hien thdi ky dau, than nhipt thudng ha vdi thdi gian keo d&i, dau lung di tieu nhieu lan, khong nln tieu dupe, khi di thudng dau buot, dau thudng dauc&ng, tim dap nhanh

Huyet ap t&ng cao, the trang suy nhUdc thieu m&u, phu thung Trong nUdc tieu co the co mau mu va vi khuan

Bieu hien dau lung doi khi dau bung cd the di tieu

ra mau Khi cac nang phat trien HA thudng t&ng, dong thdi vdi sU xo ctfng cac dong mach

3.1.6 Dong mach bi xo cilng:

Do thanh mach bi bien doi, day l§n vft xtf cuTng, tinh d&n hdi bi giam di, long mach bi nhd lai Tnldng

hc*p nay thudng dan den sii tang huyet dp toi da; con huyet ap toi thieu binh thudng hoac hoi ha Thudng gap

d lUa tuoi trung nien Trieu chufng lam sang thudng bieu hien tim dap nhanh, hoi hop, dong mach vdnh bi bien

dang, dan den dau that ngUc, ca tim bi cufng hoa.

- Do hep mieng cua d<?ng mach chu thudng do bam sinh (tim tien thien) Da phan thay d nam gidi Tinh chat nSng hay nhe la do mufc dp hep cua mieng dOng mach chu Co ngudi khi tuoi trUdng thanh mdi phdt hien thay Co the thudng bieu hi$n met moi, dau vung

tim, tim d£p nhanh Huyet Ap d tay cao, huyet Ap d chan lai thd'p hdn Thdi gian dau huyet Ap thudng bieu

hien cao d mufc do vi/a k6m theo dau d£u, chong mat, tieu nhieu, ti£u dem, phien toai, chan tay vo lUc t§

bi, co qu3p Vdi cac xet nghiem mau thay ham luang kali giam va natri tang Ngoai ra hep dong mach chu cung la nguyen nhan gay tang huyet ap

3.1.7 Ciiang nang tuyen giap:

Do hormon tuyen giap phan tiet qud nhieu dan den tim dap nhanh, tinh than cang thang nhieu mo hoi;

so nong, mat bi loi; phu tuyen giap , thudng an nhieu

ma trong luang ca the lai giam, do chuyen hoa ca ban tang kem theo la tang huyet dp toi da; huyet ap toi thieu thap

3.1.8 Do nhiern doc thai nghen:

Mot so phu nti khi co thai, cung bieu hien cao huyet ap

3.1.9 Do tdng ham luang cholesterol trong mau

Vuot qua gidi han cho phep (5,68mmol/l) se anh hudng den thanh mach

3.2 Nguyen nhan ben ngoai

- Do Sn uong:

Do an nhieu cac chat cay ndng, kich thich trong thdi gian keo dai nhu rUOu, ca phe, thuoc Id hoac che

do an uong qua nhieu md dong vat, an man.

- Do cang thang than kinh (do lam viec nghi ngoi khong dieu do dan den lo nghi, sp hai)

- Do cac yeu to moi trUdng nhu qua nhieu tieng dong manh, tieng on ao

- Uong thuoc chong thu thai, thuoc corticoid cung

la nguyen nhan gay tang HA

Nhu vay co rat nhieu nguyen nhan co the dan den b(?nh tang huyet ap Tuy nhien ngudi ta van thay rang nguyen nhan ben trong la nguyen nhan chu yeu dan den benh nay; mac du vay cac nguyen nhan ben ngoai khong kem phan quan trong dan den benh tang huyet

ap Do do de phong tri benh tang huyet ap co hieu qua can phai ket hop, vira dieu tri cac nguyen nhan ben trong dong thdi khac phuc nhufng yeu to ngoai lai

anh hudng den benh tang huyet Ap.

Cong thufc nay dupe suy ra td dinh luat Poiscuille

ve sU van chuyen chat long trong mot ong

Trong do Q la lUu lupng Trong trUdng hop mach mau thi Q la lUu lupng mau trong mach P la huyet ap; r la ban kinh long mach;l la chieu dai mach, n la

do nhdt cua mau Co the suy ra:

81nHuyet ap P= Q -(2)

n r4

Nhu vay huyet ap ty le thuan vdi lUu lupng va do nhdt cua mau; ty le nghich vdi ban kinh long mach

Cd nghia la lUu lupng mau d dong mach cang ldn huyet

ap cang cao; do nhdt cua mau cang tang huyet ap cang ldn; long mach cang rong huyet ap cang nho

Td cong thUc tren cd the thay rang:

- LUU lupng cua mau phu thuoc chu yeu vao sufc dap cua tim Tim dap cang nhanh bao nhieu luu lupng mau cang ldn bay nhieu

- Do nhdt cua mau phu thuoc chu yeu vao cac thanh phan trong huyet tifong; trong so do anh hddng dang

ke la cac chat m3 (cholesterol) , cac chat triglycerid, cac muoi mat v.v

- Long mach do co that co hoc lam nghen lai hoac

do cac yeu to hoa hoc nhi/ chat (nicotin) do hut thuoc

la gay co mach, hoSc long mach bi xo hoa, bi bien doi

do thieu vitamin P,C, do trong mau co nhieu md (cho­lesterol, triglycerid)

- TCr cong thufc (2) neu ta dat

81n - = R (la sufc can ngoai vi)

p r4

Ta se co P = QR

Vay huyet ap con ty le thuan vdi sdc can ngoai vi.Sufc can ngoai vi cang ldn, huyet ap cang tang Sufc can do do nhieu yeu to nhtf long mach, do nhdt cua mau

va do dai cua mach (do dai cua mach noi chung khong thay doi tuy vay neu co cac chan thtfdng se sinh ra tuan hoan bang he, thi do dai do co the thay doi va do cung

la nguyen nhan lam tSng sufc can ngoai vi)

Sufc can do con phu thuoc trifc tiep vao khi hau nong lanh, vao do siTng hoa cua da ben vuTng cua thanh mach (tinh dan hoi), (khi hau nong cdc mach ngoai

vi gian no, long mach rong ra khi hau lanh cac mach ngoai vi co lai, long mach hep lai)

Tren c0 so nhufng yeu to anh hifdng den HA ke tren, ta co the khai thac nhufng yeu to co lpi, dong thdi han che toi da cac yeu to bat lpi giup cho viec phong, tri HA tot hon.

IV cd C H E T A C D U N G T H U O C CO T R U Y E N PHONG TRI B E NH TANG H U Y E T AP

Tuy theo tttng the benh tang huyet ap, thuoc co truyen co nhufng co che:

- The can nhiet: Do phan dtrong cua can qua vi/ong, can hoa boc len gay ra benh Do do co che tac dung cua thuoc trong the loai benh nay la binh can thanh nhiet Dung cac vi thuoc thanh thap nhiet de ha hoa d can nhii: Long ddm thao, hoang cam, chi tuf, trach ta, thao quyet minh, ha kho thao, tCr thach, kho dinh tra

- Vdi the dam thap noi thinh

Dam la chat dich du"pc tao ra trong qua trinh chuyen hoa cua tang phii Mot li/png It cua dam la can thiet cho ca the; song vdi lupng nhieu no gay

ra thap tre va dan den benh tat Dam dong lai d

bo phan nao thi gay ra benh tat d tang phu do Doi vdi the dam thap ta cd the coi nhir the md mau cao cua y hoc hien dai Co che tac dung cua thuoc trong the nay la truf dam rao thap Cd the dung cac vi thuoc nhtf: Ban ha, ngi/u tat, trach ta, uat kim, true nhp, y di, tang

- Vdi the am hi/ duong thinh:

Doi vdi the nay, phan am trong co the bi suy yeu nhu huyet hu, tan dich hao ton, cac tang khong du manh lam phan di/ong lan at ma gay benh cao HA

Do co co che tac dung cua thuoc trong loai hinh n&y

la tu am tiem duong Co the dung cac thuoc luang huyet

bo huyet, thanh nhiet, tran kinh de dieu tri nhu sinh dia, duong quy, hoang ba, thien ma, cau d&ng

- Vdi the can than am hU:

Dieu nay dupe bieu hien ro trong quan he ngu hdnh

cua tang tupng Xem hinh 1

(Can)

Hinh 1 Quan he ngu hanh cua tang titong

O day bieu hien ro quan he tUcfng sinh gitta than (thuy) vdi can (moc) Trong moi quan h§ sdnh doi nky,

ban than phan can am da khong du manh lai cong vdi phan than am suy, do d6 khong du sure 6 i tfc che hoa cua phan can moc Do do can hod vtfpng len mi

thanh benh Ca che tac dung cua thuoc trong loai hinh nay la tif than, difdng can, tufc la dung thuoc de bo dirdng vao 2 tang can va than Cd the dung cac vi thuoc

ha thu o do, bach thuac, tho ty tuf, tang than, td thach phuc bon tiir, pha co chi

VI M O T SO LOAI THUOC CO T R U Y E N CO L I E N QUA D E N P HONG TRj B E N H T A N G H U Y E T AP

- Thuoc tran kinh an than:

Thirdng dung vdi tnrdng hop than kinh cang thing

ma tang huyet ap, dau dau, mat ngii, hoa m it chong mat.Cdc vi thuoc nhd: Cau ding, thien ma, lac tien, ngai ti/png, ba tuf nhan, trie bd nhan, vien chi, vong nem

- Thuoc binh can ha ap:

Thirdng dung trong cac triTdng hop cifdng can dirang hoa m it Cac vi thuoc thirdng dung nhii: Ha kho thao, cuc hoa, hoa hoe, mau le

- Thuoc dirdng tam an than:

Thirdng dung vdi cac triTdng hop: Tam quy, tam hoi hop, loan nhip, mat ngu, dau dau va tang huyet

ap Cac vi thuoc thddng dung nhiT: Dan sam, thien mon, mach mon, hoang tinh, ngoc true

- Thuoc tham thap, lai nieu:

Thirdng dung vdi tnrdng hap: than viem, chtfc nang than kem, viem tiet nieu dan den tieu due, tieu buot

hoac phu ne ma tang huyet ap Cdc vi thuoc thudng dung nhU: sa tien tuf, kim tien thao, long du thai, ngUU bang tiir, trach ta

- Thuoc hoat huyet hanh khi thudng dung vdi cac trUdng hop huyet tre, huyet it, khi huyet luu thong kem Cac trUdng hop tang cholesterol va triglycerid mau Cac vi thuoc thudng dung nhu: NgUu tat, uat kim (nghe) ich mau, sung uy tuf, cot khi cu, nam linh chi, actiso

- Thuoc thanh nhiet: Thudng dung trong cac trUdng hop can than nhiet, huyet nhiet, gay ra dau cang dau, hoa mat tang huyet ap Cac vi thuoc thudng dung nhu: Hoang lien, hoang ba, hoang cam

Tuy nhien, cung can thay rang, theo y hoc co truyen, thi khai niem cao HA ma chung ta thudng goi thuoc chufng 'huyen vUng" cua dong y, va nhu vay de giai quyet chufng benh nay, ngudi ta cd the dung nhieu loai thuoc khac nhau de phoi hop khong nhat thiet

phai tat ca cac vi thuoc trong phudng deu co tac dung

ha HA Song thong thudng ke ca cd phuong, ta cung tim thay it nhat cd mot vai vi thuoc cd tac dung ha huyet ap Vi du trong Thien ma cau dang thang cd cau dang, cuc hoa, dia long tac dung ha HA Trong Luc

vi cd mau dan bi cd tdc dung ha HA Trong ky cuc dia

hoang hoan cd mdu dan bi, cuc hoa cd tdc dung ha HA.

VII M O T SO T H A N H P H A N HOA HOC T R O N G THUOC CO T R U Y E N CO TAC DUNG P H O N G TRI B E N H T A N G H U Y E T AP

- Cac hap chat alcaloid

- Alcaloid toan phan trong dtfa can

- Alcaloid trong ba gac ma dien hinh la reserpin

- Alcaloid trong la sen: Nuciferin, nor-nuciferin roemerin

- Alcaloid trong binh voi: L.tetrahydropalmatin

- Alcaloid trong hoang lien, hoang ba, vang dang: Ber„berin

- Cac hap chat saponin tritecpenic clematosid trong uy linh tien ma phan genyl la oleanolic acid; hodc saponin tritecpenic trong ngi/u tat co tac dung giam cholesterol lam ha HA

- Cac hap chat flavonoid

+ Cac isoflavonoid trong cat can: Daizein, daidzin puerarin tac dung gian dong mach co, dong mach dui lam HA ha

+ Cac hap chat rutozit trong hoa hoe (rutin), trong bac ha (diosmin) co hoat tinh cua vitamin P, co tac dung lam giam tinh tham, tinh gion cua thanh mach

(do \ic che men hyaluronidase) Do do lam giam cac

nguy ca v3 mach mdu, lam xuat huyet, nhat la xuat

huyet nao khi huyet ap tang cao Mot sir phoi hop thich hop giufa flavonoid va acid ascorbic la nguyen nhan gay

ha huyet ap d mot so vi thuoc co truyen, trong do co

vi tao chua (tao ta)

- Cac hop chat coumarin: Byak engelicol trong bach chi, Peucedanin trong tien ho co tac dung gian dong mach vanh, chong dau that ngpc; cd lpi cho nhufng benh nhan tang huyet ap ma mach vanh bi xo vCfa.Mac du ngudi ta da biet mot so thanh phan hoa hoc trong vi thuoc co tac dung ha HA song tren thpc

te suf dung, dac biet trong llnh vUc YHCT ngudi ta van dung cac vi thuoc vdi cac thanh phan hoa hoc mang tinh toan phan cua chung Tuy nhien hien nay tren thi trUdng van cd nhUng che pham dupe chiet tach phan lap dudi dang mot loai thanh phan hoa hoc nao

do cua vi thuoc Vi du vien Ginkko fort la flavonoid chiet xuat tU Bach qua vdi tac dung gian mach ha ap ben mao mach Vien Daflon la mot so flavonoid chiet xuat tU vo cam, quyt de chufa benh chay mau do tac dung lam ben mao mach

PHAN II.

NHtfNG VI THUOC CO TRUYEN DUNG PHONG TRI BENH• •

BA DQT

Eupatorium ayapana Vent Ho Cue Asteraceae

- Dac diem thufc v£t

Cay thuoc thao cao tdi 50cm than mdu tim nhat,

co dot Ld moc doi, phien nguyen, m6p hoi gpn song

Ld ddi 5-10cm c6 3 gan noi ro Hoa dang dau hop

thanh ngu Hoa trdng hay phdt hong

- B q phan dung

Bo phan tren mdt dat: Herba Eupatorii cdt nho, phoi kho, sao qua cho thorn

- Thanh phan hoa hoc

Vi thuoc chufa coumarin: Ayapanin, ayapin, tinh dau, th a n h p h a n chu yeu la th ym olqu in on di- methylether ngoai ra con co methylthymylether thy- monquinon

- Tac dung sinh hoc

+ Ba dot co tac dung ha huyet dp

+ Tdc dung gian mach

- Cong dung

Nhan dan dung cay thuoc nay de tri benh tdng huyet ap, ngay 6-12g dudi dang thuoc s&c; co the phoi hop vdi hoa hoe, cuc hoa, ngUu tat Con dung de bao quan cau kho

- Chu y:

Can phan biet vdi cay man tudi Eupatorium Staechadosmun dosmum Hance cung ho cue, cung chtfa coumarin la ayapin Tuy nhien nhan dan dung man tudi lam gia vi va lam thuoc chtfa mun nhot, Id ngtfa,

be kinh va phu nU sau de bi U huyet, cung dung de

bao quan cau kho

BA GAC (BA GAC VIET NAM)

Rauwolfia verticilata (Lour) Bail.

Ho True ddo Apocynaceae

- Dac diem thxjfc vat

Cay ba gac thuoc loai cay nho cao do lm -lm 50 vo than co nhtfng lo san La nho dai 5-7cm thudng moc doi hodc moc vong 3-4 la

Hoa hinh ong, mau trdng Qua hinh trufng khi chin

co mau do tuoi Cay thudng moc hoang d rifng nui phia BSc nude ta nhu Ha Bdc, Lao Cai, Cao BSng, Lang Son

- Bp phan dung

Re Radix Rauwolfiae

- Thanh phan hoa hoc

Re chijfa alcaloid khoang 1,5-3% chu yeu la reserpin, secpentin, rescinnamin, raubasin, ajmalin, ajmalicin

- Tac dung sinh hoc

Nude s&c re ba gac co tac dung ha huyet ap ro ret

tren dong vat thi nghiem Tac dung ha ap nay duoc xac dinh do chat reserpin va rescinnamin Tac dung

ha ap cham va duy tri lau; dong thdi lam mat tac dung cua nor-adrenalin; ngoai ra con lam tim dap cham lai Ngudi ta da xac dinh tac dung ha ap cua ba gac theo

ca che than kinh trung uang Con co tac dung an than.

- Cong dung

Re ba gac duoc dung de chtfa tang huyet ap dudi dang cao long 1:1, vdi lieu 30 giot 1 ngay Tuy theo tCfng dieu kien cu the cd the tang so giot len gap rUdi

ho&c gap doi Mot lieu trinh thudng 10 den 15 ngay

- Chu y

+ Khi dung ba gac de tri tang huyet ap can ton trong nghiem ng&t ve lieu luang

+ O nUdc ta cd nhieu loai ba gac nhu ba gac An

Do (R.serpentina), ba gac Cu Ba cung chda cac hop chat

alcaloid, co tac dung ha huyet ap NgUPi ta thudng khai thac re lam nguyen lieu chiet xuat cac hoat chat de che thuoc dudi dang vien, uong theo lieu lupng quy dinh.

BA KICH (RU0T GA)

Morinda officinalis How Ho cd phe - Rubiaceae

- Dac diem thufc v£t

Cay thao song lau ndm, than leo, la moc doi IA

dai 6-14cm, hoa co mau trSng luc dau sau pha m&u

vang Qua hinh cau khi chin co mau do Ba kich \k

cay moc hoang of mot so tinh nhu Ha B&c, Yen Bai, Quang Ninh Cf Quang Ninh da co thdi trong thuf dudi tan la cay rUng

- Bp phan dung

Re Radix Morindae

- Thanh phan hoa hoc

Trong re co anthraglucozit, tinh dau, di/dng, vita­min C, nhua Gdn day ngudi ta phat hien trong re ba kich co cac hpp chat monotecpen nhu l-bomeol-6-O- [3-apiosyl-D-glucosid Cac hpp chat Iridoid: morindolid, asperulosid, morofFicinalosid acid asperulosic monot- ropein, acid desacetyl asperulosidic Cdc hpp chat tritecpen: acid rotungenic methylether, lucidin, sterol: oxsitosterol

- Tac dung sinh hoc

+ Nude sdc ba kich co tac dung ha huyet ap va tdng nhu dong ruot cua dong vat thi nghiem

+ Tac dung chong tram uat cua ba kich (do 5 hop chat: acid succinic, nystose, lF-fructo-furano ylnystose, hexasaccarid va heptasaccarid

- Chu y

Khi dung ngUdi ta thudng chich vdi muoi an, vdi luang cuf 1kg ba kich bo loi dung 150ml dung dich muoi

an 5%, tam, u roi sao vang Cd the phoi hap vdi cac

vi thuoc chtfa cao huyet dp khac nhu dd trong, ngUu tat

BACH BONG N 0 (MO TRANG)

Clerodendron fragrans Vent.

Ho Co roi ngUa - Verbenaceae

- Dac diem thtfc v£t

Cay bui cao lm -lm 5 La hinh truTng rong, dai 10-

20cm, rong 8-18cm, mep la co rang cUa Mat tren \&

co long ngan Cuong la dai Hoa mau trang hoac hong nhat hinh mam xoi, nhieu tan Ra hoa thang 7-8.Qua hach chin vao thang 9-10

• Bp phan dung

La va re Folium et radix Clerodendri

- Thanh phan hoa hoc

Trong la co cac hap chat flavonoid nhif quercitrin, quercetin TCr mot loai C.trichotomum thunb (TQ) con

co alcaloid orixin orixidin, iso-orixin, kokusagin, tinh dau va muoi canxi

- Tac dung sinh hoc

+ Tac dung ha huyet ap tren dong vat

+ Tac dung chong oxy hoa

+ Tac dung kh an g khuan tot vdi cac chung: Klebsiella pneumoniae, Proteus mirabilis, Staphylococ­ cus auvreus, ATCC 29213 Bacillus subtilis, Shigella sonei, Shigella flexneri; cdc nam Candida albicans,

Candida stellatoides

- Cong dung

Dung ld chuTa tdng huyet ap moi lan 10-15g, ngay uong 3-4 lan; co the phoi hop vdi ich mau thao, dudi dang ham hodc sdc con dung chuTa khi hu bach ddi, dung 15-20g la hodc 16-20g re sao vang sdc uong Co the dung ld tuoi gia nat ddp mun nhot hodc dung nau nude tdm sat khuan khi bi ghe Id ngUa chay nUdc vang

- Chu y;

Ngoai cay bach dong nuf noi tren c6n dung cay cung chi Cledendron vdi cong dung tuong tU, cay thap hon bach dong ntt, chieu cao do 0,6-0,7m Hoa hinh mam xoi, mau trdng thudng moc hoang d ven de Song Hong; dung ld lam thuoc chuTa tdng huyet dp va dieu kinh; phoi hop vdi huong phu, ich mau, ngai diep

BACH HAC (KIEN CO, CANH CO, NAM UY LINH TIEN)

R/iinacanthus ncisutus (L.) Kurz

Ho o ro-Acanthaceae

- Dac diem thtfc vat

Cay bui, moc hoang hodc trong lam canh d nhieu noi Cay thudng cao 1 den 2m, co nhieu canh, 1a don, moc doi; phien la hinh trufng , thuon dai, dau 1a nhon, mdt tren nhdn, mdt dudi hoi co long Hoa nho mau

trang, moc thanh kim d ke la Hoa ludng tinh, mau tring hodc hoa ca diem hong, co hinh dang nhu con co dang bay Do do cay mang ten la canh co Qua nang dai.

- Bp phan dung

La va re

- Thanh phan hoa hoc

La chOfa saponin tritecpenic vdi ham luang 2,59^, ngoai ra con co antraquinon Re chu yeu chUa antraquinon

- Tac dung sinh hoc

+ Dich chiet la bach hac cd tac dung ha huyet ap

ro ret tren cho va meo Khi dung dudng tiem tinh mach d lieu 0,lg/kg the trong (do ha huyet ap toi da tdi 40% d meo va 70% d cho; b&ng dudng uong sau 15 phut huyet ap bat dau ha, thdi gian ha keo dai 120 phut) MUe ha trung binh 18-21% so vdi huyet ap ban dau nhung bien do va nhip tim khong thay doi:+ Dich chiet bach hac lam giam nhu dong ruot tho

co lap; lam giam tac dung cua adrenalin tren tim ech

cd lap

+ Dich chiet la bach hac cd tac dung lam tdng thai

nUdc tieu, keo dai den 6 gid sau khi uong; dong thdi

vdi sU tang thai trU cac ion natri, kali, clo

cao Hoac co the dung la kho dudi dang ham nUdc che;

co the dung rieng hodc phoi hop vdi hoa hoe, hoa cuc, thao quyet minh sao den Re bach hac dung de chufa benh hac lao, nguTa, to dia Lay re, rufa sach, thai phien, phoi kho, tan thanh bot kho, ngam vdi ri/pu 40° vai tuan Lay dich rifou nay boi vao cho bi ghe ld, hac lao,

to dia, deu cd hieu qua Ngoai ra re bach hac con dung

de chufa dau nhufc xi/Ong khdp do tac dung nay ma vi thuoc con cd ten uy linh tien nam

BACH TAT LE (THICH TAT LE)

Tribulus terrestris L Ho Tat le Zygophyllaceae

- Dac diem thufc vat

Thich tat le la loai co moc bo lan tren mat dat, nhieu canh dai la kep long chim le, moc doi; cd 5-6 doi la chet deu, phu long tr^ng min d mat dtfdi Hoa mau vang, cuong ngan, moc don le d ke la Qua nho kho, gom 5 vo cufng tren cd gai hinh 3 canh

Cay moc nhieu o cac tinh phi'a Bdc Trung Quoc;

a nUdc ta moc hoang d ven bien Quang Binh, Quang

Tri, ThUa Thien

- Bp phan dung

Qua - Fructus Tribuli

- Thanh phan hoa hoc

Trong qua chufa saponin; Diosgenin, gitogenin clorogenin, tribunozit, astragalin

- Tac dung sinh hoc

+ Dich chiet con cua bach tat le co tac dung gian

co tron, ha huyet ap tren meo da gay me

+ Tac dung lpi tieu, hodc chi ho, hoa derm, binhsuven

- Cong dung

Bach tat le duoc dung trong cac trUdng hpp can khi uat ket dan den dau dau hoa mdt, chong mat TrUdng hpp tang huyet ap cd the phoi hpp vdi cau ddng, cuc hoa Con dung tri dau mdt do, nhieu niidc mdt, dau nhUc vung mdt Ngoai ra con dung tri chufng dau lung sinh due kem, tinh dich khong du

- Chu y:

Khi dung thudng sao chdy gai vi thuoc cd mau hoi

vang

CAT CAN

Vi thuoc che til r ! sdn d&y Pueraria thomsoni Benth Ho Dau Fabaceae

- Dac diem thufc vat

Sdn day la loai day leo, re phat trien thanh cu, than co long La kep gom 3 la chet, phien la hinh trufng dai 5-15cm, hai mdt 1a co long min Hoa mau xanh

luc, moc thanh chum d ke 1a Qua giap dai 10cm mau

vang nhat Sdn day dtfgc trong lam thufc pham va lam thuoc of moi ncfi tren nufdc ta

- B q phan dung

Re - Radix Puerariae; da difac qua che bien bdngcach xong diem sinh de vi thuoc co mau trdng va khong bi nam moc

- Thanh phan hoa hoc

Trong cat can chufa cac hop chat isoflavonoid nhii daidzein, daizin, daidzein-4,7- diglucosid purarin, puer- arin-7-xyloside 4’, 6’-0-diacetylpuerarin, tinh bot

- Tac dung sinh hoc

+ Tac dung ha huyet dp

+ Cai thien liAi li/Ong huyet nao tdi 134% do cdc isoflavonoid dan den

+ Gian mach vanh tim

+ Lam giam trd lire huyet quan 50%

+ Ha nhiet (thi nghiem tren tho)

- Cong dung

Dung cat can tri benh tdng huyet ap cho hieu qua tot nen phoi hap vdi ngtfu tat, thao quyet minh Cat can la thuoc giai bieu nhiet nen thtfOng dung de tri cac benh cam nhiet, phoi hop vdi cuc hoa, bac ha, tang diep hodc dung trong cam mao dau dau nhieu Vdi tac dung chufa dau dau, cat cdn co 1A1 the chufa dau dau phan cham, phan gay Ngoai ra co the dung cat can

de tri cac chufng dau thdt ngOc (do cac hop chat isofla­vonoid lam gian mach vanh), tri/ong hop nay tot nhat nen phoi hop vdi bach chi (vi bach chi cung co hop chat coumarin Byak engelicod co tdc dung ti/ong tif) vOi dia lien Cat can con duoc dung tri cac benh di/dng ruot nho ly lau ngay khong khoi

- Chu y:

Re sdn day ttfoi co the dung chufa b£nh tning thif, lay dich ttfoi cho uong

CHI TIT (DANH DANH)

Gardenia florida

Ho Cd phe-Rubiaceae

- Dac diem thufc vat

Thuoc loai cay nho cao khoang lm2 den 2m than nhdn La moc doi co la kem; mdt tren sam bong Hoa mau trdng Qua dai 5-7cm hinh cai chen co 6-9 goc; khi chin co mau vang do trong chufa hat mong det hcfi venh mau vang, di/dng kinh 3-5mm

- Bp phan dung

Ld Folium Gardeniae; qua: Fructus Gardeniae

- Thanh phan hoa hoc

Trong chi tuf (hat) co chufa cac hop chat Iridoid nhii gardosid, scanzhisid, scandozid, asperulosid, garde- nosid Ngoai ra con co tamin, tinh dau pectin va a- croxetin acid ursolic (vo qua)

- Tac dung sinh hoc

+ Chi tuf co tdc dung ha huyet dp, tdc dung an than,

ha nhiet , chong co giat hiep dong vdi hyosiamin; loi mat, ha bilirubin mau

+ tfc che vi khuan gay benh huyet hap trung.+ Tdc dung ha nhiet khi sot cao difOc xdc dinh do chat acid ursolic

- Cong dung

Chi tuf duac suf dung khi sot cao phat cuong me sang, thudng phoi hap vdi cac vi thuoc hoang lien, hoang ba, hoang cam (hoang lien giai doc thang), hoSc phoi hap vdi dau xi

- Cac benh viem gan mat, vang da, vang mdt do

tac dung lai mat cua vi thuoc, phoi hap vdi hodng b£ Cung do hai tdc dung ha nhiet va lai mat noi tren m& chi tur da duac nghiem nhien sU dung nhu mot vi thuoc

ha huyet ap Do lai mat, chi tuf giup cho tieu hod tot, thudng phoi hap vdi nhan tran

+ Khi dung vdi tinh chat cam mdu (vi du chay mau cam, tri xuat huyet, chi tuf can duac sao chay)

+ La va canh non danh danh cung duac dung lam thuoc chufa sot, chufa viem gan, chuTa dau mdt, ddc biet

de chufa viem ket mac mdt, mdt sung huyet do, lay ld

non danh danh rufa sach, gia vdt lay dich dong boc

vao mieng vai gac hay giay ban roi ddp len mdt; thinh thoang lai lat mieng gac Lam mot so lan sung huyet

mdt se het

CO MAN TRAU

Eleusine indica (L.) Gaertn

Ho Lua - Poaceae

- Dac diem thufc viit

Co mdn trau thuoc loai than thao, moc thanh cum, than moc thdng hodc moc bo dai d goc, cao 50-90cm

Ld mem moc so le hinh dai, be 1a co long Cum hoa moc thanh bong xe gom 5 den 7 nhdnh dai moc d ngon Qua thuon dai gan nhu 3 canh Co man trau moc hoang khdp nUtfc ta

- Chii y

+ De chufa tang huyet ap co the dung mdn trau dudi dang tuoi; riifa sach cdt nho, gia nat them nude soi de nguoi vdt lay dich cho uong

+ Co the dung lam thuoc xong cam, ho$c nude de goi dau cho dep tdc

COC MAN (NGA BAT THl/C THAO)

Centipeda minima L Ho Cuc-Asteraceae

- Dac diem thufc v§t

La loai co nho mem, moc lan sat m&t dat phan nhieu canh mau xanh mem, d ngon cd long min trSng

La moc sole trong giong hinh ba canh; mep la cd 2 rang cUa Hoa hinh dau moc d nach la Qua be 4 canh Cdc man thudng moc d noi dat am Udt cac bd ruong hodc cac ruong mau d cac tinh Nam Dinh, Thdi Binh, Hai Duong

- Bp phan dung

Dung toan cay Herba Centipdae

- Thanh phan hoa hoc

Toan cay chUa saponin tritecpenic, sterol, couma- rin, tinh dau, chat mau myriogynic

- Tac dung sinh hoc

+ Cdc mdn co tac dung giam ho ro ret; trong do cac hop chat saponin co tac dung giam ho tot hon; con tac dung trU ddm (tren chuot)

+ Cdc mSn cd tac dung Uc che Bacillus subtilis, B.puvillus, Sarcina lutea, Staphylococcus aureus, Salm onella typhi, Shigella flexneri, Pceudomonas pyoccanca, Escherichia coli

- Cong dung

Coc m^n duoc dung de chuTa ho nhieu ddm hodc

ho ga, ho lau ngay do viem hong viem phe quan; ddc biet tot vdi tre con Ngoai ra con dung chufa tdng huyet

ap phoi hop vdi Ich mau, ha kho thao, chufa dau mdt

do viem giac mac Co the dung ngoai de chufa r&n cdn hodc benh ngoai da, choc ld