Observation On Curative Effect Of Traditional Chinese Medicine In TCM Syndromes Of Patients With Essential Hypertension And Asymptomatic Hypertension

Essential hypertension(EH) is one form of hypertension that has no identifiable cause. It tend to be related with genetic factors and multi-pathogenic factors. EH starts and progresses in a subtle way wich can result to various kinds of symptoms. When it comes to treatments,modern medicine focus on lowering the blood pressure while traditional chinese medicine(TCM) emphasize the important of eliminating the clinical symptoms. This study is divided into two part which are based on retrospective data. The first part is to observes the TCM-related clinical status and zhengs of EH and trying to conclude some TCM therapeutic methods. We also found that there are some patients who has no clinical symptom with high blood pressure,so the second part is to study how my mentor treats this type of patients with TCM.Objective1. By observing the TCM-related clinical status and zhengs of essential hypertensive patients, complement and complete the zhengs of EH; then suggest the therapeutic methods based on zheng differentiation.2. Study the patten of TCM my mentor use to treat EH patients who has no symptom and its clinical curative effect.MethodWe study the TCM-related clinical status and zhengs of EH by reviewing the clinical cases of Dr. Zhong Jing Bai’patients at Xi Yuan hospital. There are 1534 clinical cases of outpatients diagnosed as EH from 2009/4-2014/8. First set up a database for these 1534 clinical cases; then note the TCM-related clinical symptoms, tongue images, pulse conditions seperately, and differentiate the zhengs of these 1534 cases with the clinical information. On the other side, select 75 clinical cases of EH patients that shows no symptoms out from the 1534 cases, and note the blood pressure and the TCM treatment they received.Result1 The 1534 cases of EH:(1) The general information:male of 698 cases, female of 836 cases, age distribution between 16-93, the average age is 53.78. The average age of male is 49.58, and the average age of female is 57.29.(2) There are 40 TCM-related symptoms that appears more than 1% times among the EH paitens, and 11 ones that appears more than 10% times, which are dizziness 51.7%> insomnic 27.5%> headache 17.0%> palpitation 16.6%> fatigue 16.1%>vexation 14.4%> tinnitus 14.4%>feeling of fullness of head 11.1%> stiff neck 11.1%> hidrosis 10.4%> chest distress 10.2%.(3) The statistical findings of tongue image:tint tongue 38.9%> dark tongue 35.5%> red tongue 22.2%> dingy tongue 3.4%. Tongue coating:thin coating 44.7%> thin and yellow coating 20.0%> thin and dry coating 11.7%> little coating 7.7%> white coating 4.8%> yellow coating 4.4%> greasy and yellow coating 3.8%> greasy coating2.9%(4) The statistical findings of pulse condition:thready pulse 35.7%> thready and taut pulse 13.5%> taut pulse 10.8%> thready and wavy pulse 8.3%> thready and uneven pulse 7.1%> thready and rapid pulse 5.3%> thready and weak pulse 5.1%> wavy pulse 4.2%> taut and wavy pulse 3.3%> thready and deep pulse 2.7%> uneven pulse 1.4%> deep pulse 1.3%> weak pulse 1.1%> slow and knotted pulse 0.2%(5) The statistical findings of TCM zheng:hyperactivity of the liver-yang 37.1%> deficiency of yin with excess of yang 25.4%> no symptom 9.4%> disorder of the liver-qi 6.9%> deficiency of the kidney essence 6.4%> disharmony between the liver and spleen 5.1%> stagnation of phlegm 5.1%> deficiency of both qi and yin 4.6%.(6) The accompanying zheng of blood stasis:there are 155 cases with blood stasis,and patients belongs to hyperactivity of the liver-yang, deficiency of yin with excess of yang, and stagnation of phlegm these three types of zhengs are prone to get blood stasis.2 The 75 cases of EH patients without symptoms:(1) The general information:male of 60 cases, female of 15 cases, age distribution between 16-76, the average age is 40.58. The average age of male is 39.13, of female is 46.4.(2) The statistical findings of tongue image:dark tongue 40.0%> tint tongue 37.3%> red tongue 22.7%. The tongue coating:thin coating 60.0%> thin and yellow coating 18.7%> white coating 10.7%> yellow coating 8.0%> thin and dry coating 2.7%.(3) The statistical findings of pulse condition:thready pulse 50.7%> thready and wavy pulse 20.0%> thready and rapid pulse 9.3%> tready and weak pulse 6.7%> taut pulse 4.0%> thready and taut pulse 4.0%> wavy pulse 4.0%> thready and uneven pulse 1.3%.(4) The usage of TCM of my mentor:the total number of TCM my mentor used is 56. There are 18 herbs that their frequency of use are higher than 10%, including:huangqin, shengshanza, gegen, dilong, xiakucao, shenghuangqi, shengmaiya, fulingpi, luobuma, juemingzi, hanfangji, yinchen, gouten, zhenzhumu, fuling, taoren, wujiapi, shenglonggu. The 18 herbs can be classified to "heat and wind of liver-clearing" herb, "blood flow and diuresis-promoting" herb, and "regulating and nourishing" herb according to their efficacy. They can be subdivided to 8 subcategories. The statistical results of the use of the 18 herbs:heat and wind of liver-clearing herbs 47.2%, including heat of live-clearing herbs 24.6%, liver-calming and yang-restraining herbs 10.5%, wind-clearing and meridian-regulating herbs 12.1%; blood flow and diuresis-promoting herbs 27.9%, including blood flow-promoting herbs 10.7%, diuresis-promoting herbs 17.2%; regulating and nourishing herbs 24.9%, including qi-tonifying herbs 10.2%, qi-regulating herbs 6.1%, others 8.6%.(5) The curative effect of TCM:The average reduction of systolic pressure is 13.97mmHg, and the one of diastolic pressure is 9.57mmHg. The rate of obvious effect of TCM is 37.3%; positive effect 48%; ineffectiveness 14.7%.Conclusion1 The male and female patiets of EH have similar proportion, yet female patients account for a lager portion. The age distribution of essential hypertension centers on age 41-65, female patients are elder than male and mostly are on the stage of menopause with clinical symptoms.2 Most of the clinical symptoms of EH belongs to liver-system, and heart-system takes the second place. EH is connected to multi-systems, and both deficiency zheng and excess zheng.3 Hyperactivity of the liver-yang, deficiency of yin with excess of yang, disorder of the liver-qi (along with disharmony between the liver and spleen), no symptom are the top four main zhengs of EH, so liver plays an important part in EH.4 The tongue images of EH patients without symptom show that the disease is mild and appertains to excess zheng, but their pulse conditions tell that deficiency-related zhengs still exist. So my mentor adopts the method of heat and wind of liver-clearing, blood flow and diuresis-promoting, and regulating and nourishing to treat this type of patients, and the therapy produces a good curative effect.