Retrospective Analysis And Mechanism Study On The Treatment Of Hypertension Of Spleen Deficiency And Phlegm Turbidity Type By The Method Of "replenishing Qi And Strengthening Spleen, Drying Dampness And Resolving Phlegm

Purpose:To observe the clinical efficacy of routine western medicine combined with Banxia Baizhu Tianma decoction in treating primary hypertension with spleen deficiency and phlegm turbidity,further verify the effectiveness and safety of routine western medicine combined with Banxia Baizhu Tianma decoction in treating primary hypertension with spleen deficiency and phlegm turbidity,and summarize the etiology and pathogenesis of this disease,the dialectical thinking,prescription selection and clinical experience of the tutor in treating this disease.To explore the mechanism of core prescription in the treatment of essential hypertension by using network pharmacology,and to provide basis for the treatment of this disease by traditional Chinese medicine.Materials and methods:102 patients with primary hypertension diagnosed as spleen deficiency and phlegm turbidity syndrome who visited the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from November 2020 to December 2022 were included in the study.After screening according to inclusion and exclusion criteria,the patients were divided into a control group and a treatment group based on whether to take the modified formula of Banxia Baizhu Tianma Tang.Ultimately,a control group of 52 cases(conventional Western medicine treatment)and a treatment group of 50 cases(conventional Western medicine treatment+modified Banxia Baizhu Tianma Tang)were obtained,with a treatment period of 4 weeks.Before and after treatment,the curative effect evaluation indexes such as hypertension symptom score,blood pressure value,tongue pulse and TCM syndrome score,as well as the safety indexes such as blood routine,liver function,kidney function and urine/stool routine were collected in Excel tables,and the data were processed and analyzed by SPSS24.0 statistical software,and the relevant results were obtained.The effective components and target information of the core prescription were obtained by TCM systematic pharmacology database and analysis platform(TCMSP),BATMAN-TCM database,Pub Chem and Swiss Target Prediction database,and the gene names were standardized by Uniprot database.Gene targets of essential hypertension were obtained by using Gene Cards and Dis Ge NET disease gene database,and Wayne diagram was drawn by using venny2.1software to obtain drug-disease interaction targets.Draw the network diagram of "traditional Chinese medicine-component-target" by Cytoscape3.9.1 software;Constructing protein interaction network diagram through String database;GO function and KEGG pathway enrichment were analyzed by Metascape platform,and then the mechanism of core prescription in treating essential hypertension was discussed.Results:1.As for TCM syndrome score,after treatment,the patients’ dizziness,headache,chest tightness,vomiting,phlegm and saliva,palpitation,insomnia,light mouth,anorexia,tongue quality,tongue coating,pulse and so on all improved statistically(P < 0.05).After treatment,in the treatment group,37 cases were markedly effective,accounting for 74%,11 cases were effective,accounting for 22%,and the total effective rate was 96%.In the control group,7cases were markedly effective,accounting for 13.46%,30 cases were effective,accounting for 57.70%,and the total effective rate was 71.15%,P = 0.000(P < 0.01).The curative effect of routine western medicine combined with Banxia Baizhu Tianma decoction on essential hypertension with spleen deficiency and phlegm turbidity is better than that of routine western medicine group.2.With respect to blood pressure changes,in the treatment group,33 cases were markedly effective,accounting for 66%,and 12 cases were effective,accounting for 24%,with a total effective rate of 90%.In the control group,5 cases were markedly effective,accounting for9.62%,34 cases were effective,accounting for 65.38%,and the total effective rate was 75%,P = 0.000(P < 0.01).The antihypertensive effect of routine western medicine combined with Banxia Baizhu Tianma decoction in treating essential hypertension with spleen deficiency and phlegm turbidity is better than that of simple western medicine control group.3.Safety analysis,the vital signs of patients in the two groups were stable.There were no abnormalities in blood,urine,stool routine,liver function(ALT,AST),renal function(BUN,CR)before and after treatment(P>0.05).It shows that the current western medicine treatment scheme and the prescription in this study have good safety.4.Based on the network pharmacology technology,it is predicted that there are 96 effective components in Banxia Baizhu Tianma Decoction,and the key effective components that play a therapeutic role are quercetin,beta-sitosterol,senkyunone,alisol,b,23-acetate,etc.There are247 intersecting targets between the core prescription and essential hypertension,among which blood pressure is mainly regulated by regulating the expression of PTGS2,TP53,HIF1 A,TNF,VEGFA,MMP9,EGF,IL6 and other genes.A total of 2683 biological processes,131 cell components and 255 molecular functions were obtained by GO function enrichment analysis.The core prescription mainly intervenes in essential hypertension by participating in the regulation of pathways in cancer,lipid and atherosclerosis,fluid shear stress and atherosclerosis,AGE-RAGE signaling pathway in diabetic complications,PI3K-Akt signaling pathway,calcium signaling pathway,c AMP signaling pathway,Insulin resistance and other pathways.Conclusion:1.The disease is located in the brain,and is closely related to the liver,spleen,kidney and other viscera.The spleen and stomach lose their function,the water is wet and the phlegm is turbid inside,and the clearing of the orifices is not good.Therefore,dizziness and headache can be seen.We should treat both the symptoms and the symptoms from the whole point of view.If the qi is sufficient,then the evil will move.The root is solid,but the phlegm is turbid and easy to fall.Therefore,we should adopt the method of "invigorating the qi and strengthening the spleen,and eliminating dampness and phlegm",Traditional western medicine combined with Banxia Baizhu Tianma Decoction can effectively improve the TCM symptoms of patients with primary hypertension of spleen deficiency and phlegm turbidity type,reduce the blood pressure level,and have good safety without obvious adverse reactions.2.Based on the network pharmacology technology,it is predicted that the effect of Banxia Baizhu Tianma Decoction on blood pressure may be related to quercetin,beta-sitosterol,senkyunone,alisol,b,23-acetate,which can relax vascular smooth muscle and inhibit platelet aggregation by up-regulating the expression of PTGS2;Inhibit the expression of inflammatory factors such as TNF and IL-6,and down-regulate the expression of MMP9 to control vascular inflammation and improve vascular endothelial function;Inhibit the expression of HIF1 A,EGF,VEGFA and other factors to inhibit cell proliferation and vascular smooth muscle proliferation and migration.By regulating multiple pathways such as pathways in cancer,lipid and atherosclerosis,fluid shear stress and atherosclerosis,AGE-RAGE signaling pathway in diabetic complications,PI3K-Akt signaling pathway,calcium signaling pathway,c AMP signaling pathway,Insulin resistance,we can improve vascular endothelial function,regulate vascular smooth muscle,and reduce atherosclerosis index to achieve the purpose of regulating blood pressure.