| Shen Shaogong has a wealth of clinical experience on treating hypertension since50years ago, and put forward "phlegm and blood stasis, Poison Damaged Heart collaterals" as the core of pathogenesis of hypertension, and suggested appropriately the therapy that "Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals".This study was divided into two parts:the first part reviewed the related research progress in recent five years about treating Hypertensive disease by means of eliminating phlegm and removing blood stasis, and summarized the clinical experience of Shen Shaogong in treating hypertension phlegm and blood stasis syndrome.The second part was by using the apriori algorithm of association rule to mining prescription law of therapy "Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals" impliciting in the264cases of Grade1or Grade2Hypertension patients treated by Shen Shaogong. And then further observe clinical curative effect of therapy that eliminating phlegm and removing blood stasis as well as relieving toxicity and dredging collaterals in the treatment of hypertension on the basis of previous research.1Literature ReviewTake "title=hypertension and abstract=phlegm and blood stasis (exact match)"as a search condition to retrieve China Academic Journal Full-text Database and get225bibliography. And then found literature appear the increasing trend year by year after yearly distribution, especially in the recent five years (2008-2012years) significantly increased, with a total of168articles. This shows that phlegm-stasis pathogenesis gradually get attention of researchers in the study of hypertension. And then delete the conference literature from168articles. Finally selected66articles to review and found that phlegm-stasis has become the etiology and pathogenesis of essential hypertension.The therapy removing both phlegm and blood stasis has good curative effect, its security has been validated.After summarizing academic papers and works of Shen Shaogong and his disciples,it is found that Shen Shaogong y first proposed "phlegm and blood stasis, Poison Damaged Heart collaterals" as the core of pathogenesis of hypertension from the point of view collaterals disease theory.He thinked phlegm-stasis is the start and the inducing factors of Hypertension, also the pathological products at the same time and visible in each stage of Hypertension disease. Emphasizing syndrome differentiation must be comprehensive analysis by the four examination methods, should not with the symptoms but with tongue picture as a diagnostic criteria. Put forward the "modular syndrome classification" and the opinion that Essential hypertension phlegm and blood stasis syndrome is a combination of phlegm and blood stasis unit. The main type of syndrome manifestations are:dark red tongue has petechia or ecchymosis,sublingual vessel is cyanochroia, greasy fur on tongue, pulse manifestation is string and slippery or deep and unsmooth or intermittent, vertigo and headache, head heavy as if swathed, chest tightness or chest pain. If the disease can damage the heart collaterals, will appear palpitations, shortness of breath, insomnia and other symptoms.Treatment with Wendan Decoction(Bamboo Shavings10g, Fructus Aurantii10g, Poria10g, Dried Tangerine Peel10g, Acorus Tatarinowii10g, Radix Curcuma10g)and Hypotensive Decoction of four ingredients(Uncaria decocted later lOg, Rhizoma Alismatis10g, Rhizoma Chuanxiong10g, Semen Raphani10g) to eliminating phlegm and removing blood stasis as well as relieving toxicity and dredging collaterals. And put forward the four sequential steps expectorant and four sequential methods of removing blood stasis. In addition to use ascending the clear and descending the turbid, clearing away the heart fire to soothe the nerves after syndrome differentiation. At the same time, he attached importance to protect the spleen and stomach, and combined with acupuncture to improve the curative effect, added pill consolidate curative effect in the stage of rehabilitation. He also laid emphasis on using comprehensive intervention on patients’psychology and unhealthy lifestyle, such as psychotherapy and food-therapy.2Using the Apriori Algorithm and the Visualization of Network to Explore and Analyse the Regularity of Compatibility of the Therapy for Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals ObjectiveBy using the Apriori algorithm and the visualization of network analysis to mining prescription law of the therapy used by Shen Shaogong to treat hypertension by means of Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals.MethodsComprehensively and systematically Collecting cases of Grade1or Grade2Hypertension patients treated by Shen Shaogong during the period of2008～2010.264cases diagnosed as syndrome of intermingled phlegm and blood stasis among them were recorded in the "Famous Veteran Teran Doctors of Traditional Chinese Medicine Clinical Medical Records Management System" and structured.Using Visual Studio2005software for statistical and data mining analysis of first diagnosed record symptoms, square, medication.The prescription rules mining used the Apriori algorithm of association rules. Respectively to calculate the frequency, degree of support and confidence of single herb and herb pairs. Take the frequency results into the Cytoscape2.8software to form the visual network diagram and then explore the core group of herb visually with professional knowledge and experience of Shen Shaogong. Finally, all the mining results were screened, confirmed or supplied by Shen Shaogong personally.Results(1) Single herb that support level>10%has a total of32, the top10of them were Poria (84.47%), Fructus Aurantii (84.47%), Dried Tangerine Peel (81.44%), Bamboo Shavings (76.89%), Rhizoma Alismatis (75.76%), Rhizoma Chuanxiong (71.59%), Semen Raphani (70.45%), Uncaria (65.15%), Radix Curcumae (56.82%), Acorus Tatarinowii (56.44%).(2) Strong correlation herb pairs that mutual confidence level>90%and support level>10%in turn:Acorus Tatarinowii-Radix Curcumae, Rhizoma Coptidis-Cinnamon, Dried Tangerine Peel-Poria, Bamboo Shavings-Fructus Aurantii, Fructus Aurantii-Poria, Dried Tangerine Peel-Fructus Aurantii, Raw Dragonis-Raw Oyster, Rhizoma Corydalis-Fructus Meliae Toosendan, Bamboo Shavings-Dried Tangerine Peel.(3) Through visually analysing the support level>10%herb pairs found six core herb groups:Poria-Rhizoma Alismatis-Plantain Herb-Row Coix Seed, Fruc tus Aurantii-Rhizoma Chuanxiong-Radix Achyranthes Bidentata-Semen Raphani, Poria-Dried Tangerine Peel-Semen Raphani-Acorus Tatarinowii, Rhizoma Chuan xiong-Rhizoma gastrodiae-Radix Puerariae, Acorus Tatarinowii-Radix Curcumae-Rhizoma Chuanxiong, Uncaria-Rhizoma Gastrodiae-Nacre-Semen Cassiae-Prunell a Vulgaris-Rhizoma Alismatis.ConclusionThrough the association rules Apriori algorithm and visualization of network analysis,compatibility law of the therapy for Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals was excavated and arranged preliminarily, objectively reflecting Shen Shaogong’s theory and strategy of treatment on the patients with Essential Hypertension differentiated to the syndrome of intermingled phlegm and blood stasis. Starting from the dispel phlegm, promoting blood circulation for removing blood stasis, eliminating phlegm and removing blood stasis at the same time. And Adding with Qi-Regulating drugs to increase the intensity of phlegm dampness, with diuretics for eliminating dampness to make the evil pass through the body from the urine. Moreover, pay attention to treatment from liver. But the results have certain limitations, it’s clinical guidance significance need to carry out clinical test to verify next step.3Curative effect observation on the therapy for Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals to the patients with Grade1or Grade2Hypertension ObjectiveCurative effect observation on the therapy for Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals to the patients with Grade1or Grade2Hypertension through the non-randomized controlled clinical trials.Methods Using non-randomized controlled clinical trial design methods, included the qualified cases125cases, divided into experimental group and control group.Al1the test group patients belong to phlegm and blood stasis syndrome, based o n previous treatment with "Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals" decoction(Decoction group,51cases) or granule(Granule group,26cases) were added according to the willing ness of patients. Patients in the control group (Western medicine group,48cas es)accepted the basic treatment with reference to "China Guideline for Preventio n and Treatment of Hypertension "(2010revised edition).Treatment for3months. Before and after treatment were observed the change of blood pressure and cl inical symptoms change.Results(1) General information:The3groups were comparable in age, gender, body mass index, no significant difference (P>0.05). But the course of disease and the systolic pressure, diastolic pressure have significant difference (P<0.01).(2) Clinical evaluation:After3months of treatment Decoction group, Particle group, Western medicine group total antihypertensive effective rate were77.08%,82.61%,72.92%respectively. Total effective rate of syndrome improvement were91.67%,65.22%,18.75%respectively.(3)Comparison within the group before and after treatment:3groups of systolic blood pressure and symptom scores were significantly decreased after treatment (P<0.01).In the extent of reduction, Decoction group> Particle group> Western medicine group, and as the treatment course extended, the amplitude of reduction was increased. The Decoction group droped significantly after2weeks of treatment. Decoction group and Particle group diastolic blood pressure decreased significantly after treatment (P<0.01). Western medicine group diastolic blood pressure before and after the treatment were statistically significant (P<0.05).(4) Scale points comparison among groups:After adjustment for baseline, Decoction group and Particle group of systolic pressure, diastolic pressure and symptom scores decreased values are greater than the western medicine group In every interview time. After3months of treatment systolic blood pressure difference was very significant (P<0.01), while diastolic blood pressure had no significant difference (P>0.05). Symptom scores compared, Decoction group and Western medicine group had very significant difference (P<0.01), Particle group and Western medicine group had significant difference (P<0.05)(5) The improvement of symptoms:Decoction group patients irritability, shortness of breath, dizziness, palpitation, head pain, somatic heaviness and drowsiness, soreness of waist, bitter taste in the mouth, dry mouth, aversion to wind and cold, insomnia symptoms improved significantly (P<0.01). Particulate groups, three symptoms that shortness of breath, soreness of waist and bitter taste in the mouth improved significantly (P<0.01), the difference of dizziness, palpitation, somatic heaviness and drowsiness was statistically significant (P<0.05) before and after treatment. Western medicine group before and after treatment in patients with all the symptoms had no significant difference (P>0.05). Three groups of fatigue, yellow urine, nocturia symptom improvement was not obvious (P>0.05).(6) Analysis of correlation between blood pressure and symptoms:Blood pressure and symptom scores were positively related to relationship (P<0.01), both with the extended treatment course were gradually decreased.(7)Safety observation:in the treatment of adverse reactions were not observed.ConclusionIn western medicine antihypertensive basis, application of the intervention for Eliminating Phlegm and Removing Blood Stasis as well as Relieving Toxicity and Dredging Collaterals on hypertension phlegm and blood stasis syndrome can significantly improve the antihypertensive effect, the onset mechanism may be related to the improvement of symptoms of Chinese Medicine. The research results have certain limitations, it is necessary to carry out multiple center, large sample, prospective, randomized clinical trial to further study. |
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