Study On The Treatment Of Hypertensive Liver-yang Type Hypertension With Acupuncture Of "cultivating Yin And Cultivating Yang, Pacifying Chong And Lowering Ni"

BackgroundWith the publication of the latest guidelines for hypertension at home and abroad,there is a new understanding of the definition and intervention methods of this disease.The safety and effectiveness of acupuncture in the treatment of hypertension have been confirmed,but for patients whose blood pressure is still unsatisfactory after stable medication,it is questionable whether acupuncture can further optimize blood pressure management.On the other hand,there have been theoretical and clinical studies based on viscera,yin and yang,qi and blood for acupuncture to lower blood pressure,but the pathogenesis of this disease,knowledge of traditional Chinese medicine,and treatment based on meridians are still insufficient.Based on the prerequisites of many years of clinical and experimental research by the research group,and on the basis of preliminary clinical exploration of effectiveness in the early stage,this research proposes the "Raise Yin and Submerge Yang,Depress Disobey and Subside Chong of Acupuncture Method" to treat hypertension of liver-yang hyperactivity deepen the understanding of traditional Chinese medicine for this disease,optimize clinical treatment,and explore the mechanism of treatment.Purposes1.Analyze the ancient and modern understanding of acupuncture treatment of hypertension with hyperactivity of liver yang by combing and analyzing relevant literature in ancient,modern and modern times;2.Through the development of a small sample,single-center clinical randomized controlled trial,explore the effect of "Raise Yin and Submerge Yang,Depress Disobey and Subside Chong of Acupuncture Method" on the antihypertensive effect of patients with hyperactive liver-yang hypertension who have been taking the medicine stably and still not ideal,and observe the symptom at the same time The influence of factors such as syndrome integral,anxiety and depression,positive reaction points,etc;3.Through the detection of serum amino acids in spontaneously hypertensive rats,the blood pressure-lowering mechanism of serum amino acids of "Raise Yin and Submerge Yang,Depress Disobey and Subside Chong of Acupuncture Method" was explored.MethodsLiterature research:The ancient and modern part is based on 89 ancient and modern acupuncture-related works,using bibliography,typology,and Chinese medical philology,based on acupuncture to treat hypertension of liver-yang hypertension,with acupuncture"theories,methods,prescriptions,acupoints,manipulate" as the outline,combined with relevant content of the text style for analysis and research;contemporary part of the use of evidence-based medicine systematic reviews and meta-analysis research methods,the combination of acupuncture combined with western medicine,acupuncture combined with reforcing and reducing techniques combined with western medicine in domestic and foreign databases research on the safety and effectiveness of the treatment of hypertension,and conduct qualitative and quantitative research.Clinical research:Using evidence-based clinical research methods of traditional Chinese medicine to carry out single-center,randomized,single-blind,and purely positive drug-controlled clinical research,including 52 patients with hypertension of liver-yang hypertension,and randomly divided into observations according to the ratio of 1:1 group and control group.On the basis of individualized western medicine treatment,the observation group received the intervention of "Raise Yin and Submerge Yang,Depress Disobey and Subside Chong of Acupuncture Method",acupuncture for 1 month,5 times a week,30 min each time,observation The two groups were followed up for two weeks to observe the changes of blood pressure,the scores of TCM syndromes,and the scores of anxiety and depression before and after treatment.Experimental study:36 6-week-old male SHR rats were randomly divided into model group(M),acupuncture group(A),drug group(Y),12 in each group;12 male Wistar rats of the same age as blank Group(K).Rats in the acupuncture group were treated with "Raise Yin and Submerge Yang,Depress Disobey and Subside Chong of Acupuncture Method",each time the needle was kept for 20 minutes,intervention was 5 days a week,2 days rest,and 3 weeks continuous intervention.Rats in the drug group were given intragastric administration according to different body weights.Losartan potassium tablets(10 ml/kg),gavage 7 days a week,once a day,for 3 consecutive weeks,rats in the blank group and model group received the same restraint and gavage with clean water without intervention.Observe the general conditions of each group.The blood pressure and serum amino acid metabolism of rats were measured at baseline,1 week of intervention,2 weeks of intervention,and 3 weeks of intervention,respectively.Blood pressure of rats in each group was measured.After treatment,blood was taken and serum amino acid metabolism was detected.Result1.Literature research:(1)Ancient and modern part:In terms of pathogenesis,ancient acupuncture and moxibustion literature expands the understanding of the disease,and summarizes it in four aspects:Guardqi isobey,Qisea Loss Division,Liver Disease,and Hypotension.The modern literature is compiled as hypertension of liver-yang hyperactivity.The pathogenesis of the disease is relatively consistent;in terms of treatment methods,ancient literature mainly focuses on regulating qi and blood abnormalities and symptomatic treatment,and modern methods have proposed the treatment of yin and yang;in terms of acupoints,ancient literature selects acupuncture points based on different pathogenic mechanisms.Acupoint selection based on syndrome differentiation,symptomatic acupoint selection,or both,prescriptions for single acupoints or groups of acupoints often have their own corresponding symptoms.In modern times,acupoints are semi-standardized prescriptions based on regulating viscera function and meridian qi and blood;acupoint distribution;In ancient times,specific points on the head and neck and below the elbows and knees were more common.In modern times,specific points on the head and neck,limbs,and backshu are the main points.In terms of matching points with syndromes,the collections of ancient and modern documents can show meridian differentiation,disease differentiation,syndrome differentiation,syndrome differentiation and point matching;in terms of reforcing and reducing,both ancient and modern times reflect the characteristics of reforcing and reducing methods in accordance with the characteristics of diseases,and the basis for ancient appearances replenishment and reduction are performed in different seasons.In modern reforcemnet and reduction operations,different physicians have their own characteristics in terms of replenishment and reduction techniques and sequence.(2)Modern part:In modern literature,a total of 6 studies have been included,and the results show that acupuncture combined with western medicine reduces blood pressure in hypertensive patients better than western medicine alone[SBP:MD=7.52 mmHg(95%CI:1.41,13.64),I2=91%;DBP:MD=5.56 mmHg(95%CI:1.39,9.73),I2=88%];acupuncture combined with western medicine can affect the whole-day systolic blood pressure(24hSBP),the whole-day diastolic blood pressure(24hDBP),and the day-time systolic blood pressure(dSBP),day diastolic blood pressure(dDBP),night systolic blood pressure(nSBP),and night diastolic blood pressure(nDBP)were lower than those of the western medicine group alone.The blood pressure results throughout the day(24hSBP,24hDBP),[SBP:MD=8.00 mmHg(95%CI:-1.58,17.59),I2=92%;DBP:MD=7.44 mmHg(95%CI:1.35,13.53),I2=88%],day blood pressure results(dSBP,dDBP),[SBP:MD=8.28 mmHg(95%CI:-4.05,20.62),I2=95%;DBP:MD=4.82 mmHg(95%CI:0.79,8.85),I2=72%],night blood pressure results(nSBP,nDBP),[SBP:MD=6.69 mmHg(95%CI:1.04,12.34),I2=79%;DBP:MD=5.67 mmHg(95%CI:1.78,9.57),I2=74%];acupuncture combined supplement The reduction of blood pressure by purging manipulation was better than that of western medicine alone[SBP:MD=7.55 mmHg(95%CI:-2.97,18.07),I2=93%;DBP:MD=6.42 mmHg(95%CI:-2.09,14.94),I2=95%].2.Clinical study:(1)Results of ambulatory blood pressure:After 4 weeks of acupuncture treatment,the observation group had lower mean blood pressure throughout the day,mean day and night blood pressure of ambulatory blood pressure before treatment,and the lowered values were both statistically significant and clinically significant.There was no significant change in the control group compared with the baseline period,and the difference was not statistically significant(P>0.05).(2)Results of office blood pressure and so on:As for the blood pressure in the office,the weekly measurement results of the observation group showed that the reduction was statistically significant(P<0.05);the changes in the office blood pressure of the control group were not statistically significant(P>0.05).In terms of blood pressure load,after 4 weeks of treatment,the blood pressure load of patients in the observation group was significantly reduced;comparison of blood pressure load of patients in the control group before and after treatment,the reduction of 24hSBPL,dDBPL,nSBPL,and nDBPL was statistically significant(P<0.05),and the increase of dSBPL was statistically significant Academic significance(P<0.05).In terms of salt sensitivity index,there was no difference between the two groups of patients before and after treatment(P>0.05).The scores of TCM syndromes in the two groups decreased before and after treatment(P<0.01).After 4 weeks of treatment,the anxiety and depression scores of patients in the observation group were significantly lower than before treatment(P<0.01),and there was no significant difference before and after treatment in the control group(P>0.05).(3)Results of meridian and acupoint diagnosis:Positive meridian results,6 positive reaction meridians of the two groups in the baseline period:Foot Taiyin Spleen Meridian,Full Sun Bladder Meridian,Foot Yangming Stomach Meridian,Foot Jueyin Liver Meridian,Hand Yangming Large Intestine Meridian,Foot Shaoyin Kidney Meridian,baseline period The top 5 acupoints in the two groups of positive reaction channels are:Xinshu,Sanyinjiao,Zusanli,Quchi,and Taichong.(4)Results of the follow-up period:The systolic blood pressure and diastolic blood pressure in the observation group were lower than before treatment,the difference was statistically significant(P<0.05),and the systolic blood pressure in the two follow-up offices of the control group was significantly different from the baseline period(P<0.05).The scores of anxiety and depression and syndromes of the observation group were lower than before treatment,which was statistically significant(P<0.01).The scores of anxiety and depression in the control group were not statistically significant compared with those before and after treatment(P>0.05),and the scores of syndromes were lower than those in the baseline period(P<0.05).3.Experimental study:(1)BP of SHR:The systolic blood pressure and diastolic blood pressure of each group were compared at each time point,and the difference was statistically significant(P<0.05).(2)Amino acid metabolism:Compared with SHR in normal group rats,serum serine,asparagine,arginine,glycine,threonine,alanine,lysine,tyrosine,methionine,tryptophan,γ-amino group The content of butyric acid and D-a-amino-n-butyric acid changed,and the difference was statistically significant(P<0.05).Compared with the model group,the acupuncture group had significantly lower aspartic acid and glutamic acid content(P<0.05),but there was no significant change.Comparing the drug group with the model group,histidine,asparagine,glutamine,arginine,alanine,proline,cystine,methionine,γ-aminobutyric acid,D-α-There was a statistically significant difference in the content of amino butyric acid(P<0.05).Conclusion1.The ancient and modern literature has expanded and deepened the understanding of the disease in the aspects of medical theory,acupoint extraction and acupuncture.2.Patients with high blood pressure of liver-yang hyperactivity,who have taken individualized western medicine steadily but whose blood pressure is still not ideal,can further reduce blood pressure levels such as 24 hSBP、24hDBP、dSBP、dDBP、nDBP、nSBP and clinic blood pressure by acupuncture.3.Acupuncture can reduce serum aspartate and glutamic acid levels in SHR and may reduce blood pressure by regulating the above two amino acid levels.