| Objective:As a student of Prof. Meng Dingshui, one of instructors of national fifth batch for successors of famous and old TCM physicians’academic experience, the author has inherited his experiences in the treatment of hypertension, namely, starting from nourishing the kidney and applying modified Liuwei Dihuang Pill, based on which, with the "Jinshui theory(i.e. the mutual generation between Metal and Water)" as guidance, achieving the purpose of nourishing the kidney through nourishing the lung; and clinically, applying modified decoction of invigorating kidney and resolving phlegm to treat the elderly hypertension, with rather effective clinical outcomes. Therefore, the author intended, by clinical observation, to evaluate the effectiveness of treating the hypertension under the guidance of the "Jinshui theory", so as to verify the old TCM physician’s clinical experience and carry forward the TCM physician’s academic specialty, which is one of the objectives of clinical observation.1,25-dihydroxy vitamin D3 (1,25 (OH) 2D3) has certain relevance to hypertension and is closely associated with the occurrence of atherosclerosis, and the occurrence of atherosclerosis makes the elderly hypertensive patients more prone to target-organ damage, thus increasing cardiovascular events. The deficiency of 1,25 (OH) 2D3 is also the cause of senile osteoporosis that can be easily complicated with bone fracture. TCM believes that osteoporosis is related to the physiological role of the kidney in storing the essence of life, controlling the bone and producing the marrow, and the strong kidney generates strong bones.1,25 (OH) 2D3 can promote intestinal absorption of calcium and phosphorus and promote the deposition of calcium salt, and also can stimulate the osteoblast to secrete collagen, promote the maturation of the organic matrix of bone, and is favorable for the formation of bone, which coincides with the kidney’s function of storing essence of life, controlling the bone and producing the marrow. At the same time, Vitamin D originates mainly from the skin; the skin tissue synthesizes Vitamin D3 by exposing to ultraviolet, and then synthesizes the active metabolite 1,25 (OH) 2D3 through 1 a-hydroxylase catalysis in the kidney; the elderly is lack of sun exposure, so his skin’s ability of synthesis of Vitamin D also decreases, which coincides with the "lung governing skin and hair" in the TCM theory. Researches also show that the lack of Vitamin D and the decline of 1,25 (OH) 2D3 level are associated with respiratory system diseases such as asthma, chronic obstructive pulmonary disease and other diseases, which, from the view of this physiological function of 1,25 (OH) 2D3, corresponds to the physiological function of the lung and kidney involved in the Jinshui theory of TCM. Therefore, we chose 1,25 (OH) 2D3 as a breakthrough point to investigate the functional mechanism of the Jinshui theory in the treatment of hypertension, which also is the objective of our clinical observation.Methods:Through clinical observation,60 elderly patients with hypertension were observed, and in accordance with the random number table method, these 60 observation objects were randomly divided into treatment group and control group; The 30 cases in the control group were treated with conventional antihypertensive drugs of Western medicine; the 30 cases in the treatment group were treated by adding modified decoction of invigorating kidney and resolving phlegm on the basis of Western medicine treatment; both with a treatment course of 4 weeks. Observe the effect of treatment on the indicators such as the antihypertensive effect, TCM syndrome scoring, carotid artery intima-media thickness, blood pressure variation coefficient, urine microalbuminuria,β-2 microspheres protein, matrix metalloproteinases-9 (MMP-9), and serum 1,25 dihydroxy vitamin D3(1,25 (OH) 2D3),etc. of the elderly hypertensive patients in these two groups.Results:By clinical trials, we found that the comparison of SBP and DBP levels between treatment and control groups after treatment showed no statistically significant difference (P> 0.05). This suggested that there was no difference in the clinical curative effect between the two groups of patient; as for the TCM syndrome curative effect of the two groups, the total effective rate of the treatment group was up to 90%, while that of the control group was 66.7%, and the comparison of total effective rate between the two groups showed that the difference was statistically significant (P<0.05), indicating that the treatment group achieved significant effect in terms of TCM syndrome improvement.The carotid artery intima-media thicknesses in both groups after treatment were lower than that before treatment, with the difference being statistically significant (P<0.05). After treatment, the comparison of the carotid artery intima-media thickness between the treatment group and the control group presented statistically significant difference (P<0.05), which suggested that the carotid artery intima-media thickness could be effectively reduced in the treatment group.After treatment, the SBPV and DBPV of both groups had different degrees of decline, and the difference was statistically significant (P<0.05). After treatment, SBPV and DBPV of the treatment group was significantly lower than that of the control group, with the difference being statistically significant (P<0.05), which suggested that the treatment group could effectively lower the patient’s blood pressure and at the same time could reduce the patient’s blood pressure variability.After treatment, the levels of urinary mALb and urinary β2-MG in both groups were lower than that before treatment; after treatment, the levels of urinary mALb and urinary 2-MG in the treatment group were lower than that in the control group, with the difference being statistically significant (P<0.05), which suggested that the treatment group could reduce the urinary mALb and urinary β2-MG of elderly patients with hypertension.After treatment, the serum 1,25-(OH)2D3 levels of both the treatment and the control group increased compared with that before treatment; after treatment, the serum 1,25-(OH)2D3 level of the treatment group was higher than that of the control group, with the difference being statistically significant (P<0.05), which suggested that the treatment group could effectively improve the level of serum 1,25-(OH)2D3 in elderly patients with hypertension.After treatment, the serum level of MMP-9 in both groups were lower than that before treatment; after treatment, the serum MMP-9 level of the treatment group was significantly lower than that of the control group, with the difference being statistically significant (P<0.05), which suggested that the treatment group could effectively lower the level of MMP-9 in elderly patients with hypertension.Conclusion:In the treatment of elderly hypertensive patients, although the combination of modified decoction of invigorating kidney and resolving phlegm showed little difference in the antihypertensive effect compared with pure western medicine treatment, treated with combination of traditional Chinese medicine could effectively improve the clinical symptoms of patients, reduce the exudation of urinary albumin and β-2 microsphere protein, reduce the intima-media thickness (IMT) of carotid artery, effectively improve atherosclerosis, and reduce the variability of blood pressure; the functional mechanism was possibly related to its ability to increase the level of serum 1,25 (OH) 2D3 and to reduce the activity of MMP-9. The treatment of hypertension according to the "Jinshui theory" can effectively improve the level of 1,25 (OH) 2D3, and however, whether 1,25 (OH) 2D3 can be taken as a breakthrough point for evaluating the classic TCM therapy of "Jinshui theory" so as to apply it to the treatment of other diseases needs more and deeper researches. |
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