Hypertension Tcm Syndromes Characterized By Clinical Studies

Essential Hypertension(EH) is the cardiovascular disease,of which the disease incidence is the highest in the world,the complication is the most and the case fatality is very high. Syndromes are the objects for differential diagnosis of traditional Chinese medicine (TCM) and the basis of treatment. Further research on the syndrome of EH will be useful for elevating the clinical level of TCM prevention and cure of EH.At present,the research on syndrome of EH is not overall and multi-Angle enough,and there is not unified standard of diagnosis of TCM.In order to make a further research on the feature and pathogenesis of syndrome of EH,then we adopt Delphi method of investigation of questionnaire of expert consultation and of investigation of clinical syndrome to study syndromes of EH.1. Investigation of the questionnaire of expert consultation of the syndrome of EHMethod:â‘´According to the design principle of Delphi method ,basing on TCM theory and clinical experience,referring to"The reference diagnosis standard of TCM deficiency-syndrome","Guiding Principles for Clinical Study of New Chinese Medicines",we institute"questionnaire of expert consultation of the syndrome of EH".⑵In the first round, we send by ourselves or mail"table of expert consultation of the syndrome of EH"to 31 cardiovascular experts in 8 hospitals which are located in 4 different regions of our country.After the questionnaires are done independtly,they are sent back and then analysed statistically.⑶According to the statistical analysis result of the questionnaires in the first round and the supplement advice,we integrate the advice of the experts and design the second questionnaires for experts which are sent in the same way mentioned above .Then the second round of expert consultation is done.â‘·Statistic method:We adopt Spss11.5 for statistic analysis.We analyse the constituent ratio of different evaluation level of each syndrome.The discrete degree of enumeration data of two groups is analysed with the method of paired Wilcoxon signed-rank test.Results:â‘´According to paired Wilcoxon signed-rank test,the discrete tendency of the two rounds of evaluation is descending.The suggestion of the experts is concentrated and become common though the two rounds of expert consultation.⑵Most experts confirm that the most common syndromes of EH are the syndrome of hyperactivity of liver yang(96.7% of total), the deficiency-syndrome of yin ( 83.3% of total ) , the syndrome of liver-fire ( 83.3% of total ) , deficiency-syndrome of the kidney(73.3% of total), the syndrome of sputum-turbid (66.7% of total), deficiency-syndrome of the liver(60.0% of total).Most experts confirm that the less common syndromes of EH are deficiency-syndrome of the heart( 76.6% of total ),the deficiency-syndrome of qi ( 66.7% of total ),stagnation-syndrome of qi (56.7% of total).Half and half of the experts presume that the syndrome of blood stasis or the syndrome of liver-wind is the less common syndrome respectively.Most experts think that the deficiency-syndrome of yang(80.0% of total),deficiency-syndrome of blood(67.7% in the first round)and the deficiency-syndrome of spleen(61.3% in the first round)are not common syndromes of EH.Conclusion:The common syndromes of EH are the syndrome of hyperactivity of liver yang, the deficiency-syndrome of yin, the syndrome of liver-fire, deficiency-syndrome of the kidney, the syndrome of sputum-turbid and deficiency-syndrome of the liver.The less common syndromes are the syndrome of blood stasis, the syndrome of liver-wind, stagnation-syndrome of qi, the deficiency-syndrome of qi and deficiency-syndrome of the heart,while the deficiency-syndrome of spleen and the deficiency-syndrome of blood,together with the deficiency-syndrome of yang are the uncommon syndromes of EH.2. The clinical study of syndromes of hypertensionMeathod:â‘´The objects of research are 106 hypertension -patients who have been treated at internal medicine of heart from January to Mary in 2007 at the Dongfang Hospital.⑵we frame the unified table of record for clinical study of syndromes of hypertension. We finish the collections of symptoms of TCM,history-taking, picture of the tongue and pulse condition and physical sign. Then we can obtain the diagnosis of syndromes of TCM according to related criteria.⑶Statistical method:Use the Statistical software of spss 11.5 for windows. we statistics and analysis the percentages of every symptom , syndrome, picture of the tongue and pulse condition; The comparison of percentages between groups use X2-test.Results:â‘´Distribution of syndromes: The statistical analysis shows that the common syndromes of hypertension are the deficiency-syndrome of the kidney(72.6% of total), the syndrome of hyperactivity of yang due to deficiency of yin(66.0% of total), the deficiency-syndrome of the heart(60.4% of total), the deficiency-syndrome of the liver(55.7% of total), the syndrome of liver-fire(53.6% of total), the syndrome of blood stasis(51.9% of total), the deficiency-syndrome of yin(49.1% of total)and the deficiency-syndrome of qi(44.3% of total). Besides, the syndrome of sputum-turbid(26.4% of total), the stagnation-syndrome of qi(23.6% of total)and the syndrome of liver-wind(20.8% of total)are also occupy definite prortion. while only a few syndromes are the deficiency-syndrome of both yin and yang ( 12.3% of total ), the deficiency-syndrome of yang(10.4% of total),the deficiency-syndrome of blood(5.7% of total),the deficiency-syndrome of the stomach(12.3% of total),the deficiency-syndrome of the spleen ( 4.7% of total ) and the deficiency-syndrome of the lung(4.7% of total).(2)The study of stratification for distribution of syndromes:â‘ Sex: The percentages of the syndrome of hyperactivity of yang due to deficiency of yin , the deficiency-syndrome of yin, the deficiency-syndrome of the kidney and the deficiency-syndrome of the heart in the group of female are higher than the group of male respectively .â‘¡Age: The percentages of the syndrome of sputum-turbid in the group of age higher than 50 are clearly higher than that of the group of age between 50 and 69 ,and the group of age higher than 70.â‘¢The degree of hypertension and the stratification of dangerous degree of hypertension: with the increase of The degree of hypertension or the stratification of dangerous degree of hypertension, The percentages of the syndrome of blood stasis are more higher accordingly(16.7%â†'39.5%â†'62.9%,25%â†'40.5%â†'62.3%).â‘£Coronary heart disease(CHD): The percentages of the syndrome of sputum-turbid, the deficiency-syndrome of qi, and the deficiency-syndrome of the stomach of the group of CHD are are clearly higher than that of the group of not CHD.(3)the character of distribution of symptoms: the common symptoms of hypertension are systematic symptom of the liver, systematic symptom of the kidney, systematic symptom of the heart,and the symptoms of the deficiency-syndrome of qi and the deficiency-syndrome of yin. The common systematic symptoms of the liver are vertigo(80.2%), irritable(68.9%), headache(55.7%), and heaviness of the head(53.8%).The common systematic symptoms of the kidney are tinnitus(65.1%), weak knee(60.4%),and frequency of nocturia(59.4%). The common systematic symptoms of the heart are insomnia(67.9%), amnestic(65.1%), chest distress(50%), palpitation(50%), and short breath(40.1%). The common symptom of the deficiency-syndrome of qi is tiredness(59.4%). The common symptoms of the deficiency-syndrome of yin are xerostomia(57.9%), feverish sensation in the chest(34.9%)and constipation(31.1%).(4)the character of picture of the tongue and pulse condition:The common tongue proper are pale tongue(62.3%), reddened tongue(57.5%),and dark tongue (50%). The common tongue coating are thin or lack coating(66%)and white tongue coating(59.4%). The common pulse conditions are wiry pulse(64.2%) and thready pulse(48.1%).Conclusion: (1)the syndrome of hyperactivity of liver-yang , the syndrome and the syndrome of blood stasis are often accompanied with the deficiency of viscera such as the deficiency-syndrome of the liver, the deficiency-syndrome of the kidney,and the deficiency-syndrome of the heart,or with the deficiency-syndrome of origin suach as the deficiency-syndrome of yin and the deficiency-syndrome of qi. (2) The distribution of a part of syndromes of hypertension are affluenced by the factor of sex, age, the degree of hypertension, the stratification of dangerous degree of hypertension and CHD.(3) The common symptoms of hypertension are systematic symptom of the liver, systematic symptom of the kidney, systematic symptom of the heart,and the symptoms of the deficiency-syndrome of qi and the deficiency-syndrome of yin. with the increase of The degree of hypertension or the stratification of dangerous degree of hypertension, The percentages of the syndrome of blood stasis are more higher accordingly . The syndrome of deficiency of qi and the blood stasis is an important syndrome-fator during the changes of hypertension. (4)the pathogenesis of hypertension is based on the deficiency-syndrome of the kidney, The location of disease of hypertension and the changes of the pathogenesis is the liver,and closely related to the heart.