| 1. Background and ObjectiveAs a common multifactorial chronic disease in clinic, hypertension is a syndrome which is mainly characterized by raised blood pressure; it is the major risk factor for cardio-cerebral vascular diseases.It is classified as headache or dizziness by traditional Chinese medicine (TCM). Stagnation of phlegm and stasis, poison damaging heart meridian are considered as its essential pathogenesis. With the aging tendency of population and increasing of social pressure, the incidence of hypertension is gradually increasing, while its treatment and control is significantly unsatisfactory. Therefore, it has a very important practical significance in this hypertension study.In recent years, the external therapies of TCM have made some progress in auxiliary treatment of lowering blood pressure, especially Guasha (scraping therapy).It is widely accepted among Chinese people owing to its simple, convenience, low price and effectiveness as well as it can be certainly handled by patients themselves. Clinically, it has effect of opening striae and interstitial space, activating blood,smoothing meridian and dispersing pathogenic toxic,which has quite good effect in adjusting chronic diseases. However, there is still a gap in literature regarding on its antihypertensive efficacy so far.Therefore, based on a prospective cohort study design, the antihypertensive effects of Guasha were observed in this study to provide references for other RCT with larger sample in the further.2. MethodsNinety-one patients of essential hypertension (EH) who met the inclusion criteria from July2013to March2014in Acupuncture and Moxibustion Hospital and TCM Outpatient Department of China Academy of Chinese Medical Sciences were included. Guasha therapy was applied once to serve the immediate antihypertensive effect. Of them, thirty-five patients were voluntary to receive one session treatment of Guasha, twice per week, eight times as a session and the long-time antihypertensive effect were observed.Heavy reducing manipulation was applied in patients with type of excess of liver fire and stagnation of phlegm-dampness while soft reinforcing method was applied in patients with type of yin deficiency and yang excess as well as deficiency of yin and yang. Each meridian was scraped for10times, about6cm in width. We did not impose making "Sha" appear on the skin. The Guasha therapy was given within the patient’s maximum tolerance or taking flushing skin or hemorrhagic point as endpoints. Women in menstrual period were not allowed to receive the treatment.Blood pressure (BP) observation:Since blood pressure is a continuous variable, which is fluctuated by the impact of various factors of time, environment, emotions,etc.Therefore, this study’s uniform measurement time is from2:00PM to8:00PM, scraping with the same place, temperature, humidity and other environment, unified by7200Omron sphygmomanometer calibrated sitting right arm blood pressure measurement, using the same sphygmomanometer in the same patients, during measurement time the patient is asked to avoid strenuous exercise, prolonged lying down sleeping, smoking, drinking, or emotional. The BP from2:00PM to8:00PM before the first treatment was measured subsequently followed by2:00PM、2:30PM.3:00PM.3:30PM.4:00PM、5:00PM,6:00PM、8:00PMs’ BP. The Guasha time was set to15minutes. The BP before Guasha was measured and Guasha was performed15minutes earlier. The Guasha must be finished at2PM, The BP from2:00PM to8:00PM after the first treatment and after one session treatment was measured subsequently followed by2:00PM、2:30PM.3:00PM.3:30PM.4:00PM.5:00PM.6:00PM.8:00PM. And the BP after the first Guasha24hours and48hours later were measured respectively.TCM syndrome classification quantified score, Dus’ quality of life scale of hypertension before and after treatment were measured for the patient who scraped for a session of treatment.3. Results3.1Immediate antihypertensive efficacy of Guasha(1) Changes, amplitude of BP decreasing and its maintenance time after GuashaBlood pressure was significantly decreased from (149+10.19)/(85.30±10.96) mmHg to (137.51±10.24)/(81.06±10.56) mmHg after scraping (P<0.01).The results showed that amplitude of BP decreasing was maximum at4h after treatment, and there was a tendency of BP rising since6h after Guasha. The biggest amplitude in BP was (14.90±9.54)/(4.24±6.34) mmHg. According to regression analysis, the BP maintenance time was47h.(2)Influencing factor of Guasha on BPThrough the analysis of the main risk factors regarding on BP, it was found out that①the antihypertensive effect were superior for those who didn’t smoking or drinking;②Guasha had a better antihypertensive effect on those whose age were less than45years, who were prescribed with antihypertensive drugs and who had a5to10years history of EH;③as for TCM syndromes, it was found that the Guasha had the best efficacy on patients with liver-fire excess type, followed by hyperactivity of yang due to yin deficiency type, stagnation of phlegm-dampness type and yin-yang deficiency type.3.2Long-time antihypertensive efficacy of Guasha on EH(1)Changes and amplitude of BP before and after GuashaAfter one session of treatment, the blood pressure was dropped from (148.18+8.07)/(87.41±10.19) mmHg to (129.35±9.16)/(80.15±9.41) mmHg, with the maximum amplitude of (18.83±9.67)/(7.26±8.93) mmHg. The long-time efficacy was more obviously significant than immediate effect. The BP after one session of treatment was evidently lower than that before the first treatment as well as that on the day before the first treatment (P<0.001).(2) TCM syndrome classification quantified score and quality of life scaleTCM syndrome classification quantified score was decreased from (19.12±7.32) to (4.25±3.40) after treatment, while Dus’ hypertension quality of life scale was increased from (185.56±15.40) to (205.19±7.77), which were both significant before and after treatment (P<0.001).(3) Results of the total effective rateAccording to the evaluation standard guiding principle of clinical research on new drugs of Chinese herb,12cases were markedly effective,15cases were effective and7cases were failed. The total effective rate was79.4%.4. Conclusions(1) Guasha therapy has satisfactory immediate effects for EH patients.(2) As a result, the antihypertensive effect were better on those who didn’t smoking or drinking,and on those whose age are younger than45years old as well as the course no longer than10years; heat syndrome have better effects than cold.(3) After one session treatment, Guasha has a cumulative effect and satisfactory long-time antihypertensive effect on blood pressure.(4) Guasha can obviously improve the clinical symptoms of EH, such as headache, neck force muscular aches and pains, and improve the quality of life. |
PDF Full Text Request