| Background and theoretical basis Hypertension is a chronic and complex disease high morbidity,high risk of cardiovascular and cerebrovascular diseases,high morbidity and mortality,and brings heavy burden to the society,economy and family.With the development of economy and the improvement of people's living standard,hypertension has increasingly become a serious problem threatening national health,social hygiene and economy.Therefore,it is important to control blood pressure and reduce the blood pressure level to prevent the terminal events and reduce the rate of death and disability.With rapid decompression,safe and smooth,no side effects of the characteristics,Traditional Chinese medicine(TCM)plays an important role in the clinical diagnosis and treatment of hypertension.Generally,we believes that the main pathogenesis of hypertension is nothing more than the actual situation,both ends of the deficiency,the lack of pulp sea,or viscera deficiency,clear the body loss of support,wind,fire,phlegm and blood stasis.However,in clinical practice,they are not obvious in patients with hypertension in wet,heat,always we can not see evil fire,phlegm,wind evil disturbance,but showing chills,afraid of the wind,strong neck pain,stiff aching limbs cold,pale tongue,white coating,pulse string tight and deep cold coagulation meridians.there are some discrepancy with the traditional syndrome differentiation.According to the clinical experience of Professor Xiaolin Tong,Gegen Decoction has effection in the treatment of this type.However,the current literature on the use of Gegen Decoction to reduce blood pressure is limited to case reports,or to help western medicine to reduce blood pressure clinical trials.We design this experiment to study the syndrome characteristics and curative effect of Gegen decoction as the main method from the point of evidence-based medicine.Objective:Through the retrospective analysis of the treatment of hypertension using Gegen Decoction to observe the clinical effect of Gegen Decoction on hypertension,and also to explore the key points of clinical syndrome characteristics and treatment of such patients with hypertension,summarize the clinical experience of Professor Xiaolin Tong with Gegen Decoction in treating hypertensio according to"state-target-cause-effect" theory.Content This study is divided into three parts.The literature review part mainly collects the origin and permit the ancient and modern literature Gegen decoction treatment,etiology and pathogenesis of the narrative and comment on the history of the medical and clinical application,and included in the modern clinical application of Gegen Decoction in treating exopathic disease,hypertension,cervical spondylosis,lumbar disease,limb arthralgia,dizziness,headache and other diseases the famous doctor experience,as well as the existing evidence,from the multi angle comprehensive expounds the theory and practice of ancient and modern clinical application of Gegen decoction.The part of clinical study is a retrospective analysis of the real world based on the data mining with the general situation of hypertensive patients in the treatment of Gegen Decoction(such as gender,age,course of disease),prevalence(such as the main syndrome characteristics,examination index,tongue and pulse),disease characteristics(such as merging with concurrent disease,past history,personal history,etc.)and clinical efficacy of Gegen Decoction in the treatment of high blood pressure(systolic blood pressure,diastolic blood pressure,main symptom changes),drug application(drug use frequency).In this study,patients before and after treatment of systolic blood pressure and diastolic blood pressure changes as the main therapeutic indexes to changes of the main symptoms of the secondary index,the glycosylated hemoglobin,blood lipid changes were observed,clinical curative effect of Gegen Decoction in the treatment of hypertension,and the frequency of the main symptoms,tongue and pulse of the specification processing and statistical analysis,summarized the disease symptom characteristics of Gegen Decoction in treatment of hypertension.The theory summary part through discussing the clinical research results,from the "state-target-cause-result" and the perspective of strategy analysis theory and practice basis of Gegen Decoction in treatment of cold coagulation and meridians type hypertension.Method The literature review method is used to summarize and sort out the literature retrieved.The clinical study is a retrospective analysis.With the keyword retrieval and data screening method,find the qualified patients and export to EXCEL data sheet.According to the inclusion and exclusion criteria,the retrieved cases were screened and included a total of 22 cases,89 cases,and will be included in the case were standardized;followed by the case data collation and extraction methods for analysis of patient data will be convenient,pretreatment and integration of electronic medical records in the database are outpatient cases the information to the patient first visit as a baseline,were extracted from each diagnosis case data,and for each patient to establish the case report form,the information stored in the input case report form;Using SPSS 19.0 to collect the data for statistical analysis,including description statistics,frequency statistics,parametric and nonparametric tests.Statistical description of the measurement data were expressed as mean ± standard deviation of the way,within the group before and after the measurement data were compared using a paired t test,does not meet the normal distribution using Wilcoxon rank sum test,rank data using rank sum test,count data using chi square test,above all take the method of two-sided test,P<0.05 was statistically significant.And the relevant data will be collated,draw the corresponding chart.Results The study selected 22 cases of hypertension treated by Gegen Decoction in February 1,2011 and January 31,2017.(1)The average age of the patients was 53 ?10.9 years,of whom the maximum age was 69 years,and the minimum age was 29 years.The average prevalence of hypertension was 8.23±6.19 years,the longest course was 25 years,the shortest 2 years.The total visit time of 22 patients was 89 times,the average diagnosis was 4.05±1.79 times,the longest visit was 8 times,the shortest was 2 times.Among the study population,the higher incidence of comorbidities were hyperlipidemia,type 2 diabetes mellitus,cervical spondylosis and coronary heart disease,accounting for 82%,73%,41%and 27%respectively.The average value of BMI is 25.668±3.638,the average BMI is greater than the normal value,of which the maximum value is 32.3 and the minimum value is 17.1.(2)Patients with hypertension with Gegen decoction treatment,the main symptoms of shoulder stiffness,shoulder acid cold,fear of wind,dizziness,chills,diarrhea,lumbago,sweating,muscle tension,headache,limbs cold pain,cold see;greasy and thick,white,yellow and white,tongue the fat,scalloped,pale,tongue with blood stasis and stagnation mainly,the pulse string,tight,heavy.(3)In this study,patients before and after taking Gegen Decoction in treating hypertension of systolic and diastolic blood pressure as the main indicators of efficacy,the main symptom is to change to the secondary index,glycosylated hemoglobin and blood lipid were observed.Data show that the number of compound Gegen Decoction intervention for hypertension after treatment,systolic blood pressure before treatment the average level was 145.86±14.79mmHg,131±13.13mmHg reached the average level after treatment,the average decline of 14.86mmHg,the average diastolic pressure before treatment was 90.82 ± 8.79mmHg,after the treatment reached 83±6.73mmHg,dropped by an average of 7.818±9.440mmHg,P<0.05.The results were statistically significant;the efficiency of treatment of the primary disease,including chills,diarrhea,sweating,headache,the total effective rate was 100%,the treatment of stiff back total efficiency is 95%,the cold shoulder acid treatment of the total efficiency of 92.86%,vertigo was 90.91%,muscle tension was 90%,lumbar pain was 88.89%chills,86.67%,ideal;observation indicators,combined with abnormal blood lipid triglyceride index than before by an average of 0.227±0.296,total cholesterol than the average decline of 0.1 compared to that before 51±0.283,glycosylated hemoglobin index of patients with type 2 diabetes decreased by 0.531 ± 0.568 compared with the average before treatment,and P was 0.05,which was statistically significant.(4)This study included 89 cases,a total of 89 prescriptions,involving 81 flavors of Chinese medicine,the total use of drugs 1000 times,the average prescription 11.236±3.19 flavor,taste the maximum number of 21 per prescription of flavor,taste at least 6,The decoction of seven drugs of Radix Puerariae radix puerariae,Radix Paeoniae Alba,cassia twig,licorice,ginger,jujube,Chinese ephedra were ranked first,2,3,5,6,tied for 11 place,the frequency of use were 100%,97.75%,82.02%,82.02%,75.28%,48.31%and 23.60%.Conclusion(1)The average age of the study group was 53 years,and the average duration of disease was about 8.23 years,that is,at the age of 45.If the risk factors were not actively controlled and intervened early,the risk of hypertension would be greatly increased.At the same time,this study showed that hypertension,diabetes and coronary heart disease and dyslipidemia has become a reciprocal causation,can not be separated from the syndrome,therefore,positive control of blood glucose,blood lipid,reasonable weight,is of important significance for Disease Control of hypertension.(2)Gegen Decoction in treatment of hypertensive patients with the traditional syndrome differentiation has certain difference,its clinical features are back stiffness,shoulder acid cold,fear of wind,cold,so the hypertension is defined as a type of cold coagulation meridians.(3)Gegentang can jie ji sheng yang,san han tong luo,with the treatment of cold coagulation and meridians of hypertension can achieve good effect,not only can get the blood pressure decreased significantly,and can effectively improve the symptoms,and by traditional Chinese medicine compound function,improve the body lipid metabolism state,to achieve the purpose of comprehensive regulation.(4)Gegen decoction is the core of the treatment of this disease,which is the target,in addition,the use of Salvia miltiorrhiza,Sanqi,Caulis Spatholobi,Hirudo powder,Huoxue Huayu Tongluo,with prevention before disease from fruit state,using Achyranthes root,Gastrodia elata,chongweizi auxiliary step-down,related indicators of Rhizoma Coptidis,Monascus,Weilingxian reduced metabolism,reflected the professor Xiaolin Tong "state-treatment strategy for target fruit"multi-dimensional integration.Meaning The study provide evidence for Gegen Decoction in treating hypertension;points out the shortcomings of traditional hypertension syndromes,put forward the thinking of treatment of cold coagulation type meridians of hypertension,broaden the clinical perspective;summary and inheritance of professor Xiaolintong,using "state-target-cause-result" clinical experience in the differentiation and treatment of hypertension. |
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