Based On Outpatient Cases, We Will Discuss The Principles And Prescriptions Of Professor Tong Xiaolin In The Diagnosis And Treatment Of Hypertension

ObjectivesBased on the standardized outpatient cases of hypertension treated by Professor Xiaolin Tong from 2005 to 2015,this study reviewed the clinical efficacy of traditional Chinese medicine(TCM)in the treatment of hypertension;and optimized Tong's "Six-State"differentiation and treatment principles for hypertension through the syndrome analysis as well as the core medicine exploring of each State-belonging cases respectively;finally optimized the "Three-Staging and Six-State" system for hypertension.Thereby provide new suggestions for the diagnosis and treatment of hypertension in TCM.MethodsBased on the database of TCM outpatient cases,the hypertension cases meeting the criteria were included.Used statistical methods to evaluate the antihypertensive effect.Used the scale-free complex network analysis method to mine the core medicine of different State or Syndrome type hypertension cases;In the statistical analysis method,qualitative data were compared using chi-square test,quantitative data consistent with normal distribution using paired-sample t-test,and quantitative data not conforming to normal distribution using rank sum test.Results(1)Basic information:This study included a total of 890 cases of hypertension that met the criteria,with a total of 6609 visits.There were 456 male patients and 434 female patients;576 patients with primary hypertension,241 patients with grade II hypertension,and 73 patients with grade III hypertension.In addition,the age group was concentrated in the 40-70 years old,mainly in the middle-aged and elderly.(2)Comorbidity:80.3%of the patients had other diseases,such as 715 with diabetes and 417 with dyslipidemia.There were only 175 cases of hypertension alone,accounting for 19.7%.(3)Efficacy evaluation:Although the individual blood pressure decreased spirally,the overall diastolic blood pressure and systolic blood pressure showed a linear downward trend.Besides,after 18 months of treatment,the systolic blood pressure of grade 3,grade 2,and grade 1 decreased by 50.00±18.08mmHg,36.71±11.94mmHg,and 33.00±9.84mmHg;the diastolic blood pressure grade 3,grade 2,and grade 1 decreased by 32.67±6.68mmHg,20.85±7.44mmHg,18.90±7.54mmHg.And stabilize the blood pressure to a better level within 6-9 months period.(4)Medication:In these cases,there are 247 kinds of Chinese herbal medicine with a frequency greater than or equal to 10,which are classified into 11 categories according to their efficacy:"Clearing fire,Scattering fire,Depressing qi,Digestive care","Tonifying qi","Promoting circulation and Removing stasis","Soften stiffness and Dredging collaterals","Dispelling wind,Dispelling cold,Dispelling dampness,Relaxing tendons","Resolving dampness,Resolving phlegm","Tonifying liver and kidney","Dispelling melancholy and Calming mind","Calming liver and Supressing yang","Draining dampness and Resolving turbidity","Warming middle-jiao to dispel cold".The most frequently used one is "Clearing fire,Scattering fire,Depressing qi,Digestive care".Besides,the prescription of these cases were mainly middle-sized with about 6-12 different herbs.(5)Syndrome and State Type:Fifteen Syndrome types were recorded through "Syndrom element" standardization:Liver Qi Stagnation,Stagnated Qi Transforming into Fire,Mind Disturbance,Cold Freezing Meridians,Mixed Phlegm-Heat(Middle-Jiao Resistance),Gastrointestinal Heat,Intestinal Dampness-Heat,Liver and Gallbladder Dampness-Heat,Excessive Fire in Liver,Phlegm-Dampness Impeding Middle-Jiao,Harden Vessel,Internal Blood Stasis,Dropsy in Vessel,Deficiency of Live-Kidney,Hyperaction of Liver Yang.According to "Six-State" principles,the Syndromes Mind Disturbance and Liver Qi Stagnation belonged to "Stagnation State";the Syndromes Gastrointestinal Heat,Mixed Phlegm-Heat,Intestinal Dampness-Heat,Excessive Fire in Liver,Liver and Gallbladder Dampness-Heat,Stagnation-Heat in Liver and Stomach belonged to "Heat-Stasis State";the Syndrome Phlegm-Dampness Impeding Middle-Jiao belonged to "Phlegm-Stasis State";the Syndrom Cold Freezing Meridians belonged to "Cold State";the Syndrome Harden Vessel belonged to "Harden State";the Syndromes Hyperaction of Liver Yang and Deficiency of Live-Kidney belonged to "Deficiency State";the Syndrome Dropsy in Vessel belonged to"Water State".(6)Core Medicine(CM):"Stagnation State" had Suanzaoren,Huanglian,Shengjiang,Zhimu,Huangqi,Shengdahuang,Huangqin,Chaihu,etc,and Wendan Decoction was the CM of Mind Disturbance,Sini Powder was the CM of Liver Qi Stagnation;"Heat-Stasis State"had Huanglian,Shengjiang,Shengdahuang,Zhimu,Qingbanxia,Huangqin,etc,and Dahuang Huanglian Xiexin Decoction was the CM of Gastrointestinal Heat,Xiaoxianxiong Decoction was the CM of Mixed Phlegm-Heat,Gegen Qinlian Decoction was the CM of Intestinal Dampness-Heat,Qinggan Jiangzhuo Decoction was the CM of Excessive Fire in Liver,Yinchenhao Decoction was the CM of Liver and Gallbladder Dampness-Heat,Dachaihu Decoction was the CM of Stagnation-Heat in Liver and Stomach;the CM of "Phelgm-Stasis State" was Erchen Decoction combined with Banxia Baizhu Tianma Decoction;Gegen Decoction was the CM of "Cold State";Ruanmai Huoxue Decoction was the CM of "Harden State";"Deficiency State" had Huangqi,Shengdahuang,Zhimu,Huainiuxi,Shengjiang,Jixueteng,Zhishuizhi,Duanlonggu,Duanlongmu,Chaoduzhong,etc,and Zhengan Xifeng Decoction was the CM of Hyperaction of Liver Yang,Sanbi Decoction was the CM of Deficiency of Live-Kidney;Danggui Shaoyao Powder and Wuling Powder were the CMs of"Water State".(7)"Three-Staging and Six-State" system:Hypertension could be STAGED into"Qi&Blood-Collaterals-Zangfu"from time,and STATE differentiated into six States from space,including;"Stagnation,Cold,Stasis,Water,Deficiency and Harden".Conclusions1.Through retrospective analysis of the 890 cases in the study,results showed that Chinese herbal medicine had a certain anti-hypertensive effect on all grades of hypertension,and the blood pressure could be controlled to the ideal level within 6-9 months.The study performed researches on Syndrome and State types according to the "Six-State"differentiation and treatment principles,and dug out the core medicines of all Syndromes and States,which enriched the "Six-State " theoretical connotation.2.Based on Tong's "Three-Stage" and the optimized "Six-State" theories,we had preliminarily constructed the new "Disease-Staging-State" system for hypertension's treatment.We divided the Hypertension into three Stages from time,including "Qi&Blood-Collaterals-Zangfu".In addition,divided into six States from space,including "Stagnation,Cold,Stasis,Water,Deficiency and Harden".Therefore,professor Tong pointed out that for the treatment of hypertension,it is necessary to combine the Stage and State,to determine the cause of the disease,and to prevent the consequences of the disease.