According to the 1999 World Health Organization/International Hypertension League guidelines for the prevention and treatment of hypertension [1], age R60 years and blood pressure persistent or more than 3 times non-same day sitting systolic pressure R140 mmHg and/or diastolic pressure R90 mmHg can be defined as geriatric hypertension. If the systolic pressure > 140 mmHg diastolic pressure < 90 mmhg, it is defined as simple systolic hypertension in the elderly. 2002 data from the National Survey on Nutrition and Health Status of 270,000 Residents organized by the Ministry of Health [2] showed that the prevalence of hypertension in China's R60-year-old population was 49%, significantly higher than that of the middle-aged and young people, of which only 32.2% of elderly hypertensive patients received treatment, and the control rate was only 7.6%. The clinical characteristics of hypertension in the elderly mainly include increased systolic blood pressure, increased pulse pressure, large fluctuations in blood pressure, postural hypotension, abnormal circadian rhythm of blood pressure, coexistence with many diseases, and many complications.
Hypertension belongs to the category of “dizziness” and “headache” in Chinese medicine, and the common methods used in Chinese medicine today to treat hypertension, such as nourishing Yin and submerging Yang, cooling the liver and quenching the wind, and the commonly used formulas such as Tianma and Hooked Vine Drink and Liver Resting Wind Soup, are often effective for patients with the corresponding types of initial hypertension. However, when used to treat hypertension in the elderly, the results are often not satisfactory. Based on the years of clinical experience of my mentor, Dr. Ji Zhongqiang, I believe that the important pathogenesis of hypertension in the elderly is Yang deficiency and fire floating, and treatment should be based on the warming and submerging method.
1. Deficiency of kidney yang is an important pathological basis of hypertension in the elderly
Chinese medicine believes that the most important factor leading to aging is the deficiency of kidney qi, the kidney is the innate essence, the main collection of essence, the strength and weakness of the kidney qi determines the body’s birth, growth, strength, old age, and self, the elderly mostly manifested as a deficiency of multiple organs mainly kidney deficiency. As described in Suwen? Shanggu Tianzhen theory described: “women seven years old, the kidney Qi Sheng, teeth more hair long; …… seven seven years old, any vein deficiency, Taichong vein decay less, the days of sebum exhaustion, the earth does not pass, so the form is bad and childless. Husband eight years old, kidney qi real, hair long teeth more; …… seven or eight, liver qi failure, tendons can not move, the sky is exhausted, less essence, kidney failure, the shape are extremely”. As the elderly grow older, the essence of the kidney gradually decay, the other organs do not get the kidney qi moisten, nourish will certainly produce different forms of dysfunction, which leads to various diseases. The disease damage over time, so that the kidney in the essence of the more deficient, the so-called “five organs of injury, poor will be and kidney”. The kidney qi is produced by the evaporation of kidney yang, and qi deficiency is inevitably accompanied by yang deficiency over time. The experimental study and field survey by Wei Ming [3] also proved that the elderly not only have kidney deficiency, but also tend to have Yang deficiency.
According to Zhang Jinyue, “the evidence of dizzying movement is eight or nine deficiencies, and fire and phlegm are only one or two out of ten.” And according to the theory of “Insufficient upper qi makes the brain unhappy” in “Nei Jing”, he proposed the view that “no deficiency makes dizziness, and the treatment of deficiency should be the main focus”. The exhaustion of the heavenly sap in the elderly is an important internal cause of Yang deficiency, and Yin loss and Yang deficiency are also important causes of Yang deficiency. According to Zhu Chen-Yu [4], the initial stage of hypertension is in the liver and kidney, with yin deficiency and yang hyperactivity, and over time, qi disease extends to blood, with yin damage and yang, developing into advanced hypertension with qi and blood stasis, yin and yang deficiency, and damage to multiple organs. Shang Chunsheng [6] pointed out that although the evidence of yin deficiency and yang hyperactivity is more common in patients with hypertension, we should not neglect the repeated use of heavy sedative and subdued yang method and the tendency to develop yang deficiency in patients who have taken bitter-cold and diaphoretic products for a long time. According to Xu Dihua [5], the main contradiction in hypertension is yang deficiency, with the heart and kidneys being the most prominent, and there are many concurrent evidence types. According to Su Weidong [7] and others, the kidney is the origin of the innate nature and the spleen is the origin of the acquired nature, and the deficiency of spleen and kidney yang in patients with hypertension can be caused by insufficient innate endowment, lack of nourishment in the acquired nature and inappropriate treatment and prolonged disease duration.
2, Yang deficiency fire floating is an important pathogenesis of hypertension in the elderly
Kidney yang plays the role of warming, stimulating and promoting the body, and is the root of yang energy in the whole body. The deficiency of kidney yang decreases, the function of the closed storage decreases, the true yang can not be hidden in the kidney palace, floating over the outside, in addition, the Yang deficiency warming dereliction of duty, yin cold, forcing yang floating over, both will cause changes in yin and yang refusal. The refusal of yang can float upward and outward, causing the evidence of gyang and daiyang, etc. The accumulation of yang can cause various heat signs, which become typical of floating fire. Zhang Jiebin pointed out that “Yang deficiency can also be feverish, this is because the Yang is exhausted, the fire does not return to the original.” Qing? He Mengyao also said that “kidney yin is strong, forcing its floating fire to rise, and another fire” (“medical meaning”). The most important thing is that the kidney yin is not only a source of energy, but also a source of energy. The most important thing is that the person who has a deficiency in the qi sea is the one who has a large deficiency in the yuan yang, and the lower jiao has a sinking cold that is forcing the yuan yang to run upward like a fire that is about to go out.”
In addition, the deficiency of kidney yang is weak in qi, qi does not run smoothly, heart fire can not be submerged in the kidney, false yang floating upward, lost in the submerged. This leads to heat on the top and cold on the bottom, and solidity on the top and deficiency on the bottom. For example, Su Wen? The Five Organs of Generation: “Headache and top disease, lower deficiency and upper reality.” Ming? Zhang Sanxi’s Six Essentials of Medical Standards: “Vertigo is caused by the upper real and the lower deficiency. Li Yongcui’s “The Treatment of Evidence and Remedies” states in the discussion of vertigo: “Damp phlegm vertigo is caused by damp phlegm stagnating in the upper part of the fat white man and Yin fire starting in the lower part. It is said that no phlegm does not make vertigo. …… Kidney deficiency vertigo, personal yin and yang, hold each other and do not leave. Therefore, Yang wants to get off, Yin down to absorb the. If the lustful dream is excessive, the kidney family can not return to the original, so that all the Qi rebellious run up, this vertigo out of kidney deficiency.”
Kidney Yang deficiency, loss of warmth, vascular contraction, increased peripheral vascular resistance; in addition, Yang deficiency, especially the spleen and kidney Yang deficiency, the spleen can not transport water and dampness, the kidney can not transpire and gasify water and liquid, water and liquid run metabolic disorders, the emergence of phlegm and water drink, blocking the vascular, up against the position of clear Yang; deficiency Yang floating over, drumming blood vessels, all can appear to increase blood pressure.
Yang deficiency fire floating type of hypertension in the elderly clinically presents two groups of opposite symptoms: one is kidney Yang deficiency, is the essence of the disease: the face white light white or sallow, waist and knees sore, cold, especially in the lower extremities, fatigue, or see loose stool, five night diarrhea, or frequent urination, clear long, nocturnal urination, light tongue, white coating, sunken and weak pulse, especially in the ulna and other symptoms and signs; the second is deficiency fire, as the Jing Yue Quanshu? Fire evidence”, “cold from the birth, then the Yang Qi has no attachment and diarrhea outside, that is, false fire, false heat is also called”. The symptoms are mainly dizziness and headache, dry mouth, bitterness, red face or cheekbones, head sweating, and sleeplessness. It is easy to misdiagnose as liver fire on inflammation or liver yang on hyperactivity, which should be identified in detail at the time of clinical evidence.
3.Warm and subtle method is an important treatment method for hypertension in the elderly
3.1 The origin of warming and diving method
Warm Yang medicine such as ginger, cinnamon, and clary sage are used to support the declining Yang energy, and combined with submerged medicine such as sanjia (oyster, turtle shell, turtle plate) and magnet to subdue the deficient Yang.
The warming and submerging method uses warming and heating drugs with heavy sedative drugs, and this combination can be traced back to Zhang Zhongjing. This combination can be traced back to Zhang Zhongjing. In the “Treatise on Typhoid”, “the fire reverses down, due to burning needles irritability, Gui Zhi Gan Cao Dragon Bone Oyster Soup is the main one”. This is the ancestor of the combination of warm medicine to aggravate and calm the mind. This can be said to have opened the precedent of warm submerged method. “typhoid fever pulse floating, the doctor to fire forced robbery, the death of Yang, will be frightened and restless, lying up, Gui Zhi go peony plus Shu Qi oyster Dragon Bone rescue soup main.” Here Zhong Jing expresses that the main pathogenesis of this kind of frightening and restlessness is the loss of Yang. This is also the earliest discussion of Yang deficiency causing Yang floating.
”Vertigo is the gradual development of the stroke”, “Jin Kui Essentials? The important formulas of Hou’s Black San and Feng Yin Tang for the treatment of stroke both contain the idea of the combination of warm and subtle methods. From the formula of Hou’s Black San, the formula uses oyster to pacify the liver, and cinnamon branch, hosanna and dry ginger to warm the yang energy. Although Feng Yin Tang is mainly cold and heavy, the formula is based on red and white stone resin, purple quartz, dragon bone and oyster to calm the liver and subdue Yang, but it is also combined with dry ginger, cinnamon and other warming herbs to make it warm and protect the right qi.
In the Qing Dynasty, Zheng Qin’an, the founder of the “Fire God School”, created the unique formula of Qian Yang Dan, which is a representative formula of the warming and submerging method. In the modern era, Mr. Zhu Weiju, who became famous as “Zhu Fuzi” in Shanghai for his good use of Fuzi in treating diseases, clearly proposed the name of “warming and submerging” and believed that “Yang is not too much, but submerging is valuable”.
3.2 Prescriptions and medicines for warming and submerging method
For many years, Dr. Ji Zhongqiang, our mentor, has been treating elderly patients with hypertension with the basic formula of Wen Qian Method – Wen Qian Hypotensive Formula, which has achieved good clinical results. The basic formula is as follows: 9g of gunner’s roots, 30g of raw keel, 30g of raw oyster, 15g of eucommia, 15g of cistanches, 6g of sand, 15g of zedoary, 9g of raw hawthorn, 12g of shou wu, 15g of bupleurum, 12g of geranium, 6g of roasted licorice; for Yang deficiency, add Xianmao and cinnamon; for fire floating, add turtle shell and turtle board; for Qi deficiency, add Radix Codonopsis and Astragalus; for Yin deficiency, add Radix Rehmanniae. In case of Qi deficiency, add Radix Codonopsis Pilosulae and Radix Astragali; in case of Yin deficiency, add Radix Rehmanniae and Dendrobium; in case of phlegm-dampness, add Poria and Poria; in case of Qi stagnation, add Chen Pi and Citrus Aurantium. The formula is based on cannon fenugreek, eucommia and cistanches to warm the kidneys and help Yang, to support the root, “the herb seeking truth” cloud: “fenugreek …… passes through the twelve meridians, nothing, for the first important agent to supplement the true fire of the innate life.” The “medicinal nature of the fugue” said: “strong will and strong tendons and bones, nourishing the kidneys to stop lumbago”; Cistanches replenish kidney yang, benefit essence and blood; raw keel and raw oyster heavy town products subdue floating yang, “the herbal thinking record” said “keel to return to the earth, oyster according to the yin to call yang The pungent warmth of sarenin has the effect of inducing qi to return to its original source, “Ben Cao Zhan Ya”: “with the vital gate fire failure, can not be able to return the qi to the yuan, can also make it from the descending from the incoming”; Ze Xie Li water to permeate dampness without harming yin; raw hawthorn activates blood stasis, resolves stagnation and eliminates stagnation; system shou Wu nourishes yin and nourishes blood, intended to induce yang from yin, and tonic but not help The root of Radix et Rhizoma Puerariae and Radix et Rhizoma Conium are one ascending and one descending, regulating the qi mechanism; the roasted licorice harmonizes the herbs, cultivating the earth and astringing the fire. The combination of the herbs is warm but not dry, tonic but at the same time pass, support the righteousness without leaving the evil, remove the evil without hurting the righteousness, together with the function of warming the yang and subduing, inducing the fire to return to the original state, restoring the balance of yin and yang in the human body, yin and yang secret.
4. Discussion
The warming and submerging method is suitable for elderly hypertensive patients with Yang deficiency in the lower part of the body and fire floating in the upper part of the body. In treating elderly patients with hypertension with the warming and submerging method, we should make sure that the warming of Yang does not cause dryness and the submerging of Zhen does not cause depression according to the characteristics of the elderly who are weak and have been ill for a long time. While warming Yang, attention should be paid to nourishing Yin, as Zhang Jinyue advocates, “Those who are good at nourishing Yang must seek Yang in Yin, and Yang is endlessly biochemical if it is helped by Yin.” If Yang does not transform Qi, water essence will not be distributed, and there is a lot of phlegm and water-dampness stagnation, and hypertension is a long-standing disease into the complex, phlegm and stagnation are more intertwined as a problem, so according to the condition of the disease should be combined with dampness and phlegm, blood circulation products. “The spleen and kidneys depend on each other. On the one hand, the spleen depends on the warmth of the kidney yang, on the other hand, the kidney yang depends on the nourishment of the spleen essence. The clinical evidence is often in the support of Yang and kidney at the same time, supplemented by supplementing the spleen, so that the spleen and kidney support each other and biochemically endless. In addition, attention should also be paid to the combination of warming and warming, so that the supplement does not stagnate, regulate the Qi and submerge the town together, so that the submerged and not depressed.