To be precise, hypertension is a clinical syndrome whose etiology is still not well understood and is a vascular disease, a risk factor for heart, brain and kidney diseases. The United Nations Health Organization has called it the “silent killer”. Since the cause is unknown, how are clinicians treating it? Compared to Western medicine, which is all about lowering blood pressure, Chinese medicine is more scientific and focuses more on both the symptoms and the root cause. I have always believed that the highest level of clinical treatment is individualized based on the combination of Chinese and Western medicine and standardized treatment.
Chinese medicine view.
Hypertension belongs to the category of “vertigo” and “headache”, which is called “wind vertigo”. In ancient times, the treatment of vertigo was mostly based on the liver, and the treatment of deficiency and phlegm was focused on the treatment of wind. The author will try to discuss the dialectical treatment of hypertension.
Etiology and pathogenesis: the accelerated pace of modern life, work tension, fierce competition, worry and brain anger, depression, long depression and heat injury to yin, liver and yang hyperactivity; excessive drinking, over-eating sorghum and thick flavors, damage to the spleen and stomach, phlegm and turbidity, up the clear orifices; fatigue and internal injury, physical exertion, or excessive rest and relaxation, sitting and lying for a long time to consume gas, deficiency of qi and blood, loss of nourishment of the clear orifices or old age and physical decline, damage to the internal organs, yin and yang dysregulation, yin deficiency and yang hyperactivity, each resulting in wind and yang The above factors, single or multi-factor cause the disease, the treatment first investigates the etiology of the disease, especially asymptomatic hypertension when the treatment of the cause. It can occur as headache, dizziness, tinnitus and other unclear symptoms of the head and eyes. Treatment should be based on clearing the liver, nurturing yin, submerging yang, and resolving turbidity as the main treatment method.
The disease is classified according to Chinese medicine. It is mainly divided into four types of evidence: liver and gallbladder fire, liver and yang hyperactivity, yin and yang deficiency, and phlegm and turbidity obstruction.
1.Hepatobiliary fire. Symptoms: headache and dizziness, red face and eyes, bitter mouth and dry throat, impatience and irritability, constipation and yellow urine. Red tongue with yellow coating and string pulse. Treatment: Clearing the liver and dipping fire. Prescription: Fengchi, Taichong, Xingma, Quchi, Hegu. Acupuncture and moxibustion methods: Fengchi with twisting and twisting flat tonic and flat diarrhea method, the rest of the points with lifting and twisting diarrhea method. Fang meaning: Taichong, between the line belongs to the liver meridian, clearing the liver and diarrhea; Hegu, Quchi belongs to the large intestine meridian, Yangming more gas and blood can clear heat and fire. Fengchi is the meeting point of bile meridian and Yang Wei pulse, clearing the fire of liver and gall bladder and stop dizziness.
2. Hyperactivity of liver and Yang. Symptoms: vertigo and tinnitus, headache and swelling, dizziness and headache aggravated by annoyance or irritation, flushed face, impatience and irritability, little sleep and dreams, bitter mouth. The tongue is red, with yellow fur and a stringed pulse or a fine pulse.
Treatment:Calming the liver and submerging Yang, nourishing the liver and kidney. Prescription: Fengchi, Liver Yu, Kidney Yu, Sanyinjiao, Taichong, Manxi. Add or subtract with symptoms: add Jingmen and Taixi if Yin deficiency is severe.
Acupuncture and moxibustion methods: Taixi, Sanyinjiao, Kidney Yu, Liver Yu and Jingmen for tonic method; Taichong, Fengchi and Manxi for laxative method. The formula: Taixi is the infusion point of the foot Shao Yin Kidney meridian, Kidney Yu and Jingmen are the Yu collection points of the kidney, which are used together to nourish water and conceal wood; Sanyinjiao benefits Yin and tonifies the kidney, harmonizing all Yin; Liver Yu and Taichong calm the liver and submerge Yang, lowering rebellion and stopping dizziness; Fengchi and Manxi diarrhea liver and gallbladder fire and submerge Yang to stop dizziness.
3. Yin and Yang deficiency. Symptoms: dizziness, palpitations and tinnitus, lumbar soreness and leg weakness, tendon p movement, insomnia and dreaminess, polyuria at night, if Yin deficiency, there are five heart trouble, dry mouth and throat, red tongue with less coating and less fluid, thin and stringy pulse; if Yang deficiency. There is fear of cold extremities, loose urine and stool…
Western medical view.
Hypertension in adults in China, the average incidence is 4.94% (3-10%). The cause of this disease has not been very clear. The incidence is high in people with chronic mental stress and lack of physical activity, family history of hypertension, overweight, high salt content in the diet and heavy smoking. There are many theories on the pathogenesis of this disease. It is generally believed that higher neurocentral dysfunction plays a dominant role in the pathogenesis, while humoral endocrine factors and the kidney are also involved in the pathogenesis.
It is often associated with brain, heart and kidney damage, and may manifest as dizziness, headache, head swelling, tinnitus, blurred vision, palpitations, exertional dyspnea, polyuria, nocturia followed by oliguria, proteinuria, hematuria, etc. The disease can be divided into the slow-onset type and the acute type according to the onset and progression of the disease. Most of the clinical cases are slow progressive. The diagnosis of the acute type is based on: (1) rapid progression of the disease, diastolic blood pressure is often above 17.3 kPa. (2) Fundus hemorrhage, exudation or optic nerve papillary edema.
The goal of Western medicine antihypertensive drugs is to effectively control blood pressure. The target goal of blood pressure lowering is <140/90 mmHg.
Drug selection is as follows:
1.Diuretics
For the common first-line antihypertensive drugs, for the elderly, obese, hypertensive patients with renal failure or heart failure, commonly used drugs: furosemide, spironolactone, aminoglutethimide, indapamide, hydrochlorothiazide, chlorothiazide, mannitol.
2. Angiotensin converting enzyme inhibitor (ACEI)
Suitable for young people, patients with heart failure or myocardial infarction, patients with diabetic proteinuria. Commonly used drugs: Captopril, Enalapril, Benazepril (Lodinexin), Ramipril, Fosinopril, Cilazapril, Perindopril, Enalapril, Quinapril, Dilazepril, Qondopril, etc.
3. Angiotensin II receptor antagonist (AⅡRA)
It is the latest class of antihypertensive drugs, especially for patients who have adverse reactions to other antihypertensive drugs, and can significantly improve treatment compliance. Commonly used drugs: Coxswain, Devon, Irbesartan, Temisartan, etc.
4. Beta-blockers
Especially suitable for young people who have had myocardial infarction with angina pectoris, rapid heart rate or heart failure, commonly used drugs: cardiotrope, metoprolol, atenolol, betaxolol, bisoprolol, celiprolol, aurolol, etc.
5. Calcium antagonist (CCB)
For the elderly and patients with angina pectoris, commonly used drugs: verapamil, long-acting isoptin, diltiazem, nifedipine, nifedipine, nifedipine, amlodipine, nicardipine, nisoldipine, lacidipine, etc.
6. Alpha 1 receptor blocking drugs
Can safely and effectively lower blood pressure. No adverse effects on the currently recognized risk factors for cardiovascular disease. Long-term application can appear drug resistance, often selected drugs: terazosin, prazosin, pressure ninhydrin, doxazosin, etc. Indicated in a few cases, such as secondary hypertension due to pheochromocytoma.