I. Etiology and pathogenesis.
Hypertension refers to a syndrome in which the main clinical manifestation is a sustained increase in circulating systolic and/or diastolic blood pressure with or without multiple cardiovascular risk factors, usually referred to as hypertension. According to Zhao, although hypertension has no direct name in the literature of Chinese medicine, according to its clinical manifestations, it should be classified as “vertigo” and “headache”, which are similar to “sleeplessness”, “chest paralysis”, and “hypertension”. It is also closely related to “sleeplessness”, “chest paralysis” and “stroke”. Medical doctors of all generations have different understanding of this disease.
1.Emotional and mental internal injuries
People’s emotional and mental activities are closely related to the normal function of liver drainage. If the emotions are depressed, the liver loses its discharge, that is, “liver qi stagnation”; qi depression for a long time into fire, can form “liver fire on the inflammation”, fire evil consumes fluid and injures yin, can lead to “yin deficiency and hyperactivity” situation. This series of pathological changes can lead to vertigo and headache as the main evidence of hypertension.
2, tiredness and weakness
The kidneys are the foundation of the innate nature, harboring essence and producing marrow. If the congenital deficiency, kidney yin is not full, or the body is old and decrepit, resulting in dark depletion of kidney essence and inability to produce marrow, then dizziness and headache can occur due to “insufficient upper qi and empty marrow”. This is the clinical evidence of hypertension based on kidney yin deficiency or kidney yang deficiency.
3.Disorderly diet
With the continuous improvement of living standards, modern people eat too much fat, sweet and thick taste or drink too much alcohol, which injures the spleen and stomach, and the spleen and stomach lose transportation, so that the water and grain do not transform the essence, and damp heat is blocked; coupled with the accelerated pace of life, increased work and study pressure, emotional and mental disorders, resulting in hyperactivity of liver yang, liver yang with damp heat upward attack, obscuring the clear orifices, the development of hypertension. This is one of the main causes of hypertension nowadays.
Hypertension is mainly due to the disruption of the normal physiological functions of yin and yang, qi and blood of the liver, spleen and kidney, and the imbalance of the harmonious homeostasis in the body, replaced by the pathological state of wind, fire, phlegm, deficiency and stasis. In other words, the deficiency of liver and kidney yin and qi and blood is the main cause, while wind, fire, phlegm, deficiency and stasis are the symptoms. In the process of disease development, various pathogenic mechanisms interact with each other and transform into each other, and then from real to deficiency, from yin to yang, and finally become yin and yang two deficiencies.
Second, the treatment rules and methods.
The clinical manifestations of hypertension often vary depending on the person or the stage of the disease, but the most important symptoms are headache and vertigo. The causes of headache and dizziness are qi and fire, either deficiency or actual; the lesions are in the liver, spleen and kidney; this is the main point of dialectical evidence. However, in the process of development of hypertension, it is impossible to follow the inherent rules of change as the yin and yang wax and wane, and the strength and weakness of the positive and the negative, so the identification and treatment should be carried out throughout the development of the disease.
In terms of treatment, it is necessary to target the “symptoms” of wind, fire, phlegm, deficiency and stasis, and to take into account the “root” of liver and kidney yin deficiency and qi and blood deficiency. The treatment of this disease follows the theory of combining dialectical evidence and disease identification, and according to different manifestations, different treatment plans are formulated, using methods such as draining liver and Qi, clearing liver and fire, clearing damp-heat, nourishing yin and submerging yang, etc. This has formed a unique treatment method and style of medicine for hypertension, starting from damp-heat, treating liver and kidney together, deficient supplementation and actual diarrhea, and supernaturalizing yin and yang.
1.Diversion of liver and qi method
Applicable to liver qi stagnation type hypertension. This type mostly occurs in the early stage of hypertension. The clinical manifestations mainly include Qi and blood imbalance and emotional and mental abnormalities. Such as headache, dizziness, chest distension and pain, insomnia and dreaminess, soreness and weakness of the waist and knees, mental discomfort, suspiciousness and worries, and sunken and stringent pulse. It is often reduced by adding Chai Hu Dredging Liver San: Chai Hu, fried Citrus Aurantium, Xiang Fu, Chuanxiong, Bai Shao, Qing Chen Pi, Peppermint, etc. If Qi stagnates and turns into fire, add Dampi, Gardenia, Scutellaria; if Qi stagnates and blood stasis, add Danshen, Tao Ren and Safflower; if the liver and stomach are not in harmony, add Wu Juju, Chuan Lian and Dai Ochre.
2.Clear liver fire method
It is applicable to the type of hypertension with inflammation of liver fire. Clinical manifestations include headache, head swelling, dizziness, red face, red eyes, irritability, deafness, tinnitus, bitter mouth and dry throat, red tongue with yellow fur and string veins. The symptoms are mainly headache, dizziness, deafness, tinnitus, dry mouth, red tongue with yellow fur and stringy pulse. If it is accompanied by insomnia and irritability, add mother-of-pearl and raw dragon’s tooth to clear liver heat and calm the mind; if it is accompanied by numbness and tremors of the limbs and the desire to have a stroke, add centipede and stiff silkworm to calm the liver and quench the wind, clear heat and fix spasm; if liver fire offends the stomach, add ochre and bamboo rhizome to clear heat and open depression, harmonize the stomach and subdue rebellion.
Cauliflower and Xia Ku Cao are often used as counter-herbs. Cyperus rotundus is the dried fruit of Cyperus rotundus, the dosage is usually 10-15 grams, the drug is both ascending and descending, dilates the blood vessels in the brain to activate blood circulation and remove blood stasis, cools the liver and lowers blood pressure; Xia Ku Cao is good at draining the fire of the liver and gallbladder and nourishing the blood vessels of the sympathetic yin, the combination of the two drugs has a good effect on lowering blood pressure.
3.Clear damp-heat method
It is suitable for damp-heat blocking type hypertension. Clinical manifestations include dizziness of the head and eyes, heaviness and tiredness of the body, nausea, dry mouth, bitterness of the mouth, yellow urine, irregular bowel movements, red tongue, yellow greasy moss, and slippery pulse. The following are often used to add and subtract from warm gall bladder soup: Fa Xian Xia, Fu Ling, Fried Citrus Aurantium, Green Chen Pi, Bamboo Roo, Yin Chen, Coix Seed, Bile South Star, etc. If the abdomen is full and distended, add thick park and betel nut to move Qi and eliminate stagnation; if belching is frequent, add spineflower and substitution ochre.
4.Nourishing Yin and submerging Yang method
Clinical manifestations include dizziness, headache, tinnitus, deafness, drowsiness, dry eyes, dry mouth, soreness and weakness of the waist and knees, red tongue with thin coating and thin pulse. It is often supplemented with Zuo Gui Wan: Shu Di, Shan Yu Flesh, Shan Yao, Gua Jia Gum, Cuscuta, Chuan Niu Knee, Sheng Du Zhong, Sang Sang Sang, etc.
The harmonious homeostasis in the body is disrupted, which can easily lead to hypertension due to the absence of wood Qi. The evidence of such patients is liver and kidney yin deficiency, of course it is necessary to nourish yin, but how to do it is very delicate. In fact, the process of nourishing yin is the process of nourishing vital energy. In the treatment, we should not use too many drugs, but try to select drugs that are warm, nourish the vital energy, nourish yin and at the same time submerge yang, such as the clinical use of turtle plate instead of turtle nail, because the operation of blood must depend on the promotion of yang, turtle nail is purely nourishing yin, while turtle plate can nourish yin and submerge yang.