An Intervention Study of Zhenwu Decoction in Taiyanghanshui Hypertension

Hongjun ZHU

Department of Cardiology, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi 214001, China

Abstract [Objectives] To study the therapeutic effect and mechanism of Zhenwu decoction on Taiyanghanshui hypertension based on the theory of five movements and six qi. [Methods] First of all, under the guidance of the theory of five movements and six qi, Zhenwu decoction was used to clinically intervene in the hypertensive patients with deep and taut pulse and grade 1-2, and the clinical effect of Zhenwu decoction on hypertensive patients with Taiyanghanshui was observed. [Results] Zhenwu decoction can effectively reduce systolic blood pressure and diastolic blood pressure in patients with Taiyanghanshui hypertension. [Conclusions] Under the guidance of the theory of five movements and six qi in traditional Chinese medicine, Zhenwu decoction can effectively treat Taiyanghanshui hypertension.

Key words Hypertension, Five movements and six qi, Zhenwu decoction

1 Introduction

Essential hypertension is one of the common cardiovascular diseases in clinic. From 2012 to 2015, the prevalence rate of hypertension in Chinese residents aged 18 and above reached 27.9%[1]. Literature studies also confirmed that Zhenwu decoction combined with Guizhi Fuling decoction had a good clinical effect on the patients with essential hypertension in conjunction with diastolic heart failure due to qi deficiency and blood stasis and kidney-yang deficiency. However, in the field of hypertension research, the accumulation of clinical and experimental research on Zhenwu decoction is still insufficient. Therefore, on the basis of studying and thinking about the theory of five movements and six qi, we treated the patients with deep and taut pulse by using Zhenwu decoction for Taiyanghanshui, and the clinical effect was remarkable.

2 Data and methods

2.1 Data sourcesPatients with essential hypertension who were treated in the Longsha Characteristic Diagnosis and Treatment Clinic of Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine from June 2019 to August 2020 were selected according to the following inclusion and exclusion criteria and randomly grouped according to the random number table.

2.2 Screening criteria

2.2.1Inclusion criteria. Age≥18 years; it meets the diagnostic criteria of essential hypertension, and the grade of hypertension is 1-2[2]; deep and taut pulse; the course of hypertension is less than 1 year at the first visit.

2.2.2Exclusion criteria. Grade 3 hypertension; suspected or confirmed secondary hypertension; need to use two or more antihypertensive drugs; complicated with other diseases that require drugs which may affect blood pressure; complicated with cardiovascular and cerebrovascular diseases such as stroke, myocardial infarction, heart failure, and arrhythmia; complicated with severe liver and renal insufficiency, electrolyte disorder and so on; pregnant or lactating women; complicated with other diseases that affect the evaluation of the efficacy of drugs; poor compliance and failure to take traditional Chinese medicine decoction; other traditional Chinese medicine preparations are used.

2.2.3Diagnostic criteria of pulse in traditional Chinese medicine. Deep pulse: The pulsating part of the vessel is under the skin and close to the muscles and bones, so it should not be taken lightly, only by pressing hard can you feel the obvious pulse.

Taut pulse: The pulse is straight, long, strong and hard, and there is a feeling of straight up and down when feeling the pulse.

Two conditions need to be met at the same time.

2.3 Treatment regimenWestern medicine group: 5 mg amlodipine once a day or 150 mg irbesartan once a day.

Traditional Chinese medicine group: it was treated with Zhenwu decoction, the prescription included 15 gAconitumcarmichaeliDexb, 30 g Rhizoma Atractylodis Macrocephalae, 45 g parched white peony root, 45 gPoriacocosand 45 g ginger. It was made by the preparation room of our hospital into 1 dose, 2 bags, 200 mL/bag, 1 bag in the morning and 1 bag in the evening every day.

2.4 Blood pressure measurementThe outpatient mercury sphygmomanometer was used for all data and the blood pressure was measured according to the standard specification. The blood pressure levels of outpatients at the beginning of treatment and 2 weeks after treatment were measured.

3 Results and analysis

3.1 Clinical retrospective studyAccording to the inclusion and exclusion criteria of the data, 34 patients with hypertension were selected, including 16 males and 18 females, aged from 39 to 53 years.

There were 18 cases in the control group and 16 cases in the Zhenwu decoction group.

For the patients with new onset, grade 1-2 hypertension and deep and taut pulse, the levels of systolic blood pressure and diastolic blood pressure decreased in Zhenwu decoction group, and the difference was statistically significant (P<0.05); the level of systolic blood pressure decreased in the control group, and the difference was statistically significant (P=0.004), but the decrease of diastolic blood pressure was not statistically significant. After treatment, the diastolic blood pressure in the Zhenwu decoction group was lower than that in the control group, but the difference was not statistically significant (P>0.05) (Table 1-2).

Table 1 Therapeutic effect of Zhenwu decoction on systolic blood pressure in patients with hypertension

Table 2 Therapeutic effect of Zhenwu decoction on diastolic blood pressure in patients with hypertension

4 Discussion

In the theory of five movements and six qi, the world is composed of five stable states and six changes[3]. The five movements included earth, water, fire, wind and wood. The six qi included Taiyang, Shaoyang, Yangming, Jueyin, Shaoyin and Taiyin.InnerCanonofHuangdi-PlainQuestions: "There is a certain amount of qi and blood in each meridian of a person. For example, Taiyang often has more blood and less qi, Shaoyang often has less blood and more qi, Yangming often has more qi and more blood, Shaoyin often has less blood and more qi, Jueyin often has more blood and less qi, Taiyin often has more qi and less blood, which is an innate endowment." If there is more Yin blood, the circulation volume is high and the blood pressure is high. If the Yang qi is insufficient, then the Yang temperature is not enough and there is internal cold, and the passages through which vital energy circulates are tight, then the blood pressure is high. The method of distinguishing pulse inTreatiseonFebrileDiseases: "stringy pulse turning to the hollow pulse in a middle degree", "weak pulse indicating cold", if it is cold, the pulse is tight, so the blood pressure is high.

According to the clinical experience, we classified the hypertension with deep and taut pulse as the Taiyanghanshui hypertension, and used Zhenwu decoction to treat it. The results of this study showed that Zhenwu decoction could achieve better clinical effect on Taiyanghanshui hypertension. Clinical study also found that Zhenwu decoction could maintain residual renal function in maintenance hemodialysis patients based on syndrome differentiation and oral administration[4]. The mechanism of Qizhi Zhenwu decoction in reducing urinary protein in rats with unilateral ureteral ligation[5]was considered to be related to the inhibitory effect of Zhenwu decoction on TGF-β1/Smads signal pathway and oxidative stress. This may suggest the mechanism of Zhenwu decoction.

To sum up, under the guidance of the theory of five movements and six qi of traditional Chinese medicine, Zhenwu decoction can effectively treat Taiyanghanshui hypertension, and it is necessary to further study its mechanism, which can create a good prospect for the development of new Chinese herbal medicine preparations for the treatment of hypertension.