In 1999, the World Health Organization/International Hypertension Union (WHO /ISH) defines hypertension as systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥90mmHg without taking antihypertensive drugs. In the same year, this standard was also adopted in the guidelines for prevention and treatment of hypertension in China. In the past, hypertension was divided into 1, 2 and 3 stages. Experts of WHO /ISH Steering Committee believe that "staging" refers to the progressive stage of the disease course, but at present, it is only classified according to blood pressure level, which cannot reflect the disease course, so "staging" is used instead of "staging". 1 level hypertension systolic blood pressure 140 ~ 159 mmHg or diastolic blood pressure 90 ~ 99 mmHg2 level hypertension systolic blood pressure 160 ~ 179 mmHg or diastolic blood pressure100 ~109. Systolic blood pressure ≥ 180mmHg or diastolic blood pressure ≥110mmhg in grade 3 hypertension; On the one hand, the harmfulness of hypertension is positively related to the blood pressure level of patients, on the other hand, it also depends on other cardiovascular diseases and risk factors of other diseases. Therefore, according to the risk factors of cardiovascular disease, target organ damage and other diseases at the same time, combined with the blood pressure level, patients with hypertension are divided into four categories: low risk, medium risk, high risk and extremely high risk, so as to guide doctors to determine the treatment opportunity and treatment strategy and estimate the prognosis accordingly.
Hypertension is caused by many pathogenic factors, and its pathogenesis is complex. Dysfunction of central nervous system, changes of humoral endocrine, heredity, dysfunction of renal and vascular baroreceptors, and dysfunction of ion transport in cell membrane may all be involved in its pathogenesis. Hypertension whose etiology has not been fully clarified so far is called essential hypertension or hypertension, which accounts for more than 95% of the hypertensive population. The cause is clear, and the increase of blood pressure is only the manifestation of some diseases, which is called secondary (symptomatic) hypertension, accounting for less than 5%. According to its clinical manifestations and course progress, it can be divided into slow hypertension and fast malignant hypertension.
The vast majority of hypertension (95% ~ 99%) belongs to slow progressive type, which is more common in middle-aged and elderly people. It is characterized by hidden onset, slow progress, long course of 10 to several decades, and few initial symptoms. About half of the patients found that their blood pressure increased when they went to the hospital for medical examination or other diseases. The main clinical manifestations are dizziness, headache, head swelling, palpitation, forgetfulness, dreaminess, tinnitus and fatigue. There are also many patients who do not seek medical treatment until serious complications of hypertension and corresponding symptoms caused by target organ damage occur.
The criteria for judging the curative effect of hypertension include the curative effect of blood pressure and the curative effect of syndrome, according to the 2002 edition of the Guiding Principles for Clinical Research of New Chinese Medicine. Criteria for judging blood pressure efficacy: (1) Significant effects: ① Diastolic blood pressure decreased 10mmHg and reached the normal range; ② Although the diastolic blood pressure has not decreased to normal, it has decreased by 20mmHg or more. There must be 1 items. (2) Effective: ① The diastolic blood pressure decreased less than 10mmHg, but it has reached the normal range; ② The diastolic blood pressure decreased 10 ~ 19 mmHg compared with that before treatment, but it did not reach the normal range; ③ Systolic blood pressure decreased by more than 30mmHg compared with that before treatment. There must be 1 items. (3) Invalid: those who fail to meet the above standards. Criteria for judging curative effect of syndromes:
Quantify the symptoms and signs such as dizziness, headache, impatience and irritability, backache and knee weakness according to light, medium and heavy grades. (1) Significant effect: the clinical symptoms and signs were obviously improved, and the syndrome score decreased by ≥ 70%. (2) Effective: the clinical symptoms and signs were improved, and the syndrome score decreased by ≥ 30%. (3) Ineffective: the clinical symptoms and signs have not improved significantly, or even worsened, and the syndrome score has decreased by less than 30%.
I. Etiology and pathogenesis
Hypertension is the name of modern medicine, and there is no record of hypertension in ancient Chinese medicine literature. Modern scholars believe that hypertension is characterized by dizziness and headache through clinical observation and modern medical discussion, so it can be classified as dizziness and headache in traditional Chinese medicine. The understanding of dizziness and headache in past dynasties is as follows:
(1) Dizziness
Vertigo is a general term for dizziness and vertigo. Dizziness refers to dizziness or black eyes and blurred vision; Dizziness means feeling yourself or the external scenery spinning and standing unsteadily. Both often appear at the same time, so they are collectively referred to as "dizziness". Vertigo is mostly liver disease, which can be caused by wind, fire, phlegm and deficiency.
Vertigo was first seen in Neijing, and it was called "vertigo" and "vertigo". The discussion on the etiology and pathogenesis of this syndrome in Neijing includes four aspects: ① Exogenous pathogenic factors, for example, The Theory of Lingshu Dazu says: "Therefore, the pathogenic factors are in the neck, and when the body is weak, the brain turns when it enters the brain."
When the brain turns, the eyes are anxious, and the eyes are dizzy when they are anxious. "(2) Due to deficiency, such as" On Shu Hai's Spirit ",it is said:" If the marrow sea is insufficient, the brain will turn to tinnitus, and the tibia will be painful and dizzy "; Ling Shu Wei Qi said: "Deficiency on the upper body leads to dizziness". ③ Related to the liver. For example, in Su Wen Lun Li, it is said that "all wind dazzles the liver". (4) It is related to luck. For example, "Su Wenliu's Jacky's Collection" says: "The wood is stagnant ... even the tinnitus is dizzy."
Zhang Zhongjing did not specialize in treating vertigo in Han Dynasty, but only described it in Treatise on Febrile Diseases and Synopsis of the Golden Chamber. Its etiology, or evil attack on the sun, Yang Qiyu can not stretch; Or pathogenic stagnation of shaoyang, dryness on the upper body and empty orifices; Or there is dry feces in the intestine, and the turbid gas rushes up; Or stomach yang deficiency, clearing yang does not rise; Or yang deficiency and flooding, committing Qing yang; Or yin and body fluid are exhausted, yang dies in the upper body, phlegm is blocked in the stomach (under the heart), and Qing Yang does not rise. And prescribe the corresponding treatment. For example, Xiaochaihu decoction is used to treat shaoyang vertigo; Acupuncture Dazhui, Shu Fei and Ganshu to treat dizziness caused by minor diseases; Dachengqi decoction is used to treat dizziness due to deficiency of Yangming fu-organs. Zhenwu decoction treats dizziness caused by deficiency of yin and yang; Gui Ling Shugan Decoction, Xiao Banxia plus Poria Decoction, Alisma Decoction, etc. It laid the foundation for future generations to treat vertigo.
Doctors in Sui, Tang and Song Dynasties basically inherited the viewpoint of Neijing. For example, the Sui Fang's "Evil of Sick Wind" said: "Those who are dazzled by wind are attracted by common cold because of qi and blood deficiency. ...... Every weakness of the body is injured by wind evil. When it enters the brain, the brain becomes anxious, and the eyes become anxious and dizzy. " Tang's "Secrets of Outside Taiwan" and Song's "Historical Records of the Holy Sites" are also demonstrated from common cold. Sun Simiao's Qian Jin Fang Yao first put forward the argument that wind, heat and phlegm cause dizziness. In terms of treatment, on the basis of Zhongjing's prescriptions, a wide range of prescriptions have been collected to enrich them. For example, there are nine prescriptions for dizziness and seven prescriptions for dizziness in the Secret of Outer Taiwan. There are 24 prescriptions for treating vertigo in Shengji Zonglu.
During the Jin and Yuan Dynasties, the concept, etiology and pathogenesis, treatment and prescription of vertigo developed. Jincheng Wuji distinguished vertigo from coma in Treatise on Febrile Diseases. Liu Jin advocated that the etiology and pathogenesis of vertigo should be based on the "fire" in the original disease type: "If the so-called qi is connected to cause dizziness, it means that gold follows the wind, wood fires, and both wind and fire belong to Yang, mostly for both; Yang dominates sports, and when two sports beat each other, they rotate. " Zhang Ze started with "phlegm" and put forward a treatment method based on vomiting. He said in "The Scholars": "My husband is dizzy. To stop drinking in bed, you can use Du Sheng to disperse. After vomiting, take pungent and cold medicine. Anyone who has been dizzy for many years, the chest and diaphragm are congested with phlegm and saliva, and the blood is quite solid, which is very effective in stopping vomiting. " Li Dongyuan's "Blue Room Secret Headache" talks about nausea and vomiting, anorexia, thick and sticky phlegm, black eyes spinning and eyes can't be opened, such as dizziness caused by spleen and stomach qi deficiency and phlegm turbidity. The main prescription is Banxia Baizhu Tianma Decoction. He said: "Foot Taiyin phlegm and headache, unless Banxia; Black eyes and dizziness, wind deficiency and internal injuries, non-gastrodia elata can not be removed. " Zhu Yuan's Danxi advocated the theory of "no dizziness without phlegm", such as "Dizziness in Danxi Heart Method", which said: "Dizziness in the head, qi deficiency in phlegm combined with fire, mainly treating phlegm, carrying qi-invigorating drugs and reducing gunpowder. If there is no phlegm, it will not dazzle, and phlegm will move because of fire; There are also wet sputum. "
In Ming and Qing Dynasties, the discussion on vertigo became more and more perfect. The pathogenesis of vertigo is analyzed in detail, although each has its own emphasis. For example, Xu Chunfu's Ancient and Modern Medical Treatment of Dazzling Door points out that deficiency can be divided into qi deficiency, blood deficiency and yang deficiency, and there are differences between wind-cold and summer-dampness, and emphatically points out that "four qi can take advantage of deficiency", "seven emotions are depressed and phlegm is produced" and "the kidney family can't accept qi and return to yuan, which leads to excessive prostitution". "Hematemesis or metrorrhagia, the liver can't absorb qi" is a common cause of dizziness. Liu Zonghou's books such as Yu Ji Wei Yi and Li Qian's Introduction to Medicine further elaborated the theory of dizziness caused by "excess in the upper body and deficiency in the lower body" in Neijing, and thought that "deficiency in the lower body is qi and blood, while excess in the upper body is phlegm and wind fire". On the other hand, Zhang Jingyue stressed that due to lack of dizziness, he said:
"Nothing is empty and cannot be dazzled"; "Vertigo is a syndrome, with deficiency in its 89th place, while fire and phlegm are only one tenth of the ear." Chen Xiuyuan added fire to wind, phlegm and deficiency, thus summarizing the etiology and pathogenesis of dizziness as wind, fire, phlegm and deficiency. In addition, Yu Mingtuan's argument of "blood stasis and dizziness" is also worthy of attention. He said in "Medicine True Story Volume 4 Vertigo": "There are people who are dizzy because of hematemesis, but there is dead blood in their chests." I know some dizziness caused by the injury of the fallen servant.
Regarding the treatment of vertigo, many books and works in this issue are quite detailed, which are based on the achievements of previous experience. For example, the six essentials of medicine: dizziness, phlegm-fire, wind-phlegm, yin deficiency, yang deficiency, qi deficiency, blood deficiency, blood death, wind-heat, wind-cold and blood death. Syndrome treatment can also be divided into phlegm-dampness, liver fire, kidney deficiency, blood deficiency, spleen deficiency, qi stagnation, abstinence from alcohol, yin deficiency and yang deficiency; Cheng Zhongling not only summarized the treatment methods of dizziness such as liver-fire, phlegm-dampness, qi deficiency, kidney-water deficiency, and life-gate fire failure, but also emphatically introduced the experience of treating dizziness with large doses of ginseng, aconite root and astragalus root. According to Ye's Clinical Guide to Vertigo Medical Records, Hua believes that vertigo is "the wind of liver and gallbladder rising in Yang", and its syndrome is different from phlegm, fire, deficiency in the middle and deficiency in the lower body. The treatment methods also include treating the stomach and liver. In case of fire, antelope, Gardenia, Fructus Forsythiae, pollen, Radix Scrophulariae, Radix Rehmanniae, Cortex Moutan, and Folium Mori should be used to clear up the heat of collaterals, and then treat gallbladder meridian. Those with excessive phlegm must manage Yangming, and eliminate phlegm such as bamboo juice, ginger juice, calamus, orange and Erchen decoction; Ginseng is also used for deficiency in the middle, and poria cocos is also used for external drinking; Deficiency of the lower body must be treated from the liver, tonifying the kidney and nourishing the liver, nourishing yin and suppressing yang, as well as treating the town. It can be said that clear pronunciation and mellow voice is round and not complicated.
In a word, following Neijing, through the continuous summary of doctors in past dynasties, the content of syndrome differentiation and treatment of vertigo is richer and more substantial, and gradually tends to be organized and systematic. After liberation, the experience and theory of predecessors were systematically and comprehensively sorted out, and improved on the basis of practice, and further developed the prescriptions and drugs for syndrome differentiation and treatment.
(2) Headache
Headache is one of the common clinical symptoms. Anyone with exogenous wind, cold, dampness and heat, or phlegm and blood stasis obstruction, goes up through qi; Or liver yang is disturbed and empty; Or qi deficiency and yang deficiency do not rise; Or blood deficiency and brain loss and honor. , can cause headaches. Severe headache, persistent and paroxysmal, also known as "head wind".
Neijing recorded the symptoms of headache for the first time. For example, "On Strange Diseases in Su Wen" said: "The emperor said that people are sick and have headaches for several years. What is the disease in the name of peace? " Qi Bo said: When you have a bad cold, it reaches the bone marrow, which is mainly the brain, causing headache and toothache. This disease is called syncope. Su Wen's Five Zang Roots says: "Headache is the upper part, the lower part is weak and the upper part is solid, and the foot yin is full of yang, even entering the kidney."
"Lingshu Jing" says: "Bladder Jing, the foot sun is also. If you move, you will feel sick and have a headache, your eyes will seem to fall off, and your neck will be pulled out ... ". "Su Wentong's Comment on Deficiency and Excess" says: "Headache and tinnitus, nine orifices are unfavorable, and the stomach is also raw." The cause is nothing more than exogenous factors, internal injuries to both ends, or exogenous wind and cold, or deficiency of the lower body, or gastrointestinal dysfunction, which leads to difficulty in getting up, running and pain. These discussions in Neijing laid a theoretical foundation for the treatment of headache.
In Treatise on Febrile Diseases written by Zhang Zhongjing in the Han Dynasty, there are symptoms of headache such as taiyang disease, Yangming disease, shaoyang disease and Jueyin disease. It is believed that the three Yang meridians are all on the top, and the Jueyin meridians will also be on the top, which is based on the fact that evil guests pass through the meridians, leading to headaches. Because of its different syndrome types, the treatment methods are also different, such as treating sun headache, using pungent warming agent to dispel cold; Treat "typhoid fever without defecation for six or seven days, headache and fever" and give Chengqi decoction to relieve it; To treat Jue Yin disease "retching, spitting, headache", Wuzhuyu decoction is used to warm and disperse Jue Yin and cold evil, so as to reduce turbid Yin. Medicine based on syndrome differentiation is full of the spirit of syndrome differentiation and treatment. Sui Fang's Theory of Headache Caused by Phlegm Stasis and Wind Deficiency says: "Phlegm and blood stasis means that the phlegm is above the chest, and a bad cold makes Yang Qi fail, so that phlegm and water can't gather, but go up, get mixed with wind and phlegm, and rush to the head, making the headache worse, or last for several years. Sun Simiao's "Eight Winds on the Head and Face of Ganjin Prescription" in Tang Dynasty lists some effective prescriptions for treating headache in ancient times, such as the external treatment method of "Toufeng Powder" (aconite and salt) for treating headache, which is quite enlightening to later generations.
In Jin and Yuan Dynasties, Li Dongyuan divided headaches into internal headache and external headache. On the basis of treating headache in Neijing and Treatise on Febrile Diseases, Taiyin headache and Shaoyin headache are added. This method of treating headache by dividing meridians has a far-reaching impact on future generations. "Blue Chamber Headache Gate" says: "The sun has a headache and the evil wind has a tight pulse, mainly Chuanxiong, Notopterygium, Angelica pubescens and Ephedra; Shaoyang meridian has headache, thin pulse, cold and heat, mainly Bupleurum; Yangming has headache, spontaneous sweating, fever, aversion to cold, and slow and firm pulse, mainly including Cimicifuga, Radix Puerariae, Gypsum Fibrosum and Radix Angelicae Dahuricae; There must be phlegm in lunar headache ... Rhizoma Atractylodis, Rhizoma Pinelliae and Rhizoma Arisaematis are the main components. Headache due to shaoyin meridian, unfamiliarity of Yin San yang meridian, foot cold turning to cold syncope, and deep and thin pulse, mainly ephedra, aconite and asarum; Pain on the top of Jueyin, or cold foam, and slow pulse. Mainly based on Evodia rutaecarpa soup. " There is another cloud: "Blood deficiency headache, mainly angelica and Chuanxiong; Headache due to qi deficiency, mainly astragalus; For headache due to deficiency of both qi and blood, Tiaozhong Yiqi decoction is as effective as spirit. Baizhu Banxia Tianma decoction, a medicine for treating phlegm and headache; Empty ointment is a medicine for rheumatic fever and headache; Qianghuo Fuzi decoction is also a medicine for treating Jueyin headache, which has great reference value for syndrome differentiation. Zhu Danxi's "Danxi Heart Therapy for Headache" not only followed Dongyuan's theory, but also pointed out: "Headache is mainly caused by excessive phlegm, and those with severe pain have more fire, and those who vomit can be eliminated", which is also an experience.
In the Ming Dynasty, Wang Kentang elaborated on the etiology and pathogenesis of headache. "Treating headache according to the syndrome" said: "The head looks like the sky, and the qi of clearing the yang in the three yang and six houses will all be here; The blood of the essence of three yin and five zang is also injected here. So the weather, the evil of six evils, the change of popularity and the rebellion of five thieves can all hurt each other. Or cover up its clarity, or block its meridians, because its gas is thin, depression is full of pulse, and fullness is painful. " Zhang Jingyue's "Jing Yue Quan Shu Headache" says: "Anyone who has a headache must first examine it for a long time, and then distinguish the exterior from the interior. It must be the pathogenic factors that cover up the temporary pain, and the long-term illness must be the vitality. For the time being, there are evil spirits, and this cold attacks the meridians, so it is advisable to evacuate and avoid clearing; If there is evil inside, if the fire of Sanyang flourishes inside, it is appropriate to distinguish clearly and avoid rising and dispersing, which is also the method to cure evil. If it is a long illness, it will either develop or recover. If it is manifested as deficiency, it will develop slightly. Or win with yang, and it will be slightly hot; Or insufficient underwater, take virtual fire; Or yang deficiency is better than yang deficiency, and yin cold is better than yin cold ",pointing out:" Those who suffer from temporary pain should pay attention to evil spirits; People who have been ill for a long time should regain their vitality, which will strengthen their contours; However, there are also those who suffer from temporary pain deficiency and those who suffer from long-term pain, which should be distinguished in detail because of the pulse. " Li Zhongzi's "Headache Needs Medical Treatment" briefly describes the different syndromes of this syndrome: "Those who suffer from wind pain should pull out the evil wind; Those who suffer from heat are troubled and hate heat; Because of wet pain, headache turns to yin; Because of phlegm pain, people feel dizzy and want to vomit endlessly; Suffering from cold pain, anxiety, aversion to cold, trembling; Those who suffer from qi deficiency and pain have a strong pulse. Those with blood deficiency and pain are good at fright and weak pulse. " Li Zhongzi also clarified the mechanism of using wind medicine for headache: "There are many causes of headache, but who used wind medicine in ancient prescriptions?" On the top of the mountain, only the wind can reach it. Those who taste thin, the yang in the yin, and those who ascend from the ground to the sky, are practical, that is, deficiency heat and false introduction. "
Ye accumulated rich experience in treating headache in Qing Dynasty. Zou pressed "the head is the meeting of all yang, and the liver pulse of Jue Yin must be at the top. Yin-cold pathogen can't go up against Yang, but turbid pathogen can get the above syndrome. Wind and fire in Jueyin can cause pain. Therefore, the symptoms of headache are caused by poor yang clearing and fire wind taking advantage of it. Observing the treatment of headache is nothing more than that. If the headache is caused by yang deficiency and turbid obstruction, qi stagnation and blood stasis, use insect ants to search for blood collaterals and promote Yang Qi; If the fire wind changes, and the summer wind is depressed and has a headache, fresh lotus leaves, kudingcha, Vitex negundo and Gardenia can be used. The irritating powder is light and clear; If headache is caused by yin deficiency and hyperactivity of yang, Zhongjing Fumai Decoction, Ganmai Jujube Decoction, Radix Paeoniae Alba and Oyster are used to relieve deficiency and calm down the wind. Headache due to syncope of yang wind is mainly caused by Polygonum Multiflori Radix, Semen Platycladi, Flos Chrysanthemi, Radix Paeoniae Rubra for calming liver and calming wind and nourishing kidney and promoting fluid production. Medicine should change with the syndrome, which is worth emulating.
To sum up, since Neijing, the treatment of headache by Chinese medicine has become more and more abundant and complete.
It should be noted that during the Yuan, Ming and Qing Dynasties, some doctors also realized that there was a certain internal relationship between some vertigo and various syndromes such as headache, head wind, liver wind and stroke, for example, Zhu Danxi said that "vertigo is a gradual attack of stroke". Yu Tuan's "Medicine True Story Volume 4 Vertigo" said: "Vertigo is a gradual attack of stroke". Zhang Jingyue also said, "There are different types of dizziness, so is the general dizziness ...". As for middle age, it is common for people to see dizzy servants fall. However, people whose luck suddenly stops are called dizzy; What falls awake is called phlegm in the wind. Hua pointed out more clearly in the annotation of vertigo cases in Clinical Guide: "The origin of this syndrome is liver wind; When liver wind, stroke and head valve are combined, participate. These discussions coincide with the correlation between hypertension and its complications discussed today.
Based on the understanding of hypertension-related manifestations such as dizziness and headache, contemporary physicians believe that hypertension is mostly caused by the following factors: emotional imbalance, worrying about depression, leading to liver failure, stagnation of liver qi, and wind and yang floating up; Or stagnation for a long time, resulting in liver yin damage, liver yang hyperactivity, resulting in cost disease; Improper diet, eating too much fat and sweets, or eating too much sodium, or drinking too much, damage to the spleen and stomach, spleen loss of health, resulting in abnormal water and liquid metabolism, phlegm and dampness, is the cause of this disease; Or kidney essence deficiency, excessive sexual intercourse, kidney essence loss, unable to produce marrow, empty marrow sea, or tiangui failure, imbalance of chong and ren, resulting in this disease.
The occurrence of this disease is mostly slow and the course of disease is long, but a few patients may have a sudden onset, a marked increase in blood pressure and acute clinical manifestations. The lesions are located in liver, kidney, heart and spleen, in which the liver and kidney are the main diseases, and the nature of the disease is deficiency of essence, with yin deficiency of liver and kidney as its origin, and hyperactivity of liver yang and phlegm and blood stasis as its standard. Because the disease is mostly caused by hyperactivity of liver yang, it is mainly upward, which can also lead to internal movement of liver wind, convulsion and coma, and the condition is dangerous. The course of this disease is generally long, and the transformation of pathogenesis is mostly slow. At first, it is mostly empirical, which can damage the yin of liver and kidney for a long time, leading to yin deficiency of liver and kidney; Furthermore, yin damages yang, forming a syndrome of deficiency of both yin and yang; Yin deficiency of liver and kidney can also lead to hyperactivity of liver yang because water does not contain wood, resulting in yin deficiency and hyperactivity of yang syndrome, with insufficient cost and excessive substances. Clinically, there are seven types: ① hyperactivity of liver-yang: long-term depression, depression and anger hurting the liver, stagnation of liver-qi, wind and yang floating up, or stagnation of qi leading to fire, disturbance of liver-fire leading to increased blood pressure, dizziness, head swelling, headache and other symptoms. ② Yin deficiency and hyperactivity of yang: due to long-term illness, fornication or old age, water does not contain wood, wood is lacking, and liver-yang imbalance empties, which leads to an increase in blood pressure. (3) Deficiency of kidney essence: excessive indulgence consumes kidney essence, or deficiency of kidney essence in the elderly makes the medullary sea empty and blood pressure rise. ④ Deficiency of both yin and yang: most of them are in the late stage of the disease, and the kidney is affected by the disease for a long time, resulting in deficiency of both kidney yin and kidney yang, dizziness and tinnitus, backache and leg weakness, and chills. ⑤ Phlegm-dampness connotation: dizziness, heavy head, chest tightness, anorexia and other symptoms, which are mostly caused by overeating and drinking too much, damaging the spleen and stomach, losing spleen health and accumulating wet phlegm. ⑥ Impairment of Chong-Ren: Some women may get sick when the kidney qi is failing, the pulse of Chong-Ren is weak, the blood sea is drying up, the kidney is deficient, and the fire is inflamed. ⑦ Blood stasis: Deficiency of viscera, disharmony between qi and blood, stagnation of liver-qi, dampness due to spleen deficiency, or yin deficiency of liver and kidney, all of which can lead to blood stasis and dizziness and headache. Among the above syndromes, yin deficiency and yang hyperactivity account for the largest proportion, accounting for about 50% of the disease.
Second, dialectical medication
The pathological mechanism of this disease is hyperactivity of liver yang and deficiency of liver and kidney. The first treatment is calming liver yang. Or subduing yang, purging fire and extinguishing wind, nourishing kidney and liver, resolving phlegm and promoting blood circulation, depending on the condition. In the later stage, it mainly regulates the yin and yang of the kidney. Its clinical prescriptions for syndrome differentiation and treatment are as follows:
(A) hyperactivity of liver yang
【 Key points of syndrome differentiation 】 Headache and eye pain, dizziness and tinnitus, vexation and irritability, restless night sleep, or red face and red eyes, bitter taste, dry stool, Huang Chi urine, red tongue with yellow fur, and thready or rapid pulse.
[treatment] calming the liver and suppressing yang.
[Prescription] Tianma Gouteng Drink: Gastrodia elata 15g, Uncaria Uncaria 12g, Raw Concha Haliotidis 30g, Raw Gardenia 12g, Scutellariae Radix 20g, Radix Cyathulae 20g, Eucommiae Cortex 20g, Herba Taxilli 20g, Caulis Polygoni Multiflori 20g, Poria 15g and Chrysanthemum/kloc.
Gastrodia elata, Uncaria rhynchophylla and Concha Haliotidis are used to calm the liver and calm the wind, while Gardenia and Scutellaria baicalensis are used to clear heat and purge fire, so that the heat of liver meridian will not be excessive; Chrysanthemum clearing liver and improving eyesight; Achyranthes bidentata can lead blood downward and tonify liver and kidney together with Eucommia ulmoides and Taxilli. Caulis Polygoni Multiflori, Poria, tranquilizing. * * * Play the function of calming the liver and suppressing yang.
(2) yin deficiency and yang hyperactivity
【 Key points of syndrome differentiation 】 Vertigo, headache, heaviness, insomnia, fever in hands and feet, tinnitus, palpitation, red tongue tip, thin and white fur, and thready or rapid pulse.
[Treatment] Nourishing yin and suppressing yang.
[Prescription] Qijudihuang Pill and Zhengan Xifeng Decoction: Radix Rehmanniae Preparata 24g, Cornus officinalis 15g, Yam 12g, Poria cocos 18g, Uncaria rhynchophylla 12g, Lycium barbarum 15g and Chrysanthemum/kloc-0.
Uncaria rhynchophylla, chrysanthemum and oyster in the prescription calm the liver and suppress yang; Radix Rehmanniae Preparata, Fructus Corni and Herba Taxilli nourish kidney yin, astringe liver and solidify essence; Poria cocos and yam strengthen the spleen and tonify the kidney; Tortoise shell and medlar nourish yin, liver and eyesight.
(3) Deficiency of kidney essence
【 Key points of syndrome differentiation 】 Vertigo, tinnitus, less sleep, dreaminess, backache and leg weakness, or headache and upset due to heat, red tongue with little or no coating, and thin or weak pulse.
[Treatment] Nourish kidney essence.
[Prescription] Add and subtract Liuwei Dihuang Pill and Zuogui Pill: Radix Rehmanniae Preparata 24g, Fructus Corni 18g, Rhizoma Dioscoreae 18g, Cortex Moutan 15g, Rhizoma Alismatis 15g, Poria 12g and Eucommia ulmoides Oliv. 20g, tortoise plastron 20g, medlar 15g.
Rehmannia glutinosa in the prescription nourishes kidney yin and benefits essence. Cornus officinalis nourishes the kidney and liver, and yam nourishes the kidney and spleen, which is supplemented by three yin, and the kidney is cured, which is what Bing Wang said: "The master of strong water lies in yang control" and then Alisma orientalis is used with Radix Rehmanniae Preparata to purge the kidney and reduce turbidity; Cortex Moutan and Fructus Corni purging liver fire; Poria cocos and yam ooze spleen dampness. This compatibility can not only tonify diarrhea and deficiency, but also tonify yin and prevent the tonic from stagnating. Then Eucommia ulmoides Oliv. Lycium barbarum, tortoise plastron glue and Achyranthes bidentata can enhance the strength of tonifying kidney, replenishing essence and strengthening waist.
(D) Deficiency of Yin and Yang
【 Key points of syndrome differentiation 】 Headache, dizziness, tinnitus, blurred vision, soreness of waist and knees, weakness of limbs, shortness of breath, aversion to cold limbs, increased nocturia, pale or red tongue, white fur, heavy or thready pulse.
[Treatment] Nourishing yin and supporting yang.
[Prescription] Jinkui Shenqi Pill: Radix Rehmanniae 24g, Fructus Corni 12g, Rhizoma Dioscoreae 15g, Rhizoma Alismatis 9g, Radix Aconiti Lateralis Preparata 12g, Cortex Cinnamomi 9g, and Herba Taxilli 15g.
In the prescription, Radix Rehmanniae is used to nourish kidney yin, while Fructus Corni and Rhizoma Dioscoreae are used to nourish liver and spleen and tonify kidney yin. Cinnamon and aconite are used to warm and tonify kidney-yang to supplement yin and Yang Can. It can be supplemented with Herba Taxilli for strengthening waist and tonifying kidney, Rhizoma Alismatis and Poria for promoting diuresis and eliminating dampness, and Cortex Moutan for clearing liver and purging fire, together with drugs for warming kidney and yang, so as to tonify diarrhea in the middle and make it not greasy.
(V) Connotation of phlegm-dampness
【 Key points of syndrome differentiation 】 Dizziness, headache, heavy head, chest tightness, palpitation, white and greasy tongue coating and smooth pulse.
[Treatment] Eliminating dampness and resolving phlegm is supplemented by calming the liver.
[Prescription] Banxia Baizhu Tianma Decoction: clear Pinellia ternata 12g, raw atractylodes macrocephala 15g, gastrodia elata 18g, Poria cocos 15g, ginger 6g, raw licorice 3g, 5 jujubes and orange 10g.
Pinellia ternata is used for eliminating dampness and phlegm, reducing adverse reactions and stopping vomiting, while Gastrodia elata is used for eliminating phlegm and calming wind and stopping dizziness. The combination of the two drugs is an important drug for treating wind phlegm, dizziness and headache. Rhizoma Atractylodis Macrocephalae is compatible with Rhizoma Pinelliae and Rhizoma Gastrodiae, and has the effects of eliminating dampness, resolving phlegm and stopping dizziness. Poria cocos, combined with Atractylodes macrocephala, is especially effective in treating phlegm. Orange, regulating qi and resolving phlegm; Ginger and jujube harmonize the spleen and stomach. Licorice. Blend with medium coke to adjust the medicinal properties. All kinds of drugs are combined to make the wind extinguish phlegm and dizziness heal itself.
(6) appointment and removal impairment
【 Key points of syndrome differentiation 】 This type is more common when women's days are almost over. Symptoms include burning head and face, sweating due to excessive internal heat, dizziness and headache, restlessness, dry throat, cold feet and soft knees, edema, irregular menstruation and rapid pulse.
[Treatment] Tonifying kidney and purging fire, regulating chong and ren.
[Prescription] Erxian Decoction: Rhizoma Curculiginis 12g, Herba Epimedii 12g, Radix Morindae Officinalis 10g, Herba Cistanches 15g, Cortex Phellodendri 10g, Rhizoma Anemarrhenae 9g, Radix Angelicae Sinensis 15g, Radix Paeoniae Alba/.
This prescription, named Erxian, is mainly composed of two herbs: Rhizoma Curculiginis and Herba Epimedii, which are compatible with Morinda officinalis how to warm the kidney and help yang, and the three herbs warm the kidney and strengthen the yang. Cortex Phellodendri and Rhizoma Anemarrhenae nourish kidney yin and purge liver fire; Adding Radix Angelicae Sinensis, Radix Paeoniae Alba, and Herba Leonuri to nourish blood and regulate Chong and Ren; Oysters lurk in the sun. The whole prescription is compatible with tonifying kidney and strengthening yang, nourishing yin and purging fire, and has the functions of tonifying kidney and purging fire and regulating chong and ren.
(7) Blood stasis
【 Key points of syndrome differentiation 】 Persistent headache, immobility, numbness on one side, heartache, chest pain, cyanosis of face and lips, dark purple tongue and thready pulse.
[Treatment] Promote blood circulation to remove blood stasis and dredge blood vessels.
[Prescription] Xuefu Zhuyu Decoction: Radix Paeoniae Rubra and Radix Rehmanniae each 65438±05g, Semen Persicae and Flos Carthami each 65438±00g, Radix Bupleuri, Radix Curcumae and Radix Achyranthis Bidentatae each 65438±02g, Herba Leonuri 65438±08g, Cortex Albizziae 20g and Radix Glycyrrhizae 6g.
Radix Paeoniae Rubra, Radix Rehmanniae, Semen Persicae, Carthami Flos, Herba Leonuri, and Achyranthis Radix are used in the prescription to promote blood circulation and remove blood stasis, so that blood flows downward and blood vessels are unobstructed. Bupleurum, Yujin soothes the liver and relieves depression; Albizia bark soothes the nerves; Glycyrrhiza uralensis Fisch blends various drugs. All kinds of drugs cooperate to make qi and blood run and all kinds of syndromes heal themselves.
Thirdly, acupuncture treatment.
Acupuncture has a certain curative effect on essential hypertension, and has obvious antihypertensive effect on patients with early hypertension, especially the reduction of systolic blood pressure, which is also beneficial to improve clinical symptoms. Acupuncture treatment of secondary hypertension can relieve clinical symptoms, but the curative effect is not consolidated, so it must be treated according to its primary disease.
(1) body acupuncture therapy
Treatment principle: regulating yin and yang, calming liver and benefiting kidney. Those with hyperactivity of liver fire tend to reduce yang hyperactivity, those with hyperactivity of yang due to yin deficiency mainly nourish water and tonify kidney, those with excessive phlegm and dampness are supplemented by phlegm and dampness, and those with deficiency of both yin and yang should supplement both yin and yang.
Acupoints: Fengchi, Quchi, Zusanli and Taichong.
Acupoint selection based on syndrome differentiation: excessive liver fire: intermittent overshoot; Yin deficiency and yang hyperactivity: Taixi, Sanyinjiao and Shenmen; Excess of phlegm and dampness: abundance, internal clearance; Deficiency of Yin and Yang: Qi Hai and Guan Yuan (moxibustion).
Operation: Select 3-5 acupoints at a time, and keep needles for 20min at a time, once a day/kloc-0. Except Fengchi point, all points in the prescription are treated by twisting combined with lifting, inserting and purging, and intermittent acupuncture is in line with the method of "welcoming and seizing". The needle tip of the wind pool is inserted into the contralateral orbit to make the needle feel the highest, which can immediately relieve the pain of headache and dizziness, and can be used for static needle retention. Those with yin deficiency and hyperactivity of yang should supplement Taixi point and Sanyinjiao point, and those with severe insomnia should attack Shenmen. For those with excessive phlegm-dampness and chest tightness and fullness, lifting, inserting, twisting and diarrhea are used in Fenglong and Neiguan.
Fengchi is the intersection of Foot Shaoyang Meridian and Yangwei Meridian, and Taichong is the starting point of Foot Jueyin Meridian. These two acupoints are used for purging yang, especially for patients with hypertension and headache. Quchi and Zusanli belong to Yangming of hands and feet. Yangming is the meridian of qi and blood, and diarrhea can dispel yang evil. It is the glorious point of the liver meridian and the strange point of the sun on the head and face, and the stagnation of heat in the liver and gallbladder can be relieved by diarrhea or pricking blood; Neiguan and Fenglong belong to the pericardium meridian of hand jueyin and the stomach meridian of Yangming, which harmonize the spleen and stomach with phlegm. Taixi and Shenmen are the original acupoints of kidney meridian and heart meridian respectively. These two acupoints can nourish yin, calm the heart and soothe the nerves, and are often used to treat asthenic insomnia.
(2) Other acupuncture methods
1. Ear acupuncture selects ear points such as liver, kidney, heart, ear tip, hypotensive groove, Shenmen, liver yang, forehead and pillow; Choose 2 ~ 3 acupoints at a time, use moderate and strong stimulation, and keep the needle for 20min minutes, once a day/kloc-0. According to the needle, the needle can be buried for 1 ~ 2 days.
2. Ear points are selected according to beans: hypertension point, hypotensive point, hypotensive ditch I and hypotensive ditch II. The matching points are endocrine, Shenmen, large intestine, lung and temple. According to the stages of hypertension, 1 ~ 2 pairs of main points are selected, and the matching points are added with symptoms. Operation method: Determine the therapeutic acupoints, disinfect locally, stick the seed tape of Vaccaria seed on the acupoints, and apply pressure. The patient feels acid, numbness, edema, pain or fever. Press 3 times a day. Stick only one side at a time, change it after 3 days, and smear it alternately on both ears.
3. Acupoints are divided into three groups: ① Zusanli and Neiguan; ② Sanyinjiao and Hegu; ③ Quchi and Taichong. These three groups of acupoints can be used alternately. Take a group of acupoints and inject 5% or 10% glucose solution for 3 ~ 5m 1 each time.