Based on the Theory of Five Yun Six Qi to Study the Clinical Effect of Chaigui Decoction on Jueyin Type Hypertension

Jingru GAO, Hongjun ZHU, Han YAN, Xiaohai HU, Yuanchun YAO

1. Nanjing University of Chinese Medicine, Nanjing 214071, China; 2. Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi 214071, China

Abstract [Objectives] To study the clinical effect of Chaigui decoction (CGD) on Jueyin type hypertension based on the theory of Five Yun Six Qi. [Methods] 52 patients with Jueyin type hypertension in Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine from January, 2020 to March, 2021 were randomly divided into Western medicine control group (18 cases) and CGD group (34 cases). CGD group was treated with CGD, while the control group was treated with irbesartan or amlodipine. [Results] After treatment, the systolic blood pressure (SBP) of the two groups decreased significantly, the difference was statistically significant (P<0.05). After treatment, the diastolic blood pressure (DBP) of CGD group was significantly lower than that of the control group (P<0.05). [Conclusions] Based on the theory of Five Yun Six Qi, CGD has significant effect on Jueyin type hypertension, and the effect of reducing DBP is better than that of Western medicine control group.

Key words Five Yun Six Qi, Jueyin, Hypertension, Chaigui decoction

1 Introduction

Hypertension is one of the major cardiovascular and cerebrovascular diseases. Among the people aged 18 and over in China, the crude prevalence rate of hypertension has reached 27.9%, and the weighted prevalence rate is 23.2%. Based on this, it is estimated that one out of every four adults is a hypertensive patient[1]. The prevalence of hypertension in children and young and middle-aged adults also continues to increase. Among the patients with cardiovascular diseases and those died of cardiovascular diseases, hypertension is the biggest reason. Effective control of hypertension can minimize the morbidity and mortality of cardiovascular diseases[2]. Long-term use of antihypertensive drugs of Western medicine to control blood pressure is a major burden for patients, society, and even the country. Traditional Chinese medicine has certain advantages in the treatment of hypertension and has achieved certain results. It can improve the patient’s symptoms. But the shortcomings are also very obvious, including weak strength in lowering blood pressure[3], insufficient basic research, lack of clinical evidence, difficulty for clinicians to grasp accurately and conduct treatment accurately[4].

The theory of Five Yun Six Qi is the basis of TCM theory. It is the study of the laws of climate change and the impact of the climate change on human life in ancient China[5]. The clinical technology constructed based on the Five Yun Six Qi combining the characteristics of specific disease has a good clinical effect[6]. In this study, according to the theory of Five Yun Six Qi, CGD was used to treat Jueyin type hypertension (often accompanied by Chaihu constitution and liver depression and blood deficiency syndrome), and significant clinical efficacy was achieved. CGD is significantly better than the Western medicine group in reducing diastolic blood pressure.

2 Materials and methods

2.1 Case source and groupingTotal 52 patients with Jueyin type 1-2 grade hypertension who were treated at Wuxi Hospital of Traditional Chinese Medicine from January, 2020 to March, 2021 were included. Using the random number table method, they were randomly divided into Western medicine group (control group) (18 cases, including 10 males and 8 females, aged 34-70 years) and CGD group (34 cases, including 18 males and 16 females, aged 34-68 years). There was no statistical difference in gender and age distribution between the two groups.

2.2 Diagnostic criteria

2.2.1Diagnostic criteria of Western medicine. Referring toGuidelinesforPreventionandTreatmentofHypertensioninChina(2018 Revised Edition)[1], diagnostic criteria for hypertension were determined: In the absence of antihypertensive drugs, clinic systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. According to the elevation level, hypertension was divided into grade 1, grade 2, and grade 3. Grade 1 (mild) hypertension: systolic blood pressure 140-159 mmHg and (or) diastolic blood pressure 90-99 mmHg; Grade 2 (moderate) hypertension: systolic blood pressure 160-179 mmHg and/or diastolic blood pressure 100-109 mmHg.

2.2.2Pulse differentiation criteria for Jueyin type hypertension. The pulse was flat or floating, often accompanied by fatigue, yellowish face, and swollen appearance.

2.2.3Inclusion criteria. The inclusion criteria were as follows: (i) Between the ages of 35-70 years, with no limitation on gender; (ii) Had not taken antihypertensive drugs in the past 2 weeks; (iii) The systolic blood pressure was 140-179 mmHg and/or the diastolic blood pressure was 90-109 mmHg in any two times of screening; (iv) Agree to participate in the trial, adhere to the follow-up, and go to the hospital by oneself; (v) Sign the informed consent form.

2.2.4Exclusion criteria. (i) Suspected or confirmed secondary hypertension; (ii) Drugs thought to be necessary for other diseases may affect blood pressure; (iii) Cardiovascular and cerebrovascular diseases such as stroke, myocardial infarction, and heart failure occurred in the past 6 months; (iv) A history of atrial fibrillation or frequent arrhythmia; (v) Liver function test results exceed the upper limit of normal 2 times, or blood creatinine greater than 176 μmol/L, or blood potassium greater than 5.5 mmol/L; (vi) pregnant or lactating women; (vii) Other diseases that are not suitable for participating in the trial; (viii) Poor compliance with the research process.

2.3 Treatment plansThe patients in the CGD group were given CGD (Xiaochaihu decoction ± Danggui Shaoyao powder), for 4 weeks.

CGD was composed of Bupleuri Radix (12 g), Scutellariae Radix (9 g), Glehniae Radix (9 g), Pinelliae Rhizoma (9 g), Angelicae Sinensis Radix (9 g), Paeoniae Radix Alba (30 g), Chuanxiong Rhizoma (10 g), poria with host wood (12 g), Atractylodis Macrocephalae Rhizoma (12 g), Alismatis Rhizoma (24 g) and Zingiberis Rhizoma Recens (9 g). It was prepared by the preparation room of Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, 2 bags for each dose, 200 mL for each bag, two bags a day at morning and evening, respectively.

The patients in the control group were treated with antihypertensive drugs (AHD), amlodipine (5 mg, once a day) or irbesartan (150 mg, once a day). The course of treatment was 4 weeks.

2.4 Indicators and methodsBlood pressure was measured with mercury sphygmomanometer by dedicated persons in accordance with the standard specification. Each measurement was repeated three times, and the average value was taken as the measured value. Every day, patients used electronic sphygmomanometer or mercury sphygmomanometer to monitor their blood pressure at home. Their blood pressure is checked by the researchers every week. Researcher’s check results were used as research data.

2.5 Statistical methodsAll data uses SPSS 20.0 for statistics. The difference in blood pressure before and after treatment and between groups was tested by independent sample student-Ttest.

3 Results and analysis

After treatment, the SBP of the two groups decreased significantly (P<0.05) (Table 1, Fig.1), and the diastolic blood pressure of the CGD group decreased significantly and was significantly lower than that of the control group (P<0.05) (Table 2, Fig.2).

Table 1 Efficacy of CGD for systolic blood pressure of hypertensive patients

Table 2 Efficacy of CGD for diastolic blood pressure of hypertensive patients

Fig.1 Efficacy of CGD for systolic blood pressure of hypertensive patients

Fig.2 Efficacy of CGD for diastolic blood pressure of hypertensive patients

4 Discussion

Hypertension can be divided into primary and secondary, and true and false, and the pulse condition is also classified into Yin and Yang. Therefore, the treatment of hypertension should be classified. “Diseases, pulse conditions, and symptoms must be treated together, and prescriptions, diseases, and patients must be mutually verified” is the basic principle of treatment. According to the theory of Five Yun Six Qi, hypertension was divided into three types in this study: Yangming type hypertension, Taiyang type hypertension and Jueyin type hypertension. Among them, CGD has significant efficacy for Jueyin type hypertension.

The results of this study show that in terms of reducing systolic blood pressure, the CGD group had the same effect as the Western medicine control group; in terms of reducing diastolic blood pressure, CGD was significantly better than the control group (P<0.05). Thus, it is proved from a clinical perspective that CGD has a significant effect on Jueyin type hypertension. This provides a new Chinese medicine diagnosis and treatment technology and method for the young and middle-aged hypertensive patients whose diastolic blood pressure is increased, and also reminds us that under the guidance of the Five Yun Six Qi, traditional Chinese medicine may have a better clinical effect than traditional syndrome differentiation methods in the treatment of hypertension.

Literature has also preliminarily confirmed that the use of CGD to treat hypertension has its modern pharmacological basis. CGD is the abbreviation of Xiaochaihu decoction and Danggui Shaoyao powder. Xiaochaihu decoction can significantly increase the blood flow of cerebral blood vessels, thereby improving the symptom of dizziness in patients with hypertension[7]. It also helps maintain the elasticity of blood vessel walls, inhibit the infiltration of fat into blood vessels and inhibit the changes of macrophages in hypertensive patients[8], thereby improving blood pressure through improving the elasticity of the patient’s arteriosclerotic blood vessels. Angelicae Sinensis Radix, Paeoniae Radix Alba and Chuanxiong Rhizoma in Danggui Shaoyao powder contain antihypertensive components[9]. The above-mentioned literature tracking may explain part of the mechanism of CGD in treating hypertension. A more precise mechanism needs further research.

Further carrying out clinical and basic research on natural Chinese herbal medicines and developing new, safe and effective Chinese medicine compounds for hypertension is a hot topic in hypertension research. This paper accumulates certain clinical data and inspiration for this.