TCM syndrome differentiation of hypertension needs to be standardized

Hypertension belongs to the category of vertigo and headache in traditional Chinese medicine However, it can be seen from the investigation of the authoritative literature and the academic community's clinical syndrome differentiation that there are great differences in TCM syndrome differentiation of hypertension, which greatly reduces the standardization and scientificity of syndrome differentiation and treatment of the disease At present, there are many standards of hypertension syndrome differentiation, but the authoritative standards of hypertension syndrome differentiation are not the same The guiding principles for clinical research of new drugs of traditional Chinese medicine (hereinafter referred to as the "principles") set up four syndromes for hypertension: hyperactivity of liver fire, hyperactivity of yin and Yang, hyperactivity of phlegm dampness and deficiency of yin and Yang; the diagnostic efficacy standard for syndrome of traditional Chinese medicine (hereinafter referred to as the "standards") set up four syndrome differentiation criteria for vertigo, including disturbance of wind and Yang, turbid phlegm, deficiency of Qi and blood, deficiency of liver and kidney yin Vertigo of hypertension is Vertigo can be used as a reference for syndrome differentiation and comparison The other two syndromes are different from each other except that phlegm dampness and phlegm turbid upper Mongolia, yin deficiency yang hyperactivity and liver kidney yin deficiency are basically the same In addition, the fifth and seventh editions of the unified textbook "internal medicine of traditional Chinese medicine" differentiate vertigo into four syndromes: hyperactivity of liver Yang, deficiency of Qi and blood, deficiency of kidney essence and obstruction of phlegm (dampness) The six editions of teaching materials are divided into six types: wind Yang disturbance, liver fire inflammation, phlegm turbid, deficiency of Qi and blood, deficiency of liver and kidney yin, blood stasis blocking the orifices Compared with the five and seven editions of the six editions of the textbook, it is stated that the same is deficiency of Qi and blood, while hyperactivity of liver Yang and disturbance of wind Yang, obstruction of phlegm (dampness) and obstruction of phlegm and turbid phlegm are the same; there are four obvious differences between them: deficiency of kidney essence, inflammation of liver fire, deficiency of liver and kidney yin and obstruction of blood stasis In addition to the two syndromes of liver fire inflammation and blood stasis obstructing orifices, the other four syndromes are identical According to the syndrome differentiation of hypertension and vertigo, the eight syndromes of deficiency of Qi and blood, hyperactivity of liver fire (inflammation of liver fire), dampness of phlegm (dampness of phlegm, obstruction of phlegm), hyperactivity of liver Yang (disturbance of wind and Yang), deficiency of liver and kidney yin (hyperactivity of yin and Yang), deficiency of kidney essence, deficiency of yin and Yang, obstruction of orifices by blood stasis are put forward Generally speaking, the authoritative literature is based on the understanding that "all wind and vertigo belong to liver", "no phlegm, no blood stasis, no deficiency, no vertigo" Through the comparison of authoritative literature, we can see that there is no completely unified syndrome differentiation standard for hypertension The coexistence of most standards of TCM clinical syndrome differentiation will inevitably lead to different ends of clinical syndrome differentiation Based on the analysis of the clinical reports on the treatment of hypertension with TCM syndrome differentiation in the past 20 years, it can be clear that the syndrome differentiation of hypertension can be divided into two categories: one is to differentiate hypertension with reference to authoritative literature; the other is to differentiate hypertension with personal clinical experience In the past 20 years, more than 110 papers on the syndrome differentiation of hypertension were summarized, and 44 syndromes were obtained, including liver yang hyperactivity (wind yang hyperactivity), wind phlegm hyperactivity (liver wind phlegm turbidity), liver and kidney yin deficiency (water does not contain wood), liver and kidney yin and Yang deficiency, liver fire hyperactivity (liver fire is blazing, wind fire hyperactivity), liver blood deficiency, liver qi stagnation, liver wind internal movement, yin and yang deficiency, Yang deficiency, heart and spleen deficiency, spleen deficiency Phlegm disturbance, phlegm stagnation (phlegm dampness stagnation, phlegm dampness middle obstruction, phlegm turbid upper obstruction, phlegm dampness obstruction of orifices), phlegm stasis obstruction of collaterals, heart and kidney deficiency (heart and kidney qi deficiency), Qi and yin deficiency, qi stagnation and blood stasis, kidney essence deficiency, kidney yin deficiency, kidney qi deficiency, kidney yang deficiency, kidney deficiency and spleen weakness, Qi and blood deficiency, blood stasis obstruction of collaterals, Chong Ren imbalance, liver depression and spleen weakness, Qi deficiency depression, blood deficiency and Qi inversion, marrow sea deficiency, exogenous wind evil , phlegm and heat, hot poison and Shaoyang evil depression Among them, the syndromes of hyperactivity of liver Yang and disturbance of wind Yang, disturbance of wind phlegm and turbid liver wind phlegm, deficiency of liver and kidney yin and lack of water, excessive liver fire and inflammation of liver fire, disturbance of wind fire, excessive phlegm stagnation and obstruction of phlegm dampness, obstruction of phlegm dampness, obstruction of phlegm dampness, obstruction of phlegm dampness, obstruction of orifices, deficiency of heart and kidney and deficiency of heart and kidney qi basically belong to the same syndrome and different names After classifying the same syndrome and different names, the occurrence frequency of each syndrome was counted, in order: liver fire was blazing 32 times, phlegm was turbid 29 times, liver Yang was hyperactivity 29 times, liver and kidney Yin were deficiency 25 times, yin and Yang were deficiency 23 times, yin deficiency and Yang were hyperactivity 21 times, kidney essence was deficiency 9 times, Qi and blood were deficiency 6 times, blood stasis blocking collaterals, heart and spleen deficiency, phlegm and blood stasis blocking collaterals, qi stagnation and blood stasis 5 times, liver qi stagnation 4 times, Qi and yin deficiency 3 times, Yang deficiency and kidney yang were not Deficiency of foot, deficiency of kidney yin, deficiency of liver and kidney yin and Yang, depression of qi deficiency, disturbance of spleen deficiency and phlegm, stagnation of liver wind and phlegm, deficiency of heart and kidney twice respectively, imbalance of Chong Ren, stagnation of liver and spleen, deficiency of blood and Qi, deficiency of marrow and sea, exogenous wind evil, deficiency of Qi and blood, combination of phlegm and heat, deficiency of liver blood, hyperactivity of heat toxin, deficiency of Shaoyang evil, deficiency of kidney and spleen, deficiency of kidney and Qi once respectively, a total of 34 syndromes In addition to the 12 certificates of authoritative documents, 22 certificates have been increased in academic circles Through the classified analysis, we can see that the clinical syndrome differentiation of hypertension is far beyond the scope of the principles, standards and the five, six and seven editions of internal medicine of traditional Chinese medicine Standardizing syndrome differentiation requires standardizing the name of syndrome According to the standard literature review on the symptoms and signs of hypertension syndrome differentiation, the symptoms of hypertension syndrome differentiation include: dizziness, dizziness, headache, head wrapping, neck stiffness, dizziness, red or astringent eyes, sore eyes, blurred vision, blushing, five heart upset and hot, dry mouth, weak mouth, bitter mouth, tinnitus, insomnia, forgetfulness, upset and irritable, impatient temperament, and inattention Middle and low memory, abnormal consciousness, neurasthenia, severe vomiting, little food, chest distress, palpitation and shortness of breath, pain in the precordial area, numbness of limbs, bleeding, frequent night urination, sore waist and knees, chilly limbs, constipation, scarring, and dozens of tongue and pulse phenomena, dozens of times of clinical symptoms of hypertension, far beyond the scope of symptoms of the disease If only to meet the needs of syndrome differentiation and into the disease has nothing to do with the origin or unclear symptoms, then syndrome differentiation norms can not be talked about Therefore, after making clear the origin of the symptoms used for syndrome differentiation, it should be greatly reduced According to the comprehensive analysis of authoritative literature, 12 cases of hypertension were introduced, and 22 cases were increased in academic circles Among them, hyperactivity of liver Yang and disturbance of wind Yang, disturbance of wind phlegm and turbidity of liver wind and phlegm, deficiency of liver and kidney yin and water do not contain wood, hyperactivity of liver fire and inflammation of liver fire, disturbance of wind fire, hyperactivity of phlegm and dampness, obstruction of phlegm dampness, obstruction of phlegm dampness, inversion of phlegm dampness, obstruction of orifices of phlegm dampness, deficiency of heart and kidney and deficiency of heart and kidney qi basically belong to the same syndrome and different names, which need to be standardized by the agreed unified syndrome names The differences between deficiency of liver and kidney yin and Yang, deficiency of heart and kidney, deficiency of heart and spleen, deficiency of Qi and blood, deficiency of kidney essence and deficiency of marrow and sea, deficiency of kidney yang and deficiency of Yang need to be distinguished The syndrome of exogenous wind pathogen, hot toxin and Shaoyang pathogenic depression belong to six kinds of diseases, which have nothing to do with hypertension As for the syndrome of liver blood deficiency, liver qi stagnation, liver qi stagnation and spleen weakness, spleen deficiency and phlegm disturbance, Qi deficiency and depression, kidney yin deficiency, kidney qi deficiency and spleen weakness, Chong Ren imbalance, liver wind internal movement, yin deficiency and yang hyperactivity, Qi Yin deficiency, phlegm and blood stasis blocking collaterals, blood stasis blocking collaterals, qi stagnation and blood stasis, phlegm heat interaction, blood deficiency and Qi inverse, it is mainly the objectification degree and attribute judgment of the four diagnosis information collected by the clinicians It is caused by the difference between the standard of diagnosis and the standard of syndrome differentiation No matter how complex the clinical manifestations of a disease, it is impossible to distinguish dozens of syndromes Therefore, first of all, we should make clear their respective definitions and mutual relations, and then do the necessary merge and trade-off In addition, we should also pay attention to solve the problem of confusion between syndrome and syndrome In the process of clinical syndrome differentiation of hypertension, some scholars classified the restlessness of the syndrome as the TCM syndrome type of hypertension, and confused the difference between syndrome and syndrome Therefore, we should clarify these problems in advance to pave the way for the study of syndrome differentiation Only when the above problems are clear and solved, can we adopt the epidemiological survey method to collect the four diagnosis information of hypertension patients under strict quality control Finally, through statistical analysis, we can obtain a number of syndrome sets With the help of scientific analysis methods, we can determine the basic attributes of syndrome sets, and then draw objective research conclusions, so as to realize the formulation of prospective syndrome differentiation norms Goals.