Clinical observation of kidney-qi deficiency syndrome patients with hypertension by Bushenjiangya decoction

Dong Qiozhi(董巧稚), Ci Lingling(蔡玲玲), Zhng Yinghun(張穎純), Wu Di(吳迪), Zhng Xue(張雪), Zhng Mioling(張妙良), nd Lin Qin(林謙)*

Clinical observation of kidney-qi deficiency syndrome patients with hypertension by Bushenjiangya decoction

Dong Qiaozhi(董巧稚)a, Cai Lingling(蔡玲玲)a, Zhang Yingchun(張穎純)b, Wu Di(吳迪)a, Zhang Xue(張雪)a, Zhang Miaoliang(張妙良)c, and Lin Qian(林謙)a*

OBJECTIVE: To observe the clinical efficacy of Bushenjiangya (reinforcing kidney and lowering blood pressure) decoction in curing hypertension of kidney Qi deficiency type.

METHODS: First 60 patients with hypertension of kidney Qi deficiency type were divided into control group and treatment group randomly; the conventional western medicine was given to patients of the control group for antihypertensive therapy, while the traditional Chinese medicine Bushenjiangya decoction was added for patients in the treatment group based on the therapy for those in control group; after 2 months, the blood pressure, clinical efficacy and urine microalbumin changes of patients in the two groups before and after the treatment were observed.

RESULTS: a. The systolic pressure of patients in the two groups was all reduced obviously (P＜0.05); b. The total effective rate of experiment group in antihypertensive effect was 76.7%, while that of control group was 83.3% (P＞0.05); c. The total effective rate of experiment group in TCM syndrome effect was 86.7%, while that of control group was 63.3%, showing that the effect of experiment group was better than that of control group (P＜0.05); d. The 24h urine microalbumin reduction of experiment group was better than that of control group (P＜0.05).

CONCLUSIONS: The curative effect of Bushenjiangya decoction in combination with the western medicine is better than that of simple western medicine for hypertension of kidney Qi deficiency type, and also the urine microalbumin can be obviously reduced to protect the kidney function.

Hypertension; Traditional Chinese and Western medicine therapy; Bushenjiangya (reinforcing kidney and lowering blood pressure) decoction

INTRODUCTION

Hypertension is the most common cardiovascular disease and the important factor causing the elder’s death and concurrent cardio-cerebrovascular disease. However, the kidney damage of hypertension is often hidden in the early period and shows no obvious symptom other than increased urine at night, so generally there is no abnormality found in regular laboratory examination. Yet, when proteinuria is found clinically, the kidney damage may have been severe or irreversible1-2. Therefore, this study focuses on how to prevent and improve the early kidney damage of hypertension. During January and December of 2015, the hospital made intervention to 30 patients with hypertension of kidney Qi deficiency type and got good effects. Now it is reported as follows.

MATERIALS AND METHODS

General materials

We chosed 60 cases of hypertensive outpatients of kidney-qi deficiency syndrome. The subjects inclusion criteria：①Reference to the diagnosis of hypertension and kidney-qi deficiency syndrome fromChinese medicine clinical research of new drugs guiding principles（2002）3,②Without serious organic lesion of heart,brain and kidney. These study subjects were randomly divided into control group（30 cases）and experimental group（30 cases）.And there were no statistical differences between two groups in the age, sex, BMI(body mass index),clinical course,blood pressure and the choice of antihypertensive drugs.

Therapeutic method

According to the Guidelines for prevention and control of hypertension(2010), the control group usedbasic treatment of chemical medicine，including calcium ion antagonist, angiotensin, converting enzyme inhibitors, angiotensin receptor inhibitors,β-blockers, diuretics and α-blockers. The experimental group added the Chinese traditional medicine to the basic treatment by chemical medicine. The basic prescription of Bushenjiangya(reinforcing kidney and lowering blood pressure) decoction including Astragali Radix (Huangqi) 30g, Dried Rehamnnia Radix (Dihuang) 20g, Rhizome Dioscoreae (Shanyao)20g, Poria Cocos (Fuling) 30g, Cortex Moutan (Danpi) 15g, Rhizoma Alismatis (Zexie) 15g, Gastrodia Elata (Tianma) 15g, Uncaria (Gouteng) 15g, Ligusticum Chuanxiong Hort (Chuanxiong) 15g, Salvia (Danshen) 20g, Puerarialobata (Gegen) 30g and Psoralea Corylifolia (Buguzhi) 15g. One dose a day, decoction serving twice. The treatment course lasted two months for each group.

Observation index

We observed treatment result,blood pressure and microabluminuria of two groups.

The evaluate criteria

According toChinese medicine clinical research of new drugs guiding principles（2002）,we evaluated the curative effect of blood pressure and traditional Chinese medicine syndromes. We made Chinese medicinal symptom integrating Scale including 11 items，such as thirsty, aversion to cold, head heavy and feet light, soreness and weakness of lower back and knee, lacking in strength, shortness of breath, amnesia, alopecia, dreaminess, night sweat and night polyuria.

Statistical analysis

The results were analyzed using SPSS19.0. Measurement data were indicated as “mean value ± standard deviationWe used t-test to analyze measurements which conformed with normal distributions and non-parametric test to analyze measurements which conformed with non-normal distributions. We used chi-square test to analyze enumeration data.There were statistical differences (P＜0.05), and there were significant statistical differences (P＜0.01).

RESULTS

Comparison of blood pressure values before and after treatment between two groups

The normal test showed that the two sets of data meet the normal distribution (P＞0.05). Independent sample T-test was used to compare data with the other group while paired T-test was used for data in the same group. The results were as follows: the systolic and diastolic blood pressure values in experiment group and control group both dropped after treatment (systolic pressure

P＜0.05; diastolic pressureP＞0.05).The systolic pressure was 125.53±8.33 mmHg in the experiment group and 133.75±10.68mmHg in the control group after treatment. The diastolic pressure was 63.49±5.23 mmHg in the experiment group and 64.26±6.49mmHg in the control group after treatment. The statistical tests showed that the differences between the two groups were both no significance (P＞0.05).The degree of improvement in the two groups were similar. Both of the two groups could reduce systolic pressure greatly but not remarkably in diastolic pressure.

Table1 Comparison of blood pressure values

Table1 Comparison of blood pressure values

Group Time n Systolic pressure Diastolic pressure Experiment Before treatment 30 166.54±11.43 68.79±8.25 After treatment 30 125.53±8.33 63.49±5.23 Control Before treatment 30 165.89±11.56 68.49±9.56 After treatment 30 133.75±10.68 64.26±6.49

Comparison of the curative effect in antihypertension after treatment between the two groups

After treatment, the total effective rate was 76.7% in the experiment group and 83.3% in the control group (P＞0.05).There was no statistical difference of the curative effect in anti-hypertension between the two groups. The curative effects in anti-hypertension of the two groups were equal.

Table2 Comparison of the curative effect in anti-hypertension between the two groups

Comparison of the curative effect in traditional Chinese medicine (TCM) syndrome after treatment between the two groups

After treatment, the total effective rate was 86.7% in the experiment group and 63.3% in the control group (P＜0.05).The curative effect in TCM syndrome of the experiment group was superior to that of the control group.

Table3 Comparison of the curative effect in TCM syndrome between the two groups

Comparison of the 24h urinary micro-albumin before and after treatment between the two groups

The normal test showed that the two sets of data do not comply with the normal distribution (P＜0.05). Then the nonparametric test was used. The results were as follows: there was no statistical difference of the 24h urinary micro-albumin before treatment between the two groups. The 24h urinary micro-albumin in experiment group was lower than that in control group after treatment (P＜0.05).In reducing the 24h urinary micro-albumin and protecting renal function ,the curative effect of the experiment group was better than that of the control group.

Table4 Comparison of the 24h urinary micro-albumin between the two groups

DISCUSSION

The occurrence of renal damage caused by essential hypertension is quite common. Some people think that it may have occurred before the diagnosis of essential hypertension. A large number of outpatients with high blood pressure often accompanied by symptoms such as thirsty, aversion to cold, head heavy and feet light, soreness and weakness of lower back and knee, lacking in strength, shortness of breath, amnesia, alopecia, dreaminess, night sweat and night polyuria4. The advantage of chemical medicine is in the control of blood pressure. The advantage of TCM is in improving the clinical symptoms of the patients. These clinical manifestations are closely related to hypertensive renal injury. In TCM theory, hypertension belongs to the categories of "vertigo, dizziness". Its main pathogenesis is yin-yang imbalance. The clinical manifestations of fundamental deficiency and incidental excess, liver and kidney deficiency are the main causes. the phlegmwind disturbance and fire excess from yin deficiency are its symptoms5-7. Therefore, calming the liver and suppressing yang, nourishing the liver and kidney is the main treatment guidelines of hypertension. Famous physician of TCM Liao Jiazhen's experienced prescription of Bushenjiangya decoction had a significant curative effect on kidney deficiency type of hypertension. In this prescription, Astragali Radix (Huangqi) can supplement and promote qi, which has the effects of dilating blood vessels and decreasing blood pressure. Rhizome Dioscoreae (Shanyao) can tonify the kidney and induce astringency, prevent the loss of kidney essence8-11. Psoralea Corylifolia(Buguzhi) has the activities of nourishing liver and kidney, and strengthening the bones and muscles. Cortex Moutan (Danpi) and Rhizoma Alismatis (Zexie) have the effects of clearing liver-fire, dispelling dampness and promoting diuresis. Dried Rehamnnia Radix (Dihuang) has the activities of nourishing kidney yin, enriching blood and increasing the essence, whichcan improve patients’ dizziness and head heavy and feet light symptom caused by the deficiency of the kidney yin. Salvia and Ligusticum Chuanxiong Hort (Chuanxiong) have the effects of promoting blood circulation for removing blood stasis, regulating blood lipid, anti-platelet aggregation, and preventing angiolithic degeneration and fat deposition. Gastrodia Elata (Tianma) and Uncaria (Gouteng) can expand the arteries, calm liver-wind, dispel wind and relieve pain. The combination use of these drugs has the effects of nourishing liver and kidney, dispelling wind and discharging fire, treating the incidental and fundamental aspects, activating blood and nourishing blood, dilating blood vessels and regulating blood lipid, which can achieve effective effect on lowering blood pressure12-13.

In summary, the results of the study showed that the additional use of Bushenjiangya decoction was not only significantly better than chemical medicine group in the antihypertensive effect to kidney-qi deficiency type patients with hypertension, but also can improve the patient's symptom and reduce the damage of hypertension to kidney14-15, which can protect renal function and improve the patients’ quality of life. These are the advantages of Bushenjiangya decoction which has the effects of reinforcing the kidney-qi, inducing astringency, preventing the loss of kidney essence, nourishing yin and activating blood.

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(Accepted: February 25, 2017)

a: Dongfang Hospital, the Second Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100078, China

b: Skin disease Hospital in Dalian City, Liaoning province, Dalian 110060, China

c: Beijing Xiaotangshan Hospital, Beijing 102211, China

＊Corresponding author: Email: linqian62@126.com