RESUMO
Objective To approach Professor Zhu Guangli's regular pattern of differentiation of symptoms and signs in patients with hypertension accompanied by complications and in accord with the individual manifestations to add or subtract the ingredients in the prescription.Methods The patients with essential hypertension selected were those who the first time came to the Affiliated Guangxing Hospital of Zhejiang Chinese Medical University or Hangzhou Hospital of Traditional Chinese Medicine (TCM) of Zhejiang Province from September 2012 to January 2015, and were continuously followed up in the hospitals having their clinical data comprehensive. The complications, combination diseases and symptoms of hypertension were conducted as dependent variables, while the applied Chinese medicines were acted as independent variables. QUEST algorithms were employed to analyze the different dependent variables to evaluate the importance contribution rate (ICR) of every kind of Chinese medicine.Results There were 9 types of complications or combination diseases [including hyperlipemia, coronary heart disease, cardiac arrhythmia, hyperglycemia, trace albuminuria, lacunar cerebral infarction, elevation of creatinine in blood (azotemia), liver dysfunction and cardiac dysfunction] and 39 types of symptoms obtained (including dizziness, palpitation, chest oppression, insomnia, lack of strength, soreness of the waist and knees, dry mouth, loose stool, fatigue, apontaneous sweating, headache, shortness of breath, coprostasis, fullness in the stomach, blurred vision, limb numbness, low spirit, chest pain, poor appetite, abdominal distension, excessive dreaming, tinnitus, flush of the face, neck rigidity, hectic fever, bitterness in the mouth, cough, ructus, nocturia, fremitus, stenagma, pharyngalgia, heaviness in head, nocturnal sweating, frequent urination, coughing of sputum, chillness and cold limbs, aphthous stomatitis and sialosis) being the QUEST decision models. All kinds of the TCM employed in all the patients paying visits for 755 times were summed up, and the individual drug frequency of presentation in the prescription was recorded. In the study, 171 sorts of TCM and 10 620 of cumulative frequency (freq.) were involved in 755 prescriptions. The average sorts of TCM was 14.07±1.53 per prescription. The top ten kinds of TCM the most commonly used (freq.) were as follows: tuckahoe (588), Chinese yam (551), wolfberry fruit (496), white peony root (442), abalone shell (405), gastrodia tuber (395), lilyturf root (325), Huai wheat (293), curcuma root (281), rush pith (277), accounting for 38.16% in the total frequency. There were 33 kinds of TCM with frequency > 100, accounting for 74.65% in the total frequency. By the analyses of QUEST algorithms directing to the complications and combination diseases to add or subtract the items of TCM, it was discovered that the drugs with ICR > 5% were as follows: in lacunar cerebral infarction, the drug application frequencies or ICRs of batryticated silkworm and bitter cardamom were 32.69% and 50.74% respectively; in coronary heart disease, the ICRs of pseudostellaria root, astragalus root, white sandal wood and lepidium seed were 23.05%, 17.70%, 15.31% and 5.06% respectively; in cardiac arrhythmia, the ICRs of astragalus root, flavescent sophora root, Huai wheat and dragon tooth and dragon bone were 46.65%, 11.56%, 7.56%, 7.13% and 6.28% respectively; in cardiac dysfunction, the ICRs of lepidium seed and white hyaciath bean were 92.97% and 7.03%; in hyperlipemia, the ICRs of cassia seed, white sandal wood, dried rehmannia root and sargentgloryvine stem were 24.26%, 12.47%, 10.51% and 5.81% respectively; in hyperglycemia, the ICRs of trichosanthes root and dried hawthorn fruit were 51.02% and 30.18%; in trace albuminuria, the ICR of snow in June herb was 83.33%; in elevation of creatinine in blood, the ICRs of Chinese actinidia root, herb of snow in June, glossy privet fruit and centella were 81.37%, 6.21%, 6.21% and 6.21% respectively; in liver dysfunction, the ICRs of coral ardisia root, purse grass and herb of stringy stonecrop were 86.37%, 6.82% and 6.82% respectively. When the symptoms were used as the dependent variables, for the top 3 commonly seen symptoms, in the prescription, the items of TCM used with ICR > 5% were as follows: in cases with elevation of blood pressure, parasitic loranthus (ICR 89.59%) was used; with dizziness, gastrodia tuber (ICR 46.96%) and/or abalone shell (ICR 33.61%) were added; headache, rhizome of Chinese ligusticum and/or rhizome of Sichuan lovage and/or large gentian with ICR at 85.77%, 7.11% and 7.11% respectively. Conclusion Professor Zhu's essential thought in differentiation of disease and expectant treatment of hypertension in accord with the individual manifestations to add and subtract drugs in TCM is under the guidance of TCM principle of differentiation of symptoms and signs for treatment, and based on the classical theories in TCM, the reliable drugs whose actions are demonstrated clinically and experimentally are preferentially selected.