Scholarly article on topic 'Traditional Chinese Medicine Syndromes for Essential Hypertension: A Literature Analysis of 13,272 Patients'

Traditional Chinese Medicine Syndromes for Essential Hypertension: A Literature Analysis of 13,272 Patients Academic research paper on "Clinical medicine"

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Academic research paper on topic "Traditional Chinese Medicine Syndromes for Essential Hypertension: A Literature Analysis of 13,272 Patients"

Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine Volume 2014, Article ID 418206, 19 pages http://dx.doi.org/10.1155/2014/418206

Review Article

Traditional Chinese Medicine Syndromes for Essential Hypertension: A Literature Analysis of 13,272 Patients

Jie Wang, Xingjiang Xiong, and Wei Liu

Department of Cardiology, Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China

Correspondence should be addressed to Wei Liu; lvzyxxg@163.com

Received 29 October 2013; Accepted 19 December 2013; Published 10 February 2014

Academic Editor: Bo Feng

Copyright © 2014 Jie Wang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background. To simplify traditional Chinese medicine syndrome differentiation and allow researchers to master syndrome differentiation for hypertension, this paper retrospectively studied the literature and analyzed syndrome elements corresponding to hypertension syndromes. Methods. Six databases including PubMed, EMBASE, Chinese Bio-Medical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wan-fang Data were searched from 1/January/2003 to 30/0ctober/2013. We included all clinical literature testing hypertension syndromes and retrospectively studied the hypertension literature published from 2003 to 2013. Descriptive statistics calculated frequencies and percentages. Results. 13,272 patients with essential hypertension were included. Clinical features of hypertension could be attributed to 11 kinds of syndrome factors. Among them, seven syndrome factors were excess, while four syndrome factors were deficient. Syndrome targets were mainly in the liver and related to the kidney and spleen. There were 33 combination syndromes. Frequency of single-factor syndromes was 31.77% and frequency of two-factor syndromes was 62.26%. Conclusions. Excess syndrome factors of hypertension patients include yang hyperactivity, blood stasis, phlegm turbidity, internal dampness, and internal fire. Deficient syndrome factors of hypertension patients are yin deficiency and yang deficiency. Yin deficiency with yang hyperactivity, phlegm-dampness retention, and deficiency of both yin and yang were the three most common syndromes in clinical combination.

1. Introduction

Hypertension is an important public health issue worldwide because of its high prevalence and concomitant increase in disease risk [1-3]. It has been estimated that 29% of the world's adult population, or approximately 1.56 billion people, will have hypertension by 2025 [4, 5]. Complementary and alternative medicine (CAM) isbecomingincreasinglypopular [613] and numerous interventions are regularly recommended to lower elevated blood pressure (BP) [14-17]. Traditional Chinese medicine (TCM), including herbal medicine and acupuncture, is an important component of CAM therapies [18-21]. Hypertension could be improved by insights from TCM and considerable progress has been made in lowering BP by TCM [22-26].

Syndrome differentiation is a diagnostic and treatment method used in TCM [27, 28]. It plays an important role in the therapeutic process and affects the therapeutic result of certain diseases [29-31]. The syndrome is not only

the basic unit of TCM theory and syndrome differentiation, but also the bridge to associating disease and formula [3235]. TCM syndrome, which is different from a disease or symptoms, is the abstraction of a major pathogenesis. Syndromes are identified from a comprehensive analysis of all symptoms and signs (including tongue appearance and pulse feeling) from the four main diagnostic TCM methods: observation, listening, questioning, and pulse analyses [3640]. However, syndromes are the product of speculation in TCM. Therefore, they depend on medical experience, academic origins, and other factors. Therefore, the concept of syndromes is vague and broad, which makes clinical application difficult. Syndrome elements, which are the minimum units of syndromes, contribute to simplifying syndrome differentiation and understanding TCM syndromes. Each element has specific symptoms.

To simplify TCM syndrome differentiation and enable researchers not familiar with Chinese medicine to master the laws of hypertension syndrome differentiation, this paper

retrospectively studied the literature for 13,272 patients with hypertension, published from 2003 to 2013. This study is beneficial to deepening of the understanding of hypertension and providing a basis and reference for clinical treatment using TCM syndrome differentiation.

2. Materials and Methods

2.1. Database and Search Strategies. Six databases including PubMed, EMBASE, Chinese Bio-Medical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan-fang Data were searched from 1/January/2003 to 30/0ctober/2013. Databases in Chinese were searched to retrieve the maximum possible number of trials of syndrome differentiation for essential hypertension (EH) because syndrome differentiation is mainly used in China. Ongoing registered clinical trials were searched at the International Clinical Trial Registry by the U.S. National Institutes of Health (http://clinicaltrials.gov/). The following search terms were used individually or combined: "hypertension," "blood pressure," "essential hypertension," "syndrome differentiation," "vertigo," "headache," "parting," and "traditional Chinese medicine therapy." The bibliographies of included studies were searched for additional references.

2.2. Inclusion and Exclusion Criteria. Systolic blood pressure (SBP) >140 mmHg (ImmHg = 0.133 kPa) and diastolic blood pressure (DBP) >90 mmHg from the literature were based on 1999 WHO-ISH Guidelines for the Management of Hypertension (1999 WHO-ISH GMH), 1998 WHO-ISH Guidelines for the Management of Hypertension (1998 WHO-ISH GMH), 2000 WHO-ISH Guidelines for the Management of Hypertension (2000 WHO-ISH GMH), Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005), China Guidelines on Prevention and Management of High Blood Pressure-2006 (CGPMHBP-2006), and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Syndrome differentiation of TCM diagnosis used the Standard of TCM Diagnosis and Curative Effect of Disease-Syndrome, published by the State Administration of Traditional Chinese Medicine in 1994. Standards of dialectical classification used Clinical Research Guiding Principles of New Medicine of Chinese Herbs revised by the State Food and Drug Administration in 2002. Exclusion criteria were secondary hypertension, gestational hypertension, repeated literature, reviews, and literature with no clear classification.

2.3. Classification Criteria of Syndrome Elements. According to the classification criteria of syndrome elements proposed by Wang, statistical analysis was conducted for syndromes included in the cases. The classification criteria of syndrome elements were (1) six-excess external contraction: wind, cold, dampness, dryness, and fire; (2) five endogenous qi: internal wind, internal cold, internal dampness, internal dryness, and internal fire; (3) factors related to gas: qi deficiency, qi

stagnation, qi block, qi counterflow, qi fall, and qi collapse; (4) factors related to blood: blood deficiency, blood stasis, blood collapse, blood dryness, and bleeding; (5) factors related to yin and yang: yin deficiency, yang deficiency, yin exuberance, and yang hyperactivity; (6) others: poison, excessive fluid, and phlegm turbidity.

2.4. Statistical Methods. Two authors conducted the literature search, study selection, and data extraction independently. Disagreements were resolved by discussion and consensus was met through a third party. SPSS 11.5 statistical software was used for data analyses (Chicago, IL, USA). Descriptive statistics procedures calculated frequency and percentage.

3. Results

3.1. Description of Included Literature. After a primary search of the databases, 503 articles were screened. After reading the titles and abstracts, 398 articles were excluded the reasons included; retrospective study that did not match the included criteria of this review (n = 42) and duplicated titles (n = 356). The full texts of 83 articles [41-123] were retrieved, and 22 articles were excluded for the following reasons: participants not meeting the inclusion criteria (n = 11), duplicated data (n = 5), patients having other diseases (n = 5), and no data for extraction (n = 1). In the end, 83 articles [41-123] were included, and all trials were conducted in China (Figure 1). The characteristics of included trials are listed in Table 1.

Overall, 13,272 patients with essential hypertension were included, with an average of 160 per trial, ranging from 23 to 703. Among them, 7075 were men, accounting for 53.3%, while 6197 were women, accounting for 46.7%. There was a wide range in patient age (18-92 years). Sources of cases included 24 provinces and the number of papers in each region is shown in Table 2.

3.2. Extraction of Syndrome Elements of EH. According to the definition of syndrome elements and classification criteria, syndrome elements were obtained and classified from the literature as follows: blood stasis (qi stagnation and blood stasis, qi deficiency with blood stasis, kidney deficiency and blood stasis, stasis blocking channels, phlegm and blood stasis resistance winding); qi stagnation (liver qi stagnation, qi stagnation and blood stasis); phlegm (phlegm turbidity resistance, phlegm-dampness retention); internal fire (intense liver fire, internal harassment of phlegm-heat); internal dampness (spleen deficiency with dampness encumbrance, phlegm-damp retention); internal wind (internal stirring of liver wind, wind-yang interference); qi deficiency (dual deficiency of qi and yin, dual deficiency of qi and blood, and qi deficiency with blood stasis); yang hyperactivity (ascendant hyperactivity of liver yang, yin deficiency with yang hyperactivity); yin deficiency (yin deficiency with yang hyperactivity, liver-kidney yin deficiency, dual deficiency of qi and yin, and deficiency of both yin and yang); yang deficiency (kidney yang deficiency, deficiency of both yin and yang); blood deficiency (dual deficiency of qi and blood).

Additional records identified

through other sources (n = 8)

Records excluded (n = 398)

22 articles were excluded with reasons listed as the

following participants did not meet the inclusive criteria (n = 11); duplicated data (n = 5); patients complicated with other diseases (n = 5) no data for extraction (n = 1)

Figure 1: Screening process of articles.

Records screened (n = 503)

Full-text articles assessed for eligibility (n = 105)

Studies included in the review (n = 83)

As a result, 13,272 cases of hypertension syndrome were classified as 11 syndrome element types, which cover all cases.

3.3. Analysis of Syndrome Elements of EH. Syndrome elements of 13,272 patients with hypertension were divided into excessive syndrome elements and deficient syndrome elements (Table 3, Figure 2). The proportions of excessive syndrome elements are yang hyperactivity (19.08%), phlegm turbidity (13.68%), internal fire (13.21%), internal dampness (11.04%), blood stasis (4.86%), internal wind (1.21%), and qi stagnation (0.78%). The proportion of deficient syndrome elements are yin deficiency (26.27%), yang deficiency (7.89%), qi deficiency (1.80%), and blood deficiency (0.18%). Excessive syndrome elements greater than 10% included yang hyperactivity, phlegm turbidity, internal fire, and internal dampness. Deficient syndrome elements greater

than 10% included yin deficiency. Yang hyperactivity and yin deficiency were the most common syndrome elements of hypertension.

3.4. Targets of Syndrome Elements of EH. The targets of syndrome elements are the disease locations of individual syndrome elements. Disease location of syndrome elements was confirmed according to the five zang-organs and six fu-organs, chi heng fu, and meridians.

As a result, 9091 cases (68.50%) had clear targets of syndrome elements related to liver, kidney, and spleen (Table 4). There were 7789 cases of liver syndromes (85.68%). Among them, there were 2793 cases of internal fire of liver (35.86%), 4033 cases of ascendant hyperactivity of liver yang (51.78%), 543 cases of liver yin deficiency (6.97%), 164 cases of liver qi stagnation (2.11%), and 256 cases of internal stirring of liver wind (3.29%). There were 903 cases of kidney syndromes

Table 1: Characteristics of included studies.

Study ID

Sample (M/F)

Age (years) Diagnosis standard

TCM syndrome differentiation (number of patients)

Region of China

Xu and Chen 2012 [13]

(58/64)

Ferreira and 448

Lopes 2011 [14] (243/205)

Wang et al. 2013 [15]

Lee et al. 2004 [16]

Wang et al. 2013 [17]

99 (50/49)

87 (48/39)

140 (83/57)

Wang and Xiong 76 2012 [18] (38/38)

Xiong et al. 395

2013 [19] (228/167)

Wang et al. 120

2013 [20] (60/60)

Wang et al. 2013 184 [21] (83/101)

Chen 1993 [22]

60 (30/30)

Wang et al. 2012 53 [23] (16/37)

Wang et al. 2013 [24]

WWangandXiong(M/Fnot

reported)

Chen et al. 2011 259 [26] (108/151)

Xu and Chen 81

2011 [27] (53/28)

M: 62.1 ± 10.9 F: 59.3 ± 8.7

73 ±6.1

M: 62.7 ±8.3 F: 58.9 ± 7.5

56.5 ± 9.8

Not reported

53 ± 17

T: 48 ± 8.1

C: 47 ± 6.7

Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005) Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005)

Phlegm and blood stasis resistance winding (39), yin deficiency with yang hyperactivity (44), and idney deficiency (39)

Intense liver fire (284), yin deficiency with yang hyperactivity (43), phlegm-damp retention (74), and deficiency of both yin and yang (47)

1999 WHO-ISH GMH Qi stagnation and blood stasis (99)

Chinese Guidelines for the

Management of

Hypertension-2005

(CGMH-2005)

Chinese Guidelines for the

Management of

Hypertension-2010

(CGMH-2010)

Chinese Guidelines for the

Management of

Hypertension-2010

(CGMH-2010)

Hypertension diagnostic criteria (unclear)

Hypertension diagnostic criteria (unclear)

Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005)

Ascendant hyperactivity of liver yang (32), phlegm-damp retention (27), and qi deficiency with blood stasis (28)

Intense liver fire (28), yin deficiency with yang hyperactivity (39), phlegm-damp retention (45), and deficiency of both yin and yang (28)

Kidney deficiency and blood stasis (76)

Intense liver fire (54), yin deficiency with yang hyperactivity (177), phlegm-damp retention (62), and deficiency of both yin and yang (102)

Ascendant hyperactivity of liver yang (30), yin deficiency with yang hyperactivity (30), phlegm-damp retention (30), and deficiency of both yin and yang (30) Intense liver fire (21), yin deficiency with yang hyperactivity (75), phlegm-damp retention (81), and deficiency of both yin and yang (7)

1999 WHO-ISH GMH Dual deficiency of qi and yin (60)

1999 WHO-ISH GMH

112 (83/29) 53.5 ± 11.04 1999 WHO-ISH GMH

T: 57.1 ± 6.16 C: 55.67 ± 6.28

65.58 ± 12.17

52.79 ± 12.83

Chinese Guidelines for the

Management of

Hypertension-2004

(CGMH-2004)

Chinese Guidelines for the

Management of

Hypertension-2005

(CGMH-2005)

Chinese Guidelines for the

Management of

Hypertension-2005

(CGMH-2005)

Insufficiency of spleen with overabundance of dampness (19), dual deficiency of qi and blood (20), and liver-kidney yin deficiency (14)

Intense liver fire (19), yin deficiency with yang hyperactivity (23), phlegm-damp retention (16), and deficiency of both yin and yang (22)

Blood stasis (61)

Intense liver fire (35), yin deficiency with yang hyperactivity (89), phlegm-damp retention (88), and deficiency of both yin and yang (47)

Intense liver fire (42), yin deficiency with yang hyperactivity (18), phlegm-damp retention (14), and deficiency of both yin and yang (7)

Beijing

Jiangsu Guangdong Guangdong

Heibei

Fujian

Liaoning

Hainan

Jiangsu Guangdong Neimenggu

Jiangxi

Guangdong

Beijing

Zhejiang

Study ID Sample (M/F) Age (years) Diagnosis standard TCM syndrome differentiation (number of patients) Region of China

Chinese Guidelines for the Intense liver fire (28), yin deficiency with

Chen et al. 183 66.81 ±8.81 Management of yang hyperactivity (53), phlegm-damp Jiangsu

2012 [28] (85/98) Hypertension-2004 (CGMH-2004) Chinese Guidelines for the retention (57), and deficiency of both yin and yang (45) Intense liver fire (59), yin deficiency with

Liu et al. 89 M: 59.5 ± 10.9 Management of yang hyperactivity (5), phlegm-damp Jiangsu

2011 [29] (45/44) F: 59.3 ± 11.0 Hypertension-2005 (CGMH-2005) retention (13), and deficiency of both yin and yang (12) Intense liver fire (51), yin deficiency with

Dobos and Tao 342 M: 59.43 ± 16.76 1999 WHO-ISH GMH Chinese Guidelines for the yang hyperactivity (139), phlegm-damp Guangdong

2011 [30] (213/129) F: 59.43 ± 11.82 retention (85), and deficiency of both yin and yang (67) Intense liver fire (352), yin deficiency with

Xiong et al. 562 M: 62.1 ±10.8 Management of yang hyperactivity (58), phlegm-damp Jiangsu

2011 [31] (297/265) F: 58.5 ± 9.1 Hypertension-2005 (CGMH-2005) Chinese Guidelines for the retention (97), and deficiency of both yin and yang (55) Intense liver fire (88), yin deficiency with

Wang and 398 59.20 ± 9.54 Management of yang hyperactivity (196), phlegm-damp Jiangsu

Xiong 2012 [32] (199/199) Hypertension-2005 (CGMH-2005) Chinese Guidelines for the retention (89), and deficiency of both yin and yang (25) Intense liver fire (49), yin deficiency with

Wang et al. 2013 [33] 178 (81/97) 18-80 Management of Hypertension-2005 (CGMH-2005) yang hyperactivity (43), phlegm-damp retention (57), and deficiency of both yin and yang (29) Intense liver fire (37), yin deficiency with Shanghai

Tian 2011 [34] 200 (109/91) 30-75 1999 WHO-ISH GMH yang hyperactivity (55), phlegm-damp retention (82), and deficiency of both yin and yang (26) Intense liver fire (37), yin deficiency with Tianjin

Wang and 120 T: 62.77 ± 9.18 1999 WHO-ISH GMH Chinese Guidelines for the yang hyperactivity (55), phlegm-damp Hunan

Xiong 2012 [35] 64/56 C: 59.63 ± 8.77 retention (82), and deficiency of both yin and yang (26) Ascendant hyperactivity of liver yang (313),

Wang et al. 2012 494 M: 61.6 ± 10.6 Management of yin deficiency with yang hyperactivity (52), Jiangsu

[36] (264/230) F: 58.3 ± 8.5 Hypertension-2005 (CGMH-2005) deficiency of both yin and yang (83), and liver-kidney yin deficiency (46)

150 (M/F not reported) Chinese Guidelines for the Intense liver fire (29), randomized

Xu and Chen Not reported Management of stagnation of phlegm (53), dual deficiency of Xinjiang

2008 [37] Hypertension-2005 (CGMH-2005) qi and yin (30), and stasis blocking channels (38) Intense liver fire (19), yin deficiency with

Cheung 2011 109 65.6 ± 10.6 1999 WHO-ISH GMH yang hyperactivity (18), phlegm-damp Fujian

[38] (68/41) retention (34), and deficiency of both yin and yang (38) Intense liver fire (18), yin deficiency with

Xiong et al. 2013 102 37-85 1999 WHO-ISH GMH yang hyperactivity (31), phlegm-damp Guizhou

[39] (58/44) retention (23), and deficiency of both yin and yang (30)

Lu et al. 2004 [40] 40 (23/17) Not reported 1999 WHO-ISH GMH 1999 WHO-ISH GMH and Blood stasis (40) Guangdong

Zhao et al. 2012 [41] 60 (41/19) T: 62.07 ± 8.88 C: 57.3 ± 9.09 Chinese Guidelines for the

Management of Hypertension-2005 (CGMH-2005) Blood stasis (60) Guangdong

Study ID

Sample (M/F)

Age (years) Diagnosis standard

TCM syndrome differentiation (number of patients)

Region of China

Liu et al. 2009 [42]

Wang et al. 2012 [43]

Luo et al. 2011 [44]

60 (36/24)

82 (49/33)

100 (42/58)

т^ы.2012 (48

Wang et al. 2011 251 [46] (148/103)

Bai et al. 2005

Yang et al. 2005

Xia et al. 2010

Liu et al. 2003 [50]

Yin and Liu 2005 [51]

Wu et al. 2010 [52]

Deng2008 [53] (45/15)

Wu and Xu 2010 [54]

60 (32/28)

Wang et al. 2011 276 [55] 170/106

Wu et al. 2010 156 [56] (79/77)

Fan and Liu 2010 [57]

395 (203/192)

T: 53.87 ± 5.92 C: 52.97 ± 5.40

Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005)

Phlegm-damp retention (60)

1999 WHO-ISH GMH Liver-kidney yin deficiency (82)

Hypertension diagnostic criteria (unclear)

Ascendant hyperactivity of liver yang (12), yin deficiency with yang hyperactivity (60), phlegm-damp retention (18), and kidney deficiency (10)

68.05 ± 5.41 1999 WHO-ISH GMH Liver-kidney yin deficiency (80)

122 (71/51)

(41/39)

40 (M/F not reported)

60 (43/17)

36 (M/F not reported) 90 (41/39) 60

55 ± 19

T: 44.7 ± 11.6 C: 46.2 ± 9.5

M: 51.28 ±6.96 F: 52.71 ± 6.57

T: 55.23 ± 6.01 C: 55.13 ±6.34

1999 WHO-ISH GMH

1999 WHO-ISH GMH

Intense liver fire (71), yin deficiency with yang hyperactivity (62), phlegm-damp retention (60), and deficiency of both yin and yang (58)

Ascendant hyperactivity of liver yang (35), liver-kidney yin deficiency (18), phlegm-damp retention (32), dual deficiency of qi and yin (25), and stasis blocking channels (12)

1999 WHO-ISH GMH Ascendant hyperactivity of liver yang (80)

1999 WHO-ISH GMH Ascendant hyperactivity of liver yang (40)

Chinese Guidelines for the Management of Hypertension-2009 (CGMH-2009)

Yang hyperactivity (29), phlegm turbidity resistance (31)

40.50 ± 11.51 1999 WHO-ISH GMH Phlegm-damp retention (36)

T: 61 ±4.12 C: 61 ± 4.02

1999 WHO-ISH GMH

Ascendant hyperactivity of liver yang and blood stasis (90)

1999 WHO-ISH GMH Qi deficiency with blood stasis (60)

Not reported 1999 WHO-ISH GMH Dual deficiency of qi and yin (60)

M: 53.4 ±21.1 F: 55.6 ± 17.3

T: 48 ± 6.9 C: 49 ± 8.2

Wind-yang interference (22), stasis blocking channels (73), yin deficiency with yang hyperactivity (134), and phlegm turbidity resistance (47)

Ascendant hyperactivity of liver yang (52), yin deficiency with yang hyperactivity (53), and deficiency of both yin and yang (51)

. ,-,.11. r 1 Qi deficiency with blood stasis (65), intense Chinese Guidelines for the

liver fire (91), yin deficiency with yang hyperactivity (63), phlegm-damp retention (57), deficiency of both yin and yang (39), and dual deficiency of qi and blood (18)

1999 WHO-ISH GMH

Hypertension diagnostic criteria (unclear)

Management of

Hypertension-2005

(CGMH-2005)

Shanghai Heilongjiang Guangxi

Guangxi

Liaoning

Henan Gansu

Zhejiang

Jiangsu

Hebei Hebei Guizhou

Guangxi Zhejiang

Beijing

Study ID

Sample (M/F)

Age (years) Diagnosis standard

TCM syndrome differentiation (number of patients)

Region of China

Zhu et al. 2009 54

[58] (30/24)

Liu et al. 2009 140

[59] (68/72)

He et al. 2013 230

[60] (65/165)

Tang et al. 2012 100

[61] (37/63)

Gong et al. 2010 120 [62] (60/60)

Zhang et al. 60

2005 [63] (32/28)

Liu et al. 2009 200 [64] (105/95)

61.74 ± 14.89 1999 WHO-ISH GMH

Wang 2012 [65]

200 (103/94)

Yao and Huang 47 2007 [66] (22/25)

Guo et al. 2002 120 [67] (62/58)

Zhang et al. 2011 320

[68] (135/185)

Liao et al. 2010 23

[69] (14/9)

Xiong 2010 [70]

70 (37/33)

Jiang et al. 2012 86

[71] (50/36)

Huang and Wei 260

2012 [72] (119/141)

55.1 ± 6.2

T: 55.38 ± 8.01 C: 56.80 ± 8.58

62.22 ±6.12

M: 61.88 ±11.91 F: 63.07 ± 12.45

46.4 ± 15.46

66.00 ± 12.35

T: 63.64 ± 9.22 C: 60.30 ± 3.36

Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005)

1999 WHO-ISH GMH

1999 WHO-ISH GMH

1999 WHO-ISH GMH

Chinese Guidelines for the Management of Hypertension-2004 (CGMH-2004) Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005)

1999 WHO-ISH GMH

Chinese Guidelines for the Management of Hypertension-2004 (CGMH-2004) Chinese Guidelines for the Management of Hypertension-2004 (CGMH-2004)

66.40 ± 12.56 2007 WHO-ISH GMH

T: 65 ± 5 C: 65 ± 8

53.06 ± 8.62

36-81 65.56 ± 8.42

1999 WHO-ISH GMH

Hypertension diagnostic criteria (unclear)

Hypertension diagnostic criteria (unclear) Chinese Guidelines for the Management of Hypertension-2010 (CGMH-2010)

Kidney yang deficiency (24), kidney yin deficiency (30)

Intense liver fire (16), yin deficiency with yang hyperactivity (52), phlegm-damp retention (41), and deficiency of both yin and yang (31)

Intense liver fire (28), ascendant hyperactivity of liver yang (148), and liver-kidney yin deficiency (54) Intense liver fire (19), yin deficiency with yang hyperactivity (29), deficiency of both yin and yang (20), and liver-kidney yin deficiency (32)

Intense liver fire (30), yin deficiency with yang hyperactivity (30), phlegm-damp retention (30), and deficiency of both yin and yang (30)

Intense liver fire (8), yin deficiency with yang hyperactivity (28), phlegm-damp retention (14), and deficiency of both yin and yang (10)

Intense liver fire (51), yin deficiency with yang hyperactivity (49), phlegm-damp retention (50), and deficiency of both yin and yang (50)

Intense liver fire (96), yin deficiency with yang hyperactivity (46), phlegm-damp retention (18), and deficiency of both yin and yang (37)

Intense liver fire (12), yin deficiency with yang hyperactivity (11), phlegm-damp retention (12), and deficiency of both yin and yang (12)

Intense liver fire (30), yin deficiency with yang hyperactivity (30), phlegm-damp retention (30), and deficiency of both yin and yang (30)

Intense liver fire (36), yin deficiency with yang hyperactivity (101), phlegm-damp retention (125), and deficiency of both yin and yang (58)

Blood stasis (23)

Intense liver fire (13), yin deficiency with yang hyperactivity (21), phlegm-damp retention (25), and deficiency of both yin and yang (11)

Yin deficiency with yang hyperactivity (86)

Intense liver fire (56), yin deficiency with yang hyperactivity (77), phlegm-damp retention (73), and deficiency of both yin and yang (54)

Yunnan Guangxi

Guangdong

Shanghai

Shandong

Guangxi

Guangxi

Shanxi

Tianjin

Jiangsu Fujian Heilongjiang Guangdong Beijing

Study ID

Sample (M/F)

Age (years) Diagnosis standard

TCM syndrome differentiation (number of patients)

Region of China

Lu 2004 [73]

138 (97/41)

61.84 ± 5.25 1999 WHO-ISH GMH

Sun and Wang 703 2005 [74] (382/321)

Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005)

Xiang et al. 2012 125 [75] (75/50)

Zhu 2009 [76]

97 (41/56)

Xu and Wang 80 2009 [77] (49/31)

Lin and Kang 69 2012 [78] (37/32)

Feng et al. 2013 60 [79] (60 M)

Yu and Xing 168

2010 [80] (108/60)

Qiu et al. 2011 170 [81] (122/48)

Hypertension diagnostic criteria (unclear)

Hypertension diagnostic criteria (unclear)

1999 WHO-ISH GMH

63.0 ± 7.5

T: 58 ± 12 C: 54 ± 12

54 ± 11.6

1999 WHO-ISH GMH

Chinese Guidelines for the Management of Hypertension-2004 (CGMH-2004)

Fujian

Intense liver fire (16), yin deficiency with yang hyperactivity (43), phlegm-damp retention (45), and deficiency of both yin and yang (34)

Yin deficiency with yang hyperactivity (215), phlegm-damp retention (83), deficiency of both yin and yang (91), ascendant hyperactivity of liver yang (135), liver-kidney yin deficiency (92), yang deficiency (11), qi deficiency (14), dual deficiency of qi and yin (14), blood stasis (11), qi deficiency with blood stasis (3), internal harassment of phlegm-heat (22), internal harassment of phlegm-heat and blood stasis (3), liver-kidney yin deficiency and blood stasis (2), internal harassment of phlegm-heat and Guangdong qi deficiency (1), deficiency of both yin and yang and internal harassment of phlegm-heat (1), liver-kidney yin deficiency and phlegm-damp retention (1), yin deficiency with yang hyperactivity and blood stasis (1), ascendant hyperactivity of liver yang and internal harassment of phlegm-heat (1), ascendant hyperactivity of liver yang and blood stasis (1), and deficiency of both yin and yang and phlegm-damp retention (1) Kidney deficiency and blood stasis (15), internal stirring of liver wind (68), qi deficiency with blood stasis (21), and intermingled phlegm and blood stasis (21) Ascendant hyperactivity of liver yang (13), yin deficiency with yang hyperactivity (59), liver-kidney yin deficiency (16), and deficiency of both yin and yang (21) Intense liver fire (18), yin deficiency with yang hyperactivity (17), phlegm-damp retention (35), and deficiency of both yin and yang (10)

Guangdong

Shandong

Xinjiang

Chinese Guidelines for the T: 53.48 ± 10.02 Management of C: 59.20 ± 5.610 Hypertension-2005 (CGMH-2005) Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005)

Liver-kidney yin deficiency (69)

Ascendant hyperactivity of liver yang (60)

Intense liver fire (54), yin deficiency with yang hyperactivity (45), phlegm-damp retention (36), and deficiency of both yin and yang (33)

Intense liver fire (43), yin deficiency with yang hyperactivity (40), phlegm-damp retention (38), and deficiency of both yin and yang (49)

Zhejiang

Fujian

Beijing

Beijing

Study ID

Sample (M/F)

Age (years) Diagnosis standard

TCM syndrome differentiation (number of patients)

Region of China

Wu and Xu 2012 149 [82] (74/75)

Fang et al. 2007 220 [83] (128/92)

Fang et al. 2003 229 [84] (113/116)

Peng and Shi 122 2010 [85] (57/65)

Yang et al. 2004 151

[86] (110/41)

Shi et al. 2013 60

[87] (29/31)

Han 2004 [

377 (182/195)

Shen et al. 2008 79 [89] (40/39)

Shen et al. 2005 290

Liu et al. 2009

Lu et al. 2011

Guo et al. 2006

(120/170)

240 (120/120) 80 (56/24)

60 (30/30)

Zhang et al. 2012 140

[94] (83/57)

Dong et al. 2010 166

[95] (106/60)

61.22 ±9.36

64.62 ± 8.86

Not reported

52.6 ± 12.3

T: 51.70 ±4.53 C: 51.67 ±4.36

66.2 ± 1.37

T: 66.07 ± 7.15 C: 67.10 ±7.32

Not reported

56±10

Hypertension diagnostic criteria (unclear)

1999 WHO-ISH GMH

Hypertension diagnostic criteria (unclear)

1999 WHO-ISH GMH

Hypertension diagnostic criteria (unclear) Clinical research guiding principles of new medicine of Chinese traditional medicine

Chinese Guidelines for the Management of Hypertension-2005 (CGMH-2005) Clinical research guiding principles of new medicine of Chinese traditional medicine

Chinese Guidelines for the Management of Hypertension-2004 (CGMH-2004) Hypertension diagnostic criteria (unclear)

1999 WHO-ISH GMH

Chinese Guidelines for the Management of Hypertension-2010 (CGMH-2010) Chinese Guidelines for the Management of Hypertension-2010 (CGMH-2010) Hypertension diagnostic criteria (unclear)

Intense liver fire (48), yin deficiency with yang hyperactivity (32), phlegm-damp retention (49), and deficiency of both yin and yang (20)

Intense liver fire (98), yin deficiency with yang hyperactivity (79), phlegm-damp retention (19), and deficiency of both yin and yang (24)

Liver-kidney yin deficiency (60), yin deficiency with yang hyperactivity (73), phlegm-damp retention (85), and deficiency of both yin and yang (11) Qi deficiency with blood stasis (26), intense liver fire (23), yin deficiency with yang hyperactivity (26), phlegm-damp retention (25), and deficiency of both yin and yang (22)

Ascendant hyperactivity of liver yang (151)

Phlegm-damp retention (60)

Intense liver fire (108), yin deficiency with yang hyperactivity (70), phlegm-damp retention (154), and deficiency of both yin and yang (45)

Phlegm and blood stasis resistance winding and ascendant hyperactivity of liver yang (79)

Intense liver fire (34), yin deficiency with yang hyperactivity (99), phlegm-damp retention (114), and deficiency of both yin and yang (43)

Intense liver fire (240) Blood stasis (80)

Hubei Gansu Hangzhou

Shandong Zhejiang

Guangzhou

Jiangsu

Anhui Guangxi

Yin deficiency with yang hyperactivity (60) Fujian

Ascendant hyperactivity of liver yang (28),

yin deficiency with yang hyperactivity (39),

phlegm-damp retention (45), and deficiency

of both yin and yang (28)

Kidney yin deficiency and wind-phlegm

Sichuan

(9.93%). Among them, there were 879 cases of kidney yin deficiency (97.34%) and 24 cases of kidney yang deficiency (2.66%). There were 399 cases of spleen syndromes (4.39%), all of which were spleen qi deficiency.

3.5. Combining Forms of Syndrome Elements of EH. We found that 13,272 cases of hypertension contained 33 syndrome types. According to the definition of syndrome elements, all syndromes were divided into four types: single factor,

Table 2: Number of papers and cases in region.

Region (China) Provinces Papers (pieces) Cases Male Female

Hebei 5 552 323 229

North China Beijing 6 1374 718 656

Inner Mongolia 1 53 16 37

Tianjin 2 247 131 116

Northeast Liaoning 2 646 376 270

Heilongjiang 2 152 86 66

Xinjiang 2 230 124 106

Northwest Shanxi 1 197 103 94

Gansu 2 260 148 112

Henan 2 200 101 99

Central China Hubei 1 149 74 75

Hunan 1 120 64 56

Shandong 3 368 211 157

Jiangsu 10 3004 1489 1515

Anhui 4 859 421 438

East China Zhejiang 6 655 354 301

Fujian 6 466 307 159

Jiangxi 1 112 83 29

Shanghai 3 338 154 184

South China Guangdong 12 1972 1047 925

Guangxi 7 936 519 417

Yunnan 1 54 30 24

Southwest China Guizhou 2 162 90 72

Sichuan 1 166 106 60

Total 83 13272 7075 6197

Table 3: Syndrome elements of 13,272 patients with essential hypertension.

Syndrome factors Frequency Percentage (%)

Yin deficiency 5554 26.27

Yang hyperactivity 4033 19.08

Phlegm turbidity 2892 13.68

Internal fire 2793 13.21

Internal dampness 2333 11.04

Yang deficiency 1668 7.89

Blood stasis 1027 4.86

Qi deficiency 380 1.80

Internal wind 256 1.21

Qi stagnation 164 0.78

Blood deficiency 38 0.18

Table 4: Targets of syndrome elements.

Target Percentage (%)

Liver 7789 (85.68)

Kidney 903 (9.93)

Spleen 399 (4.39)

Total 100

yin deficiency, dual deficiency of qi and yin, qi stagnation and blood stasis, and qi deficiency with blood stasis. The syndrome, yin deficiency and wind-phlegm, is the most common in the three-factor category. There were no four-factor combinations that reached a frequency of greater than 1%.

two-factor, three-factor, and four-factor syndromes. The statistics of the combined forms of syndrome and their frequency (proportion more than 1%) are shown in Table 5. Internal fire is the most common in the single factor group, while yin deficiency with yang hyperactivity is the most common in the two-factor group. From highest to lowest frequency in the two-factor group are phlegm-damp retention, deficiency of both yin and yang, Liver-kidney

4. Discussion and Perspectives

4.1. Pathogenesis of Hypertension. Syndrome elements are the expression of pathogenesis of a disease [36]. According to the statistical results of syndrome elements, pathogenesis of EH can be summarized as simultaneous insufficiency and excess. Deficiency syndrome included yin deficiency, yang deficiency, qi deficiency, and blood deficiency. Excess

Table 5: Combined syndrome forms.

Combination Class Combination Forms Frequency Percentage (%)

Internal fire 2765 20.98

Single-factor Yang hyperactivity 875 6.64

Blood stasis 398 3.02

Phlegm turbidity 149 1.13

Yin deficiency with yang hyperactivity 3059 23.21

Phlegm-damp retention 2508 19.03

Deficiency of both yin and yang 1605 12.18

Two-factor Liver-kidney yin deficiency 543 4.12

Dual deficiency of qi and yin 189 1.43

Qi stagnation and blood stasis 164 1.24

Qi deficiency with blood stasis 138 1.05

Three-factor Yin deficiency and wind-phlegm 166 1.26

Total 12559 95.29

Yin deficiency Yang hyperactivity Phlegm turbidity Internal fire Internal dampness Yang deficiency

Blood stasis Qi deficiency Internal wind Qi stagnation Blood deficiency

Figure 2: Percentage of syndrome factors.

syndrome included blood stasis, phlegm turbidity, qi stagnation, yang hyperactivity, internal fire, internal dampness, and internal wind. Among them, yin deficiency was the most common, followed by yang hyperactivity. Other elements, included in descending order, were phlegm turbidity, internal fire, internal dampness, yang deficiency, blood stasis, qi deficiency, and internal wind. The main disease location is the liver, which is closely related to the kidney and spleen.

4.2. Characteristics of Combined Syndrome Elements of EH. The combined forms of syndrome elements of hypertension have certain characteristics according to the literature, summarized as follows. (1) The combined forms of syndrome elements of hypertension have three forms, single-factor, two-factor, and three-factor forms. (2) Excess syndromes

are more common than deficiency syndromes for single-factor syndromes, with internal fire, yang hyperactivity, blood stasis, and phlegm turbidity as the main syndrome factors. (3) Deficiency syndrome and excess syndrome was the most common two-factor syndrome, followed by excess syndrome and excess syndrome and deficiency syndrome and deficiency syndrome, respectively. (4) Syndrome of yin deficiency and wind-phlegm was the most common three-factor syndrome.

4.3. Implications for Instructing Clinical Application. The discovery of distributing characteristics of syndrome elements is conducive to instructing clinical application. Several Chinese herbs and classical formulas can lower BP and improve symptoms according to syndrome differentiation (Table 6). First, when aiming to cure internal fire syndrome, use Huanglian Jie Du Tang (detoxicant decoction of Coptis) to clear heat and toxins of the liver [35]. Chinese herbs such as Xiakucao (Prunella vulgaris L.) [123], Huanglian (Coptis chinensis) [124], Huangqin (Scutellaria baicalensis Georgi), Huang-bai (Phellodendron bark), and Zhizi (Gardenia) [125] can lower BP. Second, when aiming to cure yin deficiency with yang hyperactivity, use Tianma Gouteng Yin (decoction of Gastrodia and Uncaria), a famous prescription noted in Za Bing Zheng Zhi Xin Yi (New Meanings in Syndrome and Therapy of Miscellaneous Diseases). Chinese herbs such as Tianma (Gastrodia) [126] and Gouteng (Uncaria) [127] could suppress liver yang hyperactivity. Niuxi (Achyranthes root) [128] and Duzhong (Eucommia ulmoides) [129-131] had antihypertensive effects by nourishing the kidney. Third, when aiming to cure phlegm-damp retention, use Wuling powder [132], Zexie Tang (decoction of Alisma) [133], and Wendantangjiawei decoction (modified decoction for clearing away gallbladder heat). In addition, when aiming at wind-phlegm syndrome, use Banxia Baizhu Tianma Tang (decoction of Pinellia ternata, Atractylodes macrocephala, and Gastrodia elata) to calm the liver, strengthen the spleen, remove dampness, and reduce phlegm [35]. Chinese herbs such as Zexie (Alisma), Fuling (Poria cocos) [134], Zhuling

Table 6: Chinese herbs and classical formulas that lower BP and improve symptoms according to syndrome differentiation.

Syndrome

Formula

Components

TCM efficacy

Chinese herbs

Internal fire syndrome

Huanglian Jie Du Tang (detoxicant decoction of Coptis)

Rhizoma Coptidis, Radix Scutellariae, Radix et Rhizoma Rhei, and Cortex Phellodendri Chinensis

Clear heat and toxins from liver

Classical prescription of Arcane Essentials from the Imperial Library dispensed by Wang Tao in Tang dynasty

Xiakucao (Prunella vulgaris L.), Huanglian (Coptis chinensis), Huangqin (Scutellaria baicalensis Georgij, Huang-bai (Phellodendron bark), and Zhizi (Gardenia)

Yin deficiency with yang hyperactivity

Tianma Gouteng Yin (decoction of Gastrodia and Un caria)

Rhizoma Gastrodiae, Ramulus Uncariae cum Uncis, Concha Haliotidis, Cortex Eucommiae, Radix Achyranthis Bidentatae, Herba Taxilli, Fructus Gardeniae, Radix Scutellariae, Herba Leonuri, Sclerotium Poriae Pararadicis, and Caulis Polygoni Multiflori

Suppressing liver yang hyperactivity, clearing heat, activating blood, and nourishing the kidney

Classical prescription of New Meanings of Treatment in Miscellaneous Diseases with Traditional Chinese Medicine

Tianma (Gastrodia), Gouteng (Uncaria), Niuxi (Achyranthes root), and Duzhong (Eucommia ulmoides)

Phlegm-dampness retention

Wuling powder

Zexie Tang (decoction of Alisma)

Wendan Tang jiawei decoction (modified decoction for clearing away gallbladder heat)

Alisma, Polyporus, Poria cocos, Ramulus Cinnamomi, Rhizoma Atractylodis Macrocephalae

Dissolving phlegm, draining water-dampness, and warming Yang

Alisma, Rhizoma Dissolving phlegm and draining

Atractylodis Macrocephalae water-dampness

Caulis Bambusae in Taenia, Fructus Aurantii Immaturus, Rhizoma Pinelliae, Pericarpium Citri Reticulatae (aged tangerine peel), Poria, Radix et Rhizoma Glycyrrhizae, Radix Codonopsis, Radix Curcumae, and so forth.

Classical prescription of Treatise on Febrile and Miscellaneous Diseases by Zhang Zhongjing in the Eastern Han Dynasty Classical prescription of Treatise on Febrile and Miscellaneous Diseases by Zhang Zhongjing in the Eastern Han Dynasty

Zexie (Alisma), Zhuling (Polyporus), Fuling (Poria cocos), Banxia (The tuber ofpinellia), baizhu (Rhizoma Atractylodis Macrocephalae), Zelan (Herba Lycopi), and Shichangpu (Rhizoma Acori Tatarinowii)

Dissolving phlegm and boosting

Modified classical prescription of Prescriptions Assigned to the Three Categories of Pathogenic Factors of Diseases

Wind-phlegm

Banxia Baizhu Tianma Tang (decoction ofPinellia ternata, Atractylodes macrocephala, and Gastrodia elata)

Rhizoma Pinelliae Praeparatum, Rhizoma Gastrodiae, Pericarpium Citri Reticulatae, Poria, and Radix et Rhizoma Glycyrrhizae

Calmed the liver, strengthened the spleen, removed dampness, and reduced phlegm

Classical prescription of Medical Revelations dispensed by Cheng Zhongling in Qing dynasty

Fuling (Poria cocos), Banxia (Pinellia ternata), Baizhu (Rhizoma Pinelliae Praeparatum), Tianma (Rhizoma Gastrodiae), and Chenpi (Pericarpium Citri Reticulatae)

Table 6: Continued.

Syndrome

Formula

Components

TCM efficacy

Chinese herbs

Blood stasis

XuefuZhuyu Tang

Radix Angelicae Sinensis, Radix Rehmanniae, Semen Pruni Persicae, red flower, Fructus Aurantii, Chinese thorowax root, red peony root, Radix etRhizoma Glycyrrhizae, Platycodon grandiflorum, Ligusticum chuanxiong Hort, and Radix Achyranthis Bidentatae

Removing blood stasis and promoting Qi

Classical prescription of Yi Lin Gai Cuo (correction of the errors of medical works) by Wang Qingren in the Qing Dynasty

Danggui (Radix Angelicae Sinensis), Chishao (red peony root), Danshen (Salvia miltiorrhiza), Yimucao (Leonurus japonicus), Chuanxiong (Ligusticum chuanxiong Hort), and Shengdi (Radix Rehmanniae)

Liver-kidney yin deficiency

Liu Wei Dihuang Wan (pill ofRehmannia)

Rehmannia glutinosa, Fructus corni, Rhizoma Dioscoreae, Alisma, Poria cocos, and Cortex Moutan Radicis

Replenish liver and kidney yin

Xiaoer Yaozheng Zhijue (Pediatric medicine card straight) by Qianyi in the Song Dynasty

Shanyurou (Fructus corni), Duzhong (Eucommia), Shudi (Rehmannia glutinosa), Gouqizi (Lycium barbarum L.), and Huangjing (Rhizoma Polygonati)

Yang deficiency

Shen qi Wan (kidney qi pill)

Rehmannia glutinosa, Fructus corni, Rhizoma Dioscoreae, Alisma, Poria cocos, Cortex Moutan Radicis, Cortex Cinnamomi, and Radix Aconiti Carmichaeli

Recuperate kidney yang

Classical prescription of Treatise on Febrile and Miscellaneous Diseases by Zhang Zhongjing in the Eastern Han Dynasty

Fuzi (Radix Aconiti Carmichaeli), Bajitian (Morinda officinalis), Yinyanghuo (Epimedium), Buguzhi (Psoralea fruits), and Rousongrong (Cistanche)

Qi deficiency

Buzhong yiqi Tang

Codonopsis pilosula, Astragalus membranaceus, Rhizoma Atractylodis Macrocephalae, Tangerine Peel, Rattletop, Radix Bupleuri, Angelica sinensis, and Liquorice

Replenish qi to invigorate the spleen

Classical prescription of Treatise on Spleen and Stomach by Li Dongyuan in the Jin Dynasty

Dangshen (Codonopsis pilosula), Huangqi (Astragalus membranaceus), andBaizhu (Rhizoma Atractylodis Macrocephalae)

Blood deficiency Danggui siwu Tang

Angélica sinensis, Radix Paeoniae Rubra, Ligusticum chuanxiong Hort, and Rehmannia glutinosa Libosch

Enrich and nourish blood

Classical prescription of Treatise on Febrile and Miscellaneous Diseases by Zhang Zhongjing in the Eastern Han Dynasty

Danggui (Angelica sinensis), Chuanxiong (Ligusticum chuanxiong Hort), Shudihuang (Rehmannia glutinosa Libosch), and Baishao (Radix Paeoniae Rubra)

(Polyporus) [135], and Banxia (The tuber of pinellia) [136] could effectively reduce BP as well. Fourthly, to remove blood stasis, use Xuefu Zhuyu Tang, a famous classical prescription recorded in Yi Lin Gai Cuo (Correction of the Errors of Medical Works) by Wang Qingren in the Qing Dynasty. It is effective in removing blood stasis and promoting Qi. Herbs such as Chishao (red peony root) [137], Danshen (Salvia miltiorrhiza) [138], Yimucao (Leonurus japonicus), and Chuanxiong (Ligus-ticum chuanxiong Hort) [139] could also lower BP. When aiming to remove qi stagnation and blood stasis, use herbs to promote qi circulation by taking herbs to remove blood stasis. Herbs that promote qi circulation include Chaihu (Chinese thorowax root) [137], Cangzhu (Rhizoma Atractylodis), and Zhiqiao (Fructus Aurantii). Finally, deficiency syndromes including liver-kidney yin deficiency, yang deficiency, qi deficiency, and blood deficiency are common in hypertension. When curing liver-kidney yin deficiency, use Liu Wei Dihuang Wan (pill of Rehmannia) [23]. Liu Wei Dihuang Wan was recorded in Xiaoer Yaozheng Zhijue (Pediatric Medicine Card Straight) by Qianyi in the Song Dynasty, and it can replenish liver and kidney yin. When treating yang deficiency, use Shen qi Wan (kidney qi pill) to recuperate kidney yang. When aiming to treat qi deficiency, use Huangqi (Astragalus membranaceus) [140-142] and Baizhu (Rhizoma Atractylodis Macrocephalae). When aiming to treat blood deficiency, use Danggui (Angelica sinensis) [143], Shengdihuang (Radix Rehmanniae), Chuanxiong (Ligusticum chuanxiong Hort) [144], and Baishao (Radix Paeoniae Rubra).

In summary, the syndrome elements of hypertension are limited and are combined into syndromes. Single and the combined syndrome elements of hypertension are the basis of syndrome differentiation for EH and the key to the standardization of this syndrome. In this paper, we retrospectively confirmed the validity and reliability of the theory of syndrome elements and the combined forms of syndrome elements of hypertension. This study can provide new ideas and methods for the treatment of hypertension by syndrome differentiation, and has laid a foundation for researching syndrome standardization of hypertension.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Authors' Contribution

Jie Wang and Xingjiang Xiong contributed equally in this paper.

References

[1] M. Slama, D. Susic, and E. D. Frohlich, "Prevention ofhyperten-sion," Current Opinion in Cardiology, vol. 17, no. 5, pp. 531-536, 2002.

[2] D. A. Calhoun, M. A. Zaman, and M. K. Nishizaka, "Resistant hypertension," Current Hypertension Reports, vol. 4, no. 3, pp. 221-228, 2002.

[3] V. L. Roger, D. M. Lloyd-Jones, A. S. Go et al., "Heart disease and stroke statistics 2011 update: a report from the American Heart Association," Circulation, vol. 123, pp. e118-e209, 2011.

[4] P. M. Kearney, M. Whelton, K. Reynolds, P. Muntner, P. K. Whelton, and J. He, "Global burden of hypertension: analysis of worldwide data," Lancet, vol. 365, no. 9455, pp. 217-223, 2005.

[5] D. Lloyd-Jones, R. Adams, M. Carnethon et al., "Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee," Circulation, vol. 119, no. 3, pp. 480-486, 2009.

[6] D. Su and L. Li, "Trends in the use of complementary and alternative medicine in the United States: 2002-2007," Journal of Health Care for the Poor and Underserved, vol. 22, no. 1, pp. 296-310, 2011.

[7] S. M. Ching, Z. A. Zakaria, F. Paimin et al., "Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: a cross-sectional study in Malaysia," BMC Complementary and Alternative Medicine, vol. 13, article 148, 2013.

[8] C. Hawk, H. Ndetan, and M. W. Evans, "Potential role of complementary and alternative health care providers in chronic disease prevention and health promotion: an analysis of National Health Interview Survey data," Preventive Medicine, vol. 54, no. 1, pp. 18-22, 2012.

[9] X. J. Xiong, X. C. Yang, W. Liu et al., "Banxia baizhu tianma decoction for essential hypertension: a systematic review of randomized controlled trials," Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 271462, 10 pages, 2012.

[10] X. J. Xiong, X. C. Yang, B. Feng et al., "Zhen gan xi feng decoction, a traditional Chinese herbal formula, for the treatment of essential hypertension: a systematic review of randomized controlled trials," Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 982380, 9 pages, 2013.

[11] J. Wang, X. C. Yang, B. Feng et al., "Is yangxue qingnao granule combined with antihypertensive drugs, a new integrative medicine therapy, more effective than antihypertensive therapy alone in treating essential hypertension?" Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 540613, 8 pages, 2013.

[12] W. Y. Tam, P. Chook, M. Qiao et al., "Cardiovascular protective effects of adjunctive alternative medicine (Salvia miltiorrhiza and Pueraria lobata) in high-risk hypertension," Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 132912, 8 pages, 2013.

[13] H. Xu and K. J. Chen, "Complementary and alternative medicine: is it possible to be main stream?" Chinese Journal of Integrative Medicine, vol. 18, pp. 403-404, 2012.

[14] A. S. Ferreira and A. J. Lopes, "Chinese medicine pattern differentiation and its implications for clinical practice," Chinese Journal of Integrative Medicine, vol. 17, no. 11, pp. 818-823, 2011.

[15] J. Wang, X. J. Xiong, and W. Liu, "Yoga for essential hypertension: a systemic review," PloS ONE, vol. 8, no. 10, Article ID e76357, 2013.

[16] M. S. Lee, H. J. Lim, and M. S. Lee, "Impact of qigong exercise on self-efficacy and other cognitive perceptual variables in patients with essential hypertension," Journal of Alternative and Complementary Medicine, vol. 10, no. 4, pp. 675-680, 2004.

[17] J. Wang, B. Feng, X. C. Yang et al., "Tai Chi for Essential Hypertension," Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 215254, 10 pages, 2013.

[18] J. Wang and X. J. Xiong, "Outcome measures of Chinese herbal medicine for hypertension: an overview of systematic reviews," Evidence-Based Complementary and Alternative Medicine,, vol.

2012, Article ID 697237, 7 pages, 2012.

[19] X. J. Xiong, X. C. Yang, Y. M. Liu et al., "Chinese herbal formulas for treating hypertension in traditional Chinese medicine: perspective of modern science," Hypertension Research, vol. 36, pp. 570-579, 2013.

[20] J. Wang, B. Feng, X. C. Yang et al., "Tianma gouteng yin as adjunctive treatment for essential hypertension: a systematic review of randomized controlled trials," Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 706125,18 pages, 2013.

[21] J. Wang, B. Feng, X. C. Yang, W. Liu, and X. Xiong, "Chinese herbal medicine for the treatment of prehypertension," Evidence-Based Complementary and Alternative Medicine, vol.

2013, Article ID 493521, 9 pages, 2013.

[22] K. J. Chen, "Mao ZD and integrative medicine," Zhongguo ZhongXi Yi JieHe Za Zhi, vol. 13, no. 2, pp. 711-713,1993.

[23] J. Wang, K. W. Yao, X. C. Yang et al., "Chinese patent medicine liu wei di huang wan combined with antihypertensive drugs, a new integrative medicine therapy, for the treatment of essential hypertension: a systematic review of randomized controlled trials," Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 714805, 7 pages, 2012.

[24] J. Wang, B. Feng, and X. J. Xiong, "Chinese herbal medicine for the treatment of obesity-related hypertension," Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 757540, 11 pages, 2013.

[25] J. Wang and X. J. Xiong, "Current situation and perspectives of clinical study in integrative medicine in China," Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 268542, 11 pages, 2012.

[26] K. J. Chen, Y. R. Jiang, and Y. H. Xie, "Past and present of combination of disease differentiation and syndrome differentiation," Zhongguo ZhongXi Yi Jie He Za Zhi, vol. 31, no. 4, pp. 437-443, 2011.

[27] H. Xu and K. J. Chen, "Integrating traditional medicine with biomedicine towards a patient-centered healthcare system," Chinese Journal of Integrative Medicine, vol. 17, no. 2, pp. 83-84, 2011.

[28] S. L. Chen, X. Y. Liu, W. M. Xu, W. Y. Mei, and X. L. Chen, "Clinical study of western medicine combined with Chinese medicine based on syndrome differentiation in the patients with polarized hypertension," Chinese Journal of Integrative Medicine, vol. 18, no. 10, pp. 746-751, 2012.

[29] L. Liu, E. L. H. Leung, and X. Tian, "Perspective: the clinical trial barriers," Nature, vol. 480, 7378, p. S100, 2011.

[30] G. Dobos and I. Tao, "The model of Western Integrative Medicine: the role of Chinese medicine," Chinese Journal of Integrative Medicine, vol. 17, no. 1, pp. 11-20, 2011.

[31] X. J. Xiong, F. Y. Chu, H. X. Li, and Q. Y. He, "Clinical application of the TCM classic formulae for treating chronic bronchitis," Journal of Traditional Chinese Medicine, vol. 31, no. 1, pp. 69-72, 2011.

[32] J. Wang and X. Xiong, "Control strategy on hypertension in Chinese medicine," Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 284847, 6 pages, 2012.

[33] J. Wang, X. J. Xiong, G. Y. Yang et al., "Chinese herbal medicine qi ju di huang wan for the treatment of essential hypertension:

a systematic review of randomized controlled trials," Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 262685, 10 pages, 2013.

[34] P. Tian, "Convergence: where West meets East," Nature, vol. 480, supplement 7378, pp. S84-S86, 2011.

[35] J. Wang and X. Xiong, "Control strategy on hypertension in Chinese medicine," Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 284847, 6 pages, 2012.

[36] J. Wang, P. Q. Wang, and X. J. Xiong, "Current situation and re-understanding of syndrome and formula syndrome in Chinese medicine," Internal Medicine, vol. 2, no. 3, Article ID 1000113, 2012.

[37] H. Xu and K. Chen, "Integrative medicine: the experience from China," Journal of Alternative and Complementary Medicine, vol. 14, no. 1, pp. 3-7, 2008.

[38] F. Cheung, "TCM: made in China," Nature, vol. 480, no. 7378, pp. S82-S83, 2011.

[39] X. J. Xiong, X. C. Yang, W. Liu et al., "Trends in the treatment of hypertension from the perspective of traditional Chinese medicine," Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 275279, 13 pages, 2013.

[40] A. P. Lu, H. W. Jia, C. Xiao, and Q. P. Lu, "Theory oftraditional Chinese medicine and therapeutic method of diseases," World Journal of Gastroenterology, vol. 10, no. 13, pp. 1854-1856, 2004.

[41] Q. G. Zhao, H. Li, H. M. Yang et al., "Difference of urine protein during the stage of early renal damage in elderly primary hypertensive patients with different yraditional Chinese Medical syndrome types: an analysis of 122 cases," Journal of Chinese Medicine, vol. 44, no. 7, pp. 25-27, 2012.

[42] F. M. Liu, X. H. Chen, W. Q. Du et al., "Correlativity between ACE Gene I/D polymorphism and TCM syndromes of primary hypertension," Shanghai Journal of Traditional Chinese Medicine, vol. 43, no. 11, pp. 33-35, 2009.

[43] X. Y. Wang, Z. Q. Xie, and L. L. Ji, "Clinical research of amlodipine combined Xingqi huoxue decoction on 99 elderly patients with qi stagnation and bood stasis hypertension," Chinese Medicine Modern Distance Education of China, vol. 10, no. 13, pp. 81-82, 2012.

[44] F. H. Luo, G. H. Li, Q. L. Li et al., "Clinical research on syndrome differentiation of point application in the treatment of primary hypertension," China Medical Herald, vol. 8, no. 21, pp. 108-112, 2011.

[45] C. H. Wang, Y. Gao, J. Z. Chen et al., "Effect of syndrome differentiation and treatment combined alisma decoction on traditional Chinese medicine symptom integral of hypertension," Global Traditional Chinese Medicine, vol. 5, no. 7, pp. 538540, 2012.

[46] Y. S. Wang, Z. H. Lin, and H. C. Chen, "Clinical research on the treatment of early hypertensive renal damage by tonifying kidney and invigorating the circulation of blood," Traditional Chinese Medicine Journal, vol. 10, no. 5, pp. 52-54, 2011.

[47] C. J. Bai, Y. Zhou, L. Wang, D. L. Zhang, and Y. Yang, "Delam-ination of cardiovascular risk factor, staging and grading of hypertension and the changing characteristics of blood lipids and hemorheological indexes in hypertensive patients with different syndromes of traditional Chinese medicine," Chinese Journal of Clinical Rehabilitation, vol. 9, no. 23, pp. 145-147,2005.

[48] L. J. Yang, L. Yao, A. F. Liu et al., "Relation study between erythrocyte immunological function and serum SOD activity of hypertension patients with different typing," Modern Journal of Integrated Traditional Chinese and Western Medicine, vol. 14, no. 13, pp. 1676-1677, 2005.

[49] C. X. Xia, Q. Y. Yang, H. J. Zhu et al., "Correlation study on different TCM syndromes of primary hypertension and NO/NOS system, ET21, left ventricular mass index (BMI)," Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease, vol. 8, no. 1, pp. 32-33, 2010.

[50] Z. Y. Liu, H. L. Wu, Y. Luo et al., "The effect of shenmai injection dealing with insufficient relaxation of left ventricle caused by hypertension," Chinese Journal of Chinese Medicine Information, vol. 10, no. 4, pp. 16-18, 2003.

[51] W. H. Yin and J. L. Liu, "Clinical observation on treatment of 53 cases with essential hypertension by deficiency syndrome," Inner Mongolia Medical Journal, vol. 37, no. 6, pp. 536-537,2005.

[52] R. Wu, F. D. Zhao, and S. J. Yu, "Research of different type of traditional medical syndromes on hypertension disease with regularity of blood pressure variability," Chinese Journal of Chinese Medicine Emergency, vol. 19, no. 3, pp. 443-445, 2010.

[53] H. F. Deng, "Analysis of effect on compound danshen dropping pill compared with sheng tong ping in patients with hypertension," Asia-Pacific Traditional Medicine, vol. 4, no. 10, pp. 46-48, 2008.

[54] L. Q. Wu and F. Q. Xu, "Study on the relationship between type of syndrome of high-risk hypertensive patients and target organ damage and the risk factors of cardiovascular events," Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease, vol. 8, no. 12, pp. 1409-1410, 2010.

[55] W. Wang, F. Q. Li, and Y. P. Li, "Study on the relationship between Syndrome differentiation type of hypertension and Angiotensin original gene M 235T and T 174M polymorphisms," Journal of Zhejiang Traditional Chinese Medicine, vol. 46, no. 9, pp. 628-629, 2011.

[56] D. M. Wu, X. H. Chen, and F. M. Liu, "Studying of relationship between arteriosclerosis of essential hypertension and TCM syndromes," Journal of Chinese Medicine in Inner Mongolia, vol. 3, pp. 1-2, 2010.

[57] Q. L. Fan and F. M. Liu, "Studying of relationship between ambulatory blood pressure of hypertension and syndrome differentiation type of TCM," Jilin Journal of TCM, vol. 30, no. 10, pp. 859-860, 2010.

[58] W. Zhu, S. J. Li, and X. M. Ruan, "Study on the relationship between arterial compliance and syndrome differentiation typing in hypertensive patients," Lishizhen Medicine and Materia Medica Research, vol. 20, no. 1, pp. 38-40, 2009.

[59] F. M. Liu, X. H. Chen, W. Q. Du et al., "Clinical research on the distribution regularity of TCM syndrome types," Journal of Chinese Medicine in Jiangsu, vol. 41, no. 10, pp. 33-34, 2009.

[60] S. Y. He, D. Y. Fu, and L. H. Zu, "Correlation of traditional Chinese medicine syndromes with B-type natriuretic peptide and the risk of stroke in patients with essential hypertension: a preliminary study," China Journal of Traditional Chinese Medicine and Pharmacy, vol. 28, no. 1, pp. 281-284, 2013.

[61] J. Y. Tang, Y. H. Wang, N. Tang et al., "Correlativity between Patterns of Hypertension in TCM and Polymorphism of COX-2," Shanghai Zhongyiyao DaxueXuebao, vol. 26, no. 3, pp. 32-35, 2012.

[62] N. J. Gong, Q. Li, J. Chen et al., "A correlated study between TCM syndrome and cardiac structural functional changes in patients with primary hypertension," Tianjin Journal of Traditional Chinese Medicine, vol. 27, no. 1, pp. 19-21, 2010.

[63] C. Zhang, Z. H. Xing, W. P. Liu et al., "Relativity investigation of plasma endothelin and blood pressure in patients with hypertension with different traditional Chinese medical

classification," Liaoning Journal of TCM, vol. 32, no. 1, pp. 6-8, 2005.

[64] F. M. Liu, W. Q. Du, L. Shen et al., "A correlated study between left ventricular hypertrophy of hypertension and TCM syndrome type," Liaoning Journal of TCM, vol. 44, no. 12, pp. 871-872, 2009.

[65] J. Y. Wang, "A correlated study between syndrome differentiation type of TCM and ambulatory blood pressure," Medical Laboratory Sciences, vol. 3, pp. 143-144, 2012.

[66] M. M. Yao and T. J. Huang, "A correlated study between syndrome differentiation type of TCM and blood uric acid," Fujian Journal of TCM, vol. 38, no. 5, pp. 9-11, 2007.

[67] L. L. Guo, Y. Zhou, and T. T. Zhuang, "Relationship between the endothelin/nitric oxide and hypertension with traditional Chinese medical classification," Guizhou Medical Journal, vol. 26, no. 6, pp. 502-504, 2002.

[68] J. Z. Zhang, L. G. Chen, X. Q. Hu et al., "Influence of astragalus polysaccharide on the expression of Toll-like receptor 4 and nuclear transcription factor-k B in essential hypertension patients with blood stasis syndrome," Journal of Traditional Chinese Medicine, vol. 52, no. 15, pp. 1286-1304, 2011.

[69] W. Q. Liao, W. M. Huang, B. He et al., "Observation on insulin resistance of essential hypertension treated by the therapeutic method of activating blood circulation to dissipate Blood Stasis," Chinese Journal of Information on TCM, vol. 17, no. 9, pp. 9-11, 2010.

[70] Y. W. Xiong, "Clinical effect of the modified banxia baizhu tianma decoction combining western medicine on 60 patients with phlegm-dampness type primary hypertension," Chinese Medicine Modern Distance Education of China, vol. 8, no. 13, pp. 67-68, 2010.

[71] C. X. Jiang, J. M. Cao, and J. Y. Xu, "Clinical research on effects of the renin-angiotensin-II of senile patients with high blood pressure byjianling decoction," Chinese Journal of Science and Technology of Chinese Medicine, vol. 19, no. 2, 2012.

[72] Z. C. Huang and Q. P. Wei, "Curative effect analysis on identifying treatment of resistant hypertension combined with the system of traditional Chinese medicine," Chinese Community Doctors, vol. 14, no. 35, pp. 192-193, 2012.

[73] X. Lu, "Clinical research on the treatment of patients with liver-kidney yin deficiency of hypertension by qiju dihuang wan decoction," Xinjiang Journal of Chinese Medicine, vol. 22, no. 5, pp. 20-22, 2004.

[74] H. T. Sun and C. Wang, "Different manifestations of cognitive dysfunction in hypertensive patients with different syndromes of traditional Chinese medicine," Chinese Journal of Clinical Rehabilitation, vol. 9, no. 20, pp. 63-65, 2005.

[75] Y. Xiang, G. C. Bai, and L. M. Wu, "Syndrome differentiation type and of nursing modern of community of primary hypertension," Hebei Journal of TCM, vol. 34, no. 5, pp. 766-768,2012.

[76] D. X. Zhu, "The effect of injected Ligustrazine to shenshu point in patients with hypertension," China Practical Medicine, vol. 4, no. 15, pp. 38-40, 2009.

[77] C. Y. Xu and F. L. Wang, "Clinical observation of hypertensive effect of taichong acupoint injection with ligustrazine on hypertension," Occupations and Health, vol. 25, no. 18, pp. 20002002, 2009.

[78] M. Lin and N. S. Kang, "Study on carotid ultrasound of phlegm dampness syndromes compared with yang hyperactivity syndromes of not intervention in primary hypertension," Journal of Shandong University of TCM, vol. 36, no. 2, pp. 115-117, 2012.

[79] H. Feng, Z. C. Liu, and B. Xu, "Clinical observation on the treatment of 36 cases of excessive accumulation of phlegm-dampness of essential hypertension complicated by obesity by warm acupuncture," Journal of Anhui TCM College, vol. 32, no. 1, pp. 47-50, 2013.

[80] A. W. Yu and E. H. Xing, "Clinical observation on the treatment of 90 cases with hypertension by Xifeng Tongluo Huayu decoction," Journal of Sichuan of TCM, vol. 28, no. 3, pp. 74-76, 2010.

[81] C. Qiu, X. D. Cheng, F. K. Cheng et al., "Clinical observation on the treatment of senile hypertension by Yiqihuoxue decoction," Hebei Journal of TCM, vol. 33, no. 6, pp. 838-839, 2011.

[82] T. C. Wu and T. Xu, "Clinical observation on the treatment of 60 cases of senile hypertension by tonifying qi and yin," Yunnan Journal of TCM, vol. 33, no. 4, pp. 31-33, 2012.

[83] X. M. Fang, X. Y. Huang, Q. Wang et al., "Research of clustering analysis of syndrome differentiation type of hypertension," Guangxi Journal of TCM, vol. 30, no. 5, pp. 9-11, 2007.

[84] W. Fang, T. L. Chen, and G. L. Zhu, "Research on the syndrome differentiation type of primary hypertension and the characteristics of dynamic blood pressure changes," Zhejiang Journal of TCM, vol. 4, pp. 164-166, 2003.

[85] L. L. Peng and D. Z. Shi, "Analysis on syndromes elements of primary hypertension with depression," Beijing Journal of TCM, vol. 29, no. 7, pp. 534-536, 2010.

[86] H. Y. Yang, Y. R. Jin, and H. Yang, "Relationship between the syndrome differentiation type of hypertension and ambulatory blood pressure," Chinese Journal of Information TCM, vol. 11, no. 1, pp. 23-46, 2004.

[87] X. L. Shi, Z. L. Wen, N. Zhang et al., "Clinical investigation on related factors and rule of the type of distribution of primary hypertension with depression," Jiangsu Journal of TCM, vol. 45, no. 2, pp. 25-26, 2013.

[88] Y. M. Han, "Clinical study on the treatment of primary hypertension based on syndrome differentiation of TCM," Health Guides of the International Medical, vol. 10, no. 10, pp. 120-122, 2004.

[89] R. Shen, Y. D. Chen, Z. X. Zhang et al., "Exploring the correlation of syndrome differentiation of primary hypertension and heart rate variability," China Journal of Traditional Chinese Medicine and Pharmacy, vol. 23, no. 5, pp. 453-455, 2008.

[90] Y. Shen, J. D. Zhang, L. H. Hu et al., "The relatirity of insulin resistance and syndrome differentiation typing in essential hypertension," Journal of Shandong University, vol. 43, no. 2, pp. 142-145, 2005.

[91] X. L. Liu, A. L. Wei, F. Luo et al., "Ultrasound study of carotid artery plaque score and the carotid intinamedia thickness in essential hypertension with traditional chinese medical classification," Liaoning Journal of TCM, vol. 36, no. 5, pp. 689-692, 2009.

[92] X. Lu, C. Y. Wei, L. H. Yang et al., "Study on the relationship between syndrome type of TCM of primary hypertension and apolipoprotein," Journal of Guangxi Traditional Chinese Medical University, vol. 14, no. 3, pp. 4-6, 2011.

[93] K. F. Guo, J. F. Zhang, and W. Q. Yang, "Relationships between personality characteristic and diff erentiation of symptom and sign for classification of syndrome of traditional Chinese medicine in patients with primary hypertension," Chinese Journal of Cardiovascular Rehabilitation Medicine, vol. 15, no. 4, pp. 326-328, 2006.

[94] J. P. Zhang, H. W. Yuan, H. L. Wang et al., "Correlation between concentration of ^2 microglobulin in blood and urine

in patients with primary hypertension and traditional Chinese medicine syndrome," Hebei Journal of TCM, vol. 34, no. 5, pp. 658-660, 2012.

[95] C. W. Dong, M. Dong, Q. S. Xing et al., "Relationship between polymorphism of angiotensin converting enzyme gene and different traditional Chinese medicine syndrome in patients with essential hypertension," Chinese Journal of Pathophysiology, vol. 26, no. 8, pp. 1545-1548, 2010.

[96] Z. B. Zhang, C. G. Zhou, and S. Lu, "Distribution of TCM syndrome types of essential hypertension and their relationship to biochemical indicators," Liaoning Journal of TCM, vol. 37, no. 6, pp. 969-972, 2010.

[97] J. Chen and Z. Q. Chen, "Clinical study on characteristics of changes in dynamic blood pressure in patients with primary hypertension of blood stasis syndrome," World Journal of Integrated Traditional and Western Medicine, vol. 3, no. 10, pp. 600-603, 2008.

[98] L. Liu and Y. Q. Zhang, "A correlated study between HCY, MAU and TCM syndrome type of hypertension," Heilongjiang Journal of TCM, vol. 5, pp. 5-7, 2010.

[99] X. Zhou, "Clinical effect analysis on treating 86 cases of essential hypertension with treatment based on differentiation of symptoms and signs," Clinical Journal of Chinese Medicine, vol. 5, no. 3, pp. 55-57, 2013.

[100] G. Y. Chen, L. J. Wang, J. Liu et al., "Relationship between TCM syndrome types and related risk factors of essential hypertension," Chinese Journal of Information on TCM, vol. 19, no. 11, pp. 16-18, 2012.

[101] W. Q. Zhou, D. H. Liu, Y. N. Dai et al., "Study on the correlation between the related factors and TCM syndromes of essential hypertension with left ventricular hypertrophy," Journal of Traditional Chinese Medicine, vol. 50, no. 3, pp. 248-250, 2009.

[102] Y. X. Ding, Y. X. Zhou, B. Liu et al., "Preliminary analysis on epidemiological characteristics of TCM syndromes of primary hypertension in Guangdong region," Journal of Anhui TCM College, vol. 28, no. 2, pp. 25-27, 2009.

[103] Z. W. Li, "Clinical observation on the treatment of 125 cases of essential hypertension complicated by syndrome differentiation and treatment of TCM," Forum on Traditional Chinese Medicine, vol. 17, no. 2, pp. 31-33, 2002.

[104] Z. F. Qiu, "Clinical observation on the treatment of 97 cases of essential hypertension by syndrome differentiation of TCM," Chinese Journal of Ethnomedicine and Ethnopharmacy, vol. 3, pp. 187-189, 2010.

[105] W. L. Deng and G. Zhao, "Clinical observation on syndrome differentiation of TCM of 80 cases of the hypertension patients with left ventricular hypertrophy," Xinjiang Journal of TCM, vol. 22, no. 5, pp. 20-22, 2004.

[106] Q. Chen, "Clinical study on primary hypertension early time kidney harm with Zishuiqingganyin," Chinese Archives of TCM, vol. 28, no. 6, pp. 1332-1335, 2010.

[107] T. W. Zhang and B. R. Zheng, "Clinical observation on the treatment of 30 cases of essential hypertension with liver-yang hyperactivity by " Jiangya 2"," Fujian Medical Journal, vol. 31, no. 6, pp. 133-135, 2009.

[108] Y. X. Wan and T. Z. Zhang, "Research on relationship between angiotensinogen gene M235T and TCM syndrome type in essential hypertension patients," Chinese Journal of Integrated Traditional and Western Medicine, vol. 28, no. 1, pp. 36-38,2008.

[109] Y. J. Xu and T. Z. Zhang, "Relationship of day and night rhythm of Essential Hypertension with TCM Syndrome patterns," Journal of New Chinese Medicine, vol. 40, no. 5, pp. 41-43,2008.

[110] D. Zhang and H. R. Li, "Epidemiological investigation and distribution of TCM syndrome of primary hypertension in community," The Community of Chinese Medicine, vol. 12, no. 229, p. 83, 2010.

[111] Z. H. Pu, G. D. Yang, T. Y. Ding et al., "Clinical observation on the effect of blood pressure, cholesterol, blood sugar, and the clinical syndromes of traditional Chinese medicine of 220 cases of essential hypertension by "Ping ganyin" capsule," China Journal of Chinese Materia Medica,vol. 33, no. 10, pp. 1202-1205, 2008.

[112] W. J. Cheng, Z. C. Tan, F. Guo et al., "Epidemiological studies on TCM syndrome of 602 cases ofprimaryhypertension," Chinese Journal of Integrated Traditional and Western Medicine, vol. 13, no. 4, pp. 261-263, 2003.

[113] B. Y. Ding, Z. B. Shao, L. Zheng et al., "Study on the relationship between early nephritic injures by essential hypertension and traditional Chinese medicine syndrome patterns," Journal of Anhui TCM College, vol. 5, no. 4, pp. 6-8, 2006.

[114] S. Fu and Y. L. Li, "Establishing standards of measuring essential hypertension with hyperactive of liver-Yang syndrome based on multivariate analysis of statistics," Journal of Shandong University of TCM, vol. 34, no. 1, pp. 14-16, 2010.

[115] Q. Pan, Z. D. Liu, L. P. Chen et al., "Shiliangcha Prescription of "She medicine" combined with western medicine in treating essential hypertension of damp-phlegm pattern: a report of 30 cases," Shanghai Journal of TCM, vol. 46, no. 3, pp. 49-51, 2012.

[116] G. L. Chen, B. Y. Wang, H. P. Liu et al., "Survey on traditional Chinese medicine syndrome types in 471 patients with essential hypertension," Journal ofAnhui TCM College, vol. 30, no. 4, pp. 24-26, 2011.

[117] Y. H. Zhao, Y. D. Liu, P. G. Huang et al., "Effects of clinical treatment and protection on endothelial function of early essential hypertension's patients treated with YNJY soup in southern Guangdong area," China Journal of Traditional Chinese Medicine and Pharmacy, vol. 24, no. 9, pp. 1148-1150, 2009.

[118] C. G. Zhou, Z. B. Zhang, C. X. Xia et al., "Association of the C-344T polymorphism of CY P11 B2 gene with TCM syndrome type in essential hypertension," Liaoning Journal of TCM, vol. 37, no. 4, pp. 577-579, 2010.

[119] J. H. Huang, Q. S. Zheng, R. Gao et al., "Clinical equivalence evaluation on the efficacy and safety of Niuhuang jiangya tablets and pills in the treatment of patients with primary hypertension (overabundant liver-fire)," Chinese Journal of Evidence-Based Medicine, vol. 4, no. 4, pp. 249-251, 2004.

[120] X. Lu, "Clinical observation on the treatment of essential hypertension by compound Danshen dripping pills," Journal of Guangxi Traditional Chinese Medical University, no. 2, pp. 2829, 2004.

[121] D. Zhu and S. B. Lin, "Clinical observation on the treatment of essential hypertension with yin deficiency and yang excess by Zishui pinggan decoction," Chinese Journal of Geriatric Care, vol. 10, no. 4, pp. 32-35, 2012.

[122] C. H. Wang, Y. Gao, J. Z. Chen et al., "Impact analysis of syndrome differentiation combined with modified Zixie decoction for hypertension symptoms," World Chinese Medicine,vol. 8, no. 3, pp. 285-287, 2013.

[123] D. G. Ji, "Ling kok uncaria decoction in the treatment of hypertension," Journal of Chinese Herbs of TCM, vol. 18, no. 10, pp. 92-93, 2011.

[124] L. Yuan, D. Tu, X. Ye, and J. Wu, "Hypoglycemic and hypoc-holesterolemic effects of Coptis chinensis franch inflorescence,"

Plant Foods for Human Nutrition, vol. 61, no. 3, pp. 139-144, 2006.

[125] H. J. Koo, K. H. Lim, H. J. Jung, and E. H. Park, "Anti-inflammatory evaluation of gardenia extract, geniposide and genipin," Journal ofEthnopharmacology, vol. 103, no. 3, pp. 496500, 2006.

[126] S. C. Ho, Y. F. Ho, T. H. Lai, T. H. Liu, and R. Y. Wu, "Traditional Chinese herbs against hypertension enhance the effect of memory acquisition," American Journal of Chinese Medicine, vol. 33, no. 5, pp. 787-795, 2005.

[127] J. Zhou and S. Zhou, "Antihypertensive and neuroprotec-tive activities of rhynchophylline: the role of rhynchophylline in neurotransmission and ion channel activity," Journal of Ethnopharmacology, vol. 132, no. 1, pp. 15-27, 2010.

[128] K. Hansen, U. Nyman, U. W. Smitt et al., "In vitro screening of traditional medicines for anti-hypertensive effect based on inhibition of the angiotensin converting enzyme (ACE)," Journal ofEthnopharmacology, vol. 48, no. 1, pp. 43-51,1995.

[129] J. Gu, J. J. Wang, J. Yan et al., "Effects of lignans extracted from Eucommia ulmoides and aldose reductase inhibitor epalrestat on hypertensive vascular remodeling," Journal ofEthnopharma-cology, vol. 133, no. 1, pp. 6-13, 2011.

[130] L. Li, J. Yan, K. Hu et al., "Protective effects ofEucommia lignans against hypertensive renal injury by inhibiting expression of aldose reductase," Journal of Ethnopharmacology, vol. 139, no. 2, pp. 454-461, 2012.

[131] F. Greenway, Z. Liu, Y. Yu, and A. Gupta, "A clinical trial testing the safety and efficacy of a standardized Eucommia ulmoides oliver bark extract to treat hypertension," Alternative Medicine Review, vol. 16, no. 4, pp. 338-347, 2011.

[132] Y. P. Han, N. S. Wang, S. Q. Mi, and Q. D. Liu, "Effect ofWuling Powder on rats with renal hypertension," ZhongXi Yi Jie He Xue Bao, vol. 1, no. 4, pp. 285-288, 2003.

[133] J. Y. Chen, H. L. Fan, and S. F. Zhang, "Effect of modified Zexie decoction on prevention of kidney injuries of rats with hypertension induced by high-salt diet," Zhong Yi Za Zhi, vol. 53, no. 3, pp. 234-237, 2012.

[134] S. J. Wu, L. T. Ng, and C. C. Lin, "Antioxidant activities of some common ingredients of traditional Chinese medicine, Angelica sinensis, Lycium barbarum and Poria cocos," Phytotherapy Research, vol. 18, no. 12, pp. 1008-1012, 2004.

[135] Y. Sun, S. Wang, T. Li, X. Li, L. Jiao, and L. Zhang, "Purification, structure and immunobiological activity of a new water-soluble polysaccharide from the mycelium of Polyporus albicans (Imaz.) Teng," Bioresource Technology, vol. 99, no. 4, pp. 900-904, 2008.

[136] R. Yuan and Y. Lin, "Traditional Chinese medicinean approach to scientific proof and clinical validation," Pharmacology and Therapeutics, vol. 86, no. 2, pp. 191-198, 2000.

[137] W. Y. Jiang, "Therapeutic wisdom in traditional Chinese medicine: a perspective from modern science," Trends in Pharmacological Sciences, vol. 26, no. 11, pp. 558-563, 2005.

[138] D. D. Kim, F. A. Sanchez, R. G. Duran, T. Kanetaka, and W. N. Duran, "Endothelial nitric oxide synthase is a molecular vascular target for the Chinese herb Danshen in hypertension," American Journal of Physiology—Heart and Circulatory Physiology, vol. 292, no. 5, pp. H2131-H2137, 2007.

[139] Y. Z. Hou, G. R. Zhao, Y. J. Yuan, G. G. Zhu, and R. Hiltunen, "Inhibition of rat vascular smooth muscle cell proliferation by extract of Ligusticum chuanxiong and Angelica sinensis," Journal of Ethnopharmacology, vol. 100, no. 1-2, pp. 140-144, 2005.

[140] R. L. Simeonova, V. B. Vitcheva, M. S. Kondeva-Burdina, I. N. Krasteva, S. D. Nikolov, and M. K. Mitcheva, "Effect of purified saponin mixture from Astragalus corniculatus on enzyme- and non-enzyme-induced lipid peroxidation in liver microsomes from spontaneously hypertensive rats and normotensive rats," Phytomedicine, vol. 17, no. 5, pp. 346-349, 2010.

[141] B. Xue, J. Li, Q. Chai, Z. Liu, and L. Chen, "Effect of total flavonoid fraction of Astragalus complanatus R. Brown on angiotensin II-induced portal-vein contraction in hypertensive rats," Phytomedicine, vol. 15, no. 9, pp. 759-762, 2008.

[142] L. M. Yao, T. W. Liu, W. F. Wu et al., "Effects of Astragalus injection in reversing left ventricular hypertrophy induced by renal hypertension in rats," Zhongguo ZhongXi Yi Jie He Za Zhi, vol. 29, no. 10, pp. 918-921, 2009.

[143] L. Z. Lin, X. G. He, L. Z. Lian, W. King, and J. Elliott, "Liquid chromatographic-electrospray mass spectrometric study of the phthalides of Angelica sinensis and chemical changes of Z-ligustilide," Journal of Chromatography A, vol. 810, no. 1-2, pp. 71-79, 1998.

[144] Y. Z. Hou, G. R. Zhao, J. Yang, Y. J. Yuan, G. G. Zhu, and R. Hiltunen, "Protective effect of Ligusticum chuanxiong and Angelica sinensis on endothelial cell damage induced by hydrogen peroxide," Life Sciences, vol. 75, no. 14, pp. 1775-1786, 2004.

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