Excuse me, doctor, if the weather is bad,

Your old man suffers from hypertension, accompanied by chest tightness, pain and dizziness. It may be hypertension complicated with coronary heart disease and needs symptomatic treatment after diagnosis. Let me introduce the diagnosis and treatment of hypertension for your reference: hypertension can be divided into primary and secondary, the former accounts for more than 95% of the total hypertension, which is called hypertension, also known as primary hypertension. The prevalence rate of hypertension in adults in China is about 19%, and the prevalence rate of men and women is similar. With the increase of age, the prevalence of hypertension is also increasing obviously. The cause of the disease is generally considered to be related to heredity and long-term mental stress; The risk factors of hypertension are the elderly (over 55 years old), abdominal obesity (abdominal circumference is more than 85cm for men and more than 80cm for women), complicated with diabetes (fasting blood glucose is greater than or equal to 7.0mmol/L or blood glucose is equal to or greater than1.1.0 mmol/L, accompanied with diabetes symptoms at any time or blood glucose is greater than/kloc-. Kloc-0/mmol/L dyslipidemia (total cholesterol greater than triglyceride greater than 1.7mmol/L, or high-density lipoprotein cholesterol "HDL-C" less than 0.9 1mmol/L), smoking (1 time/week), drinking (1 week) Less than 5% of patients are caused by kidney diseases, brain tumors and adrenal diseases, which is called secondary hypertension. The key points of diagnosis and treatment of essential hypertension are as follows: 1. Blood pressure According to the diagnostic criteria of 1999 WHO /ISH, systolic blood pressure is equal to or greater than 140mmHg and/or diastolic blood pressure is equal to or greater than 90mmhg (18.62/1/kloc-. The ideal blood pressure should be 120/70mmhg. (16/9.3kpa). Second, symptoms: headache, dizziness, tinnitus, palpitation, irritability, fatigue, or top-heavy, unstable walking. 3. Staging: Phase I: clinically unintentional, brain and kidney damage, but blood pressure reaches the diagnostic standard of hypertension, and blood pressure can return to normal without taking antihypertensive drugs. Stage II: Blood pressure reaches the standard of hypertension, and it can't return to normal without taking antihypertensive drugs, and there are one of the following situations: ① left ventricular hypertrophy. ② fundus arteriosclerosis. ③ Proteinuria or plasma creatinine slightly increased. Stage III: Blood pressure reaches the level of diagnosed hypertension, and there are one of the following situations: ① hypertensive encephalopathy or cerebral hemorrhage. ② Heart failure. ③ Renal failure. ④ Bleeding or exudation of fundus, or edema of optic papilla. Pulse pressure: Pulse pressure is an indicator of arteriosclerosis. The greater the pulse pressure, the greater the vascular hardness. Arteriosclerosis increases systolic blood pressure and decreases diastolic blood pressure. The increase of systolic blood pressure increases left ventricular afterload and myocardial oxygen consumption, which leads to left ventricular hypertrophy and impaired myocardial diastolic function, thus reducing ejection fraction. Many studies have proved that the risk of coronary heart disease in hypertensive patients is positively correlated with pulse pressure. When the pulse pressure 10mmHg increases, the risk of coronary heart disease increases by 25%~35%. Detecting pulse pressure is helpful to predict heart failure in patients with coronary heart disease. Key points of prevention and control 1. Western medicine: 1, calcium channel blockers, nifedipine tablets, sustained-release tablets or controlled-release tablets 10 ~ 30 mg, 1 ~ 3 times a day 1 time; Or nitrendipine tablets 10 ~ 20mg, taken orally 2 ~ 3 times a day. Or lacidipine 4mg/ tablet/time/day, or levoamlodipine besylate tablets 2.5 mg ~5 mg, 1~2 times/day. 2, angiotensin converting enzyme inhibitor, captopril tablets (short-acting)12.5 mg ~ 25 mg; Or enalapril (intermediate effect) 5 mg 1 ~ 2 times/day; Or perindopril tablets (Astra, long-acting) 2 ~ 4mg/ day; Or benazepril (Lotensin) 5 ~ 10 mgr/ day. Recently, some scholars argue that simvastatin combined with benazepril has better antihypertensive effect than benazepril alone, and is well tolerated, especially for patients with hypertension and hyperlipidemia. In addition, angiotensin II receptor antagonists, such as valsartan (Dai Wen) 80~ 160mg, can also be taken once a day 1 time; Or telmisartan (Mecamate) 40~80mg, daily 1 time. People who cough after taking Pulitzer, an angiotensin converting enzyme inhibitor, can switch to this medicine. 3. Patients with hypertension and high heart rate can be given metoprolol tablets (betaloc) 25 mg ~ 100 mg, 1 ~ 2 times a day. Or atenolol tablets, 25~50 mg, taken orally 2~3 times a day. 4, diuretic, available indapamide tablets (Shoubishan), 2.5 mg, 1 time/day. 5, enteric-coated aspirin tablets 75 ~ 100 mg, once a day. In order to reduce gastric acid secretion and prevent gastroduodenal mucosal injury or bleeding, omeprazole enteric-coated capsules 20mg/ day or ranitidine 150mg/ day can be taken orally for a long time. In particular, patients over 60 years old, or with a history of gastroduodenal ulcer, or taking non-steroidal drugs for too long and taking them at the same time with hormones need to take ranitidine or omeprazole to reduce the stimulation of non-steroidal drugs on gastrointestinal mucosa. 6, vitamin B6 tablets, 2 tablets, twice a day. 7, folic acid 10~20 mg, 2~3 times a day. Osmosis is an antioxidant. Recent studies have shown that long-term oral administration can reduce the risk of cardiovascular diseases, especially for elderly patients with hypertension and coronary heart disease. Clinical reports show that taking this medicine continuously for more than three years can reduce the risk of stroke by more than 37%. For patients with hypertension, it is recommended to supplement folic acid on the basis of routine oral antihypertensive drugs. For the health of the elderly, it is also recommended to take folic acid 5 mg orally, 2-3 times a day. Second, TCM syndrome differentiation and treatment 1, stagnation of liver-qi, wind-yang imbalance type main symptoms: headache and dizziness, red face and red eyes, irritability, dry and yellow stool, bitter mouth and dry throat, red tongue and strong pulse. Treatment principle: clearing liver and nourishing yin. Prescription: Longdan Xiegan Decoction: Radix Gentianae, Scutellariae Radix, Fructus Gardeniae, Flos Chrysanthemi 10g, Radix Rehmanniae, Semen Cassiae, Concha Ostreae and Prunella vulgaris 20g. Headache is increased or decreased: 30g of concha Haliotidis or mother of pearl. Add 30 grams of gypsum and 6 grams of rhubarb to dry stool and apply hot compress. 65,438+00g of Radix Paeoniae Rubra and Lalang Grass Rhizome were added into Fructus Trichosanthis. Add 30 grams of Radix Paeoniae Alba and 30 grams of Uncaria for limb tremor. Decoct with water. 2, liver and kidney yin deficiency, liver yang hyperactivity main symptoms: dizziness, tinnitus, insomnia, dreaminess, irritability, dysuria, backache and leg pain, and even numbness of limbs, nocturnal emission, red tongue and dull pulse. Treatment principle: nourishing liver and kidney yin and assisting latent yang. Prescription: Zhengan Xifeng Decoction: Radix Rehmanniae, Radix Rehmanniae Preparata, Mulberry, Radix Scrophulariae and Fructus Leonuri each 30g, Herba Dendrobii, Radix Asparagi and Fructus Lycii each 65438 00g, Os Draconis, Concha Ostreae and Achyranthis Radix each 65438 05g. Add and subtract: 20 grams of Magnetite and Prunella vulgaris for dizziness, 30 grams of mother-of-pearl for palpitation, 30 grams of black sesame 10 for constipation, 30 grams of mulberry branches for numbness of limbs, 0/0 grams of trachelospermum/kloc, and 0/0 grams of Herba Siegesbeckiae/kloc-0. Decoct with water. 3. Deficiency of both Yin and Yang, with Yang deficiency in the upper direction: headache and dizziness, tinnitus and red eyes, red face and dry mouth, spontaneous sweating, insomnia and dreaminess, backache and leg weakness, muscle contraction and beating, cold limbs, shortness of breath, polyuria at night, red tongue with white fur and thready pulse. Treatment principle: nourishing kidney yin and warming kidney yang. Prescription: Fu Gui Dihuang Pill (Shenqi Pill): 25g of Radix Rehmanniae Preparata, Alisma orientale, Cornus officinalis, Cortex Moutan, Rhizoma Dioscoreae, Poria, Radix Aconiti Lateralis Preparata 10g, and 3g of cinnamon powder (orally). Decoct with water. In the prescription, Liuwei Dihuang Pill nourishes kidney water to control yang hyperactivity, and Guipi Decoction is attached to reduce fire and eliminate yin cold. 4, the main symptoms of menopausal hypertension in women: irregular menstruation, low back pain, frequent urination, headache and dizziness, which is irregular. Rule: adjust and rush. Prescription: Erxian Decoction: Curculigo, Epimedium, Morinda officinalis, Angelica sinensis, Anemarrhena asphodeloides, Polygonatum sibiricum, Ligustrum lucidum, Eucommia ulmoides, Taxilli, Achyranthes bidentata, Cortex Phellodendri and Alisma orientalis 65438±00g each. Decoct with water. Curculigo, Epimedium and Morinda Officinalis are used to warm yang and tonify kidney, Cortex Phellodendri and Rhizoma Anemarrhenae are used to nourish yin and clear heat, and Angelica sinensis is used to purge fire and regulate chong and ren. This prescription also has a good effect on the syndrome caused by low female hormone secretion. Taking Chinese medicine decoction, once the condition is stable, it can be maintained by western medicine. In principle, oral western medicine should not be stopped in the treatment of hypertension, and the dose can be adjusted or reduced. The elderly should try not to take compound antihypertensive drugs orally, because most of them contain diuretics and sedatives, and long-term use will lead to potassium deficiency or mental and neurological adverse reactions. 3. One prescription can be referred to or selected: 1. People with deficiency of both yin and yang and yang deficiency can take the following prescriptions: (1) Radix Rehmanniae Preparata 25g, Herba Cistanches 12g, Mulberry 10g, and Achyranthes bidentata 10g. Decoct with water. (2) Fu Gui Huangdi Pill, 1 10,000, twice a day. (3) Whole deer pill, 1 pill, twice a day. 2. Patients with liver and kidney yin deficiency and hyperactivity of liver yang can take the following drugs: (1) Radix Rehmanniae, Fructus Tribuli and Radix Achyranthis Bidentatae each 15g. Decoct with water. ⑵ Dabuyin Pill, 1 pill, twice a day. ⑶ Qijudihuang Pill, 1 pill, twice a day. ⑷ Liuwei Dihuang Pill, 1 pill, twice a day. 5] Naoliqing, 15 capsules, twice a day. [6] Qingxuan Pill, 1 pill, twice a day. ⑺ Radix Aristolochiae 30g, ground, 65438±0g each time, three times a day, taken after meals, and 3 months as a course of treatment. (8) 30 grams of corn silk, fried in water. (9) After autumn, cucumber seedlings100g, and tea is given every day. ⑽ Soak peanuts in vinegar for more than a week, and take 3 ~ 5 capsules every night before going to bed, which can be eaten for a long time. 3. If liver depression turns into fire and Fengyang is disturbed, the following prescription can be taken: (1) 60 grams of chrysanthemum, decocted in water instead of tea. (2) Spica Prunellae 30g, Ilex kudingcha15g, Flos Chrysanthemi and Semen Cassiae, decocted in water. ⑶ Longdan Xiegan Pill, 12g, twice a day. ⑷ Niuhuang Shangqing Pill, 1 pill, twice a day. 4. Drug choice for hypertension: 1, middle-aged and young people or those with high renin type, β -blockers such as atenolol, metoprolol (betaloc), angiotensin converting enzyme inhibitor (enalapril), etc. ) priority; But the elderly or people with low renin prefer calcium antagonists (such as horizon) or diuretics (indomethacin, amipridine). 2. Beta blockers or calcium antagonists are the first choice for hypertension complicated with coronary heart disease. 3. Calcium blockers and renin-converting enzyme inhibitors are the first choice for hypertension with renal insufficiency. Beta blockers should not be used. 4, hypertension with hyperlipidemia, diabetes or gout should not use diuretics and beta blockers. 5. Combination of traditional Chinese and western medicine is more effective. 5. Non-drug therapy: 1. Adjust eating habits: advocate three lows and three highs diet (low salt, low fat, low sugar, high protein, high vitamin and high cellulose). Eat less sweets and fried foods to avoid hyperlipidemia. Smoking and alcohol prohibition are helpful to reduce the incidence of cardiovascular and cerebrovascular diseases such as hypertension. 2. Insist on exercise to lose weight, which is beneficial to patients with hypertension. Choose uninterrupted activities that suit you, such as Tai Ji Chuan, Tai Chi Sword, walking, etc., which are more suitable for the elderly. Sleep for 6-8 hours, and take a lunch break for half an hour 1 hour. 3, psychotherapy: use "contentment is always happy" to adjust the mentality and maintain the balance of Yin and Yang. Qigong can regulate the balance of yin and yang. Overcome selfishness, enjoy fame and fortune, and have five desires and six dusts (five desires: wealth, sex, fame, food and sleep). Six dusts: color, sound, fragrance, taste, touch and law). Goodluck: To be a man, we should "cultivate five virtues internally and cultivate liu de externally". Five virtues: gentleness, kindness, prudence, frugality and forbearance. (6) Seeing and knowing together, abstaining and practicing together, living together physically, speaking with your mouth, enjoying your heart, benefiting and being equal. If you keep a pure heart, you can achieve the balance of yin and yang and have a good attitude. In short, people can always think of others everywhere, except themselves, and their bodies should not get sick, and they will get better soon if they get sick. 5. Key points of acupuncture for lowering blood pressure: Baihui, Fengchi, Neiguan and Sanyinjiao. Matching points: liver depression turns into fire, Fengyang is upset: Jiaxing and Xiaxi; Yin deficiency of liver and kidney and hyperactivity of liver yang: adding Taichong, Taixi, Gankui and Shenshu; Phlegm-dampness internal resistance type: Jia Fenglong, Zhongwan, Touwei, Gongsun; Deficiency of both yin and yang, yang deficiency upward reverse type: Jia Guanyuan, Zusanli. Xie Ping was given a needle for 20~30 minutes, 65438 0 times a day, and the course of treatment was 2~4 weeks.

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