HYPERTENSION TREATMENT

In This Article

-Currently, the condition is diagnosed if diastolic pressure exceeds 90 mm Hg or if a systolic pressure exceeds 140 mm Hg in men over 50 years of age or 160 mm Hg in all women.

-It is now a well established fact that patients with this condition die prematurely.

-Find how acupuncture and TCM can be helpful for this condition

-Find out which acupuncture points are best to use.

-When using acupuncture, find out how to tailor the treatment to the patient's TCM syndrome.

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Hypertension and Acupuncture

by Dan Schalm R.Ac, R.TCMP

Contents:

What is hypertension? | TCM aetiology | TCM differentiation
Other complimentary therapies | Conclusion | Bibliography

Acupuncture and TCM (Traditional Chinese Medicine) are slowly becoming a second front line in health-care. Studies show that of all the holistic therapies, acupuncture treatment is the most often referred health service by physicians. (Article) The following article is meant to give acupuncture practitioners and students information on hypertension and the TCM approach to treatment.

What is hypertension?

Before getting into the how and why of acupuncture treatment for hypertension, let's look more closely at the disorder. Hypertension is defined as a higher than normal hydrostatic pressure of blood within the arterial system. During contraction of the left ventricle of the heart, blood is forced into the peripheral arteries. At this point the pressure is at its highest point and is known as the systolic pressure. When the heart relaxes, the pressure in the arteries is at its low point and this is known as the diastolic pressure. When a problem occurs in the pressure regulating system, of which there are many components, a condition of high diastolic or high systolic or both may develop called hypertension.

There are two main categories of hypertension. Primary, essential or idiopathic hypertension are the terms given when the cause of the disease is unknown. This is the most treatable form of high blood pressure with acupuncture, diet and stress relief. Studies show that 90-95% of all cases in North America are of this nature. Secondary hypertension is the name given to the disease when it is directly linked to a specific organic cause and it is generally not well treated by acupuncture. Only 5-10% of cases are thought to fall into this category.

Determining whether or not a person has high blood pressure is somewhat arbitrary and depends on factors such as age, sex and even emotional condition. It should also be taken into consideration that blood pressure may fluctuate in individuals and it's therefore advisable to take several readings at different intervals before diagnosing someone with with this disease. Performing acupuncture may give seemingly good results if the acupuncturist takes the blood pressure after a treatment simply because the patient is relaxed. An average measurement of hypertension is preferred.

Currently, the condition is diagnosed if diastolic pressure exceeds 90 mm Hg or if a systolic pressure exceeds 140 mm Hg in men over 50 years of age or 160 mm Hg in all women. It is generally thought that the diastolic pressure is most important in the assessment, however, patients with a normal diastolic pressure, but an elevated systolic pressure also are at a higher than normal risk of manifesting the health consequences of this disease.

Accompanying signs of hypertension include headache at the occiput or top of the head, occipital stiffness, dizziness, giddiness, tinnitus, irritability and occasionally, epistaxis. Headache presents in 70% of cases while dizziness presents in 40% of cases. (These are well treated with acupuncture, especially when treatment is applied with careful syndrome differentiation.) A very large number of hypertension cases are asymptomatic.

It is now a well established fact that patients with this condition die prematurely. Consequences of hypertension include heart disease, stroke and renal disease. To start with, treatment is based on reduction of risk factors, which include stress, poor diet, smoking, over consumption of alcohol and being overweight as well as encouraging exercise and good emotional control. The next step is through the administration of drugs. Many of these drugs produce adverse side effects and discretion must be used in their prescription. A third aspect of hypertension treatment that is becoming more popular is through public awareness. If people are aware of the risk factors and modify their behaviour to reduce this risk, hypertension can be treated before it has a chance to manifest. In some cases though, a genetic predisposition is a contributing factor ... i.e. it is well known that black people have a much higher incidence than the median.

Because of the complications which often arise during a prolonged course of hypertension drug therapy (ranging from fatigue to impotence ... Yang deficiency in TCM terminology), alternative ways of controlling this disease have been studied. Besides eliminating the risk factors, certain foods, supplements and herbs as well as complimentary forms of treatment like acupuncture and light therapy have been proven effective. Because of its direct link to premature death, hypertension is a very measurable early warning sign of future health problems, and as a practitioner of TCM (or any complimentary health profession), it would be wise to be aware of and monitor a patient's blood pressure, especially if they are over 40 years of age. This article is mainly concerned with the traditional Chinese approach of herbs, moxibustion and acupuncture.

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Acupuncture and TCM Aetiology

Hypertension is not a condition described in traditional Chinese medicine but acupuncture and herbal medicine can be helpful for this condition. As previously mentioned, some cases are asymptomatic other than showing a high reading on the doctor's pressure gauge. Therefore, great care must be taken to differentiate which syndrome or category the patient belongs to before treating with acupuncture. The symptoms below are not always present, but a skilled practitioner of acupuncture or TCM will be able to make a differentiation based on the patients general body condition and nature. Hypertension can usually be classified into the categories of either Tou Tong, Headache or Xuan Yun, Vertigo. According to Dan Xi "Without the factors of heat, wind, phlegm or deficiency, there can be no headache or dizziness." Therefore, hypertension is seen in the following TCM syndromes:

TCM HEAT: LIVER FIRE: Unexpressed or repressed emotion, such as anger or concern, leads to Liver qi stagnation. This turns to heat, subsequently resulting in the rise of Liver fire causing headache and/or dizziness (hypertension).

TCM WIND: LIVER YANG RISING: Prolonged illness, poor congenital health, overwork or overindulgence in sexual behaviour lead to deficiency of Liver Yin resulting in the inability of Yin to secure Yang. This results in Yang rising causing headache and/or dizziness (hypertension). Since wind is Yang in nature and pertains to the Liver, there is a wind component to the rising of Liver Yang.

TCM PHLEGM: PHLEGM DAMPNESS: Poor diet or over-work results in a deficiency of Spleen and Kidney qi. The resultant build up of phlegm and water in the San Jiao blocks the rise of clear qi to the head causing headache and/or dizziness (hypertension).

TCM DEFICIENCY: YIN / YANG DEFICIENCY: Yin deficiency can lead to Yang deficiency over time. (Especially if patient is on hypertension drugs.) The rising of Liver Yang is still held to be the reason for the hypertension. Many cases of hypertension have an underlying pattern of both Yin and Yang deficiency.

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TCM Differentiation

Liver Fire: (Early stage hypertension)

Symptoms:

Hypertension which fluctuates with exertion or emotional condition, dizziness, headache of a distending nature, flushed face, red eyes, congestion & swelling of the eyes, irritability, constipation, bitter taste in the mouth, dark urine, red tongue with a yellow coat, wiry-rapid-forceful pulse.

Acupuncture and herbal treatment principle:

Lower blood pressure, clear Liver fire and move qi stagnation

Herbal Formula:

Long Dan Xie Gan Tang: 1 Long Dan Cao; 3 Huang Qin; 1 Zhi Zi; 3 Ze Xie; 3 Che Qian Zi; 5 Mu Tong; 5 Sheng Di Huang; 9 Dang Gui; 1 Chai Hu; 1 Gan Cao

Acupuncture:

The acupuncture point according to its nomenclature along the meridian is given in the left-most column. The centre column is the pinyin name of the acupuncture point. The action of the acupuncture point is described in the right-most column.

Liver Yin deficiency w. Yang uprising: (Middle stage hypertension)

Symptoms:

Constantly high blood pressure, dizziness, headache, dry eyes, irritability, tinnitus, poor memory, sore lower back and knees, trembling limbs, palpitation, 5 centre heat, insomnia, red tongue with thin coat, wiry-thready-rapid pulse.

Acupuncture and herbal treatment principle:

Lower hyperactive Yang (and blood pressure) and nourish Yin.

Herbal Formulae:

If Yin deficiency is predominant:

Qi Ju Di Huang Wan: 2 Gou Qi Zi; 1 Ju Hua; 4 Shu Di Huang; 3 Shan Zhu Yu; 3 Shan Yao; 3 Ze Xie; 3 Mu Dan Pi; 3 Fu Ling

If wind is predominant with less Yin deficiency:

Tian Ma Gou Teng Yin: 3 Tian Ma; 3 Gou Teng; 10 Shi Jue Ming; 3 Zhi Zi; 3 Huang Qin; 3 Du Zhong; 3 Sang Ji Sheng; 3 Yi Mu Cao; 5 Ye Jiao Teng; 3 Niu Xi; 3 Fu Shen

Acupuncture:

The acupuncture point according to its nomenclature along the meridian is given in the left-most column. The centre column is the pinyin name of the acupuncture point. The action of the acupuncture point is described in the right-most column.

Phlegm Dampness:

Symptoms:

High cholesteral, dizziness, headache, obesity, oppression in the chest and hypogastrium, heaviness of the head, palpitation, poor appetite, expectoration of phlegm, white-greasy tongue coat, slippery pulse

Acupuncture and herbal treatment principle:

Lower blood pressure and resolve turbid phlegm

Herbal Formula:

Ban Xia Bai Zhu Tian Ma Tang: 3 Ban Xia; 3 Bai Zhu; 2 Tian Ma; 3 Fu Ling; 3 Chen Pi; 2 Sheng Jiang (+ Huang Qi)

Acupuncture:

The acupuncture point according to its nomenclature along the meridian is given in the left-most column. The centre column is the pinyin name of the acupuncture point. The action of the acupuncture point is described in the right-most column.

Kidney and Liver Yin and Yang Deficiency (Late stage hypertension)

Symptoms:

Constant hypertension or high blood pressure, dizziness, headache, tinnitus, palpitation, shortness of breath, sore or weak lower back or knees, insomnia or somnolence (depending on which deficiency is predominant), muscle twitching or cramping or muscle numbness, nocturia, spermatorrhea, impotence, pale or red tongue with a white coat, wiry-thready pulse.

Acupuncture and herbal treatment principle:

Lower blood pressure, nourish Yin and strengthen Yang

Herbal Formula: (Stay away from very hot or very cold herbs)

Er Xian Tang: 3 Xian Mao; 3 Yin Yang Huo; 3 Dang Gui; 3 Huang Bo; 3 Zhi Mu; 3 Ba Ji Tian (+Huang Qi)

Acupuncture:

The acupuncture point according to its nomenclature along the meridian is given in the left-most column. The centre column is the pinyin name of the acupuncture point. The action of the acupuncture point is described in the right-most column.

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Other Complimentary Therapies to prevent Hypertension:

Food and herbs:

Besides acupuncture and TCM, diet is very important in regulating hypertension. Patients should stay away from fats as they contribute to cholesterol deposits which in turn lead to narrowing and hardening of the arteries, a main factor in hypertension. Intake of oils should be kept at a minimum, specifically those high in saturates. Balance fatty intake with unsaturated fats like flax seed oil. Because sugar can cause salt retention in the body, it should also be avoided. Salt, especially in some genetically predisposed individuals, has been implicated in hypertension. Sodium should be reduced in favour of higher potassium intake. This is found in most fresh fruits and vegetables and especially sea vegetables.

Some foods which are known to lower blood pressure are beans, celery, squash, onions, apples and both shiitaki and reishi mushrooms.

Herbs which have a marked positive effect on hypertension are GARLIC! (esp. kyloric), hawthorn fruit (may be combined with motherwort, yarrow & lavender), dill, Gotu Kola and astragalus (Huang Qi).

As for minerals, zinc is not only good for the male urinary/reproductive system, but also keeps blood pressure at normal levels (Don't forget to balance added zinc intake with more copper as well. Very important).

Psychology:

Stress is a well known risk factor in hypertension. One study shows that hypertensive patients suffer from higher than normal feelings of entrapment, guilt and feelings of endangerment. Also, very important to control in this condition is repressed or unexpressed emotion which is the main factor in causing Liver qi stagnation. Acupuncture is extremely effective in alleviating stress. (article)

Other:

A little known but conclusive study in 1935 showed that exposure to ultraviolet light could lower blood pressure. However, the negative benefits of this type of therapy may outweigh the good ones.

Therapeutic touch, Reiki, Pranic healing, Ayurevedic medicine, Reflexology, to name some of the most popular, are also believed to help lower hypertension. However, the research into these modes of healing (except for Ayureveda) is not conclusive and needs further study. Exercise, such as Yoga, Tai Chi or Qi gong has been proven to help lower blood pressure, however, any form of exercise is also beneficial for hypertension. Acupuncture remains the most researched alternative therapy for hypertension.

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Conclusion:

In most cases, when hypertension is primary and not considered malignant, high blood pressure can be controlled with reduction of risk factors, diet, herbs, acupuncture, psychotherapy and/or a combination of all of the above. In addressing secondary hypertension, it is important to address the causative factor, rather than treat the symptom (high blood pressure) only. Often, after a long course of hypertension drug therapy, Kidney Yang deficiency becomes part of the picture, actually making the condition worse. In general, TCM and acupuncture have good results in treating this disease.

- Dan Schalm R.Ac, R.TCMP

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Bibliography:

Chen, Ze-Lin & Mei-Fang; A Comprehensive Guide to Chinese Herbal Medicine; Castle Books, 1992, USA; 

ISBN 0-7858-1076-5

Yin, Ganglin; Advanced Modern Chinese Acupuncture Therapy: A Practical Handbook for Intermediate and Advanced Study; New World Press, 2000, China;

ISBN 7-80005-558-2

Maciocia, Giovanni; The Practice of Chinese Medicine; Churchill Livingstone, 1994, UK;

ISBN 0-443-043051

Nowak, T. & Handford, A.; Essentials of Pathophysiology; McGraw-Hill, 1999, USA;

ISBN 0-697-25205-1

Harrison, T.R.; Harrison's Principles of Internal Medicine, 12th edition; McGraw-Hill, 1991, USA;

ISBN 0-07-070890-8

Johnson, J. R.; The Effect of Carbon Arc Radiation on Blood Pressure and Cardiac Output; American Journal of Physiology 114, 1935

Tenney, Louise; Encyclopedia of Natural Remedies; Woodland Publishing, 1995, USA;

ISBN 0-913923-98-2

Balch and Balch; Prescription for Dietary Wellness; Avery Publishing, 1998, USA;

ISBN 0-89529-868-6

Green, James; The Male Herbal; The Crossing Press, 1991, USA;

ISBN 0-89594-458-8

Liberman, Jacob; Light, Medicine of the Future; Bear & Company Publishing, 1991, USA;

ISBN 0-939680-80-7

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