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The Treatment of Hypertension with Traditional Chinese Medicine
By Dr. Mao-chuan Guo
Hui-an TCM Clinic
Despite the fact that hypertension is a widespread illness, scientists still do not have a complete understanding of its causes. Clinical researches indicate that the primary factors involved are disruption of the cerebral cortex, hormonal imbalances, and problems with arterial vasomotor functioning. Clinical manifestations of hypertension include increased arterial pressure as well as late stage complications, such as heart, brain, and kidney pathology. Hypertension is classified as either slow progressing or rapid progressing. Slow progressing hypertension develops gradually with no obvious symptoms, or mild symptoms, such as headache, insomnia, and dizziness in the early stages. In its later stages, damage may occur to the brain, heart, and kidneys as well as other important organs, such as hypertensive heart disease, hypertensive cerebrovascular disease, and renal damage. If such pathologies are left to progress, it may lead to heart failure, cerebral hemorrhage, or renal failure, and even life threatening.
In TCM theory, hypertension would fall under the categories of headache, dizziness, and liver wind. High blood pressure is thought to be the result of damages caused by emotions, such as vexation, anger, worry, and excessive deliberation, which cause liver Qi to become constrained and bound. Later, constrained Qi may transform into fire, which damages liver Yin. Liver Yin would then be unable to hold Yang, which develops into hyperactive liver Yang and further progresses to engender signs of wind and fire. Other causes include an unbalanced diet with a predilection for fats and sweets. Such a diet is harmful to the spleen and stomach, and leads to the production of internal damp-turbidity, which can stagnate and develop into heat. Such heat gradually scorches the fluids and engenders phlegm, which obstructs the channels and vessels, and disturbs the clear orifices. Another situation involves the elderly, whose bodies are weak. Depleted kidney Qi and an imbalance of both Yin and Yang of the liver and kidney, give rise to fire and the subsequent movement of wind.
TCM considers Qi and blood to be closely connected. Blood follows the movement of Qi, and becomes stagnant if Qi is not moving properly. Therefore, blood stasis develops when liver Qi becomes constrained and bound.
Additionally, in patients with hypertension, the case is frequent that Yang rises upwards while Yin is deficient below. This imbalance of Yin and Yang, which leads to the chaotic and rebellious movement of Qi and blood, as well as poor blood circulation, can also lead to blood stasis. In patients with hypertension, the fluids have been transformed into phlegm, which obstructs the movement of Qi and blood resulting in the formation of blood stasis. Despite the fact that hypertension manifests in a variety of ways, blood stasis is the primary differentiation factor, and can be divided into: (1) Qi stagnation and blood stasis, (2) Qi deficiency with blood stasis, (3) phlegm-turbidity with stasis, (4) Yin and Yang imbalance with stasis, and (5) liver heat with stasis. Consequently, when treating hypertension, invigorating the blood and transforming stasis are the essential treatment principles.
Symptom Groups
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Hypertension with headache, a distended feeling in the head, vertigo, red complexion, bloodshot eyes, vexation, agitation, and a propensity for anger. Cyanosis in the lips and nails, tingling and numbness in the arms and legs, and a wiry or rapid pulse. The tongue could be dark-red or dark-purple with a thin or yellowish coating.
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Severe palpitations, chest pain, chest oppression, ribside pain and distention, abdominal bloating, reduced appetite, dry stools, a dark-purple tongue with a thin yellowish coating and stasis papules, a rapid wiry pulse.
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Laboratory tests often reveal hemorheological changes, such as increases in blood viscosity, decrease electrophoretic rate of red blood cells, and an increase in platelet aggregation.
Treatment Groups
Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang) can be modified and used to treat patients with hypertension who fit into any of the aforementioned symptom groups.
Clinical Studies
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Dr. Wei-chuan Wang: Dr. Wang got notable results using Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang) as his base formula for treating patients with hypertension. For patients who presented with signs of spleen and kidney Yang deficiency, he added Rehmannia Combination (Di Huang Yin Zi). For patients with signs of liver and kidney Yin deficiency, he combined the formula with Gastrodia & Uncaria Combination (Tian Ma Gou Teng Yin) and Glehnia & Rehmannia Formula (Yi Guan Jian). In cases of kidney Yin deficiency with hyperactive liver Yang, he added Rehmannia Six Formula (Liu Wei Di Huang Wan).
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Dr. Shi-fa Deng: Dr. Deng conducted a clinical study on the treatment of hypertension with TCM, and compared with another group using Western Medicine. Among the 80 test subjects, 50 were given Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang), with an efficacy rate of 92%. Among the group of 30 subjects were given pharmaceuticals, there was an efficacy rate of 67%. This concluded that the effects of Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang) on hypertension is superior to Western Medicine.
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Dr. Yu-wen Yuan: Dr. Yuan conducted an experiment on 50 test subjects with recalcitrant hypertension using Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang). Marked results were seen in 38 of the test subjects, nine were effective and three showed no signs of improvement, for an overall efficacy rate of 94%. Statistics on the treatment course showed that those subjects in whom marked results were seen, 14 took between 5 and 15 doses of this formula, while 16 took between 20 and 30 doses, and 8 took over 35 doses. Most test subjects showed signs of improvement with less than 35 doses of the formula.
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Dr. Qi-fu Wu: Dr. Wu got satisfactory results in a study using a modified Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang) to treat hypertension.
Analysis
In TCM theory, hypertension is thought to be connected to blood stasis:
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Binding liver Qi constraint → blood stasis → hypertension: Qi and blood are intricately connected. There is a saying that goes, ˇ§Blood carries Qi, and Qi moves blood.ˇ¨ Blood follows the movement of Qi, and becomes stagnant if Qi is not moving properly. Therefore, blood stasis is often the result of psychological stimulation and a Qi dynamic that is not flowing smoothly.
Hypertension is the result of numerous factors. However, the most important is the damage caused by the seven emotions. Strong emotions can lead to an inhibited Qi dynamic and binding constraint of liver Qi. The patient may develop ascendant hyperactivity of liver Yang and liver wind moving internally. This can affect the functions of other organs. Binding constraint of liver Qi is part of the make up of hypertension, and consequently patients often develop blood stasis.
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Inadequate blood movement → blood stasis → hypertension: Hypertension and arteriosclerosis are closely related conditions, as one may give rise to the other. As the walls of blood vessels thicken and harden, the passageways become narrow and blocked. Gradually, as the endothelial cells of the arteryˇ¦s inner wall become damaged, blood platelets agglutinate on the inner surface of the vessels, and form thrombi, which obstruct the flow of blood.
As what can be seen from the aforementioned examples, blood stasis is involved in all aspects of hypertension.
Modern researches have shown that all stages of hypertension exhibit signs of blood stasis to varying degrees. In addition, such signs increase as a person passes through the various stages of hypertension, with a notable increase of such signs in Stage Three. It has been observed that blood flow of patients with refractory hypertension is quite poor because of high blood viscosity, especially the blood flow in veins. Blood tests on such patients reveal unusually high levels of cholesterol and triglyercide. Consequently, invigorating the blood and transforming stasis are possible treatment methods for hypertension.
Looking at the herbs that make up Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang), most of them have the ability to thin blood, affect the clotting mechanism, dilate blood vessels, or strengthen the heartˇ¦s regulatory function on the bloodstream. The combination of Bitter Orange (Zhi Ke), Bupleurum (Chai Hu), Cnidium (Chuan Xiong), Platycodon (Jie Geng), and Achyranthes Root (Huai Niu Xi) promotes the general movement of Qi and blood in the body, as well as stimulates the expulsion of sediment in the arteries and improves blood circulation. The addition of Rhubarb (Da Huang) makes the formula particularly effective, for it strengthens the entire formulaˇ¦s ability to invigorate the blood, move Qi, expel stasis, remove stagnation, and lead blood downwards.
Pharmacological studies have revealed that Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang) can dilate blood vessels, lower blood pressure, and reduce vascular resistance. These studies have provided a basis that Persica & Achyranthes Combination (Xue Fu Zhu Yu Tang) can be used to treat hypertension and its related complications.
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