Arterial hypertension
Systemic arterial
hypertension is defined as elevated arterial blood pressure, with systolic pressure
over 160 mmHG and /or diastolic pressure over 95mmHG. Blood pressure that is consistently
140 mmHG systolic and/or 90mmHg diastolic or higher is considered border line
hypertensions.
Hypertension is usually of two types: primary and secondary.
Essential, or primary, hypertension is systemic arterial hypertension of unknown
cause; 90 to 95 percent of systemic hypertension cases fall under this category.
Secondary hypertension is elevated systemic blood pressure of known cause; five
to ten percent of systemic hypertension cases are of this type. In this article,
we discuss only the traditional diagnosis and treatment of essential hypertension.
In traditional Chinese medicine, essential hypertension is included in the
syndromes of headache and dizziness due to interior injury.
Etiology
and Pathogenesis
1. Hyperactivity of liver-yang
The liver is related to
mental activities, such as thinking and worrying. Mental upset or a fit of anger
may cause hyperactivity of liver yang, and as a result, headache or dizziness
occurs. On the other hand, excessive liver yang turns into fire, which in turn,
injuries liver yin and eventually leads to hyperactivity of liver yang.
2.
Deficiency of both qi and blood
Under normal conditions, qi and blood nourish
the brain. Overstrain and stress may damage the function of the heart and spleen.
As a result, qi and blood production is insufficient, which fails to nourish the
brain and gives rise to headache or dizziness.
3. Deficiency in the kidneys
The kidneys use their essence to produce marrow, and the brain is the sea
of marrow. Deficiency in the kidneys impairs their ability to produce enough marrow
to nourish the brain, thus dizziness or headaches may occur.
4. Interior retention
of phlegm-damp
Improper diet, overwork and stress or a protracted illness
may impair the spleen and stomach in transporting and transforming, which results
in the production of damp and phlegm. Stagnant phlegm-damp, impeding the ascending
of pure qi and the descending of turbid yin, causes dizziness and headaches.
Differential
Diagnosis of Syndromes
1. Hyperactivity of liver yang
Primary manifestations:
Headache or dizziness aggravated by mental upset, irritability, flushed face,
tinnitus, dry mouth with a bitter taste, dream-disturbed sleep, reddened tongue
with yellow coating and tight, rapid pulse.
2. Deficiency of qi and blood
Primary manifestations: Headache or dizziness with lassitude, shortness of
breath, palpitations, insomnia, spontaneous sweating, pink tongue with thin, white
coating, and tight and thready pulse. (This morbid condition usually occurs in
patients with hypertension complicated by cardiac dysfunction).
3. Deficiency
in the kidneys
Primary manifestations: Headache or dizziness accompanied by
an empty feeling of the head, tinnitus, weakness of the lower back and knees,
impotence or nocturnal emission, dry mouth, reddened tongue with little coating
and thready and weak pulse.
4. Interior retention of phlegm-damp
Primary
manifestations: Headache or dizziness with a heavy and tight feeling in the head,
a feeling of fullness and oppression over the chest and epigastrium, loss of appetite,
somnolence, corpulent tongue with white, greasy coating, and soft and slippery
pulse.
Treatment
1. Hyperactivity of liver yang
Principle of treatment:
Calm the liver and suppress exuberant yang.
Formula of choice: Variant Gastrodia
and Ucaria Beverage; in this recipe, gastrodia root, uncaria stem, abalone shell,
and poria (prepared with cinnabar) calm the liver and suppress exuberant yang;
gardenia fruit and scutellaria root clear away heat from the liver and strengthen
the effect of calming the liver; and achyranthes root, eucommia bark and mistletoe
nourish the kidneys to regulate the liver. In cases with flushed face, bloodshot
eyes, bitter taste in the mouth, dry throat, yellow, greasy tongue coating and
signs of a flaring-up of liver fire, use Gentian Liver-Draining Decoction.
2.
Deficiency of qi and blood
Principle of treatment: Replenish qi and nourish
blood.
Formula of choice: Middle-Tonifying Qi-Enriching Decoction plus asarum,
vitex fruit, and ligusticum root for replenishing qi and expelling wind in patients
suffering mainly from qi deficiency; Four Ingredients Decoction plus chrysanthemum
flower and vitex fruit should be used with patients with headaches due predominantly
to blood deficiency to nourish blood and eliminate wind.
3. Deficiency in
the kidneys
Principle of treatment: Invigorate the kidneys
Formula of
choice: Lycium Berry, Chrysanthemum, and Rehmannia Pill; this prescription is
composed of Six Ingredient Rehmannia Pill, which nourishes kidney yin, and lycium
berry and chrysanthemum flower, which nourish and calm the liver; for patients
with deficiency of kidney yang, use Right-Restoring pill, while for patients with
deficiency of kidney yin, use Left-Restoring Pill.
4. Interior retention of
phlegm-damp
Principle of treatment: Eliminate damp and dissolve phlegm.
Formula
of choice: Pinellia, White Atractylodes, and Gastrodia Decoction, in which tangerine
peel, pinellia root, poria, and licorice root dissolve phlegm; gastrodia root
and vitex fruit calm the liver and expel wind; ovate atractylodes root, and jujube
regulate the middle-warmer and strengthen the spleen to enforce the effect of
dissolving phlegm-damp.
By
Dr. Ming's TCM Medical Center,
Hua Xi Xiao
Yuan, Hutian Developing Area,
Huaihua city, Hunan province
China