Hypertension

Introduction
Hypertension, also known as high blood pressure (HBP), is a rise in blood pressure that effects the heart. Over time, it can cause damage to the heart as well as other organs (Walker, Colledge, Ralston & Penman, n.d.).

During hypertension the blood vessels go under a change which effect the way the heart functions. It is crucial to take medication or herbs (even acupuncture) to manage the blood pressure.

Maintaining a healthy lifestyle can help slow down or prevent hypertension including acupuncture with herbal medicine (Walker, Colledge, Ralston & Penman, n.d.). Western Medicine has a lot of side effects that can cause a lot more harm to the patient, so balancing the body with Traditional Chinese Medicine the body can be bought to homeostasis quicker.
A lot of research has shown evidence that hypertension can be helped with treatments using Tradition Chinese Medicine treatments, not just Western Medicine treatments. In TCM hypertension is diagnosed under numerous patterns as the person is looked as a whole, and their constitution is taken into consideration when diagnosing.

There are different stages of hypertension and effects everyone in a different way, but your age is crucial when it occurs and how you should manage the condition. Hypertension is serious and needs to considered from a young age as we don't look after ourselves as stress takes over and we don't eat the right foods for our body type. Education is important as we all need to learn how to maintain a healthy lifestyle without disease.

Hypertension explained in Western Medicine
High blood pressure is hypertension. Blood pressure is when blood is pushing via the wall of the arteries forcefully as it flows.

Hypertension can lead to cardiovascular damage or adverse effects and is defined as a systolic blood pressure > 140mmHg and a diastolic blood pressure > 90mmHg (Kwok, McPhee & Hammer, n.d.). Two consecutive readings need to be taken to determine blood pressure or more to determine hypertension.

When hypertension gets out of control it can lead to other illnesses such as retinal vascular damage, stroke, myocardial infraction, kidney damage, aneurysm and the list can go on. Hypertension causes many deaths and needs to be taken seriously. When people have a high diastolic pressure they will suffer headaches and dizziness and in some cases encephalopathy.

Hypertension can be passed down from family members. It has been said that more than 95% of case of hypertension is unknown (Walker, Colledge, Ralston & Penman, n.d.). Treatments for hypertension is to consider to change lifestyle (quitting smoking and drinking and exercise more) from diet to sleep to rest and stress level to control it, but there is no cure. Hypertension does not cause symptoms so it is crucial that blood pressure is taken often (Kwok, McPhee & Hammer, n.d.). Treatment is important in order to manage the hypertension, especially acupuncture and herbal Chinese medicine.

How the blood vessels change with hypertension
• Increase in collagen
• Wall thickens
• Reduction in vessel lumen.
• Less density in small vessels
• Thicker arteries
• Loss of arterial compliance

Sufferers need to take medication, and it depends what stage they are in to determine what medication is prescribed to manage the hypertension.

Risk factor for hypertension is
• Obesity
• Sodium intake
• Race/nationality
• <60yrs
• alcohol/smoking/coffee
• taking oral contraceptives
• heredity
• male

How is hypertension diagnosed in Western Medicine?
1) Firstly, the blood pressure is taken and classed in the following

• < 120/80 mmHg Normal blood pressure
• 120-129/80-89mmHg Pre-hypertension
• 140-159/90-99 mmHg Stage one
• 160-179/100-109 mmHg Stage two

2) Then a physical exam is performed to evaluate

• A family history is taken and a medical history is also taken
• A physical exam is performed (readings, hear the heart & palpation)
• An exam of the eye blood vessel is performed (ophthalmoscopy)
• A chest X-ray is taken to see if enlarged heart or abnormalities
• ECG to measure activity of the heart
• Blood/Urine exams taken for testing.
(Jarvis, 2016)

3) Hypertension

• Class l mild DP 90-104 mm Hg (1st degree)
• Class ll moderate DP 105-119 mm Hg (2nd degree)
• Class lll severe DP > 120 mm Hg (3rd degree)
(Walker, Colledge, Ralston & Penman, n.d.)

Medication given
• ACE inhibitors (A)
• Beta blockers (B)
• Calcium (C)
• Diuretics (D)

(The above can cause Xu, phlegm and kidney Qi Xu if taken for long term in TCM analysis)

Combinations
• A & B (used for younger patients)
• C & D (used for elder patients)
• A & D ( young & elder)

Hypertension explained in Traditional Chinese Medicine
Hypertension is not considered as a TCM disease as in Ancient China the doctors did not have any tools to monitor blood pressure. The raising of Qi (Liver yang rising, Liver fire or Liver wind) usually causes headaches and dizziness in hypertension. In TCM it said that phlegm obstructing heart and blood vessels and blood stasis in the Luo channels. In most TCM texts it it sais that Liver, Spleen and Kidney meridians are involved and the Heart meridian as it emphasises on the blood vessels.

The Aetiology of hypertension explained in TCM:
• Old age
• Overworked and not enough rest
• Improper diet
• Emotional stress

In TCM hypertension is classified into three locations of pathology:
• Head (symptoms in the head)
• Chest and heart (symptoms in the chest)
• Middle burner (disharmony of spleen and stomach/phlegm)
• Blood vessels (Qi in/out of blood vessels)

Another way of looking at hypertension is determined by Qi and blood in and out of the blood vessels (Maciocia, 2013).

“When hyper tension is complicated and, therefore, there are signs and symptoms, it is mainly categorized as tou tong, headache, tou zhang, head distension, xuan yun, dizziness, xin ji, heart palpitations, bu mian, insomnia, and ma mu, numbness and tingling” (Flaws & Sionneau, 2013)

This case
Symptoms: headache, dizzy (if high can cause nausea/vomit-be aware as this can be a sign of stroke), numbness, red face, dry mouth, bitter taste and red & dry eyes.

If the liver Qi raises suddenly then this can cause stroke (because of liver issues or Yangming not descending and fire and wind combine). The early stage of hypertension is classified as 1st degree (early stage) and the pattern here is Liver Yang rising (Maciocia, 2013).

Visit one
Indian Man (factory shift worker, who is a little overweight) at the age of 45 came into my external clinic (I was an observer with all the visits) with the following signs and
symptoms:
• Likes to eat hot and spicy/fried food
• Head distension with pain
• Feeling dizzy (is severe)
• Vertigo
• Red face
• Tinnitus
• Ringing sound in the head
• Agitated
• Angry
• Irregular sleep pattern
• Bitter taste in the mouth
• The tongue had a red tip, with yellow fur on the edges
• The pulse on both sides was fast and wiry
• Bowels normal, urine yellow
• Appetite normal
• Feel hot and talked very fast with minimal breaths as he spoke.
• Numbness of extremities
• Blood pressure reading was at the time of diagnosis: 140-159/90-99 and the day of his visit to the clinic.
• Was diagnosed one week ago but didn't feel well the last ten days prior visiting the GP.

Tests
The doctor has prescribed medication and must go back for regular check ups. Tests have been done to determine hypertension.

History
The patient always had an irregular diet (high sodium diet) that worked as a factory worker and his hours varied and his sleep was irregular as well. He has had a lot of stress throughout the years and has suffered headaches for six months prior to the diagnosis. He also claims that he does not drink much water during the day. Doctor has him taking beta blockers and ACE inhibitors. His father had hypertension and so did his great grandfather. Taking no supplements, and has never taken them.

Chief complaint
High blood pressure

Liver Yang Rising is the differential diagnosis
This is a typical pattern in hypertension during the early and middle stages of the illness (younger people). The disease location is in the head and neck. It occurs due to the lack of Qi ascending and descending with Qi rebelling straight up. So the treatment is to subdue the Liver Yang (Maciocia, 2013).

Treatment Principle
Lower the blood pressure to a normal reading, Subdue Liver Yang

Examination
Blood pressure was taken each visit as well.

Formulae
Tian Ma Gou Teng Yin Jia Jian modified (add three extra herbs)
(all of the following ingredients can help with hypertension)
This formula helps sooth the liver and subdue the yang. Basically it clears the heat, invigorates blood, boosts yin, nourishes the liver and tonifies the kidney to encourage liver yang (Fratkin).

Shi Jue Ming 15g (level the liver and subdue the yang)
Mul Li 15g (level the liver and subdue the yang)
Long Gu 15g (level the liver and subdue the yang)
Xia Ku Cao 15g (drain the liver and clear heat)
Sang Ji Sheng 15g nourish kidney yin to help liver yang)
Gou Teng 15g (drain the liver and clear heat also rid wind)
Du Zhong 12g nourish kidney yin to help liver yang)
Tian Ma 12g (level the liver and rid wind)
Nui Xi 12g nourish kidney yin to help liver yang)
Ju Hua 9g (drain the liver and clear heat)
Huang Qin 9g (drain the liver and clear heat)

Plus
Zhen Zhu Mu 1 5g for the severe dizziness
Di Long 9g for Numbness of extremities
Xi Xian Cao 9g for Numbness of extremities

Acupuncture treatment
GB 38 subdue liver yang
LIV 3 subdue liver yang
KI 3 nourish kidney yin to help liver yang
GB 20 sooth the liver and eliminates wind
ST 36 lower blood pressure as this point drains the yang evil from the whole body
LI 11 lower blood pressure as this point drains the yang evil from the whole body
GV 20 dizzy
SP 6 Numbness

Secound visit (one week later)
Was one week later and the dizziness and numbness had gone. The heat signs were there but diminishing. Was still angry but not as much. Sleep had started to improve. The tongue and pulse was the same but less yellow and red. Appetite and stools were normal. The BP had dropper to 130/90. We we continued the herbs for another week but took out
Zhen Zhu Mu 15g for the severe dizziness
Di Long 9g for Numbness of extremities
Xi Xian Cao 9g for Numbness of extremities

And did the same points except GV 20 and added LIV 8, and GB 9. Also used KI 9 instead of KI 3

Third Visit (two weeks from first visit)
Blood pressure is nearly back to normal 125/85. Feeling a lot better. Pulse has improved and so has the tongues appearance. Minimal heat signs just a slight touch of anger. Having better nights sleep with still some odd nights that he is restless. Feeling a lot better. Gave the same herbs but added 15g of sheng Di as had dry mouth and throat. Auricular acupuncture on both ears with needles was done during visit three.

Hypertension treatment with auricular points

19 Hypertension Point
51 Vegetative Point
55 Shen men
95 Kidney Zone
97 Liver Zone
100 Heart Point