The treatment of hypertension by acupuncture

Hypertension 1996 : One Medicine, Two Cultures

Fu Yanling
Beijing University of Traditional Chinese Medicine, China

Traditional Chinese Medicine (TCM) has a recorded history of more than 2000 years, but in its theories, there was not the concept of hypertension or the concept of “blood pressure”. According to TCM, the power that forces the blood circulating in the vessels is "Qi" rather not the blood pressure.
It can be said that ancient Chinese doctors did not know blood pressure and hypertension. As a result, they had not managed to treat hypertension5 more exactly1 they had not aimed to drop the blood pressure, which they knew, elevated above normal range.
However, this does not mean that there was not the disease of hypertension in ancient China, also, this does not mean that ancient Chinese doctors did not have the experience of treating hypertension.
We have found that among the diseases described in Chinese ancient medical literatures, there are certain diseases which like hypertension in clinical manifestation, complications, prognosis and so on. These reflect that TCM had already recognised to some degree the disease, which is lately named “hypertension” by western medicine. Nowadays, most of the Chinese medical scholars consider that in the theories of TCM, the disease of hypertension was factually included in the diseases such as “stroke”, “dizziness”, “Liver wind”, “liver yang”, “fire syndrome” and “headwind”. Chinese doctors had got plenty of experiences in diagnoses and treatment of these diseases.
About at the beginning of this century, the knowledge of modem medicine about hypertension began to influence TCM, and TCM doctors began to treat hypertension on purpose. Besides the four traditional diagnostic methods, TCM doctors also began to use sphygmomanometer to measure patients’ blood pressure, taking it as an index to differentiate syndromes and to evaluate the therapeutic effects.

TCM has a plenty of methods to treat hypertension; acupuncture is one of The practice of hypertension treatment by acupuncture can be generally divided into two types: one is to treat the symptom of high blood pressure; and the other, to treat the patient as a whole. To treat the symptom of high blood pressure is more simple: some acupuncturists know that when certain acupoints are stimulated with needles, the elevated blood pressure will descend, so they always puncture on these points as soon as a diagnosis of hypertension is made; usually they do not take patients’ concrete conditions into consideration. The acupoints usually chosen by these acupucturists are Renying (ST9), Zusanli (ST16), Shaoshang (LUll), Shaohai (HT3), Fengchi (GB2O), Taichong (LR3), Hegu (LI4), etc. Clinical practice has shown that stimulating these acupoints with needles can drop the elevated blood pressure to some degrees.
To treat the patient, as a whole is much more complicated, it must be based on differentiation of syndromes. An acupuncturist, by analysing the clinical phenomena of the cases, such as the symptoms and signs, including the pulse conditions and the tongue appearances, determine the type and nature of the case, and then choose an appropriate method to treat it. TCM doctors differentiate syndromes mainly based on various clinical phenomena, which a doctor can sense. In long period of clinical practices and observation of a large amount of cases, Chinese doctors have found that hypertension has four main types of syndromes as following:

Syndrome characterised by clinical phenomena such as dizziness, headache, flushed face and eyes, bitter taste in the mouth, restlessness, red tongue with yellow coating, taut and vigorous pulse. TCM considers that this kind of syndrome is due to that the liver yang is excessive, so called it “Excessive liver-yang syndrome”. The treatment for this kind of syndrome is to reduce the liver yang.
Syndrome characterised by clinical phenomena such as headache, dizziness, dry mouth, restlessness, hot feeling in the palms and soles, palpitation, tinnitus, amnesia, sleeplessness, taut, thin and rapid pulse. TCM considers that this kind of syndrome is due to that the liver yang is excessive while the liver yin is insufficient, so called it “Yin -insufficient yang -excessive syndrome”. The treatment for it is to supplement the insufficient yin and, at the same time, reduce the excessive yang.
Syndrome characterised by dry and uncomfortable feeling of the eyes, dizziness, weakness of waist and legs, tinninus, hot feeling in the palms and soles, sleeplessness, red and dry tongue with little coating, thin and taut pulse. TCM considers that this kind of syndrome is due to insufficiency of both the kidney yin and the liver yin, so called it the “Yin-insufficiency syndrome of the liver and kidney”. The treatment for this syndrome is to supplement the liver yin and kidney yin.
Syndrome characterised by dizziness, headache, tinnitus, palpitation, tiredness, weakness of the waiste and legs, pale tongue with white coating, taut and thin pulse. TCM considers that this kind of syndrome is due to insufficiency of both yin and yang of the body, so called it “Yin and yang insufficiency syndrome”, the treatment for it is to supplement the yin and yang simultaneously.

In China, the acupoints chosen most commonly to treat hypertension are Zusanli (ST36), Sanyinjiao (SP6), Taichong (LR3), Neiguan (PC6), Quchi (LIll), Xingjian (LR2), Hegu (LI4), Fengchi (GB2O), Renying (ST9), Taixi (K13), Shenshu (BL23), Ganshu (BL18), Baihui (GV20), Qihai (CV6), Fenglong (ST4O), etc. These acupoints can be divided into two groups according to their functions:
The first group: those used to reduce the excessive yang: such as Sanyinjiao (SP6), Taichong (LR3), Neiguan (PC6), Quchi (LIll), Xingjian (LR2), Hegu (LI4), Fengchi (GB2O), Renying (ST9), Taixi (K13), Fenglong (ST4O).
The second group: those used to supplement the insufficiency of the vital energy of the body (yin and yang), such as Zusanli (ST36), Shenshu (BL23), Ganshu (BLl8), Baihui (GV2O), Qihai (CV6), Guanyuan (CV4).
In clinical practice, if the case is an excessive liver-yang syndrome, the first group of acupoints is chosen and reducing manipulation is used. If the case is a Yin -insufficient yang -excessive syndrome, both groups of acupoints are chosen to supplement the insufficiency, and at the same time, to reduce the excess. If the case is a Yin insufficiency syndrome of the liver and kidney, then Shenshu (BL23), Ganshu (BL18) in the second group of acupoints are chosen, and reinforcing manipulation is used, in order to supplement the liver-yin and the kidney-yin. If the case is a Yin and yang insufficiency syndrome3 Shenshu (BL23), Ganshu (BL18) are chosen to supplement the yin, and at the time, moxibustion on Baihui (GV2O) and Qihai (CV6), Guanyuan (CV4) are utilized to strengthen the yang.
All these mentioned above is just what to treat the patients as a whole; in other words, to treat hypertension based on syndrome differentiation. This is an important principle for the treatment of hypertension by acupuncture. It has been proved by long term of clinical practices that if hypertension is treated under the guidance of this principle, the effects is much better.
The treatment of hypertension by acupuncture has some advantages: for example, its effect is mild, the patients will not feel discomfortable when the elevated blood pressure is lowered. Furthermore, no side effects will appear when a patient is treated for a long time.
Clinical practice and laboratory studies have proved it, acupuncture lowers hypertension mainly through blocking beta-acceptor of the sympathetic nerve and through stimulating the adrenaline-angiotensin system. Studies have also showed that the descending of elevated blood pressure after acupuncture is a result of regulation of the whole body.
However, it should be seen that the anti -hypertensive effects of acupuncture are limited. Generally speaking, its effects are better when the case is in the first stage. For those in the second stage or in the third stage, the effects are sometimes not satisfactory. Furthermore, for some complications of hypertension, its effects are not very good yet.

Here are some personal opinions about the treatment of hypertension by acupuncture

Medical studies suggest that high blood pressure is a result of the feedback regulation of the body, which takes place when the blood supplies of some important organs, such as the heart, the brain and the kidney, are not in balance. This regulation is a compensatory reaction of the body, but it is imperfect and leaves a pathological state of hypertension. According to this, the proper treatment for hypertension is to make the blood supply of the heart, the brain and the kidney return to normality. It will be improper to simply drop the elevated blood pressure. TCM treats hypertension based on syndrome differentiation, this is just to regulate the functions of the whole body, help the self -balance function of the body. So TCM can play an important part in the treatment of hypertension. It has been proved by clinical practices of 40 years that the holistic concept and dialectical concept of TCM are accorded with the treatment of hypertension.
In my opinion, TCM is phenomenal medicine, it diagnoses and treats diseases mainly based on various phenomena of diseases which traditional doctors can sense. According to TCM, different type of phenomena is the manifestation of different syndrome and needs different treatment TCM treats diseases, as we have already known, based on syndrome differentiation; while the differentiation of syndromes is mainly dependent on analyses of various phenomena of diseases. According to TCM, the causes and the pathogens of hypertension are very complicated, the clinical cases can be divided into different syndromes, and different treatments are needed. As a traditional doctor, one should not always apply a single fixed method to treat different syndromes of hypertension. Through thousands of years of clinical practices, TCM has found the corresponding relations between the types of phenomena and treatment. If we treat diseases according to the experience of TCM, good effects can be achieved, otherwise no good effects can be achieved.
Owing to several causes, in a long period of time in the past1 even at present, acupuncture has almost become the synonym of TCM. As soon as TCM is mentioned, some people at once think of acupuncture, even think only of acupuncture. In fact, TCM has a lot of therapeutic methods among them, medication (herbal therapy), is the most principal. In most conditions, acupuncture is only a supplementary therapy. It should be pointed out that the way by which acupuncture works in treatment is limited. Generally speaking, acupuncture works mainly through regulating the functions of the body, mainly through regulating the nervous system and endocrine system. In acupuncture, there are no any more therapeutic factors except physical stimuli, which enter the body. So the range of disease suitable to be treated by acupuncture is limited. In order to treat hypertension better, in order to take use of TCM completely, those who are interested in TCM should know more about medication, the herbal therapy of TCM.

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Edited by Aldo Campana,