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.   

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