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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