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Evaluation of hypertension treatment by Traditional Chinese Medicine

Qiao Wangzhong
Beijing University of Traditional Chinese Medicine, China

1) A brief review of hypertension treatment by TCM

Since the beginning of this century, medical scientists have studied hypertension deeply and achieved a lot. But up to now, there are still many problems and difficulties in this field, especially in the treatment. The effects of anti-hypertensors being used are sometimes not satisfactory, their side effects are still bothering people.
Traditional Chinese Medicine (TCM) is one of the characteristics and superiority of Chinese medicine. In recent 40 years, the Chinese medical workers have made deep studies in the treatment and prevention of hypertension. For example, they have studied the pulse conditions, (1) the tongue appearances, (2) (4) the pathophysiogical basis of “TCM syndromes”, of hypertension, (5) (11) and have made researches in screening of anti-hypertensive medicinal herbs (12).
TCM has a lot of therapeutic methods for the treatment of hypertension, including Medication, Acupuncture, Qigong Therapy, Cupping Therapy, Moxibustion, Magnet Therapy, Massage, Dietary Therapy and so on. Among these therapeutic methods, medication and acupuncture are used more commonly. All these therapeutic methods are effective for the treatment of hypertension. They can lower the elevated blood pressure and alleviate symptoms due to high blood pressure. Also, they can prevent and treat the complications of hypertension.

 
Here are some brief introductions of these therapies:

1.1 medication

In China, medication is the method of TCM most commonly used for the treatment of hypertension. Chinese scientists, through about 40 years of clinical and experimental studies, have found many medicinal herbs and compound formulae to have the effects of descending hypertension. For example, the researchers of Shanghai Institute of Hypertension have screened 498 medicinal herbs and 103 compound formulae, they found 136 herbs, for example, Stephania tetrandra, Apocynus lancifolium, Menispermum dauricum, Clerodendreon trichotomum, Uncaria sinensis, Pheretima asperillum, etc. and 56 formulae, such as Decoction of Gastrodia elata and Uncaria sinensis, Decoction of longspur epimedium and Curculigo orchioides Gaertn, etc. to have anti -hypertensive effects.
Chinese medicinal herbs can not only be taken by mouth, but also can be used externally, as used in External Application, Inhalation Therapy and Soaking Therapy.
External Application refers to the therapeutic method of applying medicines to patient's body on certain parts or certain acupoint to treat diseases. Soaking Therapy treat patient by soaking patient's body partly in medicinal liquid; usually, the part chosen are patient's feet. Inhalation Therapy refers to the method to let the patient to breathe in the odour of the medicines. In these treatments, the effective elements of the medicines are absorbed into patient's body through the skin or through the air passage. On the other hand, the medicines stimulate patient's body from exterior, and give the body a regulation. All these can result in descending of blood pressure.
It has been proved that Chinese medicinal herbs lower hypertension mainly through increasing secretion of urine by the kidneys, dilating the blood vessels, regulating blood supplies of the internal organs and the brain, regulating the functions of the nervous system, cardiovascular system and endocrine system (13) (18).

1.2 Acupuncture Therapy

This includes body needling, head needling, ear needling, plum-blossom needle therapy, laser-needle therapy, hydro-acupuncture therapy, and so on. All these therapies are used in China in the treatment of hypertension. Among these methods, body needling is used most commonly. The acupoints usually chosen to treat hypertension are Zusanli (ST36), Sanyinjao (SP6), Taichong (LR3), Neiguan (PC6), Quchi (LIll), Xingjian (LR2), Hegu (LI4), Fengchi (GB20), Renying (ST9), Taixi (K13), Shenshu (BL23), Ganshu (BL18), Baihui (GV20), Qihai (CV6), Fenglong (ST40), etc. According to certain clinical reports, the effective rate of acupuncture for hypertension is about 72-80%. The effects are better for the cases in the first stage; if the case is in the second stage or the third stage, the therapeutic effects are not very good. It has been proved that acupuncture lowers blood pressure mainly through blocking Beta-acceptor and regulating the adrenaline-angiotensin system (19) [31].

1.3 Qigong Therapy

Qigong is a system of traditional knowledge and skill of regulating respiration and concentration of the mind. It is practised for physical training, for prevention and treatment of diseases. In China, the application of Qigong therapy in prevention and treatment of hypertension has a history of more than 40 years. Shanghai Institute of hypertension treated 516 patients of hypertension with Qigong for one year, the total efficiency is 86.2%; Beijing TCM Hospital reported that they treated 136 cases of hypertension with “Standing Qigong”, the result was that 91.9% of the cases responded to the treatment. It is generally considered that Qigong lowers high blood pressure mainly by regulating the whole body, especially by regulating the functions of central nervous system [32] [39].

1.4 Moxibustion Therapy

Moxibustion refers to the therapeutic method of applying an ignited cone or stick of mugwort or other medicinal herbs over certain acupoint of patient's body. This method is sometimes used in the treatment of hypertension. Usually, the acupoints chosen in moxibustion are Zusanli (ST36), Yongquan (KI1), Baihui (GV2O), Sanyinjiao (SP6), Zhongwan (CV12), etc. [4O] [41].

1.5 Cupping Therapy

Cupping Therapy refers to the therapeutic method of applying partial vacuum cups onto certain parts of the patient's body. In China, this method is also used in the treatment of hypertension. Usually the acupoints chosen are those of the Bladder Meridian, and Quchi(LI11), Zusanli (ST36), etc.[42] [44].

1.6 Magnet Therapy

Magnet Therapy refers to the therapeutic method of applying a magnet over or on certain acupoints of patient's body. In the treatment of hypertension3 the acupoints chosen are the same as those chosen in acupuncture therapy. [45] [47].

1.7 Massage therapy

Massage therapy is sometimes used to treat hypertension. It has been observed that massage can drop the elevated blood pressure to some degree [48].
Studies have shown that Moxibustion Therapy, Cupping Therapy, Magnet Therapy, and Massage Therapy mentioned above lower hypertension mainly through physically stimulating the body, reflectively leading to regulation of the central nervous system, and therefore leading to a series of reactions, and the blood pressure is then descended.

1.8 Dietary Therapy

This refers to the therapeutic method that patients take foods, which have some effects of lowering hypertension. In China, Dietary Therapy is mainly used in family by patient themselves as an accompanying treatment. It has been found that it will be helpful for patients to take celery, sea cucumber, jellyfish and sunflower seeds.

2. Evaluation of Hypertension Treatment by TCM

2.1 The advantages and shortages of the therapeutic methods of TCM

TCM has a lot of methods, which have being used to prevent and treat hypertension, as already mentioned above. These methods have some advantages:

  1. TCM treats hypertension by regulating the whole body, rather than by simply lowering the blood pressure. Medical studies suggest that high blood pressure is a result of the feedback regulation which takes place when the blood supplies to some important organs, such as the heart, brain and 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. So the proper treatment for hypertension is to make blood supply of the heart, brain and kidneys return to normality. Simply lowering the elevated blood pressure may lead to a new imbalance of blood supply. TCM treats hypertension based on syndrome differentiation, this is just to regulate the functions of the whole body, promote its self-balance function. It has been proved that the holistic concept and dialectical concept of TCM are accorded with the principle of treatment of hypertension. TCM therapies can not only lower high blood pressure, control it in a normal range, prevent and treat various complication of hypertension, but also make various imbalance states of the body return to normal.
  2. Generally speaking, although the effects of TCM therapies are a little slower, they are mild, persistent and steady. TCM therapies are mainly natural therapies, with little side effects, they are very safe, so these methods are especially suitable for the patients with complications of liver damage or kidney failure. When treated with TCM therapy, blood pressure drops gradually and slowly, the patient will not feel uncomfortable.
  3. There will not be any side effects when a patient is treated for a long time. Of course, TCM therapies have some shortages:
    1. it is a little inconvenient for patient to take medicinal decoctions by mouth, and the taste are also unfavourable.
    2. the mechanism by which some TCM therapies drop hypertension still remains unknown, this make it very hard for some people, even some medical workers to accept TCM therapy.
    3. it is very difficult to learn the principles and the methods of syndrome differentiation; if a doctor has not grasped these principles and methods, the therapeutic effects will be greatly influenced.

2.2 Treatment based on syndrome differentiation and treatment simply against the symptoms of hypertension

Treatment based on syndrome differentiation is one of the principles, and also one of the characteristics, of TCM, and the therapeutic effects of TMC depend greatly on it. In treatment of hypertension, syndrome differentiation is also very important. As we already known, Chinese medical scientists have found in experimental studies that many medicinal herbs and formulae are effective for the treatment of hypertension. Theoretically speaking, clinical case of hypertension will responds to these medicines or formulae. But in fact, if these medicines are used not according to the principle of syndrome differentiation, the therapeutic effects would be unsatisfactory, or the disease would not respond to these medicines, there would be no effect at all.
In fact, whether the Chinese medicines work or not is related closely to patient's body states. Under different body states, the effects of medicines will be different. Patient's body state is just what we call the “syndrome of TCM” also it can be called “syndrome state”. Clinically, hypertension may differ in pathological changes, in degrees of severity’s, in stages, and in complications. According to TCM, the pathogens and the pathogeneses are complicated, they have many types. Therefore, doctors should choose appropriate therapy for each concrete syndrome. It is forbidden to apply single fixed therapy to treat every case.
However, people also found that if doctors, under guidance of the principles of treatment based on syndrome differentiation, add a few medicines already known to be effective for hypertension into the main prescription1 the therapeutic effects will promoted.

2.3 About the criterion of the therapeutic effects

TCM is basically a phenomenal medicine, medical phenomena are very important to TCM. Clinical phenomena are valuable index for TCM to make diagnosis and to evaluate therapeutic effects. These phenomena include patients’ subjective feelings, i.e. the subjective symptoms. According to TCM, these symptoms should be taken to evaluate the effects of therapeutic methods. Generally speaking, alleviation of some symptoms usually reflects that patient's life quality is improved, and it also reflects that patient's body has returned to a new balance state. It has been observed that the alleviation of the subjective symptoms is usually accompanied by descending of blood pressure. So it is needed and practicable to take patients subjective symptoms as standards for evaluation of therapeutic effects, especially in the treatment by TCM.

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