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:
- 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.
- 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.
- There will not be any side effects when a patient is treated for a long
time. Of course, TCM therapies have some shortages:
- it is a little inconvenient for patient to take medicinal decoctions by
mouth, and the taste are also unfavourable.
- 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.
- 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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