Hypertension

= = =Hypertension= elevation of systolic and/or diastolic BP pre-hypertension: 120-139/80-89 [western tx: lifestyle/diet change] stage 1 hypertension: 140-159/90-99 [western tx: diuretics w/ lifestyle changes] stage 2 hypertension: greater than or equal to 160/100

increases with age - in West 1. virtually no hyp in undeveloped areas of world 2. hyp inc dramatically when move to dev area

Incidence
1. more in blacks - 32% of adults - than whites - 23% of adults --50% all males and 60% all females over age 65 in U.S. if both isolated systolic and diastolic 2. 85-90% primary (essential) - unknown etiology 3. 5-10% secondary to renal disease 4. 1-2% other curable conditions

Pathophysiology
1. increased peripheral vascular resistance: vasoconstriction or increased CO 2. stim of sym nervous system inc BP 3. renin-angiotensin-aldosterone 4. def of vasodilatory substances 5. **secondary** --renal disease [~10%] --pheochromocytoma --Cushing’s syndrome --hypo or hyperthyroid --coarctation of aorta --oral contraceptives --corticosteroids --cocaine [artery spasm] --licorice [pseudo-aldosterone affect] --alcohol --cig smoking --excess sodium --decreased potassium --high fat diet --low fiber diet --obesity

Signs and Symptoms
1. asymptomatic until complications develop 2. dizziness, HA, flushed face, fatigue, epistaxis, anxiety 3. **complications** --Left ventrical failure --AS heart disease --retinal diseases --CVA with or without stroke --renal failure

Diagnosis
1. measure on two separate occasions about one week apart and take the average of the two readings as the true measurement 2. exclude secondary causes

Prognosis
1. untreated have risk for L vent failure, MI, CVA, renal failure 2. most imp risk factor for stroke 3. one of 3 most imp for CAD (cig, hyperchol) 4. CAD most common cause of death for hypertensives 5. mortality related to systolic

Treatment
1. similar to AS, esp diet 2. sodium restriction 3. avoid food sensitivities 4. Ca/Mg 5. physical activity, meditation, biofeedback, stress reduction 6. reduce caffeine intake in those sensitive to it 7. drug treatment --diuretics --beta-blockers --Ca channel blockers --angiotensin converting enzyme inhibitor 8. Other Possibilities --CoQ10 --Potassium --Galrlic --Crateagus (hawthorne berries) --Dandelion leaf --Vitamin D --Pomegranate

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====================================================== TCM Pathology

Disease causes
Internal damage by the seven affects, unregulated eating and drinking, aging, enduring disease

Qi Stagnation & Phlegm Congelation
//modifications:// exophthalmia: +BL-1, GB-20, Taiyang ---marked irritability, emotional depression: + PC-5, GV-24 ---Insomnia & Heart palpitations: + PC-6, HT-7 ---tremors in hands & fingers: + LI-4 [Xia Ku Cao (15g.), Mu Li (12g.), Zhe Bei Mu (12g.), Fu Ling (12g.), Chai Hu (9g.), Dang Shen (9g.), Bai Zhu (9g.), Dang Gui (g.), Bai Shao (9g.), Kun Bu (9g.), Ban Xia (9g.), Chen Pi (6g.), Gan Cao (6g.), Da Zao (3pcs.), Sheng Jiang (3pcs.)] //modifications:// depressive heat: +Xuan Shen (15g.), Huang Qin (12g.) Insomnia: + He Huan Pi (12g.), Ye Jiao Teng (12g.), Suan Zao Ren (12g.) Increased appetite: + Shi Gao (15g.), Zhi Mu (9g.) Aversion to heat with sweating: + Zhi Zi (9g.), Dan Shen (9g.) Tremors of hands/fingers: + Jiang Can (15g.), Chan Tui (15g.) Severe goiter: +Huang Yao Zi (9g.), San Leng (9g.), E Zhu (9g.) Leukopenia: + Huang Qi (15g.), Ji Xue Teng (15g.), Lu Jiao Jiao (9g.) Sensation of throat obstruction: She Gan (12g.) Severe Liver Qi stagnation/depression: + Qing Pi (6g.)
 * Signs:** Goiter swelling in the front of the neck which is soft and not painful, possible nodulations on the thyroid gland, possible exophthalmia or sensation of distention in the eyes
 * Symptoms:** emotional depression, frequent suspicion, irritability, easy anger tendency to taciturnity, chest oppression, rib-side pain, great sighing
 * Tongue:** pale body, thin slimy coat
 * Pulse:** bowstring, slippery
 * Treatment Principles:** Course the Liver and rectify the Qi, transform phlegm and scatter nodulation
 * Acupuncture Treatment:** LR-3, ST-40, TW-13, SI-16, LI-17, SI-17, CV-22
 * Herbal Treatment:** Xiao Chai Hu Tang + Xiao Yao San Modification

Liver Fire Hyperactivity & Exuberance
//modifications:// exophthalmia: +BL-1, GB-20, Taiyang ---marked irritability, emotional depression: + PC-5, GV-24 ---Insomnia & Heart palpitations: + PC-6, HT-7 ---constipation: + TW-6 ---tremors in hands & fingers: + LI-4 ---sensation of throat obstruction: + HT-5, CV-23 ---profuse sweating: + KI-7, LI-4 [Xia Ku Cao (15g.), Xuan Shen (15g.), Sheng Di (12g.), Mu Li (12g.), Long Gu (12g.), Ban Xia (12g.), Fu Ling (12g.), Zhe Bei Mu (12g.), Chai Hu (9g.), Huang Qin (9g.), Zhi Zi (9g.), Dang Gui Wei (9g.), Hai Zao (9g.), Kun Bu (9g.), Chen Pi (6g.), Gan Cao (6g.)] //modifications:// If Stomach is strong & hot and Spleen is weak: use Bai Hu Jia Ren Shen Tang + Xiang Sha Liu Jun Zi Tang Modification Severe goiter: +Huang Yao Zi (9g.), San Leng (9g.), E Zhu (9g.) hand shaking & trembling: + Shi Jue Ming (15g.), Gou Teng (9g.), Bai Shao (9g.) Insomnia, emotional tension: + He Huan Pi (12g.), Ye Jiao Teng (12g.), Suan Zao Ren (12g.) constipation: + Da Huang (6-9g.) Loose stool (SP xu): + Dang Shen (12g.), Bai Zhu (12g.) Sensation of throat obstruction: +She Gan (12g.) Profuse sweating: + Fu Xiao Mai (15g.), Wu Wei Zi (15g.) Pain & distention in the eyes: + Bai Zhi (15g.), Gou Qi Zi (15g.), Shi Chang Pu (15g.), Ci Ji Li (15g.)
 * Signs:** Marked goiter which is soft and not painful, possible nodulations, possible exophthalmia
 * Symptoms:** emotional tension, irritability, impetuosity, red face and eyes, headache, dizziness, head distention, tinnitus, tongue & hand shaking and trembling, heart palpitations, insomnia, dread of heat, profuse sweating, rapid hungering with increased food intake, strong thirst, bitter taste in mouth
 * Tongue:** red body, yellow coat
 * Pulse:** bowstring, rapid
 * Treatment Principles:** Clear the Liver and drain fire, transform phlegm and scatter nodulation
 * Acupuncture Treatment:** LR-2, GB-34, TW-13, SI-16, LI-17, SI-17, CV-22
 * Herbal Treatment:** Long Dan Xie Gan Tang Jia Jian

Yin Vacuity, Yang Hyperactivity
//modifications:// ---dizziness: + GB-20 ---Rough eyes & blurred vision: + GB-37 ---Hot flashes in the face: + HT-6, GV-14 ---Tinnitus: + GB-2 ---exophthalmia: +BL-1, GB-20, Taiyang ---Palpitations: + PC-6 ---tremors in hands & fingers: + LI-4 ---profuse sweating: + LI-4 [Sheng Di (15g.), Xuan Shen (15g.), Huang Yao Zi (15g.), Mai Men Dong (12g.), Tian Men Dong (12g.), Gou Qi Zi (12g.), Suan Zao Ren (12g.), Long Gu (12g.), Mu Li (12g.), Fu Ling (12g.), Chuan Lian Zi (9g.), Yuan Zhi (9g.), Wu Wei Zi (9g.), Bai Zi Ren (9g.), Ban Xia (9g.), Hai Zao (9g.), Kun Bu (9g.), Chen Pi (6g.), Huang Lian (3g.)] //modifications:// Severe Yin vacuity: + Gui Ban (12g.), He Shou Wu (12g.), Nu Zhen Zi (12g.) Severe effulgent fire: + Huang Bai (9g.) Liver yang suddenly rising -> wind: + Gou Teng (15g.), Jiang Can (9g.) Marked Liver & Kidney deficiency:depressive heat: +Xuan Shen (15g.), Huang Qin (12g.) Insomnia: + He Huan Pi (12g.), Ye Jiao Teng (12g.), Suan Zao Ren (12g.) Increased appetite: + Shi Gao (15g.), Zhi Mu (9g.) Aversion to heat with sweating: + Zhi Zi (9g.), Dan Shen (9g.) Tremors of hands/fingers: + Jiang Can (15g.), Chan Tui (15g.) Severe goiter: +Huang Yao Zi (9g.), San Leng (9g.), E Zhu (9g.) Leukopenia: + Huang Qi (15g.), Ji Xue Teng (15g.), Lu Jiao Jiao (9g.) Sensation of throat obstruction: She Gan (12g.) Severe Liver Qi stagnation/depression: + Qing Pi (6g.)
 * Signs:** Large or small goiter, possible nodulations, possible exophthalmia or a tense feeling in the region of the eyes
 * Symptoms:** 5-palm heat, insomnia or scanty sleep, profuse dreams, dizziness, blurred vision, heart palpitations, restlessness, easy sweating, dread of heat, hot flushes, red complexion, shaking hands, tinnitus, rough eyes, low back & knee soreness & limpness, increased food intake but emaciated, lack of strength, dry mouth & throat
 * Tongue:** red body, scanty coat
 * Pulse:** bowstring, fine, rapid
 * Treatment Principles:** Enrich Yin and subdue Yang, transform phlegm and scatter nodulation
 * Acupuncture Treatment:** LR-3, HT-7, KI-7, TW-13, SI-16, LI-17, SI-17, ST-9
 * Herbal Treatment:** Tian Wang Bu Xin Dan & Yi Guan Jian

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===================================================== IBIS

Definition:
primary or secondary elevation in either systolic and/or diastolic blood pressure

Etiology:
Hypertension is characterized by a diastolic reading above 90 mm/Hg., and a systolic reading above 140 m/Hg., or both. There are two types of hypertension: primary (aka essential or idiopathic) and secondary.

primary hypertension (1°): hypertension with no discernible cause; conventionally, about 89% of cases are considered to be in this category. However, many factors are implicated in the development of primary, or essential hypertension. Some of the recognized risk factors include family history, environment (family size, crowding, eating patterns, occupation, obesity), salt ingestion and sensitivity (there is controversy over whether the sodium or chloride part of the salt molecule is the principal factor), race (blacks have more primary hypertension and more morbidity and mortality than whites), hyperlipidemia, smoking, diet

secondary hypertension (2°): This accounts for only a small minority of patients with hypertension, but must be ruled out in all cases, as discovery and treatment of the cause will cure the hypertension. Causes of secondary hypertension include: • sympathetic nervous system compensation in response to pancreatic hypoglycemia: usually will fluctuate; in the morning it will be better and in the afternoon it will be worse • epinephrine compensation in response to severe pancreatic hypoglycemia: the patient will seem like they are calm outside but really tense inside. They will tend to have increasing hypertension as the day goes on. • obese hypertension: may be hormonal, hormonal with adrenal compensation, hormonal with liver compensation, or adrenocortical compensation • renal hypertension: divided into renovascular hypertension (pre-eclampsia and eclampsia), and renal parenchymal hypertension (stenosis of a renal artery causing decreased renal perfusion which results in the kidneys activating the renin-angiotensin pathway) • endocrine hypertension: this includes adrenal hypertension (primary aldosteronism, Cushing's syndrome, and pheochromocytoma), acromegaly, hypercalcemia, and oral contraceptives (probably the most common cause of secondary hypertension). • coarctation of the aorta

Somatic Therapies:
• assess CV fitness by submax. stress test • aerobic exercise program: the preferred treatment for mild hypertension • caution patient against isometrics • qigong: relaxed standing exercise • tai qi chuan

Nutrition:
» eating principles: • low fat diet of unsaturated fats • calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18% • low cholesterol • decrease sodium and increase potassium It has been found that as the extracellular level of potassium increases, the sodium-ATP pump is activated which causes a decrease in intracellular sodium. (Patki PS. Brit J Med 1990;521-523:301; Cappuccio FP, et al. J Hypertension 1991;9:465-473.) • increase fiber As the level of fiber goes up blood pressure invariably goes down. In parts of the world where fiber intake is very high blood pressure tends to be very low. • decrease sucrose Sucrose can impair insulin function and can indirectly cause blood pressure to rise. • decrease serum glucose (Salomaa VV, et al. Brit Med J 1990;302:493-496.) • 1-2 week fast on alkaline juices or watermelon fast, followed by a vegetarian diet • if overweight, reduce weight to normal range • in extreme hypertension, restrict diet to 500 mg Sodium • elimination/rotation diet, rotation diet, rotation diet expanded

» therapeutic foods: • foods rich in Potassium and Magnesium, diuretic foods; millet, buckwheat, oats, rice, raw goat's milk, raw leafy vegetables, watermelon, garlic, onions, foods rich in rutin, cornsilk tea, garlic, broccoli, celery, cherries, nectarines, pineapple, kumquats, watermelons, squash, pomegranate, guava, parsley, cucumber, dandelion greens, cornsilk and white mushroom soup (Ni, p. 136.) • increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil

» fresh juices: • carrot, parsley and celery (Jensen, p. 50.) • lime and whey powder (Jensen, p. 50.) • grape and carrot (Jensen, p. 50.) • grapefruit - Note: adverse interaction with nifedipine (Procardia, Adalat) • carrot, spinach, beet, and parsley (Walker, p. 126.) • celery and apple (Walker, p. 126.) • watermelon (Shefi) • cornsilk tea (Shefi) • 1/2 cup fresh snowpea • soybean sprout tea (Ni, p. 136.) • carrot, beet, and cucumber (Walker, p. 126.) • carrot and spinach (Walker, p. 126.) • warm celery (Ni, p. 136.) • mung bean soup (Ni, p. 136.) • chrysanthemum and spinach tea (Ni, p. 136.) • persimmon (Yin-fang and Cheng-jun, p. 63.) • radish (Chao-liang, Qing-rong, Bao-zhen, p. 12.) • cucumber vine tea (Chao-liang, Qing-rong, Bao-zhen, p. 57.)

» specific remedies: • take 60 g of banana skins or stems, steam in water and eat three times daily (Yin-fang and Cheng-jun, p. 65.) » Liver Yang Rising: • one cup of grape juice and celery juice each, taken with warm water three times daily for 20 days. After one 20-day course of treatment, a 5-7 day rest, then resume another course. • drink the decoction of: 10 water chestnuts and 25 g each of kelp and corn silk • soak peanuts in vinegar for 5 days, eat 10 peanuts every morning • take a handful of sunflower seeds every morning and evening with 1/2 cup of celery juice for one month • drink one small "wine glass" of turnip juice morning and evening for 10 days • decoct 250 g celery (1/2 lb.) and drink, at same time eat 10 large Chinese dates • soak 6 g black fungus in water overnight; steam for one hour; sweeten with sugar to taste. Take one time per day in evening before bed until the symptoms and blood pressure have improved. • for constipation caused by hypertension: take 500 g of peeled banana and mash together with 15 g black sesame seed. Eat per day (Yin-fang and Cheng-jun, p. 65.) • take 60 g of water chestnuts and 30 g of fresh orange peel. Add water, steam until cooked and serve two to three times daily (Yin-fang and Cheng-jun, p. 68.) • take 30 g dried green peach (pitted young green fruit left to dry in the sun) cover with water and simmer until cooked and drink in place of tea. (Yin-fang and Cheng-jun, p. 69.)

» avoid: • Food intolerances; rule out food sensitivities: consider hypoallergenic diet; almost always will lower blood pressure 5-15 points diastolically within one week. (Grant C. Lancet May 5, 1979.) • Salt, salty foods: pickles, olives, chips, packaged snacks, meat, (especially ham, frankfurters, bacon, bologna, corned beef, lunch meats, frozen fish fillets, sardines, herring, caviar, anchovies, shellfish), dairy products, spicy foods: salsa, white and black pepper, mustard, ginger, canned tomato juice, V-8 juice, processed cheese, canned, dried or instant soups, frozen peas and beans, most processed and refined foods, MSG, mayonnaise, salad dressings, gravies, ketchup, food with Sodium benzoate as a preservative, Sodium proprionate in cheese and bread, baking powder, baking soda, ice cream, milkshakes, soft drinks, smoked meats and fish, Jello, pretzels, potato chips, salted nuts, candy, rennet tablets, pudding mixes, beverage mixes, spicy foods, alcohol, fried foods, fatty foods, pork, • Overeating • Low levels of Calcium • Alcohol: Some people have a genetic hypersensitivity to alcohol which causes an increase in blood pressure. • Decrease sucrose: Sucrose can impair insulin function and can indirectly cause blood pressure to rise. • Avoid caffeine: A subset of the population may be sensitive to caffeine. • Trans-fatty acids, hydrogenated oils (margarine, vegetable shortenings, imitation butter spreads, most commercial peanut butters), oxidized fats (deep fried foods, fast food, ghee, barbequed meats) • Avoid foods containing tyramine (see materia medica) • Grapefruit juice and drug interaction: grapefruit juice increases the bioavailability of nifedipine (Procardia, Adalat) by 8-69%, possibly through bioflavonoid interfernece with cytochrome P450 (Cantoni, et al., 1982; 307; 1079.)

Botanicals
• Achillea millefolium: essential hypertension (British Herbal Pharmacopoeia, p. 145) • Allium sativum • Apium graveolens: juice and seeds • Arctium lappa • Arnica spp. (toxic): (Anderson Geller) • Berberis vulgaris (root bark): (Lust, p. 106) • Cimicifuga spp.: (Anderson Geller) • Crataegus oxyacantha: cardiotonic, stabilizes heart (Priest and Priest, p. 91; Weiss, p. 164) • Fagopyrum esculentum (buckwheat): with vitamin C: raised arterial tension with capillary bleeding (British Herbal Pharmacopoeia, p. 90) • Ginkgo biloba (standardized extract): (NCNM Case Studies) • Hamamelis virginiana: (Anderson Geller) • Olea europaea (olive): in combinations (Weiss, p. 160) • Rauwolfia serpentina (toxic): primary hypertension (Weiss, p. 153) • Scutellaria lateriflora: nervine • Taraxacum officinale: diuretic, tonic (Anderson Geller) • Tilia platyphyllos: hypertension associated with atherosclerosis (Mitchell, p. 12) • Valeriana spp.: (Planta Medica, 2-28-85) • Veratrum album (toxic): (Weiss, p. 161) • Viscum album (toxic): mild; subjective improvement with symptoms associated with high blood pressure: headache, dizziness, loss of energy, irritability (Weiss, p. 158)

Chinese Formulae
• Coptis and Scute (Huang Lian Jie Du Tang) (or if constipation, Coptis and Rhubarb C. (Xie Xing Tang)); Jiang Ya Wan (patent); Uncaria 6 (patent): Liver Fire Blazing Upward: irritability, dry mouth, insomnia, dark urine, red tongue with yellow coat, forceful pulse (Coptis and Scute: Hsu, 1980, p. 175; Yeung, p. 124; Dharmananda, 1986, p. 295; Bensky and Barolet, p. 78; Coptis and Rhubarb: Hsu, 1980, p. 190; Yeung, p. 265; Dharmananda, 1986, p. 151; Bensky and Barolet, p. 79; Jiang Ya Wan: Zhu, p. 175; Fratkin, p. 235; Uncaria 6: Dharmananda, 1990, p. 92) • Bupleurum and Dragon Bone (Chai Hu Jia Long Gu Mu Li Tang): Gall Bladder Phlegm: irritability with occasional attacks of palpitations, constipation, heavy sensation in the body, wiry rapid pulse, greasy tongue coat (Bupleurum and Dragon Bone: Hsu, 1980, p. 340; Dharmananda, 1986, p. 154; Bensky and Barolet, p. 387) • Zhen Gan Xi Feng Tang; Tianma Chu Feng Pu Pien (patent); Jiang Ya Wan (patent); Uncaria 6 (patent): Liver Wind Arising from Liver Yang Rising: dizziness, headache, irritability, flushed face (Zhen Gan: Yeung, p. 284; Bensky and Barolet, p. 402; Tianma Chu Feng Pu Pien: Fratkin, p. 238; Jiang Ya Wan: Zhu, p. 175; Fratkin, p. 235; Uncaria: Dharmananda, 1990, p. 92) • Ban Xia Bai Zhu Tian Ma Tang: Spleen Qi Xu (Deficiency) causing Phlegm and Liver Wind Stirring: vertigo, headache, nausea/vomiting (Yeung, p. 41; Bensky and Barolet, p. 447), • Major Bupleurum C. (Da Chai Hu Tang): Liver Qi Stagnation in obese or strong constitution patients (Hsu, 1980, p. 128; Yeung, p. 61; Dharmananda, 1986, p. 154; Bensky and Barolet, p. 139) • Rehmannia Six F. (Liu Wei Di Huang Wan): Kidney Yin Xu (Deficiency) and Liver Yin Xu (Deficiency): low back pain, tinnitus, night sweats (Hsu, 1980, p. 245; Yeung, p. 152; Dharmananda, 1986, p. 172; Bensky and Barolet, p. 263) • Linking Decoction (Yi Guan Jian): Kidney Yin Xu (Deficiency) and Liver Yin Xu (Deficiency) with Liver Qi Stagnation: hypochondriac and chest pain/tightness, acid regurgitation (Bensky and Barolet, p. 271; Yeung, p. 271) • Tang Kuei and Gambir C.: Kidney Yin Xu (Deficiency): Weaker patients with chronic hypertension, including due to kidney disease (Hsu, 1980, p. 415) • Yao Qin Qing Dan Tang: Gall Bladder Damp-Heat: alternating fever and chills, chest pain/tightness, nausea, bitter taste in mouth, acid regurgitation (Yeung, p. 117; Bensky and Barolet, p. 141) • Gentiana C. (Long Dan Xie Gan Wan) (available as patent); Gentiana 12 (patent): Liver and Gall Bladder Invaded by Damp-Heat (Gentiana: Hsu, 1980, p. 181; Yeung, p. 154; Dharmananda, 1986, p. 229; Bensky and Barolet, p. 96; patent: Zhu, p. 172; Fratkin, p. 82; Gentiana 12: Dharmananda, 1990, p. 69) • Xue Fu Zhu Yu Tang: Xue Yu (Blood Stasis) and Liver Qi Stagnation: chest and hypochondriac pain, chronic fixed piercing headache, depression, insomnia, irritability (Yeung, p. 269; Bensky and Barolet, p. 314) • Si Sheng Wan: Xue (Blood) Heat: dry mouth, nosebleeds (Yeung, p. 219; Bensky and Barolet, p. 337) • Er Xian Tang: Kidney Yin Xu (Deficiency) with Empty Fire Blazing and Kidney Yang Xu (Deficiency): menopausal hypertension (Yeung, p. 91; Bensky and Barolet, p. 282) • Vitality C. (Zhen Wu Tang); Du Zhong Pian (Compound Cortex Eucommia Tablets) (patent): Kidney Yang Xu (Deficiency) and Spleen Yang Xu (Deficiency) with Water Stagnation: primary hypertension: edema, loose stools, dizziness, pain worse with cold (Vitality C.: Hsu, 1980, p. 278; Yeung, p. 287; Bensky and Barolet, p. 197; Du Zhong: Zhu, p. 177; Fratkin, p. 236) • Tienma and Shou Wu (patent); Uncaria 6 (patent): Liver Xue Xu (Blood Deficiency) with Liver Yang Rising. (Tienma and Shou Wu: Fratkin, p. 237; Uncaria 6 (Dharmananda, 1990, p. 92) • Wan Shi Niu Huang Qing Xin Wan (patent): Pericardium Invaded by Heat (Zhu, p. 132) • Bupleurum and Gambir F. (Sun Ten, Dharmananda, 1990, p. 39)

Acupuncture
after assessing the person and palpating, consider these patterns: Flourishing of Fire of Liver and Gall Bladder; Liver Wind Stirring; Liver Yang Rising; Liver Fire Blazing Upward; Upward Attack of Qi and Xue (Blood); Gall Bladder Phlegm; Liver and Gall Bladder Invaded by Damp-Heat; Xue Yu (Blood Stasis) and Liver Qi Stagnation; Liver Xue Xu (Blood Deficiency) with Liver Yang Rising; Pericardium Invaded by Heat; Xue (Blood) Heat; Xiao Yang imbalance in the Windows to the Sky; Spleen Qi Xu (Deficiency); Excessive secretion and obstruction by Wet Phlegm; Wind-Phlegm Obstruction; Liver and Kidney Yin Xu (Deficiency), esp. with Empty Fire Blazing; Xu (Deficiency) of both Yin and Yang

» illustrative combinations: • St-9, LI-11 and St-36 for hypertension (Shanghai, p. 165; Lee and Cheung, p. 246) • Lv-3, UB-18, St-36 and LI-11 for primary hypertension; also consider Ht-7 and yin tang with dizziness; PC-6 and UB-15 with palpitation; Ht-7 and Sp-6 with insomnia (Liu, p. 287) • GB-20, LI-11, St-36 and Lv-3 for hypertension; also consider Lv-2, tai yang, TW-7, Ht-7, an mian, Sp-6, Kd-3, GB-34, Sp-9, St-40, PC-6, CV-4 and CV-6 (Lee and Cheung, p. 245) • St-36, PC-6, Sp-6, GV-20, LI-4 and Lv-2 for hypertension (Lee and Cheung, p. 246) • LI-11 and St-36: reduce hypertension; stimulate digestion and general metabolism; and disperse noxious Yang (Finkelstein, p. 9) • Lv-3 -> Kd-3 for hypertension (Flaws, 1989, p. 100) • LI-11 -> Ht-3 for hypertension (Flaws, 1989, p. 100) • GB-20, GB-5, yin tang, GB-34 and Lv-2 with Liver Yang Rising contributing to hypertension (Qiu and Su, p. 64-67) • UB-18, UB-23, LI-11, Ht-7, St-36, Sp-6, Kd-3 and Lv-3 with Liver and Kidney Xu (Deficiency) contributing to hypertension (Qiu and Su, p. 64-67) • GV-20, GB-20, UB-2, GB-31, GB-34 and Lv-3 with Yin and Yang Xu (Deficiency) contributing to hypertension; add UB-23 and GV-4 if Yang Xu (Deficiency) greater; add Ht-7 and Sp-6 if Yin Xu (Deficiency) greater (Qiu and Su, p. 64-67) • GB-20, LI-11, LI-4, St-36 and St-40 with Wind-Phlegm Obstruction contributing to hypertension (Qiu and Su, p. 64-67) • GV-20, GV-26, shi xuan, Lv-3 and St-40 with Upward Attack of Qi and Xue (Blood) contributing to hypertension (i.e., sudden collapse) (Qiu and Su, p. 64-67) • St-41 and Ht-5 for headache with red face and eyes in hypertensive patient (Shanghai, p. 598) • GV-20, GB-19 and UB-10 for vertigo (Lee and Cheung, p. 246) • GB-15, SI-5, SI-4 and UB-62 for vertigo; HT-5, St-41 for headache, flushed face and congested eyes (Lee and Cheung, p. 246) • Ht-5 and St-41 for headache with red face and eyes in hypertensive patient (Shanghai, p. 598) • UB-17 and Lv-14 (-): reduce associated insomnia • PC-6 and St-40 (-): transform Phlegm; calm Spleen/Stomach; relax chest • GB-34 and Lv-2 (-): clear Fire from and soothe Yang of Gall Bladder and Liver • UB-23 and CV-4 (=): relieve fatigue and lassitude by tonifying the Kidney • Kd-3 and Sp-6 (+): nourish Kidney Yin • CV-6 and CV-4 (n+d. D): warm Kidney Yang • Ht-7 and an mian (-): calm the Shen

Homeopathy
Aurum metallicum: violent palpitation; orthopnea, fullness in heart region, < night Baryta carbonicum: chilly, physically and mentally dwarfed; palpitation, < lying on left side; vertigo in morning, fainting with nausea Conium maculatum: vertigo < slightest motion of head or lying down, > closing eyes; occipital headache on rising in the morning Kali iodatum: past history of syphilis or mercury poisoning; hemorrhagic diathesis; chronic acid coryza and pain in frontal sinus Lachesis: left-sided heart failure, hemorrhagic tendencies, angina, hot patient Natrum muriaticum: headache and vertigo, throbbing, one-sided; hot patient; vertigo with nausea and tendency to fall forward and to the left Picric acid: due to enlarged prostate, renal conditions; occipital headache > tight bandage Plumbum metallicum: atherosclerosis; nephritis; mental depression; < night, mental exertion; "sheep dung" stool Secale cornutum: internal heat with external coldness > uncovering; bleeding tendency; palpitation and boring pain in chest. Strontium carbonicum: flushed face and threatened apoplexy; vertigo with headache and nausea; chilly, > immersing hands in water

Subtle Support
• Fa (Hill, p. 46); Fa# (Gardner, p. 82, 87); So (Gardner, p. 93, 99)

• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

Mind/Body
• type A behavior pattern (Korn, p. 177; Bry, p. 28; et al !!) • personality characterized by increased psychomotor activity; dynamic, hyperactive individuals, with a large steady output of energy; they tend to be sensitive and quick tempered, but without serious mood fluctuations. (Locke, 1986, p. 23) • associated with anxiety, ambition, and anger. (Epstein, p. 128) • "Blood and anger are boiling over and need to be cooled." (Epstein, p. 131) • suppressed rage. (Harrison, p. 37) • fear. (Locke, 1985, p. 28) • repressed hostility resulting from frustration of dependent needs and resentment. (Locke, 1985, p. 23) • Hypertensive patient are "overreactive sounding boards." (Locke, 1985, p. 29) • increased anxiety, inappropriate coping behaviors in socially distressing situations; dependency needs. (Locke, 1985, p. 24) • Treatment procedures derived from a cognitive-behavioral base and consisting of training experiences for coping effectively with stress showed significant decreases in state anxiety and systolic blood pressure. There were no significant differences among groups with regard to trait anxiety and diastolic blood pressure. (Locke, 1985, p. 3) • Inhibited aggressive impulses and hostile tendencies (Alexander, p. 289) • Heart represents center of love and security; Heart problems are associated with longstanding emotional problems; lack of joy; belief in strain and stress. (Hay, 1984, p. 168) • Person feels threatened with being harmed by an ever-present danger; as a result, he feels the need to be on guard, and prepared to meet all threats. (Gentry, p. 43) • Those persons who habitually express anger when provoked by others have on the average lower systolic and diastolic blood pressure than do similar persons who habitually suppress such feelings. The relative risk for hypertension is approximately 1:64 for "anger-out" vs. "anger-in" individuals. (Gentry, p. 103) • A suitable psychological approach can play a very important part in treatment by changing the way of life of hypertensive patients. (Locke, 1985, p. 69) • "The blood pressure is an expression of a person's general dynamism. It arises out of the mutual effects of the behavior of the liquid blood on the one hand and the behavior of the limiting walls of the blood vessels on the other. When considering the blood pressure we always need to bear in mind these two mutually contradictory components: the fluid and the flowing on the one hand, and the limitation and the resistance on the other. To the extent that the blood corresponds to our own inner being, the walls of the vessels correspond to the limits that the unfolding personality sets upon itself and the resistances that stand in the way of our development. In the case of hypertension, the circulatory system maintains a long term excitation in the expectation that it will eventually be translated into action. If the action fails to materialize, the patient stays 'under pressure'. Of even greater importance is that the same relationship applies where conflict is concerned. These patients take refuge in superficial 'busy-ness', attempting through great external activity to divert both themselves and others from the challenge to come to grips with their conflict." People with hypertension have a good deal of aggression which they repress by exercising self-restraint. (Dethlefsen, p. 195-197, 201)

• Liver ~ Gan is the residence of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Xue Xu (Blood Deficiency) predisposes to Xue Yu (Blood Stasis). Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Xue Yu (Blood Stasis) often begins with Qi Stagnation. » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; tinnitus; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc. » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems.
 * Chinese psychophysiology:**

• Gall Bladder ~ Dan is the source of courage and initiative, and is responsible for decision-making as the bodily Minister of Justice; controls circulation of the nourishing and protecting energies [Ying Qi and Wei (Protective) Qi]; and opens into the eyes. Its channel purifies Yang energy in the body. » Healthy expressions are kindness, decisiveness, control, and spirit of initiative. » Gall Bladder Shi (Excess) signs include tiredness; sighing; irritability; bitter taste in the mouth in the morning; pain in all joints; edematous knees and legs (Seem, p. 29); tinnitus; lateral headache; heaviness in head and stomach; muscular spasms; and limbs slightly cold. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder. » Anger, frustration, and resentment can cause Liver Qi Stagnation which, in turn, can produce Heat which affects the Gall Bladder.

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing, sadness, obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Dampness and Phlegm Shi (Excess) usually derive from Spleen Yang and/or Qi Xu (Deficiency). » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the stabilizing and nourishing qualities of Water and Yin to temper the Fiery Yang qualities and functions, and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; tinnitus; fearfulness; apathy; discouragement, and scatteredness » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Integrative Therapies
Modern life has brought refined, highly processed, high fat, salty foods and stress with little opportunity for exercise, resulting in weight gain. These factors have been found to promote hypertension, which is indicated by blood pressure readings of 140 over 90 or above that are taken on 3 separate occasions. Hypertension generally has no outward symptoms and commonly occurs in industrialized countries. It is rare in countries where diets are high in fiber such as in China, Africa, and areas of South America. Therefore, the main focus in the treatment of hypertension is diet.

Other causes of hypertension include overconsumption of caffeine and alcohol. Alcohol causes overstimulation of adrenalin secretion. It is also high in sodium Smoking and chewing tobacco also stimulate adrenalin secretion. Smoking has also been found to increase the desire for sugar, alcohol, and caffeine, and it reduces levels of vitamin C in the body as well. Always consult a physician if you suspect hypertension, and never stop medication on your own, especially a beta blocker.

THE FOLLOWING SUPPLEMENTS ARE USED FOR HYPERTENSION AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: • Calcium and magnesium supplement – 1,000 milligrams of calcium and 500 milligrams of magnesium per day. • Vitamin C – 1,000 milligrams, 3 times a day. • B complex – 50 milligrams, 2 times a day. • Niacin or Niacinamide (vitamin B3) – 200 to 400 milligrams once or twice a day. Niacinamide can cause the sensation of a heat rush and should be used under a physician's guidance. • Coenzyme Q 10 – 20 milligrams, 3 times a day. • Flax Seed oil or Evening Primrose oil – 1 tablespoon a day. • Salmon oil – 2 capsules, 3 times per day with meals. • Garlic – Take 2 capsules, 3 times a day with meals.

THE PROPER DIET FOR HYPERTENSION WILL INCLUDE: Decreasing or avoiding the following foods: 1. Meat and other animal products – Vegetarians have lower blood pressure levels. Try, at least, to cut down the amounts of red meats, dairy products, and fatty foods. Totally avoid fried foods. 2. Salt – Keep it to a minimum. 3. Caffeine – such as in coffee, tea, chocolate, and sodas. 4. Alcohol – even moderate amounts can produce high blood pressure. 5. Sugar – such as in candies and pastries. This should be kept to a minimum. Replace it with fresh fruits and unsweetened juices.

Add to your diet: 1. Fiber – A high fiber diet is important. To achieve this, eat: • Fresh vegetables – at least 1 cup per day. • Fruits – at least 1 piece per day. • Whole Grains like brown rice and oatmeal –1 cup per day. • Oat bran – at least 1 to 2 tablespoons per day. Fruits and vegetables are high in potassium, which helps in lowering blood pressure. 2. Fluids – Drink at least 8 cups a day in the form of water, herbal teas, broths, or diluted juices. Other beneficial foods are onions, garlic, brewer's yeast, lecithin, and soy products (such as tofu).

HERBS FOR HYPERTENSION: Choose 2 of the following: • Hawthorne Berry (Crataegus) – Take 2 capsules, 3 times a day. • Mistletoe (Viscum album) – Take 1 capsule, 2 times a day. • Dandelion leaf – Take 2 capsules, 3 times a day. For hypertension, use the leaf and not the root. • Linden flowers (Tilia) – Take 1 capsule, 3 times a day. Please note: For maximum effectiveness, take these herbs regularly and for long periods of time.

OTHER MEASURES FOR HIGH BLOOD PRESSURE INCLUDE: • Regular Physical Exercise – This is an essential part of a hypertension treatment program. Start gradually and work up to at least 30 minutes 4 times a week. If you haven't exercised for awhile or feel out of shape, consult a physician to set up an exercise program. • Weight loss – It is of utmost importance that you maintain an appropriate weight, depending on age and height. The diet and exercise recommendations in this program can help you accomplish this. • Smoking – try to quit. You may want to listen to our "Stop Smoking" article. • Stress Reduction – You may not be able to eliminate stressful situations in your life (such as a busy schedule or a stressful relationship) but you can learn to cope better with the stress by following these guidelines: Regular Physical Exercises – at least 30 minutes three times per week. Relaxation Exercises – 20 minutes once a day. Tapes can be bought at one of your local bookstores. Yoga, practiced on regular basis, can serve the same purpose. Deep Breathing – most of us tend to hold our breath or breathe shallow breaths during stressful situations. That can cut down the amount of oxygen available to the body with every breath. Try to have a few 1 minute intervals of breathing and relaxation during the day. At these times, pay special attention to relaxing your shoulder muscles and breathing deeply.

If you need further information, refer to the articles on weight loss and stress reduction.

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================================================================================ =Potential Contributing Factors= Potassium Deficiency

=Treatment= -Hot Bath

Recommended Minerals
-Iodine

Orthomolecular Treatment
Nitric Oxide

=Contraindications= -Cold Bath/