Essential Hypertension (EH) is easy to be controlled by many drugs, but hard to be cured. We need to treat the disease based on its radical cause, otherwise the evil Qi could not submit itself to the treatment.
The modern recognition of TCM classify EH into different syndrome types such as Yin Deficiency of Liver and Kidney, excessive rising of liver-Yang, asthenia of both Yin and Yang and stagnation of turbid phlegm in middle-JIAO. Big make cannot be divided into many parts, so this is a bad way letting physicians lose their intelligence. What we need do is to get on the road as an ancient saying said: “when you get one, you get the whole world”. What’s the “ONE”? It is the radical points of the disease. If we lost “ONE”, we would lose recognition of the disease.
The pulse of EH are commonly wiry, powerful, or small. Patients usually have red or pale countenance. Those are the basis of diagnosis. “Wiry” suggests the disease comes from liver; “powerful” suggests the radical cause of disease is excessive Yang; “small” is a indication of deficiency of Qi and blood or damp. Damp means stagnation of Qi or blood like the image of obstacle of hexagram Ken. Red is the color of fire; pale is indication of insufficient blood. So though EH has many TCM syndromes, they could all be ascribed to a common cause. The hypothesis is: deficiency of water in kidney induces the excess of damp, forming stagnation; as well as reduces nutrition of wood, leading the excessive Yang of liver. Thus we could say, the common and radical cause of EH is deficiency of kidney. The absence of water in kidney leads flaring of fire and increasing of damp, producing many symptoms of EH. To make more detailed consideration, EH is a problem in vein, which belonging to heart. The origination of heart energy comes from meridian of Hand Jue Yin Xin Bao , the organ like a honest minister helping blood in and out of heart on the basis of the function hexagram Xun. The activation of heart is based on the hexagram Chen of assistant fire and hexagram Xun of Xin Bao meridian. The pulse of blood is like coming from a epicenter. We know pressure could be conducted in a closed system. If the pulse of epicenter is too big, or it getting the amplification of delitescent fire in blood, it will induce hypertension. In addition, many spigots of offset could reduce the pressure by regular opening. If the way is blocked by stagnation of damp, the pressure has to climb peaks greatly. Thus we can conclude the cause of hypertension is the interaction of Chen and Ken. The increasing of peripheral arterial resistance, hyperlipemia, siltation and muddy are images of Ken. The pulse of Chen is blocked by Ken will induce thickening of cardiac muscle, artherosclerosis and fibrosis of vein. The hypothesis could be completely demonstrated by symptoms and etiological factors of EH. Patients commonly like to drink wine, the image of Chen. Addition of Chen induces the disease. Long term noise is also Chen, stirring the pulse of blood. Chen means irritation, activation and stimulation, so agitation, mental stress can also induce hypertension. Obesity is the image of Ken with accumulation of fat. Potassium and calcium are all images of Chen. All knowledge of modern medicine could be analyzed easily by the framework. When Chen and Ken is excess, the Xun shows its deficiency. Xun means volatilization, out and in; Ken means stagnation, deficiency of Xun provide the convenience of Ken. The reduction of elasticity of blood vessel is a sign of deficiency of Xun. Why does EH commonly happen in aged people? It is because the growth force is exhausted and postnatal damp is increasing. Originally the blood vessel is dominated by trigram Li, but now it is dominated by Chen. Chen and Li construct hexagram Feng, the image of magnificent scene while the sun in middle heaven, so the power is very strong and we can feel excessive Yang. If damp is excess in vessel, we sometimes cannot find the image of excessive Yang but just gloom and dark scene.
To sum up, we get the changes of essential hypertension is originally coming from kidney. The deficiency of kidney will induce the fire of Ming Men floating and scattering. The fire of Ming Men is the basic origination of Chen, so its deficiency will induce the increasing of Ken. The wood (Xun) of Jue Yin could hardly grow for deficiency of water, adding the insulting from damp, it will have to turn to Chen, the activation of later one is so-called liver fire and liver Yang. The assistant fire of Xin Bao is excess too. Out of control of assistant fire will change into delitescent fire in blood or roaring fire in Shao Yang in top of the head. When the damp is heavy, the patient will feel heavy in head; when the fire roars upward, the patient will feel headache.
How to deal with those symptoms? Of course we should treat its radical cause of hypertension, which is regarded as a disease with asthenia in origin and excess in superficiality. The basic principle of treatment is lowering as domination and cultivation as assistance. “Lowering” means breaking Ken and assisting Xun; “cultivation” means clearing and dispersing fire in Xin Bao and blood.
The basic prescription is Jia Jie Ba Wei (formula 3, listed below). The formula could invigorate kidney water and lower fire greatly. In the formula Shu Di could help kidney mount its water as well as disperse the fire of Li. Ze Xie could get rid of muddy of damp. Shan Yu could help Jue Yin restore its function of fluency and spreading. Dan Pi could disperse the delitescent fire in blood. Shan Yao could moist spleen and lung, reinforcing Qi and Yin to have correspondence with physical fire. Fu Ling could permeate damp. Wuwizi could collect floating Qi of lung and moist water of kidney. Rougui has four effects: first is making Shao Yin kidney meridian rise; second is cultivating the assistant fire of Ming Men; third is leading other drugs into kidney; fourth is agitating growth of Qi and blood. It has characteristic of “sustaining but not running”, being the master of Ming Men. I dreamed an immortal pursuing me when I got the wonderful function of Rougui. If Fuzi is added, it could agitate kidney Yang by its characteristic of “running but not sustaining”, being the general of Ming Men. The whole construction of the formula was very rigorous. When people use it to treat paediatric diseases they often delete Rougui and Fuzi for infancy originally has sufficient fire of Ming Men. It is regretful that modern people just use Liu Wei Di Huang for adult. We must be careful when we use Fuzi for patients commonly have floating fire, an inappropriate use of Fuzi might assist the floating fire. How to control the floating fire? Xuesheng is the best choice for its cool and moist characteristics. Huanniuxi also could be used to lead the fire lower to kidney. When the fire returns to its origin, we should add Huangbai to sustain Yin and control fire, so that it could not rush to bladder. However, single fire control could not cure hypertension radically. We have to get rid of damp at the same time. We need provide a road that damp could get out. That’s diuresis. The best choice is Xiagucao. Xiagucao grew when thunder was under the earth at Winter Solstice and withered at Summer Solstice for the excessive Yang. It could reinforce the blood of Jue Yin. If there was problem in heart, we could add Chuangshanjia to the formula. Chuangshanjia has function of removing blood stasis and breaking through Ken. Cheqianzi could be used in diuresis and dispersing fire. Shanzhi could reduce liver fire. If the patient is irritable, Zhigancao could be added to calm his emotion. To treat key symptoms such as dizzy and headache, we can choose Tian Ma Gou Teng Yin (formula 1) to control Biao . If the patient is old and could not be cured by Tian Ma Guo Teng Yin, we should give him Da Huang, Huang Qin and Huang Lian to dispersing his fire and dispelling dampness, and then prescribe Banxia, Xiagucao, Yimucao, Baishao, Danggui, Shengdi, Zhimu and Gancao (formula 2).
Main prescriptions:
Formula 1: Tian Ma Guo Teng Yin
Formula 2: Banxia 6g, Xiagucao 15g, Yimucao 9g, Baishao 9g, Danggui 6g, Shengdi 9g, Zhimu 9g, Gancao 3g.
Formula 3: Shudi 24g, Zexie 9g, Shanyao 12g, Fuling 9g, Shanzhuyu 12g, Danpi 9g, Wuweizi 3g, Rougui 3g, Xuansheng 9g, Huangbai 6g, Huanniuxi 6g, Cheqianzi 6g, Shanzi 6g, Zhigancao 3g, Xiagucao 12g.

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