Apart From Western Medicine for Lowering Blood Pressure, How Much Do We Know About the Current Status of Traditional Chinese Medicine (TCM) and Chinese Herbal Medicine in Treating Hypertension?

Hypertension is a common chronic disease in clinical practice and the most significant risk factor for cardiovascular and cerebrovascular diseases. More than 95% of patients have unknown causes, which is called "essential hypertension", or hypertension disease; less than 5% of patients can identify the causes, which is called "secondary hypertension". Hypertension disease is a systemic disease caused by the interaction of multiple genetic inheritances, environmental factors, and various risk factors. Its main characteristic is the increase in systemic arterial blood pressure. As one of the diseases with the highest mortality risk globally, the prevalence rate of hypertension in China is 29.6%. Common clinical symptoms include headache, dizziness, head distension, facial flushing, red eyes, insomnia, forgetfulness, inattention, irritability, and stiff neck. Long-term elevated blood pressure can lead to damage to target organs such as the heart, brain, and kidneys, with myocardial infarction, heart failure, stroke, and chronic kidney disease being its main complications.

In recent years, despite some progress made by scholars at home and abroad in the pathogenesis and pharmacological treatment of hypertension, blood pressure indicators in patients have not reached satisfactory levels, especially when long-term use of antihypertensive drugs leads to poor treatment compliance and significant adverse reactions. Currently, the research results of traditional Chinese medicine (TCM) in hypertension have attracted widespread attention. It can not only effectively and holistically regulate the body's balance but also possesses unique advantages in controlling blood pressure stability.

1. Oral Chinese herbal medicine decoction therapy

Studies have found that in a study involving 108 patients with hypertension, self-designed Chinese herbal medicine prescriptions were used. For patients with liver and kidney yin deficiency, Cortex Moutan Radicis, Poria Cocos, Fructus Lycii, Rehmanniae Radix Preparata, Fructus Ligustri Lucidi, Semen Ziziphi Spinosae, Rhizoma Dioscoreae, Radix Puerariae Lobatae, and Radix Salviae Miltiorrhizae were used. For patients with hyperactivity of liver yang, Gastrodia Elata, Gardenia Jasminoides, Eucommia Ulmoides, Scutellaria Baicalensis, Caulis Polygoni Multiflori, Radix Cyathulae, Uncaria Rhynchophilla, and Concha Haliotidis were used. For patients with deficiency of both yin and yang, Fructus Corni Officinalis, Rhizoma Dioscoreae, Poria Alba, Alisma Orientale, Radix Cyathulae, Cortex Cinnamomi, and Rehmanniae Radix Preparata were used. These prescriptions were formulated and administered, achieving a clinical total effective rate of 96.30%. In another study involving 176 patients with hypertension, based on different disease patterns, Longdan Xiegan Decoction was used for the hyperactivity of liver yang type, Banxia Baizhu Tianma Decoction for the yin deficiency and yang hyperactivity type, and Dihuang Yinzi for the deficiency of both yin and yang type. Medications were adjusted according to the specific symptoms of different patients, achieving a clinical total effective rate of 89.80%.

2.Acupoint application therapy

Acupoint application is a commonly used external treatment method in traditional Chinese medicine based on the meridian theory. The acupoints for preventing and treating hypertension generally follow the principles of acupuncture point selection, with bilateral Yongquan (KI1), Neiguan (PC6), Sanyinjiao (SP6), Shenque (CV8), and Quchi (LI11) being the most commonly selected. These acupoints can be used singly, in pairs, or in combinations. In terms of the timing of acupoint application, it is generally recommended to perform it at night, with an application time of 6-9 hours. An application time of less than 4 hours may not result in significant blood pressure-lowering effects, while a time longer than 10 hours may increase the risk of adverse events such as skin allergies, detachment of the application, and excessive penetration of the medication. Clinical observations on the effects of acupoint application timing on hypertension treatment have found that prolonged storage of the medication after preparation can lead to volatilization, reduced humidity, and decreased drug penetration and permeability, which can affect the local skin microcirculation and transdermal absorption of the medication. This can weaken the diffusion of the drug within cells and in the intercellular space, thereby affecting the therapeutic effect. In terms of medication selection, different syndrome types require different herbs. For yin deficiency and yang hyperactivity, Gastrodia Elata, Chrysanthemum, Radix Cyathulae, Leech, and Magnetitum are commonly used to calm the liver, subdue yang, and extinguish wind. For phlegm-dampness accumulation, White Mustard Seed, Pinellia Ternata, Atractylodes Macrocephala, and Oyster Shell are used to strengthen the spleen, resolve phlegm, and eliminate dampness. For qi deficiency and blood stasis, Codonopsis Pilosula, Radix Salviae Miltiorrhizae, Chuanxiong Rhizoma, Astragalus Membranaceus, and Angelica Sinensis are used to tonify qi, nourish blood, and remove blood stasis. For yin deficiency and yang hyperactivity, modified Tianma Gouteng Yin, Zhen Gan Xi Feng Tang, and Jiao Tai Wan are used. For phlegm-dampness accumulation, modified Banxia Baizhu Tianma Decoction, Er Chen Tang, Sanzi Yangqin Tang, and Wendan Tang are used.

3.Research on Acupuncture Therapy

Studies have reported that oxidative stress can accelerate the onset and progression of hypertension, which can damage blood vessels. Furthermore, the decoupling of endothelial nitric oxide synthase (eNOS) can lead to further development of hypertension and vascular complications. Observational studies on rats with spontaneous hypertension treated with acupuncture at the Renying (ST9) acupoint have found that it can reduce reactive oxygen species (ROS) and increase nitric oxide or eNOS levels, thereby lowering blood pressure and enhancing the body's antioxidant capacity. In a study comparing the immediate effects of balanced acupuncture versus captopril in the treatment of 80 cases of essential hypertension, balanced acupuncture was found to be superior. Some scholars believe that clinical treatments for hypertension using auricular acupuncture, bloodletting, massage, and medication can also achieve good results. Clinical observations have shown that auricular acupuncture combined with bloodletting at the ear tip has a significant effect in treating hypertension.

Although there have been an increasing number of clinical studies on acupuncture therapy for hypertension in recent years, the small sample sizes and the lack of high-quality randomized controlled trials (RCTs) for evaluation remain bottlenecks in the development of acupuncture research. Therefore, there is a need to design large-sample, high-quality RCTs and establish unified clinical operation standards (such as the selection of acupuncture depth and stimulation intensity). Additionally, gradually shifting the research focus of the mechanisms of acupuncture-induced blood pressure reduction towards proteomics and genetics is an important direction for future clinical acupuncture research.

4.Chinese Tuina Massage Therapy

Studies have shown that Chinese Tuina massage can effectively stimulate acupoints or foot reflex zones to trigger reflexes in the cerebral cortex, thereby regulating the central nervous system. The manipulation of "pushing the bridge arch" (an area along the sides of the neck) has been proven effective in lowering blood pressure. Its mechanism of action involves applying massage to the carotid sinus to stimulate the baroreceptors, leading to a decrease in heart rate and vasodilation. In a study involving 100 patients with essential hypertension, a combination therapy of the Western medicine nimodipine with point pressing on acupoints such as Yintang (GV29), Taiyang (EX-HN5), and Touwei (ST8), along with slow pushing of the bridge arch using the thumb and kneading the neck and shoulders, achieved a total effective rate of 96%.

Currently, Western medicine, primarily through the use of antihypertensive drugs, serves as the primary treatment for hypertension, often supplemented by dietary regulation. Western medicine antihypertensive drugs can effectively control blood pressure, but sometimes do not significantly alleviate symptoms, and due to individual differences, they may produce varying degrees of adverse reactions. In contrast, traditional Chinese medicine (TCM) can effectively improve clinical symptoms associated with elevated blood pressure and has certain advantages over Western medicine in maintaining stable blood pressure control. The theories of TCM in treating hypertension are continually being refined, its mechanisms are gradually being elucidated, and its efficacy is increasingly recognized. However, research on TCM for hypertension still lacks systematic and detailed studies. For instance, standardized clinical diagnosis and treatment studies lack the necessary reference data. Therefore, only by continuously improving the research level of TCM in the prevention and treatment of hypertension and leveraging its advantages can TCM play a greater role in hypertension management.

References:

[1] Chen Chunling, Cai Tao, Li Yuhua, Yin Huhai, Huang Jie, Yue Guihua. Research Progress on Traditional Chinese Medicine Constitution and Hypertension [J]. Journal of Liaoning University of Traditional Chinese Medicine, 2019, 01: 116-118.

[2] Hu Mengyi, Zhang Manli, Liu Yong. Research Progress on the Treatment of Hypertension with Traditional Chinese Medicine [J]. World Latest Medicine Information (Electronic Version), 2019, 20: 232+235.

[3] Pan Jingshun. Research Progress on the Treatment of Hypertension with Traditional Chinese Medicine [J]. People's Military Surgeon, 2016, 03: 101-103.

About the Author

Xiaonisha, a food technology professional holding a Master's degree in Food Science, is currently employed at a prominent domestic pharmaceutical research and development company. Her primary focus lies in the development and research of nutritional foods, where she contributes her expertise and passion to create innovative products.