Understanding and treating Hypertension

Western perspectives

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.
1) primary hypertension :  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

2) 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:


signs and symptoms:

primary hypertension: patients are often asymptomatic until late in the disease, and frequently hypertension is discovered during routine physical examination.

 occipital headache: seen only with severe, advanced disease; worse in the morning on rising, and better as the day goes on
 dizziness
 palpitations
 blurred vision: (+) fundus changes are a late sign
 epistaxis
 hematuria
 (+) bruits over renal arteries: abdominal aorta aneurysm
 no fall in BP from supine to standing

secondary hypertension: the same symptoms as primary HT, plus symptoms or history related to whatever is the inciting cause. In addition:

 blood pressure falls during orthostatic measurement
 sympathetic nervous system compensation may cause BP fluctuations, better a.m., worse p.m.; the individual will appear calm but experiences internal tension (Easley)

lab findings:
 chem screen to monitor renal status, blood glucose, potassium levels
 microscopic exam of urine for casts
 chest x-ray: for aortic aneurysm, coarctation of the aorta
 Fantus test for urine chloride: high chloride may indicate NaCl-sensitive HT
 specific studies to rule out suspected causes of secondary HT
It has been estimated that untreated  HT decreases lifespan by 10-20 years, principally by increasing atherosclerosis. Death is usually from heart disease, stroke, or kidney failure. Approximately 1% of HT patients will develop malignant HT (extreme HT with papilledema, retinal hemorrhages and exudates, severe headache, vomiting, convulsions, stupor, coma). Malignant HT is a medical emergency. Conventional treatment of 1
 HT management consists of stress management, dietary modifications (decreased salt intake, decreased calories in overweight patients, decreased cholesterol and saturated fats), regular exercise, control of risk factors that promote atherosclerosis, and drug therapy.



Mind body connections

 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)

astrology:
 birth chart indicators: prominent Sun, with heavily afflicted Saturn or Mars (Zain, 1947, p. 75)
 progressed indicators: an aspect to either the Sun or Mars  (Zain, 1947, p. 75)



Chinese psychophysiology:

 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.

 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).


TREATMENT FOR HYPERTENSION 

Chinese Herbal Medicine

The following information is for general information purposes and not intended as a specific recomendation. For evaluation, please refer to my self assesment/intake form 
email: alohadoc@addr.net

     Current estimates place 20-40% of the adult population in the category of higher than desirable blood pressure. Chinese researchers have invested much of their research time on investigating the influence of Chinese herbs on cardiovascular diseases. As a result, hypotensive action of varying degrees has been identified in a large number of herbs. For example, in Pharmacology and Applications of Chinese Materia Medica, nearly 100 herbs are listed as having a hypotensive action.From a traditional Chinese viewpoint, hypertension is merely one symptom of a more complex pattern of disharmony. The underlying pattern that gives rise to hypertension may be any of several deficiency types (Yin, Yang, Blood, or Essence) or excess types (Liver and Heart fire being the most likely). Thus, complete treatment of hypertension would include the treatment of the actual underlying pattern and this is the recommended approach. (See intake form)
The herbs that appear to have the strongest and most prompt effect on hypertension are generally those that influence the Liver function, especially by purging Liver fire. Herbs that purge liver fire include rhubarb, uncaria, coptis, scute, sophora, moutan, prunella, gardenia, phellodendron, and gentiana. Perhaps the most effective of the hypotensive agents is Uncaria rhyncophylla (gou teng; this herb is called "gambir" in the OHAI and some ITM publications, however, the term uncaria is adopted here). It has been extensively investigated by researchers at the Tianjin Institute of Materia Medical The main active constituent, rhyncophylline, appears to have actions similar to the whole herb. Hypotensive action was demonstrated in laboratory actions in rats, cats, and dogs. It was shown that lengthy decoction of the herb decreased the effect, in correspondence with the traditional recommendation that uncaria not be cooked for an extended period of time.
The hypotensive effect was found to occur primarily as a result of peripheral vasodilation, which is the mechanism of action for most of the Chinese hypotensive agents. The vasodilation was found to result from inhibition of the vasomotor center, probably corresponding, in part, to the traditional indication of "clearing Liver fire."
Clinically, uncaria is often found effective in treating hypertension, and it is usually combined with other herbs for accomplishing this purpose. In a trial of the isolated total alkaloids of uncaria, 77% of 245 cases of hypertension responded favorably (with 38% showing a marked decrease in blood pressure). It resolved symptoms of headache, insomnia, palpitation, tinnitus, constipation, and numbness in the extremities. Its action was reported to be stable and prolonged.
 

Another herb which clears Liver heat and lowers blood pressure is prunella. The herb contains triterpenoid saponins, anthocyanins, and aromatic terpenes such as camphor. In laboratory experiments, it showed a hypotensive action in sheep and dogs, and the peripheral dilatory action was shown in toads. Clinically, hypertension and symptoms accompanying severe hypertension were treated successfully using the prunella decoction. Similar results were obtained for scute in laboratory and clinical tests. Scute, like uncaria and prunella, relieves Liver fire, but its main active constituents are flavones. Scute and prunella should be used cautiously with patients who have a cold syndrome of the digestive system. Uncaria is a sweet herb which does not adversely influence gastro-intestinal functions.
In the population as a whole, practitioners are finding numerous deficiency syndromes. These syndromes have been attributed to the adverse effects of toxic chemicals in the food and drug supply as well as in the environment, and to certain stresses of modern life-style. Thus, in a general remedy for hypertension, some attention must be paid to the possible presence of deficiency syndromes. To make a remedy which is well-rounded, the liver fire purging herbs must be balanced by liver tonic herbs. Liver tonics include the Yin, Blood, and Essence nourishing herbs.
A Liver tonic which shows very good peripheral dilatory action and is useful in treating hypertension is tang-kuei. This herb shows numerous cardiovascular actions, including hypotensive, anti-platelet aggregation, and anti-lipimic activities. Traditionally, it is said to nourish the blood and promote blood circulation.
Another Liver tonic which is effective for lowering blood pressure is Eucommia. This herb, which is also classified as a Kidney Yang tonic, has been shown to have a significant hypotensive effect in dogs, rabbits, cats, and rats. It was shown that the degree of hypotensive action was proportional to the degree of hypertension present.
In a clinical study of 251 cases of hypertension, 125 cases showed marked effects and improvements were found in another 80 cases with one month daily administration of Eucommia compound tablets. The tincture produced poorer effects in both animals and in clinical trials. Enhanced effects were obtained when the herb was combined with scute, prunella, loranthus, and lonicera. Of 62 cases treated with this mixture, 58 responded favorably. Headache, dizziness, palpitation, and insomnia were relieved.
Loranthus is classified as a Yin tonic, benefiting the liver and kidney. It has been shown to have a hypotensive effect in dogs, guinea pigs, and rats. The hypotensive action was attributed to a central or reflexive effect. Avicularin, the main active component, was shown to be diuretic and the entire herb was shown to counter the excitation effects of caffeine. Loranthus has been used clinically in the treatment of angina pectoris and cardiac arrhythmia.
Uncaria 6 contains three herbs to purge liver fire with significantly different types of active constituents (alkaloids, triterpenoid saponins, and flavones) though all have the effect of peripheral vasodilation. The use of differing agents to achieve a common physiologic goal is one method of generating synergistic action. There are also three herbs nourish the Liver and are categorized as Blood, Yang, and Yin tonics respectively; together, they benefit the Essence. The combination is similar to the Eucommia compound mentioned above successfully tested for the treatment of hypertension except that lonicera flower in that compound is replaced here by uncaria and tang-kuei. The tonic ingredients of Uncaria 6 are also useful for the treatment of arthritis and lumbago. Tang-kuei, eucommia, and loranthus are ingredients of Tu-huo and Loranthus Formula and other traditional and patent medicines used for treating pain, especially of the back and lower limbs.
Patent medicines for hypertension were developed during the past twenty years and are directed towards treatment of both hypertension and the symptom complex associated with severe hypertension. Prunella, tang-kuei, and uncaria are important ingredients of the patent formula Chiang-Ya-Wan for hypertension. Compound Cortex Eucommia Tablets are reported to contain only eucommia, uncaria, prunella, and scute, thus missing the blood nourishing agents tang-kuei and loranthus of Uncaria 6. Hypertension Repressing Tablets contain prunella and scute among the major hypotensive agents.
Some ancient formulas have been adopted for the treatment of hypertension by modern practitioners, especially in Japan. Major Bupleurum Combination, Coptis and Scute Combination, and Bupleurum and Dragon Bone Combination have all been recommended for hypertension; all contain scute. Bupleurum Formula, Gambir Formula, and Tang-kuei and Gambir Formula, also recommended for hypertension, all contain uncaria. All the traditional formulas mentioned here purge Liver fire, and this is a major function of the formulas.
Since hypertension can have several causes, and also individuals suffering from hypertension may react better to certain agents than to others, Uncaria 6 can be used as a central treatment to which various adjunct formulas are added. Thus, patients with various deficiency syndromes would simultaneously take a suitable tonic formula, while those with blood stasis syndrome would consume a blood vitalizing formula. A second hypotensive formula, based primarily on herbs that have the dual role of alleviating stiffness and pain in the joints and lowering blood pressure, Clerodendorn 6, has also been prepared as an alternative for those who may not respond adequately to Uncaria 6.

Chinese Herbal Formulas (comprehensive list)

 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)

It is clear that many possible treatments exist and as stated many times, cookbook treatment is not the approach that we as Chinese Medicine doctors promote. A proper intake and assessment is vital.



Eating principles:

 low sugar
 low fat diet of unsaturated fats
 calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18%
 high fiber
 low cholesterol
 low Sodium/Sodium-restricted diet
 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
 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 t.i.d.  (Yin-fang and Cheng-jun, p. 65)
 Liver Yang Rising:
 one cup of grape juice and celery juice each, taken with warm water t.i.d. 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 q.d.  (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 b.i.d.-t.i.d. (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
 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, sucrose, 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)

Physical therapy

 Spondylotherapy: concussion or sine between T3,T4; for acute hypertension, concussion T9
 spine: check and align upper cervicals for high diastolic; check and align C7-T3 or T10-L2 for high systolic - very high BP don't adjust cervicals
 massage: gentle, full body



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