| In the past history,there is no the medical term "hypertensive disease" in traditional Chinese medicine.This term is named by the western medicine.The Chinese medicine diagnoses the disease pattern by the patient's chief complaints and clinical manifestations and gives the name of disease. According to the theory of Chinese medicine,the doctor can figure out the causes and mechanisms of the disease.From the dictionary writtern by Professor.Lin Zhao-Geng which concerns about the eastern medicine term comparing with western medicine term.We find that the ancient literature "dizziness","stroke","liver wind","liver yang hyperactive","head wind" maybe in some parts belong to the territory of hypertensive disease. In Chinese medicine,they think that the causes of hypertension are due to ying-yang imbalance,long term nervous,think too much,easy angry,eat too many spicy and high lipid meals and drink too much wine,these causes induce liver fire,liver-yang hyperactive,liver-kidney ying hypoactive or plegm-wet being blocked.《Huangdi Neijing》has described that all the winds that induced dizziness belong to liver,when the blood goes to the head will let human feel fainting,all the marrows belong to the brain,brain is the sea of marrow,if the sea of marrow is insufficienct then the brain will induce the happening oftinnitus,《Jiayijing》also said " hyperasthenia will cause dizziness".From the Chinese medicine point of view,the mechanisms of hypertension are due to liver-yang hyperactive,kidney energy insufficiency, deficiency of gi and blood and retention of phlegmatic dampness——etc.The hyperactive of liver-yang will cause gi and blood retrograde to the top, against the downgrade route.The deficiency of Gi and blood and insufficiency of kidney energy will induce deficiency of ying energy in the head and face, These mechanisms will lead the circulation of human qi-blood abnormal and induce the happening of hypertension.Hypertension is one of the common physiologically abnormal diseases in our country.The prevalence rate in adult is about 20%.Most hypertensive patients belong to primary hypertention,the actual cause of primary hypertension is still unclear.Suffering from long term hypertension will lead to organ damage,disability,even death.If the hypertensive patients are scheduled to receive operation.The control of patient's pre-operative blood pressure will affect the anesthesia care,peri-operative risk and prognosis of postoperative care.In general,Hypertension is controlled by medicine.Besides,patients must fully coorperate with the doctor,take drugs for a long time and monitor the blood pressure change on time.Long term drugs intake also will be considered the side effects of drugs such as palpitation,headache,hypotension and abnormal metabolism.Sudden discontinuing the drugs will induce the rebound phenomenon of the blood pressure,sexual dysfunction——etc.To treat the hypertensive patient we must take care not only the blood pressure control but also the improvement of life quality.For example:the quality of sleep, the endurance of exercise,the ability of judgement and management in elderly person——etc.It is our supreme realm that finding an alternative medical method to cooperate with the anti-hypertensive drugs in order to lower the drugs side effect and improve the patients' life quality.Acupuncture is one of the alternative treatments that we trying to find.Acupuncture is one of the methods to cure the disease as medical treatment on traditional Chinese medical science of our country,it is oldest and a part rich in scientific evidence at the same time.U.S.A.'s national health mechanism(National Institutes of Health,NIH) once described to acupuncture, thought acupuncture was an essential member of health care system,and has already implemented it for 2000 years at least in China,acupuncture has already been applied to the prevention of pain and improvement of different health status extensively by doctor,dentist,acupuncturist and clinical practicer,According to the meridian theory of traditional medical science in China,selecting the acu-point to give the acupuncture treatment can use in the treatment of pain,it can also be used for adjusting and controlling various physiological dysfunctions.The meridian theory think that human body keep its life activities by qi and blood.Qi and blood is gone back to enclose in whole body and does not stop,its passway is called meridian.Meridians gather in the body surface of whole body and deep department,its backbone is called meridians through which vital energy circulates,and the branch is called the collaterals.The physiological state of whole body is controlled by the meridians system,《Lingshu》said merdians are the passways that qi and blood walk in then nourish the ying and yang,the tendon and bone and good for the joints.The meridians can decide live or death,deal with the illness, accomadate hypoactivity and hyperactivity.so,meridians can not be blocked. Because medrdian let viscera have close relationship with body surface,make the viscera have close contacts with body surface,the viscera have pathological change and may be seen and reflected in the body surface,and stimulate the body surface to influence the viscera function to change; Acupoint is the action point of meridians,so is constructing and can act on meridians and achieve the result of treatment by acupuncture from the acupoint. This is the theoretical foundation why acupuncture can be used to regulate and control the blood pressure of hypertensive patients.ObjectiveWe choose hypertensive patients to enroll in our study.The acupoints which we want to try in the patients are the combination of bilateral Neiguan(P6) and Zu-San-Li(S36) acupoints.Each patient will receive 3 different treatments which include 5Hz low frequency electric acu-point stimulation,simple acupuncture treatment and the blank at 3 different day interval.Under the physiological condition,we observe the degree of down regulation effect of blood pressure,the cardiovascular vessel dynamics and questionnaire to understand the relevant symptom improved situation.Compare acupuncture with blank which just take a rest in the bed,Does acupuncture has more benefit in lowering blood pressure than the blank? Can 5 Hz low frequency electro-acupuncture strengthen the effect of acupuncture? From the pulse waves which are measured by Dynapulse,we observe the hemodynamic changes of acupoint stimulation.After each study,we have questionnaire for the patients to evaluate the degree of life quality improvement.From this clinical trial,if acu-point stimulation can lowering the blood pressure.We hope it can be used as a long term treatment method for the hypertensive patients.Methods1.inclusion criteria:(1) patient aged 37-75 years old(2) being subjected to the diagnostic criteria of primary hypertension2.exclusion criteria:(1) secondary hypertension(eg.drug induced hypertension,pregnancy induced hypertension,organ dysfunction induced hypertension)(2) white coat hypertension.3.case grouping:23 hypertension patients are enrolled in our study flow chat.There are three treatment groups in this study which include 5Hz low frequency electric acu-point stimulation,simple acupuncture treatment and the blank.Each patient will receive these 3 different treatments at 3 different day interval.Under the physiological condition,we observe the degree of down regulation effect of blood pressure,the cardiovascular vessel dynamics and questionnaire to understand the relevant symptom improved situation.4.study methods:Each patient received these 3 different treatments for about 20mins on three individual days.We collect 4 time sections of BP,HR and hemodynamic changes from dynapulse,which include data of pre-treatment,treatment for 10min,treatment for 20min,and post-treatment 10min.All of these data were collected by dynapulse.5.questionnairethe contents of questionnaire include:Insomnia,palpitation,headache, dizziness,the degree of breathe smoothly,the improvement of neck and back aches,The improvement of these 5 conditions are divided into 5 classes which rank from +2 to -2.Data collected are analysed by statistics. Results:Our result shows:In the groups we find both electro-acupuncture and acupuncture groups could cause hypotensive effect and heart rate decrease (P＜0.05),whereas in the bed rest group no such effects were found.The differences between groups are as following:At first,electro-acupuncture group has more apparent heart rate decrease effect on post-acupuncture 10min than bed rest group(P＜0.05).The hypotensive effect of systolic pressure at time course of post-acupuncture 20min and 10 min after removing acupuncture needles in both electro-acupuncture and acupuncture groups are more explicit than the bed rest group(P＜0.05).Secondly,in the analysis of hemodynamic change,acupuncture group significant decrease cardiac out and cardiac index after treatment time course;furthermore,electro-acupuncture group is superior in increasing systemic vascular compliance.Lastly,in the post-treatment questionnaire we find both acupuncture and electro-acupuncture group have signi ficant improvement of hypertension associated symptoms(F =10.62,P=0.02).As a result,no significant differences between acupuncture and electro-acupuncture groups were found from the eva luation of heart rate, BP change,post-treatment and the survey result.Conclusion:We know blood pressure have something to do with the resistance of the blood vessel of the blood and blood volume that can type from the blood vessel, it may be a factor of reducing some influence blood vessel resistance that the acupuncture can lower blood pressure,it is relaxed to impel the muscle cell of the blood vessel wall in the course of acupuncture:This may relate to nerve factor.In other words,it may be the reciprocation among central nervous system,brain,peripheral nervous system,the interaction between blood vessels,or changes on the equilibrium of body hormone,for example: makes the hormone which induce the blood vessel shrink decrease and the hormone which relax the blood vessel wall increase.The accommodation effect of acupuncture in heart rate and blood pressure depends on the blood pressure level before stimulation,the acu-point selected,the intensity of acu-point stimulation,frequency selected and timing of treatment.Though our research has only observed the immediate hypotensive effect of acupuncture in 23 primary hypertensive patients,the preliminary observation reveals there is situation that makes heart rate and blood pressure drop immediately in the electro-acupuncture group and simple acupuncture group. It seems that electro-acupuncture group which has 5Hz low frequency stimulation at the acu-point present the trend of lowering effect more earlier. In 10min after the needle being pulled out,there is no difference in lowering effect between acupuncture treatment and electro-acupuncture treatment.In the analysis of cardiovascular hemo-dynamics:The electro-acupuncture group has more benefit in the increasing of compliance of systemic blood vessel and lowing the vessel resistance.The acupuncture group has more apparent effect in lowering the cardiac output and cardiac index level.From questionnaire analysis which reveals the degree of symptom improvement,we find electro-acupuncture group and acupuncture group are superior to blank group in the treatment results.From the experience of this clinical observation,we expect to increase the sample number in the future,improving the dominance.As to the thing that assessment of patient can increase dialectical theory of Chinese medicine manage,choose appropriate acu-points in accordance with patient's physical character.In addition,the establishment of frequency of electro-acupuncture can also be discussed too. As for the acupuncture applies on the hypertensive patients in controlling blood pressure for a long time,worth our doing further research in the future.
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