Integrated Treatment of Hypertension in Traditional Chinese and Western Medicine

Integrated Treatment of Hypertension in Traditional Chinese and Western Medicine Edited by Pei Zhengxue, Compiled by Li Yanyi

Series on Integrated Treatment of Common Diseases: Integrated Treatment of Hypertension in Traditional Chinese and Western Medicine Edited by Pei Zhengxue, Compiled by Li Yanyi Cataloging-in-Publication Data (CIP) of Gansu Science and Technology Press Integrated Treatment of Hypertension in Traditional Chinese and Western Medicine / Compiled by Li Yanyi. Lanzhou: Gansu Science and Technology Press, September 2000. (Series on Integrated Treatment of Common Diseases / Edited by Pei Zhengxue) ISBN 7-5424-0736-8 I. H... II. Li... III. Hypertension - Integrated Therapy IV. R544.1 China Version Library CIP Data Verification No. (2000) No. 47024

Integrated Treatment of Hypertension in Traditional Chinese and Western Medicine

(Series on Integrated Treatment of Common Diseases) Author: Pei Zhengxue, Editor-in-Chief Editor-in-Charge: Chen Xuexiang · Cover Design Design: He Wei

Layout Design: Shi Yang

Published by: Gansu Science and Technology Press (No. 296 Binhe East Road, Lanzhou)

Distributed by: Distribution Department of Gansu People’s Publishing House (No. 123 First New Village, Lanzhou) Sold through: Xinhua Bookstores nationwide Printed by: Gansu Geological Printing Factory (No. 357 Fuli West Road, Xigu District, Lanzhou) Format: 850mm × 1168mm, 1/32

5.25 printing sheets Total words: 123,000

Edition: First edition, September 2000; First printing, September 2000

Print run: 1–4,120 copies

ISBN 7-5424-0736-8/R ·202 Price: 7.40 yuan ⊙ If any books published by Gansu Science and Technology Press are

damaged or missing pages, please contact the printing factory directly for replacement ● All rights reserved. Reproduction prohibited without permission Series Editorial Committee Editor-in-Chief: Pei Zhengxue Associate Editors: Li Yongshou, Wang Xinshun Committee Members: Li Yanyi, Li Min, Dai Enlai, Qiu Yumei, Xue Wenhan Preface The treatment of common diseases is a matter of great importance to the national economy and people's livelihood; the health and well-being of the people, as well as the prosperity of the nation, are closely linked to the prevention and control of these diseases. Both Traditional Chinese Medicine and Western Medicine have their own unique strengths in preventing and treating common diseases. In terms of overall efficacy, the two approaches each have their advantages and are roughly equal; from the perspective of concepts and methods, they also exhibit clear complementarity. Traditional Chinese Medicine views diseases from a macroscopic perspective, emphasizing holistic regulation and the body's responsiveness; Western Medicine, on the other hand, focuses on the microscopic level, concentrating on local treatments and the pathogenicity of the disease. Generally speaking, the occurrence of a disease involves two key factors: first, the pathogenicity of the causative agent, and second, the body's reactivity. Neither factor alone is sufficient for the disease to develop; similarly, the clinical manifestations of a disease also consist of two aspects: local changes and systemic symptoms, neither of which can be absent. Whether it is the "two factors of disease onset" or the "two aspects of symptoms," Traditional Chinese Medicine and Western Medicine each occupy one end, creating a striking complementarity. It is no wonder that diseases that Western Medicine cannot treat often respond very well to Traditional Chinese Medicine, while diseases that Traditional Chinese Medicine cannot cure frequently show excellent results under Western Medical treatment—this fully demonstrates the necessity of integrating Traditional Chinese and Western Medicine. As early as 40 years ago, Comrade Mao Zedong, with his far-sighted vision, called for "integrating Traditional Chinese and Western Medicine to create a new unified medicine for our country." Over the past four decades, both domestically and internationally, there has been a surge in interest in learning Traditional Chinese Medicine among Western medical practitioners, leading to the emergence of a number of highly skilled experts in integrated TCM-WM therapy. Their research achievements and accumulated experience have earned widespread acclaim in the medical community, shining brightly and pushing the clinical efficacy of medicine to new heights. To further promote this discipline and bring greater benefits to humanity, the author previously served as editor-in-chief eight years ago of China's first large-scale monograph on integrated TCM-WM therapy—“Practical Internal Medicine of Integrated TCM-WM.” After its publication, the book was widely welcomed by senior and intermediate medical professionals at home and abroad; however, numerous letters from grassroots practitioners revealed that the content was rather advanced and not suitable for rural doctors or self-study readers. Therefore, we formulated the purpose, outline, format, and detailed rules for compiling this series and established the editorial committee for the Series on Integrated Treatment of Common Diseases. The target audience for this series includes a broad range of grassroots physicians and self-taught medical practitioners, while also serving as a useful reference for patients seeking self-care. We hope that the publication of this series will bring benefits to grassroots doctors and patients alike. Benevolent Learning, May 1, 2000

Table of Contents [Chapter 1: General Overview (1)] Section 1: Epidemiological Characteristics (2) [Section 2: Etiological Factors (4)] Section 3: Pathogenesis (5) Section 4: Pathology (6) Chapter 2: Diagnosis (8) [Section 1: Clinical Manifestations (8)] Section 2: Clinical Types (10) Section 3: Clinical Examinations (11) Section 4: Points to Note (12) [Chapter 3: Traditional Chinese Medicine Treatment (20)] [Section 1: Discussions by Past Physicians on Conditions Similar to Hypertension (20)] Section 2: TCM Understanding of the Etiology and Pathogenesis of Hypertension (20) Section 3: TCM Syndrome Differentiation and Formulas (21) [Chapter 4: Western Medicine Treatment (50)] Section 1: Non-Pharmacological Treatment (51) Section 2: Antihypertensive Pharmacotherapy (52) Section 3: Treatment Protocols (61) Section 4: Treatment in Special Cases (63) Section 5: Discontinuation of Medication (65) Section 6: Treatment of Acute Emergencies (65) Section 7: Several Issues in Treatment (66) [Chapter 5: Clinical Experience of Renowned Physicians (68)] [Chapter 6: Prognosis and Prevention (93)] Section 1: Prognosis (93) Section 2: Prevention (94) [Chapter 7: Secondary Hypertension ( 101)] Section 1: Diagnosis (101) Section 2: Treatment (106) [Chapter 8: Complications of Hypertension ( 110)] Section 1: Atherosclerosis (110) Section 2: Coronary Heart Disease (114) Section 3: Cerebrovascular Disease (135) Chapter 1: General Overview

Hypertension is the most common cardiovascular disease in China and one of the most widespread epidemics. Not only is its prevalence high, but it also frequently leads to severe complications affecting the heart, brain, and kidneys, serving as a major risk factor for stroke and coronary heart disease. Among them, 90%–95% of hypertensive patients have an unknown cause, referred to as primary hypertension, or simply hypertension. In about 5% of patients, elevated blood pressure is a manifestation of certain underlying diseases, hence termed secondary hypertension, or symptomatic hypertension. Although many scholars have conducted extensive and in-depth research on the pathophysiology of hypertension over the years, achieving significant progress, numerous questions remain poorly understood, thereby affecting the effectiveness of prevention and treatment. The diagnosis of hypertension is based on elevated blood pressure. The problem lies in the fact that the degree of elevation is merely quantitative, lacking qualitative distinction, and there is no clear boundary. Some argue that diagnostic criteria should vary according to gender, age, and ethnicity, which further complicates the diagnosis of this condition; to date, there is still no unified international standard. In 1978, the World Health Organization's Expert Committee on Hypertension established the following standards: normal adult systolic pressure ≤18.7 kPa (140 mmHg), diastolic pressure ≤12.0 kPa (90 mmHg). Systolic pressure ≥21.3 kPa (160 mmHg) and diastolic pressure ≥12.7 kPa (95 mmHg) can be diagnosed as hypertension; values between these two ranges are considered borderline hypertension. In 1992, the U.S. Joint National Committee formulated hypertension standards as shown in Table 1. Previously, it was believed that diastolic pressure had a significant impact on the incidence of cardiovascular diseases; now, however, it is recognized that systolic pressure also plays an important role. Among two groups of individuals with normal diastolic pressure, one group had systolic pressure ≥21.3 kPa (160 mmHg), while the other had systolic pressure ≤17.3 kPa (130 mmHg). Prospective Table 1: U.S. Joint National Committee Hypertension Standards (1992)