Journal of Chinese Medicine Number 101 February 2013

The Treatment of Primary Hypertension Using Plum Blossom Needle Therapy

37

The Treatment of Primary Hypertension Using Plum Blossom Needle Therapy

Abstract
The purpose of this study was to evaluate the efficacy of seven star plum blossom needle therapy on a patient with primary hypertension. Although conventional treatment of primary hypertension with medications is frequently successful, many of these drugs produce harmful side effects, so there is a demand for efficient and safe alternative methods of regulating blood pressure. The patient in this case was a 55-year-old Caucasian male who had suffered from chronic hypertension since the age of 30, with a 40-year history of smoking and a 30-year history of heavy alcohol consumption. The patient also suffered from chronic obstructive pulmonary disease (COPD) and reported palpitations and shortness of breath on exertion. A seven star plum blossom needle hammer was used to stimulate various acupuncture points twice a week for six weeks. The patients blood pressure was evaluated before and after treatment during the six-week treatment period and during a subsequent 19-day monitoring period. This resulted in a reduction in both systolic and diastolic blood pressure over the six-week period, which was sustained during the 19-day follow up. The authors conclude that seven star plum blossom needle hammer therapy effectively lowered the patients blood pressure to pre-hypertensive values, and that the efficacy and safety of this treatment method should be further evaluated in a larger controlled clinical trial. By: Frank Yurasek and Brett Martin

Keywords: Plum blossom needle, hypertension, traditional EastAsian medicine, Chinese medicine, acupuncture, cardiovascular disease

Introduction
According to the Center of Disease Control, 33 per cent of adults over the age of 20 suffer from hypertension in the United States.1 There are two types of hypertension: primary or essential hypertension accounts for 95 per cent of cases and is idiopathic; secondary hypertension is associated with preexisting conditions such as renal disease, endocrine disorders, cardiovascular disease (CVD) and neurologic disorders.2 According to Robbins and Cotran: Pathologic Basis of Disease, hypertension is considered to be a chronic elevation of blood pressure for a duration of at least six months.2 Many hypertensive individuals can be asymptomatic for years. Since primary hypertension is asymptomatic and often easily manageable with treatment, it is considered benign hypertension. However, hypertension is a contributing factor to CVD, cerebrovascular accident (CVA), aortic dissection and renal failure,2 and is therefore often referred to as the silent killer. Roughly 95 per cent of the cases of primary hypertension are considered benign while the remaining five per cent of cases manifest as malignant hypertension, which involves a rapidly rising blood pressure over 200/120 mmHg.2 If these individuals remain untreated, death usually ensues within one to two years.2 See Table 1 for the diagnostic criteria for hypertension.

Diagnosis Normal Prehypertension Hypertension Stage 1 Hypertension Stage 2

Systolic 120 mmHg or less 120-139 mmHg 140-159 mmHg

Diastolic 80 mmHg or less 80-89 mmHg 90-99 mmHg or greater

Table 1: Diagnostic criteria for hypertension

160 mmHg or greater 100 mmHg

Aetiology
There are many predisposing factors to hypertension, including chronic stress, smoking, poor diet, sedentary lifestyle, renal, thyroid, cardiovascular and adrenal disease, ethnicity and psychogenic factors.2 Genetic contribution to the development of hypertension is rare and is attributed to a defect in a single gene that alters the amount of sodium reabsorbed by the kidneys, causing an increase in water retention and thus blood volume and pressure.2 Environmental factors such as smoking, poor diet and lifestyle can adversely affect vascular smooth muscle, leading to vasoconstriction. Vasoconstriction increases peripheral resistance, which elevates blood pressure. Chronically elevated blood pressure can lead to damage to the vascular walls and the development of atherosclerosis. Damage to the arterial walls can attract LDL cholesterol, which adheres to the site of

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The Treatment of Primary Hypertension Using Plum Blossom Needle Therapy

Journal of Chinese Medicine Number 101 February 2013

tissue damage and narrows the vascular lumen and can eventually progress to arteriosclerosis. The combination of arteriosclerosis and prolonged high peripheral vascular resistance requires the cardiac musculature to increase the force of contraction, leading to complications such as CVD, CVA, aortic dissection or renal failure.2

Chronic stress is a major contributing factor to the development and progression of hypertension.
Chronic stress is a major contributing factor to the development and progression of hypertension. It causes the adrenal glands to secrete cortisol, a glucocorticoid steroid hormone synthesised in the adrenal cortex. Cortisol causes epinephrine and norepinephrine to be secreted, which increase cardiac output and vasoconstriction and elevate blood pressure. Prolonged activation of the sympathetic nervous system can thus lead to chronic hypertension. Stimulation of the sympathetic nervous system also activates the hormone renin, which is produced and stored within the kidney.3 Renin converts the hormone angiotensinogen into angiotensin.3 The conversion of angiotensin to angiotensin II - a potent vasoconstrictor - is catalysed by angiotensin converting enzyme (ACE).3 ACE is secreted from the vascular endothelial cells and acts as a vasomodulator via two mechanisms: the first involves the activation of angiotensin II, as described above; the second involves the conversion of bradykinin - a vasodilator - to an inactive metabolite. By activating the vasoconstrictor and inactivating the vasodilator, a more pronounced elevation in blood pressure results.

of the organs. All of these pathological mechanisms can be involved in hypertension. Emotional excesses are another potential cause of hypertension due to the harm they cause to organ/channel function. Disharmony of the Spleen and Liver is commonly associated with hypertension. The Spleen is associated with worry and the Liver with anger. Worry causes Spleen qi deficiency, and predisposes an individual to accumulation of dampness. Anger disrupts the Liver function of regulating the flow of qi, causing qi stagnation that can then result in hyperactivity of Liver yang, heat that consumes yin and blood stasis. In addition, stagnant Liver qi has a tendency to invade the Spleen. The stagnant Liver qi leads to blood stasis and generates heat and hyperactivity of the Liver yang. In such cases, although small amounts of naturally sweet foods relax the Liver and reinforce the Spleen, overindulgence will damage the Spleen and exacerbate phlegmdamp obstruction.4

Case report
A 55-year-old Caucasian male (six foot, 193 pounds) presented with hypertension. The patient had been diagnosed with primary hypertension at age 30, but for unknown reasons was not prescribed medication until he was aged 50, at which point he was prescribed lisinopril (an ACE inhibitor), pravastatin (a statin to lower cholesterol), fenofibrate (a fibrate drug to reduce cholesterol and triglycerides), naproxen (a non-steroidal anti-inflammatory [NSAID] drug), indomethocin (an NSAID), hydrocodone (an opioid analgesic drug), gabapentin (an anti-convulsant drug) and medrol (a corticosteroid). The patient had also been diagnosed with COPD. He experienced occasional palpitations upon movement, shortness of breath and frequent urination. He had a 40-year history of smoking one packet of cigarettes a day, and a 30-year history of heavy alcohol intake, although he reported giving up drinking alcohol three years previously. He worked as a manual labourer, but did not participate in any other regular exercise or physical activity. His diet consisted of pre-packaged products of poor nutritious value - without fresh fruits or vegetables - that were provided by charity organisations.

Hypertension and Chinese medicine

According to Chinese medical theory primary hypertension tends to be closely associated with an individuals constitution.4 Constitution predisposes individuals to either excess or deficient conditions, and therefore to particular degenerative diseases. The major pathologies associated with hypertension involve hyperactivity of yang, phlegmdampness and yin deficiency,4 and may also involve excess or deficiency of the internal organs.4 For example, deficiency of the Spleen can contribute to the formation of dampness, or excess of the Liver can generate an exuberance of yang. A poor diet can strongly contribute to the development of hypertension. Habitual over-indulgence in sweet, fatty or greasy foods - particularly if combined with insufficient exercise - impairs the transportation and transformation function of the Spleen and produces pathogenic dampness within the body. Dampness causes stagnation and subsequently heat, which transforms the dampness into phlegm and consumes yin. Phlegm-damp obstructs the flow of qi, while the consumption of yin leads to an exuberance of yang.4 The obstruction of qi in conjunction with consumption of yin causes further malnourishment

Methods
This study employed a specific protocol for the treatment of hypertension as detailed in the Hong Kong text Plum Blossom Needle Therapy.5 Therefore, tongue and pulse diagnosis were not performed and a traditional Chinese medicine pattern diagnosis was not determined. A sphygmomanometer was used to take the patients blood pressure on the left arm before and after each treatment, and the patient was also instructed to monitor his blood pressure daily at home for six weeks. Treatment utilised a seven star plum blossom needle hammer. The hammer is seven inches long with a thin, flexible shaft leading up to a

Journal of Chinese Medicine Number 101 February 2013

The Treatment of Primary Hypertension Using Plum Blossom Needle Therapy

39

bullet-shaped head with seven needles equally distributed on one side and five closely-grouped needles on the other. The therapy was administered twice a week by two different practitioners, tapping specific points approximately 100 times with light to moderate pressure with the side with the seven equally-distributed needles. Each therapy session lasted about 10 minutes. The first treatment of each week used the following acupuncture points as recommended in Plum Blossom Needle Therapy: Dazhui DU-14, Wangu GB12 bilaterally (B/L), Quchi L.I.-11 (B/L), and Zusanli ST-36 (B/L). The second treatment of the week used Fengchi GB20 (B/L), Mingmen DU-4, Shenshu BL-23 (B/L) Neiguan P-6 (B/L) and Sanyinjiao SP-6 (B/L).5

 Sanyinjiao SP-6 resolves dampness, calms the spirit and tonifies the Kidneys and Spleen.6

Results
Although blood pressure values varied throughout the treatment period, reductions in systolic and diastolic blood pressure were frequently observed immediately after treatment. The most marked decreases were seen in systolic blood pressure. The average systolic blood pressure before treatment was 141.1mmHg, and the average after treatment was 128.9mmHg, with an average drop after treatment of 12.9mmHg. The therapy did not have as profound an effect on diastolic blood pressure. The average pre-treatment diastolic blood pressure was 86.4mmHg, and after treatment was 80.41mmHg - an average drop of 6mmHg (see Table 2). After two weeks of treatment, blood pressure readings remained consistently at or below pre-hypertensive criteria (under 140/90mmHg), with the exception of a few days (see discussion below). The average day-to-day blood pressure during the treatment period was 133.5/84.4mmHg, with a range of 106 to 154mmHg for systolic pressure and 70 to 96mmHg diastolic (see Figure 1).
Systolic Blood Pressure (mmHg) Date 24 May 26 May 31 May 2 June 7 June 9 June 14 June 16 June 21 June 23 June 28 June 30 June Average Before 154 162 138 150 140 147 142 142 148 118 124 130 141.25 After 146 142 122 135 134 106 126 126 138 117 122 126 128.33 Diastolic Blood Pressure (mmHg) Before 92 86 82 99 78 98 78 88 88 80 86 82 86.42 After 86 96 74 84 72 79 82 76 82 72 84 78 80.42

Explanation
 Dazhui DU-14 is the meeting point of the six yang channels of the hand and foot; it regulates yang, clears heat and tonifies qi. It is also classified as a point of the the Sea of Qi, and as such can regulate qi to dissipate excess conditions.6  Wangu GB-12 calms the spirit and benefits the head, and is notable for its ability to regulate disharmony between the head and the body.6  Quchi L.I.-11 is a Ma Danyang Heavenly Star Point. Ma Dan-yang considered Quchi LI-11 to be one of the most important acupuncture points, especially for treating heat conditions. This point can be used to clear heat, cool the blood, eliminate dampness and regulate qi and blood.6  Zusanli ST-36 is also a Ma Danyang Heavenly Star Point; it reinforces the Stomach and Spleen, clears fire and calms the spirit.6  Fengchi GB-20 benefits the head and eyes and clears heat from the sense organs.6  Mingmen DU-4 clears heat and tonifies the qi of the Kidneys; because it is positioned between the Kidneys it controls mingmen and ministerial fire, and controls yang qi.6  Shenshu BL-23 is the back-shu point of the Kidneys; it tonifies, nourishes and firms Kidney qi and yin, and eliminates dampness.6  Neiguan P-6 is the luo-connecting point of the Pericardium and the command point for the chest. As a confluent point of the Yin Linking vessel, it treats painful conditions of the heart, chest, costal and lumbar regions. It is particularly beneficial for heart pain due to phlegm obstruction. The primary functions of Neiguan P-6 are unbinding the chest, regulating qi and the heart, calming the spirit, opening the Yin Linking vessel and clearing heat.6

Table 2: Changes in systolic and diastolic blood pressure after treatment

Blood

60

40

Systolic Diastolic

40

The Treatment of Primary Hypertension Using Plum Blossom Needle Therapy

0
Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly Ju ly 10 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 Ju ly

20

Journal of Chinese Medicine Number 101 February 2013

Dates Following Plum Blossom Therapy

19

180

160
+12 +20 +2 -2 +2 -10 -22 -20 +15 -12 +5 +14 -10 -8 +24 +10 +2 -24 -22 -6 +8 +12 +2 0 -2 +2 +22 +6 -10 -8 -2

140

-6

Blood Pressure (mmHg)

120

+6

100
-5

-2 +2 +5 -4 -8 +14 -10

+10 0 0 +6 -4 -8

-20 +6 +5 +12 +10 0

+8 +8 -2 -12 0 +10 0 -10 -4 -4 -2

80

+1

-12

60

-14

-14

40

Systolic Diastolic

20

0
ay ay ay m ay 1 Ju ne 3 Ju ne 5 Ju ne 7 Ju ne 9 ju ne 11 Ju n 13 e Ju n 15 e Ju n 17 e ju n 19 e Ju n 21 e Ju n 23 e ju n 25 e Ju n 27 e Ju n 29 e Ju ne M M M 24 26 28 30

Dates From First Day of Treatment

Figure 1: Daily blood pressure readings

After the therapy concluded, the patients blood pressure was monitored for 19 days. During the 19-day follow up period, the systolic and diastolic blood pressures remained below 140/90mmHg, except for one day (see Figure 2).
160

140
-4 -6 +2 +18 -26 -6 +4 +6 +8 +6 -2 -4 +4 -6

Blood Pressure (mmHg)

120

100
-4 -12 -10 +2 +20 +2 -6 +2 +6 -4 0 +2 +4 -6

80

60

40

Systolic Diastolic

20

0
ly ly ly ly ly ly ly ly ly ly ly ly ly ly ly ly ly ly Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju Ju 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Dates Following Plum Blossom Therapy

Figure 2: Blood pressure during follow-up period
180

Discussion 160
+12suffered +20 This patient from Stage I hypertension (see Table +8 140 +2 +22 1). He had many predisposing risk that have +10 factors -6 0 +2 may +12 -2 +14 -10 development +24of his+2 +2 +5 +2to the contributed condition, including a+6 -2 -10 +15 +6 120 -8 -22 -20 previous history of high-12 alcohol consumption, smoking,-10 poor -8 -24 -2 -22 -6 diet, 100 sedentary lifestyle and COPD. Although he had been -20 -2 +8 +10 0 taking medication pressure prior to the +2 to regulate his blood +6 -5 +12 +14 +8 +10 0 0 +5 +5 -2 -10 -4 treatment, his blood pressure remained within hypertensive 0 +10 +6 80 -4 -8 -8 -4 -12 -4 parameters. The patient remained anti-hypertensive +1 -12 on -2 0 -14 -14 -10 60 medication throughout the treatment and follow-up period.

This study suggests that seven star plum blossom hammer treatment constitutes an effective alternative form of therapy for primary hypertension. A significant reduction in systolic blood pressure was observed after plum blossom therapy from the beginning stages of treatment. In the later stages a smaller decrease was observed as the blood pressure was closer to normal. A slight reduction in diastolic blood pressure was also observed before and after most treatments. Throughout the treatment period the patients blood pressure was consistently at or below hypertensive levels. However, on a few occasions there were spikes in the blood pressure readings, which were likely due to specific factors. For instance, on 26th May (the second treatment session) the high post-treatment diastolic blood pressure was likely due to anxiety caused by unfamiliarity both with treatment and the second practitioner. On June 15th the increase in the patients blood pressure coincided with his primary care physician prematurely diagnosing him with kidney cancer (of which follow up studies were negative). Throughout the month of June, the patient was interviewing for jobs, and reported feeling anxious while waiting for potential employment. On June 26th the patient experienced an episode of gout and reported being in severe pain, which likely caused a rise in blood pressure. The patients poor lifestyle choices and dietary habits may also have impeded the effects of the therapy; the raised blood pressure on July 5th was likely caused by the patient drinking a six-pack of beer on the 4th (and, of course, contradicted his claim of abstinence from alcohol). Alcohol acts as a diuretic causing the patient to urinate, thus increasing sodium reabsorption, causing the body to retain water so that the blood fluid volume increased. Towards the end of the treatment period the patients blood pressure approached normal levels and became more consistent, and during the post-treatment period it remained consistently below hypertensive levels. There were limitations to this case study. The first was that the patient remained on antihypertensive medication throughout the treatment period, which may have affected the outcome of the therapy. The second limitation was that the points selected were based on a generic protocol for primary hypertension instead of an individualised Chinese medicine diagnosis. Additionally, the two practitioners taking the patients blood pressure were not blinded and they alternated taking blood pressure readings for the first two weeks of the case study, which may have caused variation in the blood pressure values; it was subsequently decided that the results would be more consistent if the same practitioner monitored the blood pressure each time.

Blood Pressure (mmHg)

19

Ju

ly

Conclusion
Seven star plum blossom needle therapy may be an effective alternative treatment for primary hypertension. Throughout this study, the patients blood pressure became progressively more stable and consistent. The most notable

40

Systolic Diastolic

Journal of Chinese Medicine Number 101 February 2013

The Treatment of Primary Hypertension Using Plum Blossom Needle Therapy

41

aspect of the study was the reduction in blood pressure values after each treatment. Although the patients blood pressure was not below pre-hypertensive values until the end of the therapeutic period, it remained within the normal parameters during the follow up period. Additional studies are necessary to determine the efficacy of treatment in a larger population. In addition, the long-term effects of treatment need to be monitored to determine if the therapy can be used as an alternative to conventional medicine.
Brett Martin, DC, MsAc, is a chiropractor and acupuncturist. He has clinical experience working in the Salvation Army Drug and Alcohol Rehabilitation center, Martin Chiropractic Clinic (a family practice), a Post-Traumatic Stress Disorder Clinic, Living Well Cancer Resource Center and John Stroger Hospital Pain Management Department. He teaches anatomy and physiology, biochemistry, medical genomics and botanical medicine at National University in Florida. He can be contacted at 6698 68th Ave. N., Pinellas Park, Fl 33781, telephone: 630254-4804, bmartin@nuhs.edu. Frank Yurasek, PhD, LAc, is Chair of the Acupuncture and Oriental Medicine Programme at National University of Health Sciences, Chief of the PTSD Clinic there, and Attending Acupuncturist at Stroger County Hospital in Chicago. He received his Masters of Science in Oriental Medicine at Midwest College of Oriental Medicine, and taught there for 16 years as professor of tuina. He received his PhD in traditional Chinese medicine from Guangzhao University of Traditional Chinese Medicine. He teaches tuina, medical qigong, botanical medicine, and micromeridian acupuncture at National University, and is Vice President of the Illinois Acupuncture and Oriental Medicine Association.

References
1. L e h n e R . ( 2 0 0 4 ) . Pharmacology for Nursing Care. 5th ed. Elsevier Saunders: St. Louis. 2. Abbas A., Fausto, N. Kumar, V. [2005]. Robbins and Cotran Pathologic Basis of Disease. Elsevier Saunders: Philadelphia. 3. Brenner, B. (2004). Brenner & Rectors The Kidney, Seventh Edition. Saunders: Philidelphia. 4. Flaws B. (2005). The Treatment of Modern Western Medical Diseases with Chinese Medicine. B l u e P o p p y P re s s : Boulder. 5. (1999). Plum Blossom Needle Therapy. Medicine and Health Publishing Co: Hong Kong. 6. Deadman, P., Al-Khafaji, M. & Baker, K. [2007]. A Manual of Acupuncture. Journal of Chinese Medicine Publications: Hove.