Guiding Patients Through Worry, Hypertension, and Healing
By Martha Lucas, PhD, LAc
Hypertension is a relatively common condition that is in some ways associated with aging. But treating it using TCM, is in my opinion, a partnership rather than a series of treatments. The treatment plan does not only involve the practitioner, acupuncture, herbs, and other TCM therapies, it involves the behavior of the patient.
It revolves around his or her willingness to participate in the journey to better health. One of my hypertensive (and worrying) patients recently asked me, after only three treatments, if she is a "hopeless case."
This is a person to whom I have given my usual and customary advice about doing Qi Gong (it's my homework "assignment" for people), nutritional advice to help her digestion, and reading and behavior modification advice about how to help her stop worrying. But, she was still hoping for a magic pill. That is not going to happen; treatment is a partnership, it's a plan for regaining good health. So on the third treatment, we revisited her pulse diagnosis picture of how worry affects digestion and I reminded her about the fact that if her digestion doesn't work well then it is a strong possibility that other systems will not work well either. "But how do I stop worrying?" she asked. Here is how I talk with patients about worrying: I ask "are you worrying about something that you can control? If so, then take action; worry is non-action.
If you are worrying about something out of your control then you have to put that on the "I won't worry about it" side of the behavioral contract that you have made with yourself. Because if you continue to worry and your spleen qi keeps reversing and attacking or stealing your kidney qi, your aging process will accelerate and your general health will continue to suffer. Those are just the plain and simple facts: worry negatively affects the flow of digestive qi and can potentially damage kidney qi. The psychologist in me wants to believe that the patient is receiving some sort of "positive" feedback for her worrying but that's something for her to figure out with a therapist. My job is to unblock her energetic "stuckness," keep her qi strong and flowing freely using my TCM tools, and help her realize that thoughts change qi. This is one of the strengths of our medicine - it should not hold the expectation of being a magic pill. It is a life alteratiing partnership when the patient allows it to be so.
Let's face it, allopathic medicine has created a sort of monster by creating a system where people wait until their symptoms are unbearable before they see a physician and by then they want immediate relief. The magic pill was born in this system. Take the aforementioned patient's hypertension as an example of a condition that generally does not respond well in the magic pill system. An important statistic about hypertension (HTN) is that roughly 50 percent of patients who are on drug therapy for HTN do not take their medication as directed if they take it at all. Since research is demonstrating the biological mechanisms that explain the effects of acupuncture, this is another perfect opportunity for our medicine to shine. Studies have shown that acupuncture affects the cardiovascular system, that it changes the level of blood pressure modulators, and that it impacts the sympathetic nervous system in a positive direction.
A randomized trial to study the effects of acupuncture to lower blood pressure was published in Circulation in 2007. The study subjects were 160 outpatients whose diagnosis was uncomplicated arterial hypertension. Subjects were split into two groups: one received acupuncture two times a week for six weeks while the other group received a six week course of sham acupuncture. Participants who were taking antihypertensive medication continued to take such medication during the course of the study. At the end of treatment course there was a significant difference in blood pressure between the acupuncture and sham acupuncture groups. The systolic and diastolic blood pressures of the acupuncture group subjects decreased by 5.4 mm Hg and 3.0 mm Hg respectively. A important caveat to this important demonstration of the effectiveness of acupuncture treatment for one of our major health issues is that – without treatment - at three and six months post-study blood pressures returned to pre-treatment level. There it is again: the magic pill doesn't work and neither does quitting acupuncture. A smaller study of 41 subjects reported a reduction in pre-treatment BP of 136.8/83.7 to a post-treatment reading (on average) of 122.1/76.8 while the sham acupuncture group showed no significant decrease in BP. Comprehensive reviews suggest that more studies need to be done with more rigorous controls but we should be optimistic.
For your patients who think that it is their stressful life that is causing their issues with rising blood pressure you can tell them that it is generally known that acupuncture treatment can reduce the negative impact of stress on the body. But is there a real link between stress and high blood pressure? You can't really say that stress "causes high blood" pressure per se but stress does temporarily increase blood pressure. It does that by causing a surge in hormones that make the heart beat faster and cause narrowing of the blood vessels. The bottom line is that stress damages the blood vessels and the damage is cumulative.
The World Health Organization has called stress a "worldwide epidemic." The stressed patient may be moody, anxious, depressed, angry, restless, and even feeling overwhelmed. What does this do to their qi? It can negatively affect the digestion's ability to make good quality qi and might also block the flow of qi to the Spirit level. Then we have a tired anxious patient: he or she does not make good qi and the Spirit is restless. Herein lies the importance of acupuncture treatment; it will improve the digestion and unblock the Spirit. But, it is still imperative that the patient get out of the magic pill mindset and properly participate in treatment and lifestyle changes. "Worrying" is not something that is cured by acupuncture treatment. It's negative side effects can be treated, but the patient must change his or her own behavior. Who knows, controlling worry may turn out to be a new and refreshing experience!
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