Ulcerative Colitis : Definition

Western Medicine

** Do not stop taking medications without consulting a physician first. Notify your doctor if side effects become too troublesome. Also, women should notify their doctor immediately if they suspect they are pregnant because the medicine can be harmful.

Chinese Medicine

Ulcerative Colitis : Causes

Western Medicine

Chinese Medicine

Ulcerative Colitis : Symptoms

Western Medicine

Chinese Medicine

Hypertension : Diagnosis

Western Medicine

To minimize the fluctuation of blood pressure caused by negative influences such as stress and environment, the diagnosis of high blood pressure usually requires at least two measurements at two different times after the first initial screening.

Before the screening, those being tested should relax and should not consume coffee or any drink that contains caffeine before the measurement. Caffeine can transiently elevate your blood pressure, although there is no evidence that suggests caffeine contributes to long-term hypertension. Smokers should refrain from smoking before their blood pressure is measured. taking blood pressure

Blood pressure is measured with an instrument called a sphygmomanometer and is counted in millimeters of mercury (mm Hg). A rubber cuff is wrapped around the upper arm and then inflated. This compresses a large artery in the arm, momentarily stopping the blood flow. The air in the cuff is then released and the health care provider measuring the blood pressure listens with a stethoscope. When the blood pressure starts to pulse through the artery, it makes a sound. While the physician listens and watches the gauge, two measurements are recorded. The first number is the systolic pressure, which is the amount of pressure in your arteries when your heart is pumping or the pressure when the first sound is heard. The second number, known as diastolic pressure, is the amount of pressure when your heart is resting between beats and the pressure when the last sound is heard. As follows with medical custom, the systolic pressure is always reported first and the diastolic pressure second.

Hypertension is defined as systolic blood pressure (SBP) of 140 mm Hg or greater, diastolic blood pressure (DBP) of 90 mm Hg or greater. Normal blood pressure is equal or below 120/80 mm Hg.

Hypertension is further classified into different stages. These stages, along with other risk factors, help determine the degree and type of treatment. Table 1 shows the classification of blood pressure in adults over 18 years of age not currently taking any medications for high blood pressure.

Blood pressure table

Chinese Medicine

Hypertension is largely diagnosed by abnormal readings of blood pressure that measured on three separate occasions. (Please see above western medicine section for reference). Physician takes pulse for the patient

Based on the four examination skills, TCM practitioners will diagnose hypertension according to its clinical symptoms and further specify it by the disharmony patterns displayed by individuals. As TCM believes that at various stages of a disease, specific disharmony patterns are present which require different types of therapy. That is why two individuals with the same disease may be treated very differently by their TCM practitioners. Common disharmony patterns of hypertension are:

1. Hyperactivity of liver-yang

Main features: distending pain in the head, dizziness, blurred vision, irritability, poor sleep, flushed face, bitter taste in mouth, a red tongue with thin yellow coating, and the pulse is taut and forceful. There may also accompany rib-side discomfort.

Analysis: liver hyperactivity means the organ can’t play its regulatory role properly and thus results in the distending headache, dizziness and blurred vision; liver fire irritates the spirit that results in the irritability and poor sleep; while the rib-side discomfort, flushed face and bitter taste are caused by fire transformed from stagnated qi in the liver and gallbladder. Other signs like the red tongue with thin yellow coating, taut and forceful pulse are the indications of liver-yang hyperactivity. This pattern usually occurs in the early stage of hypertension.

2. Yin deficiency of liver and kidney

Main features: dull pain in the head, dizziness, blurred vision, buzzing of the ears, hot sensation in the chest, palms and soles, lumber soreness and lower leg weakness. The tongue is red with little fur, and the pulse is thready or thready and rapid.

Analysis: yin deficiency results in relatively yang hyperactivity, when this affects the head region, there will be dull pain in the head, blurred vision and dizziness; yin deficiency tends to generate virtual fire , and thus results in the hot sensations; kidney is housed in the lumbar and it also dominates the bones, so the lumbar soreness and lower leg weakness are related to kidney weakness; other signs like the red tongue with little fur, and thready pulse are coincided with yin deficiency of liver and kidney, the rapid pulse means the internal body is heated. This pattern usually occurs in the middle stage of hypertension.

3. Deficiency of both yin and yang

Main features: dizziness, poor memory, skinny, mouth dryness, hot sensation in the chest, palms and soles, general weakness, spiritual fatigue, breath shortness, night frequency, lumbar soreness, and knee weakness. The tongue is pale, and the pulse is thready and forceless.

Analysis: kidney essence is an important component of body’s yin, and due to its depletion, the whole body is under-nourished. The brain can’t function normally, and thus develops the dizziness and poor memory; the muscles are wasting and thus becomes skinny; insufficiency of fluid production and thus has the mouth dryness; yin deficiency creates virtual fire, and thus has the hot sensations. On the other hand, yin deficiency leads to a gradual depletion in body’s yang, and so has the spiritual fatigue and breath shortness; while night frequency, lumbar soreness and knee weakness are the indications of kidney deficiency; other signs like the pale tongue, thready and forceless pulse are coincided with yin and yang deficiency. This pattern usually occurs in the late stage of hypertension that has last for a long time. Individuals are mostly older, have persistent high blood pressure and with complications in the heart, brain or kidney organs.

4. Phlegm and dampness accumulation

Main features: distending and heaviness sensations in the head, dizziness, chest stuffiness, nausea, poor appetite, sleepiness, greasy tongue coating and taut and rolling pulse.

Analysis: the head orifices are obstructed by the excess dampness and phlegm, and thus cause the distending headaches, dizziness and sleepiness; phlegm and dampness accumulation is often associated with dysfunction of the middle burner, so there is chest stuffiness and nausea; since spleen and stomach are located in the middle burner, and so affected the appetite; the white greasy tongue coating, and taut and rolling pulse are the indications of excess phlegm and dampness. This type of individuals is often obese, not physically active, and they tend to have inefficient digestion and absorption, or a poor appetite.

5. Blood stasis blocking collaterals

Main features: dizziness, stabbing pain in the head or chest, chest stuffiness, limb numbness, purplish tongue and lips, or purple spots on the tongue, thready or hesitant pulse.

Analysis: persistent high blood pressure tends to develop blood stasis and impede blood flow, which cause the dizziness, stabbing pain in the head or chest, chest stuffiness and limb numbness; the purplish lips, tongue and pulse signs all indicate that blood stasis has developed. This pattern usually occurs in the late stage of hypertension that accompanies organ damages.

6. Asymptomatic hypertension

Hypertensive individuals feel fine and have not symptom. During examination, the tongue may be red or pale red color, the pulse is taut and thready or taut and rolling.

Individuals should be differentiated from conditions where the hypertension is caused by a specific disease process, secondary hypertension is more frequently seen in:

Individuals with clinical or biochemical features of a specific disorder. For example, abnormal blood hormone levels, such as catecholamines might suggest an endocrine disease of pheochromocytoma.
Young age (30-years-old and under)
Accelerated hypertension (severe cases of hypertension) suggests cardiovascular causes like aneurysm.
Troublesome hypertension (hypertension that does not respond to medication) suggests renal causes like congenital polycystic kidneys.

Note: If a TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual to see a western doctor for further follow up.

Hypertension : Treatment

Western Medicine

1. Lifestyle Modification

Lifestyle modification is important for prevention of hypertension and can be used as treatment for people with high normal blood pressure or people with stage 1 hypertension who have a low risk for heart disease. Lifestyle changes include weight reduction; if the person is overweight, alcohol intake should be limited to no more than 720 ml of beer, 300 ml of wine, or 60 ml of 100 proof whisky per day. For women and people without a weight problem the numbers should be halved. In addition, regular aerobic physical activity such as walking briskly for 30 to 45 minutes several times a week helps reduce blood pressure. Limiting sodium or table salt to 2.4 grams per days can also help reduce blood pressure.

Cigarette smoking increases the risk for cardiac disease. Blood pressure rises with each cigarette that is smoked. Quitting smoking can significantly reduce blood pressure. Having healthy eating habits can reduce your risk for heart disease, and if you need to be on medication, eating a well-balanced diet will help keep your medication dose low.

2. Blood pressure goals

Lifestyle modification should be attempted for at least 6 to 12 months. After that, drug therapy with medications may be initiated if goals are not met. In some cases, medications may be initiated first, and depending upon how high the blood pressure is, additional risk factors for cardiovascular disease and the presence of other organ damage. For example, the target blood pressure level for people with diabetes is 130/80 mm Hg.

3. Self-measurement of blood pressure

Measuring your own blood pressure at home could give an accurate blood pressure reading as some people become very anxious when they visit the health care professional and their blood pressure is elevated because of the stress. This is known as "white coat hypertension." If you are on medication, measuring your own blood pressure can help determine your response to the medication. This will let you know whether your dose is appropriate or if it needs adjustment. Although the sphygmomanometer is the most reliable method for measuring blood pressure, there are many personal home monitors that make measuring blood pressure convenient . It is important to follow the manufacturer's instructions for optimal results. The blood pressure cuff should be of appropriate size and the batteries should be checked frequently. Although home monitors can be of valuable assistance, it is still most important to see your physician for appropriate follow-up.

4. Drug Therapy

Controlling blood pressure with medications clearly decreases your risk of heart disease, kidney disease and stroke. Many kinds of medication are available now, and most of these agents can be taken once a day to help control blood pressure. Initially, the drug should be started at the lowest dose possible to help prevent adverse effects such as too abrupt a reduction in blood pressure. Adjustments are usually made every one to two months depending upon tolerability and response because there are certain side effects that occur quickly and can be serious. It is important to remember to take your medication at the same time each day because this minimizes the fluctuation of blood pressure. There are times, however, when one or more agents must be used to control your blood pressure. Some of these agents have undesirable side effects. Be sure to tell your doctor if any side effects occur because he or she may be able to choose another medication for you. It is important to take medication consistently even if you are feeling well.

Medication types for hypertension

Diuretics
Beta-blockers
ACE Inhibitors
Calcium channel blockers
Angiotensin receptor blockers
Alpha adrenergic blockers
Central alpha agonists
Vasodilators

Pharmaceutical targets of hypertension drugs

Hypertension Treatment Facts and Myths

Chinese Medicine

TCM Treatment of hypertension tends to focus on the overall body rather than the blood pressure alone, the remedies are tailored according the disharmony pattern each individual has. Below are some example prescriptions that used in treating common disharmony patterns associated with this disease.

1. Hyperactivity of liver-yang

Therapeutic aim: Soothe the hyperactive liver, clear fire and extinguish wind

Sample prescription: Gastrodia and Uncaria Decoction

2. Yin deficiency and yang hyperactivity

Therapeutic aim: Nourish yin and check yang

Sample prescription: Calming Liver and Extinguishing Wind Decoction

3. Deficiency of both yin and yang

Therapeutic aim: Warm up kidney-yang, nourish kidney-yin, clear kidney fire, regulate Thoroughfare and Conception Vessels

Sample prescription: Promoting Yin and Yang Decoction

4. Liver wind and turbid phlegm

Therapeutic aim: Resolve phlegm, extinguish wind and unblock collaterals

Sample prescription: Modified Dispelling Phlegm Decoction plus Restoring Facial Distortion Powder

5. Blood stasis blocking collaterals

Therapeutic aim: Activate blood and resolve stasis

Sample prescription: Modified Lower Abdomen Blood Stasis Dispelling Decoction"]

6. Asymptomatic hypertension

Therapeutic aim: Invigorate kidney, nourish liver and lower blood pressure

Sample prescription: Six-ingredient Rehmannia Pill plus rehmannia root, eucommia bark, gambir vine stem, white peony root, red sage root, chrysanthemum and liquorice root.

Individuals should note that hypertension is a chronic and even lifelong condition, therefore long term and regular treatment is necessary, so as to keep the blood pressure in a healthy level, prevent the symptom occurrences and reduce the risk of organ damages.

Hypertension : Prevention

Western Medicine

The best way to prevent hypertension is to live a healthy lifestyle. Researchers are not certain what the exact causes of hypertension are, so it's hard to pin point how to prevent it. However, there are several risk factors that may contribute to hypertension, and put you more at risk for heart disease and stroke. Some prevention strategies for the risk factors include:

Maintain an optimal body weight. People who are obese with a body mass index (weight in kilograms divided in height in meters squared) of 27 or higher are more likely to have hypertension.
Reduce salt intake in your diet. Eating too much salt can increase blood pressure in some people.
Drink alcohol in moderation. Heavy and regular consumption of alcohol can increase blood pressure.
Exercise regularly. Lack of exercise and inactivity can lead to excess body weight and increase the chances of high blood pressure.
Avoid tobacco use. Cigarette smoking is a powerful risk factor for heart disease.

Chinese Medicine

As high blood pressure is often due to a combined effect of long term emotional stimulations, internal injuries and improper diet, some active measures can help reduce the chance of developing it, such as healthy diet, regular exercise, controlling body weight, reducing stress, no smoking, moderate drinking and appropriate medical prescriptions.

1. Exercise regularly
Life relies on motion and health depends on exercise. It has been proven that regular exercise and training lead to a stronger body which helps to resist negative influences.

2. A balanced lifestyle
The Chinese medicine approach to healthcare is no different from the general philosophy of western approaches. It considers that appropriate exercise, diet, relaxation, social relationships, and habits all play a part in promoting a healthy body. Where the Chinese model may differ in the area of what is considered "appropriate." It emphasizes the importance of dynamic balance in everything we do, and might lead to approaches that do not favor our lifestyles. Balance and the "middle way" are everything, and although little is ever completely ruled out, nothing is ever considered very dominant.

3. Peace of mind and optimism
TCM believes a person's mindset contains the power to influence the body's functions positively or negatively; positive thinking and an optimistic outlook on life can definitely help maintain a healthy balance in the body.

4. Use herbs for medical prevention
Herbs that have been time tested by TCM practitioners and medically researched can be beneficial in maintaining a healthy balance in the body and preventing chronic diseases such as hypertension. It is important to understand which herbs are fit for your particular condition, and so consult a qualified TCM practitioner for follow up.

Ulcerative Colitis : Definition