by Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM

Hypertension affects 23% of the total white American population and 28% of the total African American population. Therefore, it is a very common problem. However, only 68% of those with hypertension are aware of their problem. Of those that are aware of their condition, 15% are not receiving any treatment for the problem, and only 26% of those who are on Western hypotensive medications have their blood pressure adequately under control. One of the reasons for this less than perfect adherence to treatment are the side effects of Western hypotensive medications, which can run the gamut from fatigue, headache, and cough to sexual dysfunction and even exacerbation of heart failure. Typically, the incidence of such side effects increases with dose and the number of hypotensive medications given.

In terms of Chinese medicine, there is a common assumption among contemporary Chinese doctors that most hypertension is associated with ascendant liver yang hyperactivity. However, when many patients with asymptomatic hypertension are examined via the four examinations, a sizable proportion, if not the majority, do not present the signs and symptoms of ascendant liver yang hyperactivity. In fact, many of these patients present a qi and yin vacuity set of symptoms, and, in that case, using heavy, settling, yang-subduing medicinals common to most formulas indicated for ascendant liver yang hyperactivity may fail to control and may even aggravate the hypertension. To understand this, it is important to understand Li Dong-yuan's theory of yin fire.

According to Li, yin fire is pathologically stirring (i.e., hyperactive), upwardly counterflowing ministerial fire. Ministerial or lifegate fire is rooted in the yang of the kidneys located in the lower burner. However, this yang qi ramifies or connects with the yang of all the other organs and tissues in the body. In particular, ministerial fire has an especially close relationship with liver-gallbladder yang, and hyperactivity of liver yang is sometimes referred to as flaming of ministerial fire. If yin becomes too vacuous and insufficient to control yang, this yang qi may become hyperactive and counterflow upward; but yin vacuity is not the only reason why ministerial fire may stir upward. According to Li Dong-yuan, if ministerial/yin fire counterflows upward, it damages the spleen qi. Conversely, a strong, fortified, and healthy spleen can prevent this ascension and counterflow, stirring and hyperactivity, while a vacuous, weak spleen allows and promotes such counterflow and hyperactivity.

In other words, there is the inverse relationship between the spleen's upbearing of the clear and upward counterflow and hyperactivity of ministerial fire. The spleen governs the upbearing of the clear yang. However, the clear yang is not the same as kidney or liver yang, and it is important not to think that promotion of upbearing of the clear necessarily causes or aggravates ascension and hyperactivity of liver yang. In fact, according to Li-Zhu medicine, just the opposite is the case. One of the ways to control ascension and hyperactivity of liver yang is to promote and fortify the spleen's upbearing of clear yang.

Clinically, this typically means the combination of one or more spleen-supplementing medicinals, such as Huang Qi (Radix Astragali Membranacei) or Dang Shen (Radix Codonopsitis Pilosulae) with one or more yang-upbearing medicinals, such as Chai Hu (Radix Bupleuri) or Sheng Ma (Rhizoma Cimicifugae). However, in the case of Chai Hu, because this medicinal plunders yin and is so strongly upbearing and ascending, it can cause exacerbation of ascendant liver yang hyperactivity. The good news is that there are other medicinals in Chinese medicine which also upbear the clear. One of these is Ge Gen (Radix Puerariae). Many Western practitioners think of Ge Gen only as an exterior-resolver. However, its scope of indications is greater than the treatment of flus and colds. In fact, this is such a useful medicinal that some premodern Chinese doctors were nicknamed Dr. Ge Gen because they seemed to prescribe this cheap and common medicinal to everyone. What makes this medicinal so useful is not that it is an exterior-resolver; it is that it is a clear yang upbearing, fluid-engendering medicinal. Unlike Chai Hu which plunders yin, Ge Gen actually enriches yang ming fluids.

Wang Mao-song, a contemporary Chinese doctor from Shanxi, has taken this theory and applied it to the treatment of hypertension. Like myself, Wang sees many cases of hypertension, especially early, asymptomatic hypertension, as yin fire conditions. According to Wang, in cases where there is a qi and yin vacuity failing to control liver yang hyperactivity, one must fortify the spleen and enrich yin, upbear the clear and clear the liver as opposed to heavily settling and subduing yang and downbearing counterflow. If one uses heavy, settling medicinals in such cases, these may damage the qi mechanism all the more, thus creating even more depressive heat internally. In that case, the blood pressure does not go down and may actually go up, even though one is using Chinese medicinals which are known empirically to lower the blood pressure.

Based on Wang Mao-song's research and the theories of Li Dong-yuan published in issue #5, 2001 of Shan Xi Zhong Yi (Shanxi Chinese Medicine) on pages 60-61 under the title of, "An Examination of Li Dong-yuan's Method of Upbearing Clear Yang & Scattering Yin Fire," I have created Blue Poppy Herbs' HyperQuell. This formula is for the treatment of spleen qi and liver blood vacuity with wind, heat, and/or blood stasis resulting in hypertension. Within this formula, Huang Qi (Radix Astragali Membranacei), and Tai Zi Shen (Radix Pseudostellariae Heterophyllae) fortify the spleen and supplement the qi, while Ge Gen (Radix Puerariae) acridly upbears clear yang. Tai Zi Shen and Ge Gen both engender fluids, so that acrid upbearing and out-thrusting does not damage fluids and lead to even further yin vacuity loss of control over yang. Suan Zao Ren (Semen Zizyphi Spinosae) and Bai Shao (Radix Albus Paeoniae Lactiflorae) nourish liver blood, emolliate and relax the liver, and quiet the spirit. Gou Teng (Ramulus Uncariae Cum Uncis), Tian Ma Mi Huan Jun (Armillaria), and Bai Ji Li (Fructus Tribuli Terrestris) level the liver and extinguish wind. Gou Teng and Ju Hua (Flos Chyrsanthemi Morifolii) clear the liver and drain heat. Fu Ling (Sclerotium Poriae Cocos) fortifies the spleen, leads yang downward into the yin tract (via urination), and quiets the spirit, Sheng Ma (Rhizoma Cimicifugae) helps Ge Gen upbear clear yang while also clearing heat from the stomach, and Dan Shen (Radix Salviae Miltiorrhizae) and Hong Jing Tian (Herba Rhodiolae Roseae) quicken and nourish the blood and eliminate vexation. In addition, according to Traditional Chinese Treatment for Hypertension by Hou Jing-lun et al. (Academy Press, Beijing, 1995), Gou Teng, Tian Ma, Ju Hua, Ge Gen, Sheng Ma, Bai Shao, Suan Zao Ren, and Bai Ji Li are all known to lower blood pressure.

HyperQuell may be prescribed individually or in combination with Western hypotensive medications for the treatment of hypertension in largely asymptomatic patients. When combined with diet, exercise, and lifestyle modifications, HyperQuell may be enough on its own to control blood pressure adequately, or it may be used to help reduce the dosage and/or numbers of Western hypotensive medications. It is a complex formula based on Li Dong-yuan's yin fire theory and takes into account the inverse relationship between upbearing the clear and downbearing ministerial fire.

Note: Due to Blue Poppy Herbs' concern for the environment, in this formula we use Tian Ma Mi Huan Jun (Armillaria) instead of Rhizoma Gastrodiae Elatae (Tian Ma), which is an endangered species and either is or should be banned from trade. Tian Ma Mi Huan Jun is a fungus associated with Tian Ma and has the same therapeutic effects in terms of hypertension. It is widely substituted for Tian Ma in China and is easily grown.