15 October 2012

This month’s blog sets out Leilani Lea’s unique hypertension acupuncture treatment protocol as taught to the Barefoot Clinics' students in Nepal and India and offers practicing acupuncturists the chance to join efforts with Barefoot Clinics in trialling the treatment.

Hypertension (high blood pressure or HBP) is known as the "silent killer" because it rarely presents with obvious symptoms. According to the NHS, around 30% of adults suffer hypertension and many do not realise it. Having high blood pressure increases your chance of having a heart attack or stroke. For Barefoot Clinics patients in India, the influence of ethnicity means that the risk is even higher. Most of the patients that we see have no access whatsoever to any healthcare to gain a diagnosis, let alone medication. In our Barefoot Clinics in Nepal we found that hypotension (low blood pressure) among women is surprisingly common.

Fortunately, hypertension can be effectively managed through acupuncture treatment. At Barefoot Clinics, during the intensive 6-month Acupuncture course, our students are  trained to understand the physiology of hypertension and how to effectively measure their patients’ blood pressure and then learn our hypertension acupuncture treatment protocol.

A summary of hypertension

 The force with which the blood is pumped out to flow through the arteries is called the systolic pressure, and the following resting pressure, when the heart contracts, or rests, after each beat, is called the diastolic pressure. Either one or both of these numbers can be too high. We train our students to take blood pressure readings using the cuff and stethoscope. (See photo 1).

In India, medical equipment is highly prized and last year on arrival in India, when I unpacked my stethoscope from my suitcase I found the outer rim broken; the bit that attaches the filament onto the steth - the piece you then place onto a patient and listen with. So it was no good as a diagnostic implement. My stethoscope was sick and broken. I commented upon this sad sate of affairs to the head of operations in the clinic in the morning; as I had to borrow another stethoscope. Well, they can fix anything in India, it is truly amazing, and within 5 minutes they had returned the stethoscope to me - mended with elasticized sticky bandage!! Patient better!!  It looked so very funny but I didn’t dare laugh. (See photo 2). They were very proud of their work and explained that they had even blown through one of the tubes which was a bit blocked. My stethoscope looked comical but was working beautifully. It is refreshing to see such resourcefulness.

Back to blood pressure readings: There are two readings, the first, the “top” is the systolic pressure, the second or “lower” is the diastolic. For example, the blood pressure may read 120/80 -described as “120 over 80” and written as 120/80mmHG. Or the top reading may be 130 and the lower 90 - described as “130 over 90” and can also be written as BP: 130/90.

Blood pressure, but especially the systolic pressure can vary with changes in the body and throughout the day, for example, it can rise when rushed, stressed, anxious or worried. It can read higher if a patient has not slept well or has consumed too much salt. It will lower following rest. The diastolic pressure however does not change much as it reflects the heart at rest. Therefore it is often considered as the most important. It can be more relevant to the patient's long term health.

 Factors which influence the readings

 - The top, or systolic pressure, is more mobile and will rise in response to worry, agitation, rushing, emotional disturbance, lack of sleep, and a variety of other causes. If you think your patient's blood pressure may not be accurate, due to any of these factors, let them relax and rest awhile and take it again later.

- Age. As we get older, the blood vessels lose their soft elasticity and the blood pressure goes up, marginally.

- Diseases or conditions such as heart attack, diabetes, nervous system disorders and kidney disease can affect blood pressure.

 Hypertension (HBP) is diagnosed if the blood pressure reads 140/90 or higher.

 Risks associated with high blood pressure

 Untreated hypertension can cause serious health problems and can be life-threatening. It can lead to heart attacks, stroke, kidney disease, blindness. For this reason it is imperative that it is found early and treated. The Barefoot Clinics protocol insists on blood pressure checks with every new patient, and annually afterwards.

 Think about the pressure and sheer force of the blood pumping around the body, pushing against the artery walls; rushing through the kidneys. 1.2 litres of blood pours through the kidneys every single minute, for filtering. It is easy to understand how an excess force can cause damage to the delicate tissue of the vital organs. The pressure of the blood affects every area where the blood flows, for example the eyes. Of course, the greatest pressure is directly onto the arterial wall - it is likened to using a fire hose against a brick wall, weakening the plaster -eventually you will get a breakthrough bleed. It is vital first of all to lower the blood pressure.

 The arterial wall is composed of cells held together by intracellular cement. The intracellular cement (collagen) is created by vitamin C in the body. An effective therapy in long-term hypertension is to increase the amount of vitamin C daily - by one or two grams.

This is likened to having a little plasterer working full-time in the body, rushing around and strengthening the plaster, or collagen, where it is showing signs of weakness.

Symptoms of hypertension

Usually there are no symptoms, which is why the blood pressure must be checked with every initial visit -and the next visit if there is any doubt. If the blood pressure is undetected and continues, it can lead to patients developing heart or kidney disease, can produce stroke or heart attack and can be life-threatening.

 However, there are some symptoms if the pressure is dangerously high, so always check blood pressure if a patient suffers from dizziness, nosebleeds, frequent headaches, confusion, problems with their vision -this could be a dangerous form of hypertension that needs hospitalization.

 Other diseases and factors which can create high blood pressure are:

·      chronic kidney disease

·      pregnancy (pre-eclampsia)

·      some medications, eg, birth control pills, migraine pills, diet pills, etc.

 

Prevention

 Check blood pressure annually

Limit use of salt instantly, both in cooking and as a condiment. Get used to the natural taste of food without added salt.

Drink plenty of water, a minimum of 1litre daily.

Eat a heart-healthy diet with sufficient fibre.

Excercise regularly - get used to doing a daily hour's walk - make time for it and enjoy it.

Do not smoke.

Reduce stress and avoid the things that cause anxiety and stress. Try meditation and yoga.

Maintain a healthy bodyweight. If overweight, then find a suitable sensible diet to shed kilos.

Have your blood pressure checked regularly - every 6 months. Take immediate steps if it is high.

 How to take blood pressure

The pressure is recorded by a blood pressure cuff (sphygmomanometer) and stethoscope. (See photo 3 of one of our Barefoot Clinics students in clinical practice). It can also be recorded by an electronic device which mimics the same pressure and recording of the blood pressure beats, which can be heard through the stethoscope.

 

Here is how to interpret the numbers:

- When the blood pressure is below120/80 most of the time, this is normal.

- When the blood pressure reads 120/80 or higher, but below 140/90, it is considered as pre-hypertension. This means the patient is at a higher risk of developing hypertension.

- If the blood pressure numbers are 140/90 or higher, this is high blood pressure, or hypertension.

BLOOD PRESSURE

CLASSIFICATION

SYSTOLIC

DIASTOLIC

low

less than 100

less than 70

normal

120

80

borderline

130 - 139

85 - 89

stage1HBP

140- 159

90- 99

stage 2 HBP

160 - 179

100 - 109

stage 3 HBP

180 - 209

110 - 119

stage 4 HBP

210 and over

120 and over

 

Stages 3 & 4 are very dangerous and need to be treated with urgency.

Hypertension acupuncture treatment protocol

It is very rewarding to treat patients for hypertension as the results are excellent and consistent. The unique blood pressure protocol set out below was developed by Leilani Lea, founder and CEO of Barefoot Clinics, through years of experience, especially when working with up to 100 patients per day in India, where rapid and reliable results are needed. Initial studies showed it to be consistently successful with lasting results. If you would like to join in our proposed trial of this and other protocols, please send an email to Leilani at leilani.barefootclinics@gmail.com

 

1. Ask your patient to lie down on the couch, check the blood pressure and record it immediately in the notes before checking pulses and administering treatment. Deflate and leave the cuff loosely in place on the arm for a re-check later. As he is already on the couch one can simple proceed with treatment.

2. In this order, place the needles: GV.20, KI. 3, KI. 7, ST.36. Give needles a small twist and retain.

3. Leave the needles in situ for 20 minutes, without any stimulation at all, before checking the blood pressure again.

4. Take the BP again 20minutes later. If the drop in pressure is good, fine -if not leave theneedles in situ a little longer.

5. Do not remove the needles until the BP has lowered sufficiently, generally after 20 -30minutes but the needles can be left in situ for up to 45 minutes.

7. Record the reading after treatment on the patient's notes.

The drop in pressure always follow the same pattern, it is one of the most scientific and predictable patterns that can be found in acupuncture treatment. The initial systolic drop will be between 10 and 30 points, the diastolic 10 or more. For example, if a patient presents with a BP of 170/110 he is likely to show 140/100 after the initial session. Next time he presents, he will read in the region of 150/105. The next drop will register 145/100, he presents again reading 150/100. For the next few sessions, the diastolic will not rise above 100.

It drops in a pattern of 3 steps forward, one step back, but once either the diastolic or the systolic pressure has read the same for 3 sessions, both before and after treatment, it is stabilising at that level.

 With continued treatment, and when the systolic has stabilised, the pressure then drops again. The blood pressure now reads 130 over 90, for example.

Once a healthy level has been obtained and reads the same over 3 sessions, both before and after treatment, the blood pressure has usually stabilised at this level. Continue to see the patient monthly for 3months, if still stable, see again in 6 months, then in a year. If the blood pressure sees to be varying too widely, continue to see monthly until it is very stable.

The basic treatment is simple and consists simply of needling GV. 20, KI. 3 and KI. 7, in that order. Add ST.36 - especially if the patient seems lacking in energy - as if the body has not the energy or strength to control the blood pressure. ST. 36 is the ginseng of the body - it gives vigour and endurance of energy, it is adaptogenic in other words it will adapt to the individuals own nervous system and where there is tension it will relax at the same time it will give energy where it is lacking. Thus it will lower high blood pressure and raise low pressure. Moxa on ST. 36, with or without a needle in situ, is very good for low blood pressure.

On the other hand, if the patient is very tense and stresses, add the Four Gates: CO. 4 & LIV. 3

This treatment can be given alongside any other acupuncture treatment being given, simply add the trio - GV.20, KI. 3 & KI.7.

Reducing medication

Do not take a patient off their blood pressure medication until the blood pressure is controlled and within a normal range . Then reduce the medication slowly - no meds taken for two days only, in one week. The next week, eliminate the treatment for 3 days, and soon, until the end of the 5th week (one month) when there is only one day left, ignore this and keep the patient off medication. During this time be scrupulous about checking the blood pressure and treating as necessary.

An interesting phenomenon sometimes occurs - as the blood pressure is coming down and being controlled by the patient's own body, and they are continuing to take medication, at one point they may suddenly have low blood pressure. This means that the patient is overmedicated.

The acupuncture has caused the blood pressure to stabilise, the medication is forcing it down even further, with the result that it can drop too low. At this stage, simply remove the medication altogether and continue to monitor the patient once or twice a week until you are sure that it is controlled.

 It is worth getting familiar with this pattern, with experience it is easy to read and one can even predict how long a patient will need before the blood pressure is completely stable and controlled.

 Patients are always recommended to make the usual healthy lifestyle changes.

For further information about hypertension:

Journal of Chinese Medicine:

www.jcm.co.uk/search/

NHS:

www.nhs.uk/conditions/Blood-pressure-%28high%29/Pages/Introduction.aspx
British Heart Foundation:

www.bhf.org.uk


For more information, please visit our website: www.barefootclinics.org.uk

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Leilani Lea can be contacted by email: leilani.barefootclinics@gmail.com