The most useful definition of hypertension for the doctor is that level of pressure above which treatment has been shown to be beneficial. At present this cut-off is about 160/95 mm hg. The main clinical importance of hypertension is not that it is a disease but that it is the most important single factor that enables a doctor to make a prediction about the future risk of vascular diseases.

TCM holds that hypertension usually develops for those with a background of long-standing mental stress, emotional disturbance, improper diet, and deficiency and impairment of Qi and blood due to internal damage. Persistent or intense emotional stress often results in functional disorder of the liver and stagnation of Qi of the liver giving rise to symptoms of liver-fire sooner or later. These symptoms are dizziness, hypertension, distention sensation in the head, headache, red face and eyes, bitter taste in the mouth, irascibility, sometimes even hematemesis and epistaxis, red tongue with yellow coating, wiry and rapid pulse. Disturbance of Yin and Yang of the liver and kidney due to overwork, often results in exuberance of liver-Yang, which arises as a result of deficiency of kidney-Yin, known as the socalled "water(kidney) fails to nourish the wood (liver)," which is indicated by hypertension, dizziness, blurring of vision, tinnitus, poor memory, feverish sensation in the palm and soles, malar flush, night sweat, hot deep-yellow urine, constipation, red tongue, thready and rapid pulse.

Selection of points and manipulation methods:

1. Select 3-4 of the following points: Blood pressure reduction groove, forehead, kidney, liver, Shenmen, ear apex, subcortex and occiput. Stimulate with medium intensity and retain the needles for about 20 minutes while twisting them intermittently, once every day, 5-7 sessions constituting a course. The needles may be embedded in the points for 2-3 days, during which the patient may press them with medium intensity 3 times a day for several seconds each time.

2. Main points: adrenal gland, blood pressure reduction groove, heart, Shenmen.

Associated points: endocrine, Taiyang, forehead, liver, kidney.

Seed-pressure, electric needle, embedded needle, laser radiation or magnetic pellet of 500 gauss are the choices that can be applied alone or in pair especially in the treatment of persistent hypertension. Four to five points are employed for each treatment, 10 sessions constituting a course, with an interval of 7 days before the start of the next course.

Remarks:

1. Apart from a blood pressure above the normal range, hypertension is often manifested by dizziness and headache. It may therefore be considered under the categories of "dizziness" and "headache" in TCM.

2. The longer the needles are retained, the better the therapeutic results.

3. For severe hypertension showing no response to needle stimulation or depressor, bloodletting is applied at the blood pressure reduction groove.