Effect of tuina manipulations on blood pressure and its variability in hypertension patients

Shen Zhi-fang (沈志方), Bian Xiao-dong (邊曉東), Gao Feng (高峰), Li Qiu-ju (李秋菊), Yuan Ju-ying (袁巨英)

Jiaxing Hospital of Chinese Medicine, Zhejiang 314000, China

Effect of tuina manipulations on blood pressure and its variability in hypertension patients

Shen Zhi-fang (沈志方), Bian Xiao-dong (邊曉東), Gao Feng (高峰), Li Qiu-ju (李秋菊), Yuan Ju-ying (袁巨英)

Jiaxing Hospital of Chinese Medicine, Zhejiang 314000, China

Objective:To observe the effect of tuina manipulations on blood pressure and its variability in hypertension patients.

Tuina; Massage; Meridians; Acupuncture Points; Hypertension; Blood Pressure

Hypertension is the most common cardiovascular disease, and has become a major global health issue. The 2004 National Nutrition and Health Status Survey showed that the prevalence of hypertension was 18.8% in Chinese people over 18 years old. Given the Chinese population size and structure in 2010, 0.2 billion people are estimated to have developed hypertension so far, i.e. 2 out 10 adults have hypertension, occupying 1/5 of global hypertension patients[1]. The increased fluctuation and circadian changes of blood pressure are closely related to the incidence and severity of the target-organ damage in hypertension, especially a significant increase in cardiocerebrovascular events in the morning and at night[2-3]. Therefore, it’s important to decrease the variability of blood pressure and turn the non-dipper type into dipper type to reduce the target-organ damage and complications while modulating blood pressure. We have adopted tuina manipulations to treat hypertension by tonifying kidney, promoting blood circulation, and unblocking collaterals. The observation is presented as follows.

1 Clinical Materials

1.1 Diagnostic criteria

By referring to the2010 Chinese Guidelines for the Management of Hypertension[1]: the systolic blood pressure (SBP) ≥140 mm Hg and/or the diastolic blood pressure ≥90 mm Hg without using any anti-hypertensive drugs measured 3 times in different days.

1.2 Inclusion criteria

Hypertension grade 1-2, and low or moderate risk according to risk stratification; having signed the informed consent form.

1.3 Exclusion criteria

Initial cerebrovascular accident; severe heart failure.

1.4 Drop-out criteria

Those who failed to finish the whole study; those who failed to cooperate in the study.

1.5 Statistical analysis

The SAS 6.12 and SPSS 10.0 software were adopted for data processing. The measurement data were expressed by mean ± standard deviationand the inter-group comparisons were analyzed by independent-samplet-test, while the intra-group comparisons were by pairedt-test.P＜0.05 indicates a statistical significance.

1.6 General data

Totally 40 patients were recruited from our hospital. By coin flipping, they were divided into two groups, the front side to the observation group and the back side to the medication group. If the patient number reached 20 in one group, the rest would be enrolled into the other group. Finally, there were 20 subjects in each group. There were no between-group significant differences in comparing data of gender, age, and disease duration (P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Tuina manipulations of kidney-tonifying bloodcirculating and collaterals-unblocking

The following tuina manipulations were performed in order: An-pressing the three meridians on head (Figure 1), An-pressing the head with five fingers, Tui-pushing the occiput, Rou-kneading Fengchi (GB 20), (Figure 2), and Tui-pushing the neck on both sides. Each manipulation lasted 0.5 min, and it took about 3 min to finish all the manipulations.

It’s followed by Tui-pushing up the Governor Vessel (Figure 3), Gun-rolling bilateral Bladder Meridian (Figure 4), Rou-kneading Ganshu (BL 18) and Shenshu (BL 23), Na-grasping Jianjing (GB 21), (Figure 5), digital Rou-kneading Xueyadian (EX-HN 32) and Jiaji (EX-B 2) points. Each manipulation was performed for 0.5 min, 6 min in total.

Tui-pushing forehead, parting Mo-wiping forehead (Figure 6) and rim of the eyes, Yun-circular-pushing Taiyang (EX-HN 5), (Figure 7), Sao-sweeping Qiaogong (sternocleidomastoid), (Figure 8), Tui-pushing thenar, and deep An-pressing Jianjing (GB 21) were then performed in sequence, 0.5 min for each manipulation and 5 min in total.

Figure 1. An-pressing the three meridians on head

Figure 2. Rou-kneading Fengchi (GB 20)

Figure 3. Tui-pushing up the Governor Vessel

It’s then followed by Mo-wiping the midline of chest with the palms, Shu-combing the intercostal spaces, Fen-parting abdominal yin and yang with fingers(Figure 9), Mo-rubbing Zhongwan (CV 12) and abdomen with both palms (Figure 10). Mo-rubbing Zhongwan (CV 12) took 2 min and 0.5 min for each of the rest manipulations, totally for 5 min.

Figure 4. Gun-rolling bilateral Bladder Meridian

Figure 5. Na-grasping Jianjing (GB 21)

Figure 6. Parting Mo-wiping forehead

The last group of manipulations included Roukneading Zusanli (ST 36), Sanyinjiao (SP 6), Fenglong (ST 40), and Xingjian (LR 2), 20 times for each point, and Rou-kneading Yongquan (KI 1) for 40 times, followed by Rou-kneading the anti-hypertensive groove on the back of the auricle for 1 min. Finally, it’s ended with Roukneading Binao (LI 14), Quchi (LI 11), Neiguan (PC 6), and Hegu (LI 4), 10 times for each point.

Figure 7. Yun-circular-pushing Taiyang (EX-HN 5)

Figure 8. Sao-sweeping Qiaogong (sternocleidomastoid)

Figure 9. Fen-parting abdominal yin and yang

The tuina manipulation was applied once a day, 1 month as a treatment course, for 3 courses in total.

2.1.2 Medication

Valsartan Capsule (Diovan) (Novartis, Beijing, China; China Food and Drug Administration approval number: H20040217) 80 mg, once a day, taken orally for 3 months.

Figure 10. Mo-rubbing Zhongwan (CV 12) and abdomen

2.2 Medication group

The medication group was only prescribed with the same medication, at same dose and for same duration.

3 Observation of Therapeutic Efficacy

3.1 24-hour mean SBP

There was no significant difference in comparing the 24-hour mean SBP between the two groups prior to the intervention (P＞0.05). After 3-month treatment, the 24-hour mean SBP dropped significantly in both groups (P＜0.05), and the decrease in the observation group was more marked than that in the medication group (P＜0.05), (Table 2).

3.2 24-hour mean DBP

There was no significant difference in comparing the 24-hour mean DBP before the intervention (P＞0.05). After 3-month treatment, the 24-hour mean DBP dropped significantly in both groups (P＜0.05), and the decrease in the observation group was less significant than that in the mediation group (P＜0.05), (Table 3).

3.3 24-hour blood pressure variability

There was no significant difference in comparing the 24-hour blood pressure variability between the two groups prior to the intervention (P＞0.05). After 3-month treatments, the 24-hour blood pressure variability dropped in both groups, and the decrease in the observation group was more significant than that in the medication group (P＜0.05), (Table 4).

Table 2. Comparison of 24-hour SBP

Table 2. Comparison of 24-hour SBP

Note: Compared with before treatment result in the same group, 1) P＜0.05; compared with the medication group, 2) P＜0.05

Group n Before treatment After 3-month treatments Difference between before and after treatment Observation 20 159.53±16.64 131.42±11.571) 28.11±13.422)Medication 20 156.47±13.74 139.42±16.211) 17.05±12.34

Table 3. Comparison of 24-hour DBP

Table 3. Comparison of 24-hour DBP

Note: Compared with before treatment result in the same group, 1) P＜0.05; compared with the medication group, 2) P＜0.05

Group n Before treatment After 3-month treatments Difference between before and after treatment Observation 20 95.61±11.26 84.17±8.531) 11.44±7.622)Medication 20 95.67±14.13 80.27±10.341) 15.40±9.78

Table 4. Comparison of 24-hour blood pressure variability

Table 4. Comparison of 24-hour blood pressure variability

Note: Compared with before treatment result in the same group, 1) P＜0.05; compared with the medication group, 2) P＜0.05

Group n Before treatment After 3-month treatments Difference between before and after treatment Observation 20 44.32±7.18 27.14±6.641) 17.18±5.262)Medication 20 46.24±8.47 34.35±8.721) 11.89±9.21

4 Discussion

In traditional Chinese medicine (TCM), hypertension belongs to the scopes of headache, vertigo, and wind stroke[4], caused by deficiency of the liver and kidney, disharmony between qi and blood and imbalance between yin and yang resulting from emotional disturbances, improper diet or dysfunctions of Zang-fu organs. It’s mainly associated with the heart, liver and kidney.

The heart dominates blood vessels. The heart qi promotes blood circulation, and regulates the beating of heart and dilation of vessels, keeping the vessels unblocked and a smooth blood circulation. The vessels house blood, working as both container and channels to transport blood. The heart, vessels, and blood together form up the blood circulation system, and thus we say the heart governs blood and vessels. The liver stores blood and maintains free flow of qi. A normal liver function guarantees regular qi activity and blood circulation. The kidney stores essence and dominates water and absorbs qi. Kidney yin and kidney yang can promote and harmonize the yin-yang of Zang-fu organs. Kidney qi governs and regulates the metabolism ofbody fluids, not only modulating the Zang-fu organs involved in the metabolism, but also adjusting the production and discharge of urine. Nan Jing (Classic of Difficult Issues) holds that expiration depends on the function of the heart and lung, while inspiration depends on the function of the liver and kidney[5]. It’s believed in Western medicine that heart pumping blood, circulating blood volume, and vascular resistance are three basic components for blood pressure and also three key factors that influence blood pressure, corresponding to the physiological functions of heart, liver, and kidney. Meanwhile, the liver and kidney share the same origin. Liver is the son and kidney is the mother. This is also to say that essence and blood share the same origin. Storing and discharging interact with each other and yin and yang reinforce and restrict each other. Therefore, this study took tonifying kidney, promoting blood circulation, and unblocking vessels as the general treatment principle.

The results showed that the two methods can both improve the blood pressure and its variability, either with tuina plus medication or with medication alone. However, the effect of tuina plus medication is more significant than medication alone, especially on improving blood pressure variability. It’s also confirmed the long-term effect of tuina manipulations on blood pressure and its variability by tonifying kidney, promoting blood circulation, and unblocking vessels. By working on specific points, tuina manipulations work to tonify liver and kidney, supplement yin and balance yang, relax tendons and unblock collaterals, and promote blood circulation. Modern studies indicate that tuina manipulations modulate blood pressure by the following four aspects. First, it regulates the nervous system, activating vagus, inhibiting sympathetic nerves, and adjusting autonomic nerves in both ways, and further dilating capillaries and reducing the resistance of peripheral blood vessels[6]. Second, the manipulations can relax major muscle groups, release vascular spasm, increase vascular bed, and improve blood flow in peripheral vessels[7]. Third, it stimulates the carotid baroreceptor to excite the vagus, reduce heart rate and pumping blood volume, inhibit vasomotor neurons, dilate blood vessels, and decrease the resistance of peripheral blood vessels[8]. Four, the manipulations can also reduce symptoms such as pressure and anxiety[9-10]. It’s also found that the blood pressure variability is associated with the target-organ damage in hypertension patients[11-12]. The tuina manipulations of kidney-tonifying blood-circulating and collaterals-unblocking can produce a significant effect on anti-hypertension and improving blood pressure variability, and it can effectively reduce the target-organ damage in hypertension and benefit the prognosis. Moreover, it’s safe and causes no adverse effects. Therefore, this method is worth to promote in clinical application.

Conflict of Interest

There was no conflict of interest in this article.

Acknowledgments

This work was supported by Project of Zhejiang Provincial Administration of Traditional Chinese Medicine (浙江省中醫(yī)藥管理局項(xiàng)目, No. 2012zb154).

Statement of Informed Consent

Informed consent was obtained from all patients.

Received: 10 August 2014/Accepted: 18 October 2014

[1] Writing Group of 2010 Chinese Guidelines for the Management of Hypertension. 2010 Chinese guidelines for the management of hypertension. Zhonghua Xinxueguan Zazhi, 2011, 39(7): 579-616.

[2] Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahl?f B, Sever PS, Poulter NR. Prognostic significance of vist-to-vist variability, maximum systolic blood pressure, and episodic hypertension. Lancet, 2010, 375(9718): 895-905.

[3] Zhang YM, Cheng N. Relationship between ambulatory blood pressure and carotid artery atherosclerosis as well as left ventricular hypertrophy. Zhonghua Gaoxueya Zazhi, 2008, 16(8): 749-750.

[4] Zhang BY. Internal Chinese Medicine. Shanghai: Shanghai Science and Technology Press, 1985: 198-208.

[5] Sun GR. Basic Theory of Traditional Chinese Medicine. Beijing: China Press of Traditional Chinese Medicine, 2007: 104-128.

[6] Liu P, Chen YF, Liu K, Liu J, Cao DW. Clinical efficacy of tuina treatment for 71 hypertension. Zhongguo Minkang Yixue, 2010, 22(21): 2771.

[7] Hao F. Tuina treatment for 60 hypertension. Anmo Yu Kangfu Yixue, 2011, 2(9): 35-36.

[8] Wang CH, Ran MS. Clinical observation of traditional Chinese tuina on the management of essential hypertension. Zhonghua Zhongyiyao Xuekan, 2010, 28(7): 1546-1549.

[9] Xu L, Chen YQ. Discussion of Tuiqiaogong in the treatment of essential hypertension. Zhongyi Xuebao, 2013, 28(1): 146-147.

[10] Low XF. Clinical comparison of head and facial massage and Qiaogong point massage as adjuvant therapy of hypertension. Zhejiang J ITCWM, 2009, 19(4): 209-211.

[11] Wang DQ, Wang SX. Research progress of blood pressure variability. J Jining Med Univ, 2013, 8(4): 292-294.

[12] Ma PR. Application value of ambulatory blood pressure monitoring in the elderly hypertension combined with target organ damage. Zhongguo Yiyao Kexue, 2013, 3(23): 177-178.

Translator:Hong Jue (洪玨)

推拿手法對(duì)高血壓患者血壓及血壓變異性的影響

目的：觀察推拿手法對(duì)高血壓患者的血壓及血壓變異性的影響。方法：選取高血壓患者40例, 將其隨機(jī)分為觀察組和藥物組, 每組 20例。觀察組在常規(guī)藥物治療基礎(chǔ)上予以“益腎活血通脈”推拿手法治療, 藥物組僅采用與觀察組相同的常規(guī)藥物治療。分別于治療前及治療3個(gè)月后行24-hour動(dòng)態(tài)血壓監(jiān)測(cè), 比較兩組患者血壓及血壓變異性的變化。結(jié)果：治療前兩組患者的血壓及血壓變異系數(shù)組間差異無統(tǒng)計(jì)學(xué)意義(P＞0.05); 治療3個(gè)月后, 兩組患者血壓及血壓變異系數(shù)均較本組治療前顯著改善(P＜0.05); 觀察組改善情況優(yōu)于對(duì)照組, 兩組間差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：“益腎活血通脈”推拿手法結(jié)合常規(guī)藥物對(duì)高血壓患者的血壓及血壓變異性改善情況優(yōu)于單純常規(guī)藥物治療, 且操作方便, 無毒副作用, 適宜臨床推廣應(yīng)用。

推拿; 按摩; 經(jīng)絡(luò); 穴位; 高血壓; 血壓

R244.1 【

】A

Author: Shen Zhi-fang, bachelor, attending physician of traditional Chinese medicine.

E-mail: shenzf08@163.com

Methods:Forty hypertension patients were randomized into an observation group and a medication group, 20 cases in each group. The observation group was intervened by tuina manipulations of kidney-tonifying blood-circulating and collateralsunblocking in addition to regular medication, while the medication group was by the same medication. The 24-hour blood pressure monitoring was performed before intervention and after 3-month intervention. The blood pressure and its variability were observed and compared.

Results:There were no significant differences in comparing the blood pressure and blood pressure variability between the two groups before intervention (P＞0.05); after 3-month intervention, the blood pressure and its variability were significantly improved in both groups (P＜0.05); the improvements in the observation group were more significant than those in the control group (P＜0.05).

Conclusion:Tuina manipulations of kidney-tonifying blood-circulating and collaterals-unblocking plus medication can produce a better effect than regular medication in promoting blood pressure and its variability, and this method is worth applying in clinic as it’s easy-to-operate and has no adverse effect.