280

Kadek Buja Harditya, Komang Rosa Tri Anggaraeni, Ni Made Candra Citra Sari, Ni Luh Gede Nita Sri
Wahyuningsih
Clinical Manifestation of Differentiation Syndrome Diagnosis in Hypertension

Clinical Manifestation of Differentiation Syndrome Diagnosis in Hypertension

(Manifestasi Klinis Diagnosa Sindrom Diferensiasi pada Hipertensi)

Kadek Buja Harditya1*, Komang Rosa Tri Anggaraeni2, Ni Made Candra Citra Sari3, Ni Luh Gede
Nita Sri Wahyuningsih4

1,2
Acupuncture and Herbal Medicines Study Program, Faculty of Health, Institute of Technology
and Health Bali
3,4
Nursing Study Program, Faculty of Health, Institute of Technology and Health Bali

*Email: [email protected]

Abstract
Hypertension is a cardiovascular disease known by the increasing level of blood pressure and the symptoms
continue to the target organ. Traditional Chinese Medicine (TCM) in acupuncture diagnosis has a different
perspective regarding the clinical manifestations of hypertension as shown in organ phenomena and as
syndrome differentiation. The purpose of this study was to determine the clinical manifestations and the
diagnosis of syndrome differentiation in patients with hypertension. The research method was a quantitative
study with one shot case study approach. The research sample was taken by using purposive sampling
technique as many as 40 respondents. The results showed that the majority of respondents had hypertension
in grade I conditions (57.5%), with a diagnosis of excess syndrome (75%), and liver fire flaring upward
(50%). Respondents showed symptoms of irritability (67.5%), tremor (25%), tingling sensation (25%),
headache (75%), epigastric pain (70%), insomnia (32.5%), nausea (10 %), and blurred vision (100%). On
inspection of the tongue, it was found that the majority of the tongue was red, swollen and yellow tongue
coating (67.5%), while on palpation of the pulse there was a wiry pulse (100%), rapid pulse (100%), thready
pulse (52.5%), powerful pulse (75%), and weak pulse (25%). This research is the basis for the development
of diagnostic in acupuncture science and acupuncture health services for people with hypertension.

Keywords: Acupuncture Diagnosis; Hypertension; Syndrome Differentiation.

Abstrak
Hipertensi adalah penyakit kardiovaskular yang dikenal dengan peningkatan tekanan darah yang gejalanya
berlanjut pada organ target. Traditional Chinese Medicine (TCM) dalam diagnosa akupunktur memiliki
perspektif yang berbeda mengenai manifestasi klinis hipertensi yang ditunjukkan dalam fenomena organ dan
diferensiasi sindrom. Tujuan dari penelitian ini adalah untuk mengetahui manifestasi klinis dan diagnosis
diferensiasi sindrom pada pasien hipertensi. Metode penelitian yang digunakan adalah penelitian kuantitatif
dengan pendekatan one shot case study, sampel penelitian diambil dengan teknik purposive sampling
sebanyak 40 responden. Hasil penelitian menunjukkan bahwa mayoritas responden mengalami hipertensi
pada kondisi derajat I (57,5%), dengan diagnosis sindroma ekses (75%), api hati menyala ke atas (50%).
Responden menunjukkan gejala mudah marah (67,5%), tremor (25%), kesemutan (25%), sakit kepala (75%),
nyeri epigastrium (70%), insomnia (32,5%), mual (10%), penglihatan kabur (100%). Pada pemeriksaan
lidah, ditemukan mayoritas lidah berwarna merah, bengkak dan lapisan lidah berwarna kuning (67,5%),
sedangkan pada palpasi nadi ditemukan wiry pulse (100%), rapid pulse (100%), thready pulse (52.5%),
powerful pulse (75%) dan weak pulse (25%). Penelitian ini menjadi dasar pengembangan diagnostik dalam
ilmu akupunktur dan pelayanan kesehatan akupunktur bagi penderita hipertensi.

Kata kunci: Akupunktur; Hipertensi; Sindrom Diferensiasi.

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Clinical Manifestation of Differentiation Syndrome Diagnosis in Hypertension

INTRODUCTION according to a TCM diagnosis that is enforced

Cardiovascular disease is the third biggest based on the eight basic TCM diagnoses, and
cause of death. The Institute for Health Metrics aims to balance vital energy (jingqi) in people
and Evaluation (IHME) in 2017 stated that of the with hypertension (Li, Xu, & Chen, 2014).
1.7 million deaths in Indonesia, 23.7% were TCM syndrome differentiation as the
caused by hypertension (Kemenkes, 2019). breakthrough point, along with comprehensive
Based on data from the Directorate of Non- modern and traditional medical methods based
Communicable Disease Control of the Bali on dialectical thinking as means of holistic and
Provincial Health Office (P2PTM Dikes Prov. symptomatic treatment of Western medicine
Bali) in 2019 in the 2020 Bali Province Health integrated with the eight principles of TCM
Profile it is known that the number of diagnosis, Zang-Fu organs, six meridians, Qi,
hypertension morbidity over the age of 15 years blood and fluid, as well as other dialectical
has reached 820,878 people and Denpasar City is methods, in order to provide a broader idea for
known to be 11.97% (117,672 people) of the total TCM treatment and lay a foundation for further
hypertension morbidity rate in Bali Province and better development of integrated TCM and
(Denpasar & Modeling, 2020). Western medicine treatment (Kou & Zhao, 2022)
Hypertension is characterized by an increase In TCM study for hypertension caused of
in systolic blood pressure ≥ 140 mmHg and diabetes in syndromes can be divided into four
diastolic blood pressure ≥ 90 mmHg which can deficiency syndromes: Qi (life force or vital
result in the supply of oxygen and nutrients energy, which belongs to Yang) deficiency; Yin
carried by the blood being obstructed to reach the deficiency and excessive heat syndrome; Qi and
body tissues or organs that need them Yin deficiencies and kidney Yin deficiency; and
(Yogiantoro, 2006). If it continues continuously, two excess syndromes that include blood stasis
it can result in an increase in intracranial blood and phlegm-dampness syndromes (Dou et al.
pressure which is characterized by headache, 2021). In addition, according to the other TCM
nausea, vomiting, blurred vision due to retinal syndromes’ research on syndrome differentiation
damage, increased urination at night due to and treatment in the management of hypertention
increased renal blood flow and glomerular caused chronic stable coronary artery disease
filtration, and edema due to increased capillary showed the tongue diagnosis includes pale red
pressure (Kumar, Abbas, & Fausto, 2005) with luster tongue, enlarged tongue, teeth-
In Traditional Chinese Medicine (TCM), marked tongue, purple dark tongue, pale dark
clinical manifestations that appear in people with tongue, petechiae tongue, sublingual varicose
hypertension are related to organ phenomena, the veins, white coating, yellow coating, thin
balance of yin and yang, the five elements coating, thick coating, and greasy coating. Pulse
(wuxing) in the body's organs (zangfu) and in the taking and palpation part include slippery pulse,
meridian system (jingluo) (J. Chen & Wilson, wiry pulse, thready pulse, and deep pulse (Bi et
2011). Syndrome differentiation (Bian Zheng) in al., 2018). Whereas in studies related to
traditional Chinese medicine (TCM) is the hypertension in western medicine, the
comprehensive analysis of clinical information classification of diagnosis does not use syndrome
gained by the four mains diagnostic TCM differentiation based on the root cause or
procedures: observation, listening, questioning, symptoms of imbalance in the body.
and pulse analysis, and it is used to guide the Hypertension is one of the strongest risk factors
choice of treatment either by acupuncture. for almost all different cardiovascular diseases
Disorders or diseases that arise due to imbalances acquired during life, including coronary disease,
in the body's organs or the meridian system need left ventricular hypertrophy and valvular heart
to identify the syndrome through four ways of diseases, cardiac arrhythmias including atrial
examination to provide appropriate management fibrillation, cerebral stroke and renal failure.

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Clinical Manifestation of Differentiation Syndrome Diagnosis in Hypertension

Hypertension is known to have significant effects a sample of 40 respondents was obtained. The
on cardiovascular (CVD) outcomes such as heart sampling technique used in this study was
failure, myocardial infarction, and stroke. purposive sampling, namely sampling based on
mechanisms of hypertension in adult or older consideration of certain characteristics based on
persons, including mechanical hemodynamic research criteria.
changes, arterial stiffness, neurohormonal and Inclusion criteria:
autonomic dysregulation, and the aging kidney. 1. Patients with hypertension aged more than 20
Aging results in several structural and functional years in around Denpasar city
changes in the arterial vasculature. Over time, the 2. Patients with hypertension who have not
arteries stiffen, with fracturing of the elastic received hypertension drug therapy, or have
lamellae and intimal hyperplasia is seen in the not taken hypertension medication in the last
aorta. The stiffened arteries have decreased 2 months.
capacitance, and limited recoil, with subsequent 3. Patients with hypertension who are willing to
difficulty to accommodate volume changes sign an informed consent.
throughout the cardiac cycle (Frost et al., 2018). Whereas the exclusion criteria are:
Based on the description above, there are 1. Patients with essential or primary
differences in scientific perspectives in the hypertension, an increase in blood pressure for
management of patients with hypertension which there was no known cause,
between conventional treatment methods 2. Hypertensive patients who were not treat with
(western medicine) and TCM traditional acupuncture (TCM).
complementary medicine within the scope of The type of data collected in this study was
holistic examination, diagnosis and treatment for primary data using acupuncture study sheets to
hypertension sufferers. The objectives to be obtain data on the degree of hypertension,
achieved in this study are as follows: to clinical manifestations of organ syndromes and
determine the clinical manifestations of organ identification of syndrome differentiation. The
syndrome in hypertension sufferers, to determine data that has been collected is entered into the
the differentiation of syndromes in hypertension master table and coded to make it easier to
sufferers, and to determine the relationship analyze the data. Data analysis used Statistical
between the degree of hypertension and the type Package for the Social Science (SPSS) version
of syndrome in hypertension sufferers. 23, descriptive quantitative analysis by
presenting the results of data analysis in the form
METHODS of a frequency distribution table. Spearman
The research design was a type of research is Correlation Analysis (non-parametric) was used
quantitative research. This study aimed to to determine the relationship between the degree
describe the clinical manifestations of the of hypertension and the type of differentiation
syndrome in TCM in hypertensive patients. This syndrome (Pallant, 2020).
study used one shot case study approach.
Researchers here did not intervene but only RESULTS
examined the condition of the respondent to Characteristics of respondents in this study,
obtain blood pressure data, a description of the namely gender, age and occupation (n=40).
clinical manifestations of the TCM syndrome Based on the results of data collection, it can be
and identified diagnosis of the syndrome explained that the majority respondents were
differentiation in hypertension sufferers. male as many as 25 respondents (62.5%). The
The population of this study were majority respondents were in the age group 55 to
hypertensive patients aged over 20 years in the 64 years, as many as 14 respondents (35%).
Denpasar city area who wish to have their health Respondents had occupation as private
checked from a TCM perspective. In this study, employees as many as 18 respondents (45%).

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Table 1 respondents (25%) had tingling sensation, 40

Characteristic Respondent respondents (100%) had blurred vision.
Frequency Percentage
(n) (%) Table 3
Gender
Tongue diagnostic
Male 25 62.5
Frequency Percentage
Female 15 37.5
(n) (%)
Age
35-44 years old 8 20.0 Red, greasy yellow 18 45.0
45-54 years old 12 30.0 tongue coating
55-64 years old 14 35.0 Red, yelllow coating 12 30.0
65-74 years old 6 15.0 Red, greasy white 10 25.0
Occupation coating
Civil servant 6 15.0 Red-purple tongue 0 0
Private employees 18 45.0
Entrepreneur 7 17.5 According to inspection of the tongue, it was
Labourer 3 7.5 found that the majority of the condition of the
Pensioner 6 15.5
tongue was red, greasy yellow tongue coating as
Table 2 many as 18 respondents (45%), red, yellow
Symptoms of Differentiation Syndrome coating as many as 12 respondents (30%), red,
Frequency
(n)
Percentage (%) greasy white coating as many as 10 (25%)
Irritability
Yes 27 67.5 Table 4
No 13 32.5 Pulse diagnostic
Tremor Frequency Percentage
Yes 10 25.0 (n) (%)
No 30 75.0
Insomnia Wiry pulse
Yes 13 32.5 Yes 40 100
No 27 67.5 No 0 0
Headache Rapid pulse
Yes 30 75.0 Yes 40 100
No 10 25.0 No 0 0
Epigastric pain Thready
Yes 28 70.0 pulse
No 12 30.0 Yes 21 52.5
Tingling No 19 47.5
sensation Powerfull
Yes 10 25.0 pulse
No 30 75.0 Yes 30 75.0
Blurred vision No 10 25.0
Yes 40 100 Weak pulse
No 0 0 Yes 10 25.0
Nausea No 30 75.0
Yes 10 25.0
No 30 75.0
According to palpation of the pulse (n=40)
Frequency distribution and Percentage of
there was a wiry pulse as many as 40 respondents
symptoms (n=40) showed that 27 respondents
(100%), rapid pulse as many as 40 respondents
(67.5%) experienced irritability, 10 respondents
(100%), thready pulse as many as 21 respondents
(25%) tremors, 13 respondents (32.5%) had
insomnia, 30 respondents (75%) had headaches, (52.5%), strong pulse as many as 30 respondents
(75%), and weak pulse as many as 10
28 respondents (70%) had epigastric pain, 10
respondents (25%).

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Clinical Manifestation of Differentiation Syndrome Diagnosis in Hypertension

Table 5 The data showed that from 40 respondents

Hypertension Degree and Diagnose of the majority had excess syndrome as many as 30
Differentiation Syndrome respondents with degrees of hypertension
Frequency Percentage including prehypertension as many as 7
(n) (%) respondents (17.5%), stage I hypertension as
Hypertension degree
many as 18 (45%) and stage I hypertension as
(n=40)
Pre hypertension 7 17.5 many as 5 (12.5%). Spearman Correlation
Hypertension stage I 23 57.5 Analysis (non-parametric) was used to determine
Hypertension stage II 10 25.0 the relationship between the degree of
Differentiation hypertension and the type of differentiation
syndrome according to
body zheng qi (n=40)
syndrome based on Zheng Qi body. There was a
Excess 30 75.0 significant relationship between the type of
Deficiency 10 25.0 syndrome and the degree of hypertension,
Differentiation r=0.380, p<0.05.
syndrome diagnose
(n=40)
Liver fire flaring upward 20 50.0
DISCUSSION
Liver yang hyperactivity 10 25.0 Hypertension as a chronic disease is
Kidney yin deficiency 10 25.0 influenced by various factors. Factors for the
Turbid phlegm misting 0 0 occurrence of hypertension are divided into risk
the mind factors that cannot be modified, such as heredity,
Blood stasis obstructing 0 0
the mind
gender and age. Meanwhile, modifiable risk
factors are lifestyle, stress, activity, obesity and
Frequency distribution and percentage of
eating and drinking patterns (Casey & Benson,
hypertension degree and diagnose of
2006). In this study, which showed that of the 40
differentiation syndrome (n=40) showed that the
respondents who experienced hypertension, it
majority of respondents experienced
was shown that the majority of the 40
hypertension in grade I conditions as many as 23
respondents were male, the most age of
respondents (57.5%), excess syndrome as many
respondents was in the age group of 55 to 64
as 30 respondents (75%) and differentiation of
years while the least were aged 65 to 74 years.
organ disorder syndrome which showed liver fire
This is in line with Hasan's study (2017) which
flaring upward as many as 20 respondents (50%).
showed that 83.3% of the elderly had
hypertension compared to young people (16.7%)
Table 6
with statistical test results showing a significant
Crosstabs between hypertension degree and
relationship between age and hypertension
differentiation syndrome according to body
(p=0.001<0.05) (Hasan, 2019). Hypertension or
Zheng Qi
Differentiation syndrome high blood pressure usually occurs between the
according to body Zheng Qi ages of 30 and 65 years, systolic pressure
Excess Deficiency increases by an average of 20 mmHg after the age
n (%) n (%) of 70 years, after menopause (Casey & Benson,
Hypertension 2006). Women's blood pressure often increases
degree sharply with age, this is due to the influence of
Pre hypertension 7 (17.5) 0 (0)
Hypertension 18 (45.0) 5 (12.5) the production of the hormone estrogen which
stage I 5 (12.5) 5 (12.5) decreases during menopause. The prevalence of
Hypertension hypertension in men is almost the same as in
stage II women, but women are potentially protected
Correlation coefficient = 0.380, p=0.016 from cardiovascular disease before menopause

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because the hormone estrogen plays a role in organ disorders or endocrine diseases. There is a
increasing high-density lipoprotein levels narrowing of the arteries that circulate blood to
(Kaplan, 2010). High density lipoprotein (HDL), the kidneys to be disrupted. Kidney damage can
which is a class of lipoproteins that binds cause a buildup of fluid in the body which can
cholesterol in the blood or from cells and tissues cause symptoms such as shortness of breath,
of the body, is carried to the liver. With high chest pain and palpitations. A very high increase
HDL levels, the risk of atherosclerosis will in blood pressure (systolic > 160mmHg and
decrease, thereby reducing the risk of coronary diastolic > 100mmHg) is also called malignant
heart disease and stroke which are characterized hypertension and has a high risk of complications
by increased blood pressure or hypertension such as hypertensive encephalopathy, which is
(Appel et al., 2006; Kaplan, 2010). caused by increased blood pressure in the brain,
Based on the blood pressure classification swelling and impaired brain function which is
made by the Joint National Committee VII (JNC characterized by headaches, sleep rest disorder,
VII) in 2003, based on the average of two or more disturbance of consciousness (Zaman &
blood pressure readings or measurements that Calhoun, 2003). In addition, damage to the heart
were taken correctly at the initial visit and then muscle affects the performance of the heart, the
measured again at each visit twice or more after inability of the heart to pump blood from the
initial visit. Normal blood pressure: systolic lungs to the arterial system, causing edema or
<120mmHg and diastolic <80mmHg, swelling of the lung tissue which is characterized
Prehypertension: systolic 120-139mmHg and by chest pain, epigastric pain and shortness of
diastolic 80-89mmHg, Stage 1 hypertension: breath. There is damage to the heart muscle
systolic 140-159mmHg and diastolic 90- (Marik & Varon, 2007).
99mmHg, Hypertension stage 2: systolic TCM emphasizes personalized diagnosis,
>160mmHg and diastolic >100mmHg. This but the wisdom used in analyzing disease pattern
study shows that respondents experienced is different from western medicine, which is
different degrees of hypertension such as mostly symptom-based. Syndrome also known
prehypertension), hypertension stage I and as a pattern or zheng, that is a basic unit and a key
hypertension stage II (Chobanian et al., 2003). concept in TCM theory, which has been used in
Patients with hypertension show symptoms China for over 2,500 years (Wang, Wang, &
such as headaches, dizziness, vertigo, tinnitus, Xiong, 2012). This is different from a disease or
and visual disturbances. On physical symptom. TCM syndrome is an abstraction from
examination, hypertension is also suspected the pathogenesis of major disharmony, which
when hypertensive retinopathy is detected, where was identified from a comprehensive analysis of
an increase in blood vessels in the retina can be a all symptoms and signs (including tongue
cause of impaired visual function such as blurred appearance and pulse feeling) from the four main
eyes (Pikir, 2015). This is in line with what was TCM diagnostic methods: observation, listening,
found in this study indicating that respondents questioning, and pulse analysis (Chen, 2008;
experienced irritability, tremors, tingling Saputra, 2017). This is a generalization of the
headaches, epigastric pain, insomnia, blurred causes, location, nature and predisposition of the
vision while nausea was absent. On examination disease at a certain stage. In summary, all
of the optic fundus behind the eye using an diagnostic and therapeutic methods in TCM are
ophthalmoscope. Ophthalmoscope results can based on differentiation of TCM syndromes (Liu,
provide an indication of how long a person has Leung, & Tian, 2011; Maciocia, 2015). In
hypertension (Ndimande, 2006). Some clinical ancient China, due to technological
manifestations that can indicate the presence of backwardness and lack of testing methods,
secondary hypertension, namely hypertension Chinese practitioners explored the etiology and
whose cause is clearly known, such as kidney pathogenesis of a disease by estimating the

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Clinical Manifestation of Differentiation Syndrome Diagnosis in Hypertension

interior by observing the exterior; explore the hyperactivity patients have been related to
intrinsic etiology of extrinsic appearance; uncoordinated sympathetic nervous system
examine the state of the internal organs; and activation and yin yang deficiency associated
differentiate symptoms and signs. In general, it is with low metabolic rate. Furthermore, because
believed that syndromic differentiation is a Yin deficiency is recognized as a major
special feature and priority of TCM. Thus, pathology to both yin deficiency yang
differentiation syndrome plays an important role hyperactivity and yin yang deficiency syndrome,
in the therapeutic process and influences the this study also found that abnormal glucose
therapeutic outcome of certain diseases (Xiong, metabolism is common to both yin deficiency
Chu, Li, & He, 2011). yang hyperactivity and yin yang deficiency,
According to TCM theories, hypertension indicating the significant role of glucose
can be categorized into four syndromes, metabolism in yin deficiency. Another TCM
including liver fire ascending, yin deficiency ang pattern of hypertension is the accumulation of
hyperactivity, yin yang deficiency, and dampness damp phlegm caused by spleen and stomach
phlegm accumulation syndromes. Etiologically, deficiency, which connects blood pressure
TCM believes that liver-fire syndrome is regulation to the digestive tract. Wu et al. found
primarily caused by the deficiency of kidney yin, that elevated uric acid could be a biomarker of
which subsequently loses its control over liver damp phlegm syndrome as compared with other
yang. The exuberating yang of the liver goes syndromes and normotensive condition
upward and causes symptoms such as dizziness (Tianmin, Chen, Xue, & Gao, 2016). Moreover,
and headache, etc. Many genetic factors, such as the metabolic pattern of damp phlegm syndrome
aging, genetic dispositions, and emotional factors featured on the increase of citric acid, alanine,
are acclaimed to be responsible for this low-density lipoprotein (LDL), very low-density
syndrome. Jiang et al. Found that the urine and lipoprotein (VLDL), and the decrease of glucose,
blood samples of liver fire presented salient lysine, proline, lactose in blood when compared
abnormalities in amino acid and glucose with liver fire (Tianmin et al., 2016).
metabolism as compared with healthy controls Characterizing the biological basis of TCM
(Yang & Lao, 2019). By constructing a metabolic syndrome of hypertension is the premise to
network, they further linked this syndrome to a understand the mechanism of TCM treatment for
disrupted metabolic network that features on hypertension. There are insufficient research
abnormal noradrenaline, hexanoic acid, and tools to portray the whole picture of TCM
arachidonic acid metabolisms (Jiang, LI, & diagnosis in the early days. Metabolomics and
Medicine, 2013). other analytical technologies bridge this gap
However, due to the lack of valid between research demands and tools available.
comparators such as another TCM syndrome, Because metabolomics helps to unravel the
one can only infer that metabolic perturbations constellation of TCM diagnosis, the hypertensive
exist in liver fire syndrome, but not able to population can be further stratified for the
“metabolically tag” this syndrome with such optimization of therapeutic effect. The
metabolic perturbation. Further subgroup elucidation of the metabolic pattern for different
analysis to directly compare the metabolic TCM syndromes is also the root for
features of different TCM syndromes is understanding the actions of TCM
necessary. Li et al. conducted a metabolomics antihypertensives (Shao & Zhang, 2013).
analysis of plasma samples of yin deficiency Impaired organ function caused by increased
yang hyperactivity patients, yin yang deficiency blood pressure can affect the imbalance of Qi and
patients, and healthy subjects and found that each Xue (blood) in the body, disharmony of Yin and
pattern has its unique pattern of metabolism Yang causing symptoms that are defined as the
(Shao & Zhang, 2013). Yin deficiency yang causative factors of the syndrome. The clinical

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manifestations of the syndrome that arise majority of respondents experienced

include; Yin deficiency, Yang hyperactivity, hypertension in grade I with a diagnosis of excess
organ deficiency, organ excess (Koosnadi & syndrome and differentiation of organ disorder
Agustin, 2017). In the theory of Traditional syndrome indicating the presence of liver fire
Chinese Medicine, Qi (energy), Xue (blood) and flaring upward. There is a significant relationship
Jin Ye (bodily fluids) are interconnected, Qi is between the type of syndrome and the degree of
the commander of Xue. Qi stimulates blood hypertension.
formation and Xue nourishes nutrition. The heart For further researchers can examine by
governs the Shen (spirit). If there is interference reviewing various factors from this research that
with the cardiovascular system, the heart's yin have not been disclosed such as six exogenous
and heart's Xue will also decrease in number, so pathogenic factors and pattern identification of
the heart's own heart's function will also suffer the seven emotions. The results of this study are
from interference. So this affects the function of expected to be useful as a reference in various
the liver (liver) which regulates the amount and aspects both for the development of acupuncture
circulation of blood. Disorders of the liver are science and acupuncture health services for
shown in clinical manifestations such as people with hypertension. Future researchers can
irritability, increased blood pressure, blurred use the results of this study as a reference for
vision, headaches and abnormal pulse palpation developing further research on hypertension and
such as weak, fast, strong and thin. This is in line acupuncture therapy.
with the results of the study showing that out of
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