E Douglas Kihn, DOM, LAc (ret.)


  • The three root causes of hypertension are liver qi stagnation, blood heat/heart heat, and spleen damp.
  • While acupuncture and herbology can have a powerful effects on qistagnation and blood heat, they cannot prevent the recurrence of these syndromes.
  • Talk with your patients about how to stop the unhealthy habits of worrying, hurrying, and overeating.

Hypertension, also known as high blood pressure, occurs when the pressure in a person’s blood vessels is too high. At rest, a pressure cuff reading higher than 140 mmHg systolic or 90 mmHg diastolic two days in a row qualifies as hypertension. According to the World Health Organization:1

  • 1.28 billion adults ages 30–79 years worldwide have hypertension.
  • 46% of adults with hypertension are unaware that they have the condition.
  • Two-thirds of hypertensive people live in underdeveloped countries.
  • Only one in five adults with hypertension have it under control.

The consequences of leaving this condition untreated can be serious: heart attack (myocardial infarction), heart failure (an exhausted heart), stroke (brain bleeding) or kidney failure.

Any one of the following symptoms should make you want to take someone’s blood pressure: severe headaches, chest pain, dizziness, difficulty breathing, nausea or vomiting, blurred vision or other vision changes, confusion, tinnitus, nosebleeds, or abnormal heart rhythm.

The three root causes of hypertension are:

  • Liver qi stagnation
  • Blood heat/heart heat
  • Spleen damp

1. Liver Qi Stagnation

Imagine a muscular tube — a blood vessel — through which blood flows. Now, squeeze it from the outside all along its length, and imagine the actual space inside decreasing while the volume of blood remains the same. A cramped space encourages more qi of the blood to press against the sides and less moving the blood forward.

This constant “tug-of-war” can also disrupt the interior lining of the vessel. The body will use slippery cholesterol to patch over the crack in order to re-establish an aerodynamic flow. However, layer after layer of patching material will decrease the interior space, thus increasing blood pressure. This risky condition is known as atherosclerosis.

Acute fear elicits a healthy fight-or-flight response in the body’s muscles. However, chronic fear, also known as worry, anxiety, dread, guilt, and a hundred other synonyms, will cause a continuous and unhealthy fight-or-flight response. Muscles, including muscular organs and blood vessels, remain contracted in readiness for action, but that action never takes place because the perceived threat is a false one. When thoughts get stagnated in the imaginary past or future, blood pressure rises.

2. Blood Heat

Blood heat is also known by another name — heart heat. Imagine a healthy blood vessel. Now add heat to the blood. Pressure and heat have a direct relationship because heat expands. As the heat increases, the molecules of blood go crazy, pounding in every direction, including against the insides of the vessel. And up goes the pressure.

The heart governs the blood and houses the shen. In all cases of heart heat, the shen will be overactive and disturbed.

Origins of Blood Heat

Excessive movement or excessive speed causes unnecessary friction. Overwork, sleep deprivation, multi-tasking, and living in the fast lane are common causes of excessive movement.

Stagnation of liver qi/blood can cause excessive friction. Imagine a qi flow that is blocked by a wall. The frustrated qi will grind and grind, trying to get through or go around. (Make a tight fist for 15 seconds, then open your hand. You’ll feel the heat and see the reddish palm.)

Food stagnation in the gut ferments and will likely develop into “yangming heat,” which rises and expands into any tissue, organ, and even the blood.

Smoking introduces hot gases into the body and sometimes the blood; and stimulants such as energy drinks, cocaine, or caffeine will increase the busyness of the qi and add heat to the blood.

3. Spleen Damp

A damp spleen is synonymous with excess body fat, spleen qi deficiency, and weak or no hunger. Imagine a healthy blood vessel. Increase the amount of fluid in the vessel. Again, we have a cramped space. The extra molecules will press against the insides of the vessel in an attempt to make room or escape, thus raising the pressure.

In addition, crowding of the body’s interior with excess yin/material will press against the outer walls of blood vessels, decreasing space inside and increasing the blood pressure.

There is only one cause of spleen damp: overeating. And there is only one remedy for a damp spleen: undereating. Overeating is the consumption of more calories — food energy / guqi —than the body uses. Undereating is the consumption of fewer calories than the body uses.

Contrary to the century-long barrage of advertisements from the food and diet industries, there is no food that, by itself or in combination with other foods or supplements, causes spleen damp or enlarged fat cells — the body’s first choice for the storage of extra food.

Wellness Coaching

Prevention and cure are two sides of the same coin. If you can decrease high blood pressure in such a way that it never returns, you have achieved a cure. While acupuncture and herbology can have a powerful effects on qi stagnation and blood heat, they cannot prevent the recurrence of these syndromes. They alone cannot cure hypertension. And they will do nothing for spleen damp.

As an aside, all my life, my blood pressure reading was the same — the high end of normal at 140/90. Then I practiced one year of OMAD (one meal a day). In that time, my waist measurement decreased from 34 inches to 29 inches. At the same time, my pressure dropped to the low end of normal: 90/60. I was stunned. It remains there today.

While the needles are in, and your assistant is preparing the formula, talk with your patients about how to stop the unhealthy habits of worrying, hurrying, and overeating, dependent of course on the diagnosis. Replacing unhealthy habits with healthy ones is the essence of wellness coaching.


  1. Fact Sheet: Hypertension. World Health Organization, March 16, 2023.
  2. Kihn D. “Hunger Is Your Patient’s Best Friend.” Acupuncture Today, February 2024.
  3. Kihn D. “OMAD and the Shedding of Excess Yin.” Acupuncture Today, January 2023.
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