Hypertension II (Too!): A TCM look at types of high blood pressure

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Michael has just done a great blog on hypertension, so I decided to supplement that with further information that I use. I have found a system created by the acupuncturist/teacher, Jimmy Chang, to be very useful clinically, as a couple of these patterns are not normally mentioned in books, classes or articles. He determined a correlation between blood pressure and pulse rate to help determine the TCM patterns involved. What he created follows the Eight Principle Diagnostic system and treats not only hypertension, but hypotension as well.

This system starts by first taking the blood pressure with a machine. Now I learned from an MD how to get the best reading when taking blood pressure. First of all, put the cuff on loosely and then completely rest the arm for 10 minutes (lay it down by one's side, it doesn't have to be up at heart level according to this doctor). After the 10 minutes are up, tighten the cuff and take the blood pressure. Next, take 10 points off the top number (the MD said that the portable machines available measure higher than the traditional cuff and pneumatic machine found in doctor offices). As well, note the pulse rate.

Once you get the numbers, jot them down. The overall blood pressure measures the pressure of the blood flowing through the blood vessels. The higher the blood pressure, the harder the heart has to work. The top number is the systolic rate and measures the pressure in the arteries while the heart beats; diastolic pressure measures the pressure in the arteries between the heart beats, (the pressure should decrease between the heart beats).

Next, compare the numbers from the machine with the following:

Normal blood pressure: 120/80

Hypertension: greater than 140/90

Normal pulse rate: 60/100; 40 range for highly trained athletes

Note the broad range for the pulse. Some have said that 72-80 is normal, but that's the average range. Thus, the higher the number is, the more it's toward the fast side and vice versa.

Now, take all of this information and see which of the following categories the obtained numbers fit:

 

 

 

Jimmy Chang's Blood Pressure Patterns:

TYPE

PRESSURE

HEART RATE

DIAGNOSIS

HERBS

Type 1

High   High

Fast

Excess Heat

Heat clearing

Type 2

Low    Low

Slow

Yang Deficiency

Yang tonics

Type 3

High   Normal

Slow

Deficient Heat & Blood Stasis

Blood moving, herbs that cool the Blood & herbs that clear Heat from Deficiency

Type 4

Low    Low

Fast

Yin Deficiency Heat

Yin tonics, herbs that cool the Blood & herbs that clear Heat from Deficiency

 

This system presents us with one new pattern not normally included when following a TCM hypertension treatment protocol, Blood stasis with Deficiency Heat. As well, there is clearly one pattern, low systolic, low diastolic and slow pulse, that indicates hypertension.

Again, I give credit for this above system to Jimmy Wei-Yen Chang (L. Ac., Dipl. Ac., licensed acupuncturist in Taiwan and New York state). What follows now is from me:

TYPE SYSTEM ANALYSIS:

 

Type 1: Excess Heat - this generally correlates with either Ascendant Liver Yang hyperactivity or Phlegm Fire.

Ascendant Liver Yang

Symptoms: headache, dizziness, vertigo, tinnitus, ringing in the brain, head distention and pain, red face, restlessness and agitation, easily angered, bitter taste in the mouth, insomnia, tongue with red tip and/or edges with yellow coat, and bowstring pulse

Treatment Principle: Ascendant Liver Yang: sedate uprising Yang and clear Heat; Phlegm Fire: transform Phlegm and clear Fire

 

Herbal Therapy: Ascendant Liver Yang: Gastrodia and Uncaria Combination (Tian Ma Gou Teng Yin); Phlegm Fire:  (Huang Lian Wen Dan Tang)

 

Appropriate Hypotensive Chinese Medicinals to include:

prunella (xia ku cao), abalone shell Concha haliotidis (shi jue ming), cassia seeds (jue ming zi), chrysanthemum (ju hua), gastrodia (tian ma), tribulus (bai ji li), gardenia (zhi zi), coptis (huang lian)

 

 

Phlegm Fire

Symptoms: dizziness, chest oppression, profuse phlegm and balls of it, nausea, vomiting, head distention, palpitations, bitter taste, slimy tongue with tip and/or sides red with yellow coat, slipper, fast and bowstring pulse

Treatment Principle: transform Phlegm and drain Fire

 

Herbal Therapy: Coptis Decoction to Warm the Gallbladder (Huang Lian Wen Dan Tang)

 

Appropriate Hypotensive Chinese Medicinals to include:

coptis (huang lian), pueraria (ge gen), phellodendrun (huang bai), prunella (xia ku cao), gardenia (zhi zi), moutan (mou dan pi), scute (haung qin)

 

 

Type 2: Yang Deficiency

Symptoms: coldness, cold back and knees, nighttime urination, abundant clear urination, infertility in women, impotence, paleness, low back pain, knee pain, joint problems, urinary problems, poor memory, especially short term, sexual issues, poor digestion, premature ejaculation, edema of the legs, loose stools, pale, swollen and wet tongue, and a weak, deep and slow pulse

Treatment Principle: tonify Kidney Yang

 

Herbal Therapy: Replenish the Right Decoction (You Gui Wan) or Rehmannia Eight Combination (Ba Wei Di Huang Wan)

 

Appropriate Hypotensive Chinese Medicinals to include:

cordyceps (dong chong xia cao), eucommia (du zhong)

 

 

Type 3: Deficient Heat and Blood Stasis:

Symptoms of Deficient Heat:heat in the palms and soles, night sweats, irritability, restlessness, thirst, tidal fever, afternoon fever, fevers at night followed by coolness in the morning (without sweating), steaming bones, loss of semen, abnormal bleeding (from the nose, lungs, vagina, intestines and so on plus hemorrhage, subcutaneous bleeding, menorrhagia, coughing up or vomiting blood) all due to Heat in the Blood, purpuric rashes due to Heat in the Blood, red or scarlet tongue that's possibly peeled, and thin and fast pulse

Symptoms of Blood Stasis: sharp fixed, stabbing or boring pains, blocked, painful or difficult menstruation with dark blood and large clots, immobile masses and lumps, painful and irregular periods, serious pain in the chest, blood clots, dark complexion, purple lips, nails, tongue or veins, some cysts, fibroids, tumors, varicosities, bleeding with dark blood and dark clots, tremors and swelling of the Organs, purplish tongue with large sublingual veins, and wiry, choppy or rough pulse

Treatment Principle: move the Blood, clear Heat from the Blood and clear Deficient Heat

 

Herbal Therapy:Most Blood moving herbal formulas that I know are warming in energy, which could create more Heat in the Blood here. Thus, use Cooling or neutral herbs to create your own formula or to modify another. Be sure to combine blood movers with herbs that Cool the Blood, herbs that clear Heat from Deficiency and if indicated, herbs that stop bleeding:

Possible Herbs to Choose:

Blood movers: Salvia miltiorrhizae (dan shen), red sage root, safflower (hong hua), achyranthis (niu xi), turmeric tuber (not rhizome, which is warming) (yu jin), motherwort(yi mu cao), Polygonum cuspidatum (hu zhang), bushy knotweed or giant knotweed rhizome, persica (tao ren), peach kernel, red peony root (chi shao), white peony root (bai shao), Sparganium stoloniferum (san leng), common burr reed, myrrh (mo yao), achyranthis (niu xi), cyathula (chuan niu xi), vaccaria seeds (wang bu liu xing)

Herbs that Cool the Blood: raw rehmannia (sheng di huang), moutan peony (mu dan pi), lithospermum (zi cao)

Herbs that clear Heat from Deficiency: lycii cortex (di gu pi), Artemisia annua (qing hao), sweet wormwood or sweet annie

Herbs that stop bleeding: cattail pollen (pu huang), sanguisorbae (di yu), sophora flowers (huai mi), sophora fruit (huai jiao), agrimony (xian he cao), blettilla (bai ji), donkey skin gelatin (e jiao), calcined human hair (xue yu tan), Panax pseudoginseng (san qi).

Appropriate Hypotensive Chinese Medicinals to include:

rhodiola (hong jing tian), phellodendrun (huang bai), eucommia (du zhong), abalone shell Concha haliotidis (shi jue ming), dragon bone Os draconis (long gu), oyster shell (mu li), pearl shell Concha margaritiferae (zhen zhu mu), hematite (dai zhe shi), chrysanthemum (ju hua), uncaria (gou teng), gastrodia (tian ma), loranthus (sang ji sheng)

 

Type 4: Yin Deficiency Heat

Symptoms: heat in the palms and soles, night sweats, irritability, restlessness, thirst, tidal fever, afternoon fever, fevers at night followed by coolness in the morning (without sweating), steaming bones, loss of semen, red tongue that's possibly peeled, and thin and fast pulse

 

Treatment Principle: tonify Yin, clear Deficient Heat and cool the Blood

Herbal Therapy: Replenish the Left Decoction (Zuo Gui Yin) modified with herbs that clear Heat from Deficiency and herbs that Cool the Blood:

 

Possible Herbs to Choose:

Herbs that clear Heat from Deficiency: lycii cortex (di gu pi), Artemisiae annuae (qing hao), sweet wormwood or sweet annie

Herbs that Cool the Blood: moudan peony (mu dan pi), raw rehmannia (sheng di huang), lithospermum (zi cao)

Yin Tonics (if you desire to create your own formula): eclipta (mo han lian), ligustrum (nu zhen zi), privit fruit, black sesame seeds (hei zhi ma), (glehenia/adenophorae (sha shen), American ginseng (xi yang shen), ophiopogon (mai men dong), asparagus root (tian men dong), dendrobium (shi hu), lily bulb (bai he), polygonatum (yu zhu), scented Solomon's seal rhizome

 

Appropriate Hypotensive Chinese Medicinals to include:

rhodiola (hong jing tian), phellodendrun (huang bai), eucommia (du zhong), abalone shell Concha haliotidis (shi jue ming), dragon bone Os draconis (long gu), oyster shell (mu li), pearl shell Concha margaritiferae (zhen zhu mu), hematite (dai zhe shi), chrysanthemum (ju hua), uncaria (gou teng), gastrodia (tian ma), loranthus (sang ji sheng)

 

HYPERTENSION AGGRAVATING MEDICINALS:

 

And last but not least, here are herbs that should NOT be used if there's hypertension because THESE CAN RAISE THE BLOOD PRESSURE:

ginseng (ren shen), licorice (can cao), ephedra (ma huang), deer antler (lu rong), immature tangerine peel Citri aurantii (zhi shi), Angelica dahurica (bai zhi), mugwort (ai ye), psoralea (bu gu zhi), asarum (xi xin), wild ginger, Portulacae oleraceae (ma chi xian), mint (bo he), garlic, although in some cases it can lower blood pressure (Yang Deficiency), in others it can elevate it (Heat conditions).

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