In addition to the eight principle differentiation, there are many other tools that an acupuncturist can use to generate an accurate clinical diagnosis. In fact, it is my belief that a diagnosis is not complete until certain parameters have been thoroughly evaluated. Among these parameters are of course pulse diagnosis and examination of the ear. But also included are blood pressure, heart rate, temperature, color, and skin texture. At a glance, these extra diagnostic measures may seem more western than TCM. However, they reveal vital information that may not necessarily be established from traditional methods alone. In part I of this discussion, I will explain the relevancy and applications of how taking the blood pressure and heart rate of patients can establish a more accurate diagnosis.
Blood pressure and heart rate can help to determine excess or deficiency, hot or cold in a patient. This is useful for diagnosing the true underlying condition of a patient whose subjective complaints contradict objective findings. Normal blood pressure of an adult is around 120/80 mmHg, 120 being the systolic pressure, and 80 being the diastolic pressure. According to the American Heart Association, a normal resting heart rate for an adult ranges from 60-80 beats per minute. Based on the different combinations of blood pressure and heart rate, we are able to distinguish four distinct types of patients.
Type I patients have relatively high systolic pressures (above 140 mmHg), and high diastolic pressures (above 90 mmHg). They also have relatively fast heart rates (over 85 bpm). This type of patient definitely has some sort of excess heat in the body. Even if the patient complains of feeling cold, if they present with this type of blood pressure and heart rate, their underlying condition is still heat. The sensation of cold may be an exogenous pathogenic cold factor affecting the body, in which case you would release the exterior cold first before sedating the excess internal heat. If the patient is coming in for chronic fatigue, and looks pale, tired, and deficient, but they present with this type of blood pressure and heart rate, you still sedate them. Giving tonic herbs to this type of patient will exacerbate his or her condition.
Type II patients have relatively low systolic blood pressures (below 95 mmHg) and low diastolic blood pressures (below 60 mmHg). They also have relatively slow heart rates (below 60 bpm). This type of patient is deficient and cold in nature, and must be given tonics such as Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction), or Ren Shen Yang Ying Tang (Ginseng Decoction to Nourish the Nutritive Qi). Do not use any sort of cold medicine for these patients.
Type III patients have relatively high systolic blood pressures (above 140 mmHg) but they have normal diastolic pressures. Their heart rates are generally slow (below 65 bpm), and the patient is not on any type of blood pressure medication. It is difficult to determine whether this is excess or deficient, hot or cold without any other parameters. However, these types of patients typically have blood stagnation. The flow of blood is stagnated due to the low heart rate not being able to pump the blood, but the pressure within the vessels is high because the volume of blood is not being circulated adequately, creating higher blood pressure. In these cases, the patient should take blood movers such as Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction), Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction), and Shao Fu Zhu Yu Tang (Drive Out Blood Stasis in the Lower Abdomen Decoction). For cases of blood stasis, the Liver must be addressed because it is the organ that stores blood, and can often be the center of dead blood, especially in cases of trauma. Fu Yuan Huo Xue Tang (Revive Health by Invigorating the Blood Decoction) or Zheng Gu Zi Jin Dan (Purple and Gold Pill for Righteous Bones) are excellent formulas for trauma.
The last type of patients, Type IV, manifests with relatively low systolic blood pressures (below 90 mmHg), and low diastolic pressures (below 60 mmHg), but they have fast heart rates (over 80-100 depending on the age, sex, and physical constitution of the person). This type of patient has yin deficiency heat. The blood pressure is low because there is not enough substance (represented by blood and yin) in the body, but the heart rate is fast from the underlying heat. Usually this type of patient is thin, tends to be fatigued easily, and may have sleep issues. Formulas to tonify the yin should be used. Herbs with sour properties to tonify the Liver, such as Wu Wei Zi (Fructus Schisandrae Chinensis) and Shan Zhu Yu (Fructus Corni), are also good to use for fast recovery of the Liver to produce more energy. It is possible for patients with hepatitis to manifest with this type of blood pressure and heart rate. In that case, Wu Wei Zi (Fructus Schisandrae Chinensis) should be used at 30% or higher of the overall formula to boost Liver function.
About the Author
Master Jimmy Wei-Yen Chang has over 25 years of concentrated clinical experience applying his expertise in differential diagnosis and herbal prescription. The author of a pulse diagnosis manual, Pulsynergy, Master Chang currently pursues his specialties in private practice in Hacienda Heights, California, and is widely recognized for his skills in correlating expert pulse taking and herbal prescription.
To learn more about pulse diagnosis and herbs, click here [2] to view a complete list of courses by Jimmy Chang.