Using Blood Pressure and Heart Rate Measurements to Determine an Objective TCM Diagnosis: A Method Devised by Jimmy Chang, MPH, PhD, OMD, LAc
Using Blood Pressure and Heart Rate Measurements
to Determine an Objective TCM Diagnosis:
A Method Devised by Jimmy Chang, MPH, PhD., OMD, LAc.
by Tina Chen, L.Ac.
Edited by Debra Nash-Galpern and Britta Becker-Thomas
Published January 10, 2020
INTRODUCTION:
During the last twenty plus years in which Dr. Jimmy Chang has been teaching, he has taught us that a proper assessment of patients’ blood pressure and heart rate can prove to be a much more reliable diagnostic measure than the patients’ subjective complaints. Dr. Chang has made the distinction of four different blood pressure and heart rate types. These types lead to an objective Eight Principle pattern differentiation, often independently of the patients symptoms. Such an accurate diagnosis, which often stands in stark contrast to the patient’s symptoms, can guide the practitioner to prescribe very effective formulas.
In 2018, based on a new study on blood pressure done in Taiwan, Dr. Chang discovered further systolic and diastolic blood pressure types with corresponding effective herbal prescriptions. We present here a summary of all of these patterns in order to assist practitioners to use this information correctly for diagnosis and sound treatment protocols.
GENERAL CONSIDERATIONS:
SYSTOLIC PRESSURE:
A normal systolic pressure should be no higher than 160 mmHg, and no lower than 110 mmHg.
Systolic pressure is directly correlated with blood pressure in the head. High systolic pressure is an indication of an overactive sympathetic nervous system which indicates that the patient is under too much stress. Other common reasons are decreased kidney function or neck and shoulder congestion.
DIASTOLIC PRESSURE:
Diastolic pressure should be in the range of 70 to 95 mmHg.
Diastolic blood pressure is the pressure found in the vessels in between heartbeats, and correlates directly with the pressure found in the heart.
HEART RATE:
A normal heart rate is between 60 - 80 beats per minute (bpm). Heart rate is most significant when it’s above 110 where you should suspect infection and pus should the patient also displays fever in your clinic.
DIAGNOSING AND TREATING BLOOD PRESSURE TYPES:
Type 1: High blood pressure, fast heart rate:
Description:
This type of patient presents with a systolic blood pressure above 140 mmHg, a diastolic blood pressure above 90 mmHg, and a rapid heart beat (above 85 bpm). No matter what the patient’s complaints are, even if they appear as paradoxical (for example the patient may complain of weakness, dizziness, and other deficiency signs), the objective finding based on this blood pressure type is one of excess heat.
Measurements:
Systolic > 140 mmHg
Diastolic > 90 mmHg
HR: > 85 bpm
Possible symptoms:
Any symptoms associated with excess heat, but may include paradoxical symptoms, such as weakness, dizziness and deficiency symptoms.
Pulse Quality:
Expanding, forceful, thick, convex, big
Eight Principle Differentiation:
Excess Heat
Treatment Principle:
Clear Excess Heat via acupuncture, blood letting and/or heat purging herbs.
Possible Formulas:
Bai Hu Tang (White Tiger Decoction)
Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver)
Dr. Chang likes to use Gardenia Complex (Evergreen Herbs) as it consists of the above listed formulas plus Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron and Rhemannia Pill). He prefers to combine all three formulas, using the metaphor that it is faster to ventilate a car by opening all the windows at once instead of one at a time. This concept applies here in that the three formulas used together clear heat from all Three Jiaos simultaneously.
Contraindications:
Tonic formulas are contraindicated and put patients with this blood pressure presentation at risk.
Type 2: Low blood pressure, slow heart rate:
Measurements:
Systolic < 95 mmHg
Diastolic < 60 mmHg
HR: < or = 60 bpm
Possible symptoms:
Any signs of deficiency
Pulse Quality:
Small
Eight Principle Differentiation:
Deficiency
Treatment Principle:
Tonification via tonifying formulas.
Possible Formulas:
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Shi Quan Da Bu Tang (All Inclusive Great Tonifying Decoction)
Contraindications:
Avoid using too many heat clearing herbs. Should some heat be present, be sure that the majority of your prescription is tonifying. Acupuncture is contraindicated.
Low systolic blood pressure (< 110 or 90 mmHg) indicates that the body is deficient and needs tonification. In this case dietary advice should include eating a more hearty diet including beef, which is high in zinc, in order to build more protein. Ideally beef should be included in every meal. Exercise in this case should be mild.
Type 3: High systolic blood pressure, slow heart rate:
Description:
In this case the systolic blood pressure is above 140 mmHg, diastolic blood pressure is usually normal (around 80 mmHg) and the heart rate is lower than or equal to 65 bpm. This reading would be indicative of someone who does not require blood pressure medication.
Measurements:
Systolic > 140 mmHg
Diastolic normal (around 80 mmHg)
HR: < or = to 65 bpm
Possible symptoms:
Dark lips, tongue, gums and elbows, brownish spots on the ears
Pulse Quality:
Stagnant, sluggish, low amplitude
Diagnosis:
Blood Stasis
Treatment Principle:
Move Blood
Possible Formulas:
Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood)
Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction)
Shao Fu Zhu Yu Tang (Drive Out Blood Stasis in the Lower Abdomen Decoction)
She Chong Yin (Break the Conflict Decoction)
Zheng Gu Zi Jin Dan (Purple and Gold Pill for Righteous Bones)
Contraindications:
Use less tonics to avoid more stagnation in the body.
Type 4: Low Blood Pressure, Fast Heart Rate
Description:
Here the systolic blood pressure is below 90 mmHg, diastolic blood pressure is usually below 60 mmHg and the heart rate is over 80 or 100 bpm. These patients are usually chronically ill and have exhausted themselves physically and emotionally over prolonged periods. Hospitalized patients often present with this blood pressure type.
Measurements:
Systolic < 90 mmHg
Diastolic < 60 mmHg
HR: > 80 bpm
Possible Signs and Symptoms:
Physical and mental exhaustion
Pulse Quality:
Rapid
Diagnosis:
Deficiency, heat - Yin deficiency
The faster the heart rate the more deficient the yin fire has become. Dr. Chang refers to this as a deficiency of substances, such as blood, hormones and proteins.
Treatment Principle:
Nourish yin, clear deficiency heat with herbs and diet (no needling)
Possible Formulas:
Mild tonics such as Ren Shen Yang Ying Tang (Ginseng Decoction to Nourish the Nutritive Qi)
Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia)
Other Recommendations:
Patients need to eat more, especially red meat such as beef. Nutrients from food are essential for recovery. Avoid raw foods.
Contraindications:
Strongly warming or tonifying herbs cannot be handled by these patients. When used, deficient fire will flare up and patient may experience symptoms of irritability, restless sleep, hot flashes, etc. Needling is contraindicated.
MORE SPECIFICS JUST ON THE SYSTOLIC AND DIASTOLIC PRESSURES
Type 5: High Systolic and Diastolic Pressures:
Description:
Patients with this type have both high systolic (>170 mmHg) and diastolic (>110 mmHg) blood pressures, and are usually robust and appear overweight. Left unchecked for ten years or more, this condition puts the patient at high risk for myocardial infarction. Left untreated for over twenty years, stroke is likely to occur. Renal hypertension is also a likely consequence if left untreated.
Measurements:
Systolic > 170 mmHg
Diastolic > 110 mmHg
Pulse Quality:
Thick and forceful indicating hardening of the vessels and sympathetic hyperactivity.
Left CUN pulse will be a gu pulse
Right CHI pulse may be a turtle pulse or just generally thick and forceful. This indicates that blood flow to the head is reduced due to neck tension.
Diagnosis:
Blood Stasis and Heat
Treatment Principle:
Move Qi and Blood, Clear Heat, Drain Dampness
Possible Formulas:
To lower blood pressure use:
Mao Dong Qing (Radix Ilicis Pubescentis)
Shui Ding Xiang (Herba Ludwigiae Prostratae)
Xiang Feng Cao (Herba Bidentis)
Chuan Niu Xi (Radix Cyathulae)
Di Long (Pheretima Lumbricus?)
For neck tension add:
Ge Gen Tang (Kudzu Decoction) OR Flex Spur (this is Dr. Chang’s special formula, and is made by Evergreen herbs)
Dietary and Other Considerations:
Avoid all carbohydrates (except wheat) and reduce meat consumption, concentrating on vegetables. Consume as little food as possible, always remaining slightly hungry. Reduce meals to twice per day. This is essential to improving this precarious situation, even though it may constitute a challenge to the patient.
Regular gua sha, cupping, or massage to release the tension in the neck can be also very helpful.
Contraindications:
Avoid tonic herbs to prevent more stagnation from forming. Use only when necessary.
Type 6: High systolic, normal diastolic pressure:
Description:
In this case the systolic blood pressure is above 170 mmHg, but the diastolic blood pressure remains normal (around 80 mmHg). This blood pressure presentation is usually due to constriction in the neck area, stenosis of the spine or the carotid arteries? , bone spurs or muscle tension resulting in poor blood flow to the head and increased pressure rising upwards.
Measurements:
Systolic > 170 mmHg
Diastolic normal (around 80 mmHg)
Possible signs and symptoms:
Neck pain or headache are common symptoms.
Neiguan (Pericardium 6) will be pale upon examination, indicating poor blood flow to the head.
Possible purplish tongue or brown spots on the neck area of the ear.
Pulse Quality:
Right CHI is thin and tight. The thinner and tighter it is the more severe the neck constriction and the higher the blood pressure.
Diagnosis:
Blood and Qi Stagnation in the Neck area
Treatment Principle:
Move Qi and Blood in the neck with herbal formulas, gua sha, massage or cupping.
Possible Formulas:
Ge Gen Tang (Kudzu Decoction) and/or Dr. Chang’s formula Flex Spur, available at Evergreen Herbs
For headache add Chuan Xiong Cha Tiao San (Ligusticum Chuanxiong Powder) to be taken with Green Tea.
For blood stasis add Shen Tong Zhu Yu Tang (Drive Out Blood Stasis from a Painful Body Decoction) and Zheng Gu Zi Jin Dan (Purple and Gold Pill for Righteous Bones). If blood stasis is present, patient will present with a purplish tongue and/or brown spots on the neck area of the ear.
For heat add Ge Gen Huang Qin Huang Lian Tang (Kudzu, Coptis, and Scutellaria Decoction)
Other Considerations:
Check the height of the patient’s pillow for proper ergonomic alignment. Recommend hot baths, yoga and/or stretching exercises to the patient.
Contraindications:
None noted. Avoid using tonics unless necessary.
Type 7: High Systolic and Low Diastolic Pressures 160/75 mmHg
General Manifestation:
Systolic pressure is above 160 mmHg and Diastolic Pressure below 75 mmHg. This indicates a heart valve problem with blood regurgitation. The heart is too weak to pump enough blood through it, causing a back up of blood.
Measurements:
Systolic > 160 mmHg
Diastolic < 75 mmHg
Possible signs and symptoms:
Dizziness, headache, shortness of breath and fatigue, especially upon exertion. Examine the shins for edema. Check kidney function via lab tests.
Diagnosis:
Deficiency and Blood Stasis - Heart Qi and Blood deficiency, Heart Blood Stasis
Treatment Principle:
Tonify Qi and Blood of the heart, move Qi and Blood in the Upper Jiao
Possible Formulas:
Mao Dong Qing (Radix Ilicis Pubescentis)
Sheng Mai San (Generate the Pulse Powder)
Ge Gen Tang (Kudzu Decoction)
Shen Tong Zhu Yu Tang (Drive Out Blood Stasis from a Painful Body Decoction)
Zheng Gu Zi Jin Dan (Purple and Gold Pill for Righteous Bones)
Formulas such as Ge Gen Tang (Kudzu Decoction) can be added to enhance the overall effect.
Contraindications:
None noted.
To normalize a low diastolic pressure, the patient should be encouraged to eat more heartily, and include foods, such as red meat, to provide nutrients and blood flow to the organs and tissues.
Type 8: Low Systolic and Low Diastolic Pressures
General Manifestation:
Both systolic and diastolic pressure are below normal. The patient is in danger of suffering a stroke because the pressure outside of the blood vessels (in the connective tissue) is higher than the pressure inside the blood vessel. This can press into the blood vessel obstructing blood flow, resulting in stroke.
Diagnosis:
Qi and blood deficiency
Treatment Principles:
Tonify qi and blood
Possible Formulas:
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction)
Contraindications:
Avoid using heat clearing and other harsh herbs.
Other Considerations
Low systolic blood pressure (< 110 or 90 mmHg) indicates that the body is deficient and needs tonification. In this case dietary advice should include eating a more hearty diet including beef, which is high in zinc, in order to build more protein. Ideally beef should be included in every meal. Exercise in this case should be mild.
Type 9: Low Systolic and Normal Diastolic Pressures
General Manifestation:
This is just qi and blood deficiency.
Pulse Quality:
Can be merely small or thick, or weak and scattered.
Possible Signs and Symptoms:
Fatigue
Diagnosis:
Qi and blood deficiency
Treatment Principles:
Tonify Qi and Blood
Formulas:
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction)
If the pulse is thick and scattered, use Wu Wei Zi (Fructus Schisandrae Chinensis), Shan Zhu Yu (Fructus Corni) and Sheng Mai San (Generate the Pulse Powder).
Contraindications:
Avoid using harsh or strong herbs.
Other Considerations:
To normalize a low diastolic pressure, the patient should be encouraged to eat more heartily, and include foods, such as red meat, to provide nutrients and blood flow to the organs and tissues.
Type 10: Normal Systolic and High Diastolic Pressures
General Manifestation:
This indicates that the heart is weak and the patient may suffer from congestive heart failure.
Measurements:
Diastolic > 95 mmHg
Pulse Quality:
Can be merely small or thick, or weak and scattered.
Possible Signs and Symptoms:
Exhaustion, shortness of breath with exertion, lower limb edema, cough, stiff neck and shoulders.
Herbs:
Ge Gen Tang (Kudzu Decoction), Ge Gen Huang Qin Huang Lian Tang (Kudzu, Coptis, and Scutellaria Decoction).
Other considerations:
When high diastolic pressure is found, the patient should be advised to eat lightly and consume plenty of fresh vegetables.
About Jimmy Chang, MPH, PhD, OMD, L.Ac.
Master Jimmy Wei-Yen Chang is a Doctor of Oriental Medicine trained in Taiwan and a licensed acupuncturist in California and New York. He has over 40 years of concentrated clinical experience treating over 500,000 patients, applying his expertise in differential diagnosis and herbal prescription. Master Chang is the author of the pulse diagnosis manual, Pulsynergy, and is currently in private practice in Hacienda Heights, California. He is widely recognized for his skills in correlating definitive pulse diagnoses with herbal prescription.
Live webinars and videos on Dr. Chang’s pulse system and prescriptions are available on www.eLotus.org
To Intern with Dr. Chang visit: http://pulsynergy.com/intern-with-jimmy/
About the Author
Tina Chen is respected herbologist holding a Masters of Oriental Medicine degree in Chinese Medicine and is a California Acupuncture Board Licensed Acupuncturist. She has had extensive training and practice in pulse diagnosis and Chinese herbal medicine. Tina graduated from South Baylo University of Oriental Medicine, the University of California, Irvine, and pursued extensive post-graduate training in China at Anhui Hospital in Anhui, First Tianjin Hospital in Tianjin, and Guananmen Hospital in Beijing.
In addition to being a Licensed Acupuncturist, Tina is also certified in Traditional Chinese Medicine by the World Health Organization, with specialties in herbology, gynecology, and internal medicine. She co-authored textbooks in Chinese herbology — Chinese Medical Herbology and Pharmacology in 2003 and its companion volume Chinese Herbal Formulas and Applications in 2008. In 1995, Tina became an apprentice of Dr. Jimmy Chang, and is now a leading practitioner of Dr. Chang’s Pulsynergy method. Currently she works at Evergreen Herbs and practices at Jian Tai Clinic.
More information on the single herbs and and formulas mentioned in this article can be found in volumes “Chinese Medical Herbology” and “Chinese Herbal Formulas and Applications”. Sample pages can be found here aompress.com To purchase these books, please visit www.evherbs.com
