Edited by Debra Nash-Galpern and Britta Becker-Thomas
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 upward.
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). 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
General Manifestation: Systolic pressure is above 160 mmHg and diastolic pressure is 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 backup 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.
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 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.
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). 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.
Possible Formulas: 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.
