Using Chinese Medical Pattern Discrimination for Prescribing Western Hypotensive Drugs

abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, treatment based on pattern discrimination, hypertension

For a number of years, I have been suggesting that Chinese medical pattern discrimination could help Western doctors more accurately prescribe Western drugs. Till now, I have never read or heard anyone else make this suggestion. However, this may be one of the most important gifts of Chinese medicine to the history of world medicine. Therefore, I was gratified to recently read a Chinese article on this very subject. On pages 255-258 of issue #3, 2007 of the Zhong Xi Yi Jie He Xue Bao (Academic Journal of Integrated Chinese-Western Medicine), Gu Wan-li et al. published an article titled “Looking at the Use of Hypotensive Medicines Based on Pattern Discrimination.” Three of the authors of this article are doctors at the National Integrated Center of Cardiovascular Disease at the China-Japan Friendship Hospital in Beijing, while the fourth author is an overseas Chinese working at the Center for East-West Medicine at the University of California in Los Angeles. These authors reviewed 11 articles on hypertension published in Chinese medical journals published between 1995 and 2006, with all but one those articles published between 2000 and 2006. I believe this article is particularly important because I think most experienced Chinese medical practitioners agree that, in the majority of cases, pure Chinese medicine does not handle hypertension very well. Therefore, some use of Western hypotensive drugs is often necessary, with or without the simultaneous use of Chinese medicinals. However, not every Western hypotensive is effective for every hypertensive patient, and, unfortunately, Western MDs primarily determine which drugs to use based on trial and error. On the other hand, if it could be determined which Western hypotensive drugs were best for patients presenting this or that Chinese medical pattern(s), then determining which Western hypotensive drugs to use would be quicker, easier, more effective, and fraught with less side effects. Therefore, a summary of this article is presented below.

The six classes of Western hypotensive drugs used in China

The authors begin their article with a discussion of the six classes of hypotensive drugs currently used by Western medical practitioners in China. These include diuretics, beta-adrenergic blocking agents, angiotension-converting enzyme (ACE) inhibitors, angiotension II receptor blocking agents, alpha-adrenoceptor antagonists, and calcium channel blocking agents. As the authors note, the therapeutic effects of these six classes of Western drugs are far from ideal in terms of controlling blood pressure. In addition, all six of these classes of Western drugs have potential adverse reactions in individual patients. For instance, diuretics may lower potassium, magnesium, calcium, and sodium, may adversely effect low density lipid (LDL) cholesterol, triglycerides, and glucose, and may cause rashes and erectile dysfunction (ED). The side effects of beta-blockers include inducing or exacerbating bronchospasm, sinus node and atrioventricular conduction depression, nasal congestion, Raynaud’s phenomenon, and central nervous system symptoms such as nightmares, excitement, depression, and confusion. In addition, fatigue, lethargy, and impotence may occur. While the side effects of ACE inhibitors are relatively few, they do cause a chronic, dry cough in 5-10% of patients and may cause rashes, alterations in the sense of taste, and angioedema. Angiotensin II receptor blocking agents do not cause dry cough or rashes but may cause hypotension and renal failure as well as rare cases of angioedema. The most common side effects of calcium channel blockers are headaches, peripheral edema, bradycardia, and constipation, while alpha-adrenoceptor antagonists may cause hypotension and syncope, postdosing palpitations, headache, and nervousness. According to the Chinese authors of this article, because both the Chinese and Western disease mechanisms of hypertension are different in different patients, individual patients react differently to these various types of medications. What works well in one patient may cause unacceptable side effects in another patient.

The use of hypotensive drugs based on Chinese medical pattern discrimination

Readers should note that the following opinions are merely provisional since they are based on relatively scanty evidence, in some cases, only a single clinical trial.

1. Diuretics

Based on clinical experience, diuretics work best on patients who present a pattern of phlegm dampness congestion and exuberance. Their effect is less in patients presenting yin vacuity and yang hyperactivity patterns.

2. Beta-blockers

Beta-blockers work best on patients presenting a pattern of ascendant liver yang hyperactivity.

3. Calcium channel blocking agents

These agents seem to work best on patients presenting phlegm dampness congestion and exuberance and/or blood vessel stasis and obstruction.

4. ACE inhibitors

ACE inhibitors seem to work best on patients presenting an ascendant liver yang hyperactivity pattern. However, they also have been shown to work relatively well in patients presenting with yin vacuity and yang hyperactivity as well as liver-kidney yin vacuity patterns. However, it is my own experience that chronic cough is most likely to occur in patients with yin vacuity. In fact, other published Chinese research has shown that Chinese medicinal which supplement yin and engender fluids can eliminate or reduce ACE inhibitor induced cough. To me, this suggests that patients with yin vacuity and yang hyperactivity or liver-kidney yin vacuity taking ACE inhibitors should also simultaneously be administered Chinese medicinals to supplement yin.

5. Angiotensin II receptor blocking agents

Similarly, angiotensin II receptor blockers seem to work best in patients presenting ascendant liver yang hyperactivity signs and symptoms.

6. Alpha-adrenergic receptor blockers

This class of hypotensives is effective in patients presenting ascendant liver yang hyperactivity, liver yang mixed with dampness, liver-kidney yin vacuity, and yin vacuity with yang hyperactivity where there are hot-natured signs and symptoms. Their effect is less in patients presenting spleen-kidney yang vacuity, phlegm turbidity internally obstructing, spleen-stomach vacuity cold, wind and phlegm obstructing the network vessels where there are cold-natured signs and symptoms.

The authors of this article believe that more attention should be given to the administration of Western hypotensive drugs based on pattern discrimination. As yet, Chinese doctors in China are only beginning to consider this kind of study. I also believe this is a very important area for Chinese medical research. If one could correctly prescribe Western drugs based on Chinese medical pattern discrimination, it is my own clinical experience that A) the therapeutic results are better, B) at lower doses, and C) with less or no side effects.

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