Eight Classic Formulas for High Blood Pressure: A Complete Guide

3. Eight Classic Formulas for High Blood Pressure: A Complete Guide

High blood pressure has no exact corresponding disease name in TCM, but classical records on “dizziness,” “headache,” “liver yang,” and “liver wind” have long clarified its core pathomechanisms. TCM treatment of hypertension never fixates on the numbers alone; it observes the person — constitution, pattern type, and the imbalances among qi, blood, phlegm, stasis, fire, wind, and deficiency.

1. Taohexu Chengqi Tang

Stasis-heat mutual binding type · Source: Shanghan Lun

Composition: Peach Kernel 12g, Rhubarb 12g, Cinnamon Twig 6g, Processed Licorice 6g, Mirabilite 6g

Efficacy: Expels stasis and drains heat

Primary Application: Lower jiao stasis-heat mutual binding pattern

What kind of hypertension does this treat?

The most prominent feature of this patient type is stasis and heat twisted together. Headache like a needle stab, fixed location without migration; dull or flushed face, purple-dark lips and tongue, even ecchymotic spots; constipation, stool only every few days; irritability and restlessness, blood pressure stubbornly elevated, conventional antihypertensive drugs with unstable effect. On abdominal palpation, periumbilical area especially left lower quadrant may show resistance and tenderness.

2. Xuefu Zhuyu Tang

Qi stagnation with blood stasis type · Source: Yilin Gaicuo (Qing · Wang Qingren)

Composition: Peach Kernel 12g, Saffron 9g, Angelica 9g, Raw Rehmannia 9g, Achyranthes 9g, Chuanxiong 4.5g, Platycodon 4.5g, Red Peony 6g, Auras (Zhike) 6g, Licorice 6g, Bupleurum 3g

Efficacy: Invigorates blood and resolves stasis, moves qi and stops pain

Primary Application: Qi stagnation with blood stasis pattern

What kind of hypertension does this treat?

For these patients, “pain at a fixed location” is the gold standard. Headache fixed to one side or one area, as if pinned by a nail; chest fullness and palpitations, as if a stone is pressing on the chest; purple-dark tongue with ecchymotic spots or ecchymosis, choppy or wiry-choppy pulse. Course is often long, blood pressure stubbornly difficult to lower, commonly accompanied by coronary artery disease and atherosclerosis. Professor Yan Dexin in treating hypertension especially emphasizes “chronic disease entering the collaterals” and skillfully uses this formula with modifications for this type.

3. Chaihu Jia Longgu Muli Tang

Shaoyang phlegm-heat disturbing the heart type · Source: Shanghan Lun

Composition: Bupleurum 12g, Fossilized Dragon Bone 4.5g, Oyster Shell 4.5g, Scutellaria 4.5g, Ginseng 4.5g, Cinnamon Twig 4.5g, Poria 4.5g, Pinellia 6g, Fresh Ginger 4.5g, Jujube 6 pieces, Rhubarb 6g (original formula’s lead [Pb3O4], modern practice mostly substitutes with Magnetite or Ocher)

Efficacy: Harmonizes and clears heat, settles fright and calms the spirit

Primary Application: Shaoyang pathogen diffusing, phlegm-heat disturbing the heart pattern

What kind of hypertension does this treat?

For these patients, “mental symptoms” stand out more than the blood pressure numbers. Insomnia with vivid dreams, nightmares, easy to startle and fear; chest and abdominal palpitations, feeling as if the heart is about to leap out of the throat; unstable mood, marked anxiety or depressive tendencies; bitter taste and dry throat. Blood pressure often spikes with emotional fluctuations — rises when tense, drops when relaxed; typical “emotional hypertension.” Common in middle-aged and young脑力 workers.

4. Da Chaihu Tang

Shaoyang-Yangming combined disease type · Source: Shanghan Lun

Composition: Bupleurum 15g, Scutellaria 9g, Peony 9g, Pinellia 9g, Fresh Ginger 15g, Immature Bitter Orange (Zhishi) 9g, Jujube 4 pieces, Rhubarb 6g

Efficacy: Harmonizes Shaoyang, internally drains heat accumulation

Primary Application: Shaoyang-Yangming combined disease pattern

What kind of hypertension does this treat?

For these patients, “robust build + abdominal excess” is the signature feature. Strong or obese physique, flushed face, upper abdominal fullness with resistance on palpation; constipation with no stool for several days; bitter taste and dry throat, vexation and irritability; commonly accompanied by cholecystitis, cholelithiasis, hyperlipidemia, and fatty liver. Pulse mostly wiry, slippery, and forceful, tongue coating thick and greasy with yellow tint.

5. Huanglian Wendan Tang

Phlegm-heat disturbing the heart type · Source: Liu Yin Tiaobian (Qing · Lu Tingzhen)

Composition: Coptis 6g, Bamboo Shavings 12g, Immature Bitter Orange 6g, Pinellia 6g, Tangerine Peel 6g, Licorice 3g, Fresh Ginger 6g, Poria 10g

Efficacy: Clears heat and dries dampness, transforms phlegm and harmonizes the middle burner

Primary Application: Internal phlegm-heat disturbance pattern

What kind of hypertension does this treat?

For these patients, “phlegm” and “heat” are stirred together, disturbing the mind. Dizziness with heavy head, as if wrapped or veiled; chest fullness with irritability, dry or bitter mouth; insomnia with vivid dreams, continuous nightmares; palpitations easily startled, elevated heart rate; yellow greasy tongue coating, rapid slippery pulse. Common in middle-aged and young people, medium to slightly overweight build, oily facial skin — a long list of chief complaints but physical examination shows no major issue. Also includes typical “white coat hypertension.”

6. Huanglian Jiedu Tang

Triple burner fire-toxin type · Source: Wai Tai Miyao (citing Cui’s formula)

Composition: Coptis 9g, Scutellaria 6g, Phellodendron 6g, Gardenia 9g

Efficacy: Drains fire and resolves toxins

Primary Application: Triple burner heat-toxin exuberant pattern

What kind of hypertension does this treat?

For these patients, “fire everywhere from head to toe.” Flushed face with red congested eyes, dark red lips; irritability and insomnia, rapid heart rate; mouth and tongue ulcers, dark scanty urine; skin prone to sores, carbuncles, and acne. Tongue body firm, contracted, and red; rapid, slippery, forceful pulse. Strong physique, firm muscles, red oily face — typical “fire constitution” person. Often accompanied by metabolic syndrome.

7. Xietan Tang

Fire-heat upward rushing type · Source: Jinkui Yaolüe

Composition: Rhubarb 6g, Coptis 3g, Scutellaria 3g

Efficacy: Drains fire and resolves toxins, dries dampness and relieves fullness

Primary Application: Exuberant heart fire forcing blood to move erratically pattern

What kind of hypertension does this treat?

For these patients, “fire raging, onset sudden and aggressive.” Severe headache like a splitting blow, flushed face with red eyes, irritability and anxiety; may even present with emergencies such as cerebral hemorrhage or subarachnoid hemorrhage. Constipation with dark urine, hematemesis and epistaxis, red tongue with yellow coating, rapid forceful pulse. Blood pressure often spikes sharply, falling into the category of hypertensive emergencies or sub-emergencies. Chen Xiuyuan noted: “When all other formulas fail, Xietan Tang is effective every time.”

8. Linggui Zhugan Tang

Yang-deficiency with fluid retention type · Source: Jinkui Yaolüe

Composition: Poria 12g, Cinnamon Twig 9g, Atractylodes 6g, Processed Licorice 6g

Efficacy: Warms yang and transforms fluid retention, strengthens spleen and leaches dampness

Primary Application: Middle burner yang insufficiency, internal fluid retention pattern

What kind of hypertension does this treat?

Unlike the previous seven formulas, this is a formula for treating “deficiency-cold.” Patients have dizziness and vertigo, worse when rising or with postural changes; palpitations and shortness of breath, chest fullness with nausea; dull or puffy complexion, cold aversion with cold limbs; pale puffy tongue with tooth marks, white slippery coating, deep tight or wiry slippery pulse. Zhang Zhongjing said, “For fluid retention disease, treat with warming herbs to harmonize” — the root of this type of hypertension is not fire, but “fluid rising upward.” Common in elderly hypertension and isolated systolic hypertension.

Three-Step Pattern Differentiation for Formula Selection

Step 1: Distinguish Excess from Deficiency

• Excess patterns (first seven formulas): robust build, red or dark red face, loud voice and coarse breath, constipation with dark urine, red tongue with thick coating, forceful pulse

• Deficiency pattern (Linggui Zhugan Tang): weak with cold aversion, pale or puffy face, shortness of breath and fatigue, pale tongue with white slippery coating, deep tight pulse

Step 2: Distinguish Pathomechanism

• Stasis present → Taohexu Chengqi Tang (constipation + stasis-heat) / Xuefu Zhuyu Tang (qi stagnation + stasis)

• Shaoyang pattern present (bitter taste, dry throat, chest and flank fullness) → Da Chaihu Tang (constipation + abdominal distension) / Chaihu Jia Longgu Muli Tang (insomnia + fright)

• Phlegm-heat present → Huanglian Wendan Tang (phlegm-heat disturbing heart) / Chaihu Jia Longgu Muli Tang (Shaoyang + phlegm-heat)

• Pure fire present → Huanglian Jiedu Tang (triple burner diffuse) / Xietan Tang (fire-heat rushing upward emergency)

• Yang deficiency with fluid retention → Linggui Zhugan Tang

Step 3: Distinguish Target

• Stubborn blood pressure + constipation → unblock the intestines and drain heat first (Taohexu Chengqi Tang, Da Chaihu Tang, Xietan Tang)

• Fluctuating blood pressure + emotional factors → settle fright and calm the spirit primarily (Chaihu Jia Longgu Muli Tang, Huanglian Wendan Tang)

• High blood pressure + coronary artery disease → invigorate blood and resolve stasis with emphasis (Xuefu Zhuyu Tang)

• High blood pressure + target organ damage → cool blood and resolve toxins (Huanglian Jiedu Tang)

• Elderly hypertension + dizziness → warm yang and transform fluid retention (Linggui Zhugan Tang)