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Cholesterol and Chinese Medicine Journal of Chinese Medicine • Number 89 • February 2009

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Cholesterol and Chinese Medicine Journal of Chinese Medicine • Number 89 • February 2009 30 Cholesterol and Chinese Medicine Journal of Chinese Medicine • Number 89 • February 2009 Cholesterol and Chinese Medicine By: Udi Luria & Abstract Keren Zelicha Neither cholesterol nor hypercholesteremia exist as entities in traditional Chinese medicine. Nor, given that hypercholesteremia can be asymptomatic, is it necessarily easy to make a diagnosis and pattern differentiation. In Keywords: order to understand hypercholesteremia better in terms of Chinese medicine, this article works forward from the Cholesterol, known aetiology of hypercholesteremia and backwards from a. those disease processes that hypercholesteremia hyper- can precipitate, b. the nature of Chinese herbal substances that have been demonstrated to reduce cholesterol, and cholesteremia, c. the actions and side-effects of Western medical drugs used to treat hypercholesteremia. Five major treatment Chinese herbal strategies based on differentiation of patterns are offered along with herbal prescriptions and acupuncture. medicine, acupuncture. he aim of this article is to examine hyper- High levels of cholesterol in the blood increase the cholesteremia from the perspective of Chinese risk of peripheral and coronary atherosclerosis, medicine and to establish a suitable treatment leading to myocardial infarction, stroke or peripheral Tstrategy with herbal medicine and acupuncture. artery disease1. However, not all types of cholesterol increase the risk for those diseases. LDL is thought to Western medicine background increase risk while HDL reduces it. Excess LDL can Roughly one quarter of cholesterol in the body comes accumulate within the vessel walls, where it becomes from consumed food and the rest is created in the liver oxidised and altered in other ways. The altered and other cells. Cholesterol is a vital component in components then incite an inflammatory response that the cell membrane, used for the formation of steroid progressively and dangerously changes the arteries hormones, vitamin D and bile acids, as well as for fat leading to the creation of atherosclerotic plaques2. transfer into the blood. Cholesterol, like other fats Ideally, LDL levels should be under 130mg/dl (3.36 in the blood, is not soluble. It is transported into the mmol/L), while HDL should be over 40mg/dl (1.03 blood by lipoproteins of which there are two kinds: mmol/L )3. HDL levels should also be higher than low density lipoprotein (LDL), also known as ‘bad 20% of total cholesterol. The total cholesterol level is cholesterol’, and high density lipoprotein (HDL), also less important as a cause of risk for heart disease and known as ‘good cholesterol’. stroke4. High levels of fats in the blood do not in general create signs and symptoms. At especially high levels, Chinese medicine growths named xanthomas are created on tendons The Su Wen (Plain Questions 28) said: “Diabetes‑like and skin. Very high levels of triglycerides may cause disease with internal heat, sudden fainting, an enlargement of the liver and the spleen, and acute hemiplegia, weakened and cold limbs, fullness of pancreatitis. energy causing upward pressure, are the symptoms of rich people who are in the habit of consuming Hypercholesteremia has two causes: greasy and rich flavoured foods.”5 • Primary (genetic): Self overproduction in the liver It can be seen, therefore, that as early as the Su or defective clearance in cells. Wen we can find the first evidence of the damage • Secondary: Sedentary lifestyle with excessive that is today connected to cholesterol. The Su Wen dietary intake of saturated fat, cholesterol (from speaks here of diseases linked to nutrition and not to animal products) and trans fatty acids (commonly cholesterol itself because Chinese medicine holds a used in many processed foods), obesity, diabetes qualitative approach rather than a quantitative one. mellitus, alcohol abuse, chronic renal failure, Emphasis is put on the signs and symptoms that the hypothyroidism, ageing, menopause etc. Foods patient presents, which are gathered to compose a of vegetable origin do not contain cholesterol, but clinical picture, from which a diagnosis and treatment some of them contain trans-fats that can cause an are produced. Due to the fact that high levels of intensified production of cholesterol by the body. cholesterol in themselves do not produce any signs Journal of Chinese Medicine • Number 89 • February 2009 Cholesterol and Chinese Medicine 31 Herb name Comments Dan Shen (Salviae miltiorrhizae Radix) Appropriate mainly for conditions of heat in the blood and stasis10 Cold Found in research to reduce the ratio of cholesterol and to have a nature Da Huang (Rhei Radix et Rhizoma) haemostatic effect11 Research shows that it lowers triglycerides and cholesterol, promotes Shan Zha (Crataegi Fructus) vasodilatation, is anti‑clotting, and improves circulation in the blood Blood Effect vessels12 San Qi (Notoginseng Radix) Hot nature Herbs with a Regulating Chuan Xiong (Chuanxiong Rhizoma) Huang Lian (Coptidis Rhizoma) Yin Chen Hao (Artemisiae scopariae Herba) Research shows a reduction of cholesterol, triglyceride and an increase Ze Xie (Alismatis Rhizoma) of HDL13 He Ye (Nelumbinis Folium) Clears heat and fire from the Liver, penetrates the Kidneys and Treat dampness Treat Clear Liver Heat Jue Ming Zi (Cassiae Semen) nourishes14 Shu Di Huang (Rehmanniae Radix Lowers blood pressure and serum cholesterol15 preparata) Found in research to lower cholesterol levels by diminishing its He Shou Wu (Polygoni multiflori Radix) absorption in the small intestine; relieves arteriosclerosis and improves 16 the microcirculation Warm herbs Warm The yeasts contain Monascolin which inhibits HMG‑CoA reductase, Hong Qu (Red Yeast Rice) an enzyme that triggers cholesterol production. Strengthening herbs Jiao Gu Lan (Rhizoma seu Herba Found to lower both total cholesterol and triglyceride levels17 Cold herbs Gynostemmatis) and symptoms, we might suggest that no diagnosis will try to unite them to create a uniform picture of the Table 1: Herbs (or treatment) can be offered using Chinese medicine best ways to diagnose and treat hypercholesteremia. that have tools. We might even say that if an imaginary patient First, the illnesses caused by hypercholesteremia will been found arrives, who has no complaints and does not show be examined, followed by an account of the nature of empirically any signs and symptoms, with the pulse and tongue those Chinese herbs that have been found to be efficient to treat appearing normal (although laboratory tests may empirically for the treatment of hypercholesteremia. cholesterol point to hypercholesteremia), according to Chinese In addition, the aetiology of hypercholesteremia will medicine there is no tool that we can use to treat be examined, as well as those foods that are known to him, due to the inability to establish a diagnosis or have a positive influence on high levels of cholesterol. differentiation. Finally, an analysis of the Western drugs used in the Thus, it appears that diagnosing and treating treatment of cholesterol will be made. cholesterol according to Chinese medicine has to be It is important to emphasise that cholesterol is undertaken in two ways. The first approach would a part of normal body physiology and therefore make a complete diagnosis of the patient and treat him is considered to be a part of zheng (upright) qi. according to any pattern/s diagnosed, without taking Only when it is in excess does it become xie into account the cholesterol. This approach assumes (pathogenic) qi. that alongside the return of the patient to a balanced state, an improvement will also occur in the level of Cholesterol and analysis of illnesses cholesterol. The second approach is to try and analyse caused by cholesterol the expected damage due to hypercholesteremia and As shown above, hypercholesteremia may lead to the energetic nature of cholesterol, and to formulate atherosclerosis with consequent risk of heart attack a treatment suitable to these. This article deals with and stroke. the second approach, taking the view that in the clinic there must be a combination of both systems. Heart attack (myocardial infarction/MI) This article will analyse the energetic nature of The pain and other symptoms of MI suggest a clinical cholesterol from a number of different angles, and picture of Heart blood stasis6. From this it can be 32 Cholesterol and Chinese Medicine Journal of Chinese Medicine • Number 89 • February 2009 concluded that a strategy of regulating blood and removing Bladder. Turbid damp phlegm is produced due to a stasis can be undertaken so as to prevent the damage chronic weakening of the middle warmer caused by caused by hypercholesteremia. A part of regulating the an inadequate diet and an overload on the digestive blood is regulating qi, as it is said to be the commander of system. the blood7. Hence, an additional zang that is essential to c. Lack of physical activity: Physical activity can lower refer to is the Liver, because of its function of maintaining cholesterol levels and in doing so constitutes a method free flow in the body. As it is said in Su Wen chapter 70: of treatment. Physical activity also helps regulate the “The moderate energy of wood prevails everywhere, Liver qi which in turn helps to transform phlegm. causing the yang energy to relax, the yin energy to d. Hypothyroidism: Characterised by a low metabolism spread and the qi activities of the five elements to become that causes obesity, tiredness, gloomy expression, unimpeded and moderate”8. hoarse voice, slow speaking, eyelid droop, swelling of the face, constipation, lack of tolerance to cold, Brain damage thin and dry hair, confusion, forgetfulness and Another important consequence of hypercholesteremia dementia, and a slow pulse18. It appears mostly in is a significantly elevated risk of cerebrovascular adults. These signs can be connected to Spleen qi accident (CVA) or transient ischaemic attack (TIA). This deficiency, Kidney and Spleen yang deficiency, Liver corresponds to ‘zhong feng’ (‘struck by wind’) in Chinese qi stagnation with phlegm, and stasis of blood and medicine. There are four possible mechanisms that can phlegm19.
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