Cholesterol & Chinese Medicine: Article Review
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Cholesterol & Chinese Medicine: Article Review

How is hypercholesterolemia diagnosed and treated in Traditional Chinese Medicine (TCM)? The article “Cholesterol and Chinese Medicine” by Luria & Zelicha (2009) poses two key points, (a) hypercholesterolemia does not exist as a diagnosis in TCM theory; and (b) hypercholesterolemia is not easy to diagnosis using TCM diagnostic techniques (pulse, tongue and physiognomy etc.). According to TCM theory, if a patient does not show any signs and symptoms of hypercholesterolemia, with the tongue and pulse appearing normal, it cannot be treated directly due to inability to establish a differentiation diagnosis (Luria & Zelicha, 2009, p. 31). This is a modern dilemma where the quantitative lab value is beneficial for primary care and preventive medicine. 

The authors discuss the Western background on hypercholesterolemia, (a) primary hypercholesterolemia, a genetic disposition towards over production of cholesterol by the liver, verses (b) secondary hypercholesterolemia, a factor of predisposing lifestyle & dietary habits (e.g. saturated fats, trans fatty acids, and alcohol abuse etc.), and diseases (e.g. diabetes, renal disease, hypothyroidism). They briefly discuss comparative levels of LDL verses HDL. Luria & Zelicha (2009, p. 30) state that TCM traditionally uses the qualitative sequel/ manifestations of primary & secondary hypercholesterolemia and dylipidemias, focusing on poor nutrition and lifestyle choices in general (verses the quantitative cholesterol level). 

A Western manifestation of hypercholesterolemia is myocardial infarction, which in TCM translates to a diagnosis of blood stagnation and/or phlegm accumulation in the chest. Cerebral vascular accident is another sequel of hypercholesterolemia, which translates to the TCM diagnosis of liver fire and/or liver yang rising with wind stroke. While TCM has the capability of diagnosing and treating the sequels of hypercholesterolemia after they manifest, it is more desirable for the purpose of primary care and prevention, to diagnose and treat etiological risk factors early on. 

Some etiological risk factors associated with hypercholesterolemia are old age, a diet rich in saturated fats and alcohol, sedentary lifestyle, hypothyroidism, and uncontrolled diabetes. In TCM, respective etiological diagnosis are, kidney yin deficiency; turbid-damp-phlegm in the liver and gallbladder; liver qi stagnation transforming to phlegm; spleen qi deficiency, and/or kidney yang deficiency; and lung, stomach and kidney yin deficiency. These can be treated with herbs, acupuncture, food as medicine, and lifestyle counseling.

The authors cite Ku Ding Cha, a variety of black tea, as one dietary intervention researched to lower blood lipids including cholesterol. In TCM terms it regulates blood flow, dries phlegm, and generates fluids (yin). They present standard TCM herbal formulas to regulate blood flow and remove stasis in the upper body; drain phlegm; strengthen the spleen and leach dampness; strengthen the liver and kidney yin; and clear damp-heat from the liver/gallbladder. Modifications can be made with single herbs for any signs of hyperactive liver yang.

Luria & Zelicha (2009, p. 33) discuss the known pharmacodynamic benefits of statin drugs. They also point out that statins predispose to a diagnosis of spleen qi deficiency that manifests as muscles weakness and pain. These are indeed pharmacological side effects of statin drugs that may decrease medication compliance. Along these lines, the authors present a case study in which a 24 year old woman refused pharmacotherapy for hypercholesterolemia. Her total cholesterol of 487 was decreased to 268 after 12 months of treatment with Chinese herbs and acupuncture. 

Contrary to what Luria & Zelicha say, TCM does have methods to qualify for and diagnose coronary artery diseases (CAD). CADs are vascular disorder that narrow or occlude the coronary arteries. E.g. atherosclerosis secondary to dyslipidemia/ hypercholesterolemia. Signs of hypertension due to atherosclerosis (dampness, phlegm) are present in the physiognomy of the auricle (ear), as explained by Huang (2005). Upon inspection & palpaton of the specific auricular point called BloodPressure Reducing Point, one will  "see a cord [or line of palpable hardness] if hypertension is due to atherosclerosis" (Huang, 2005, p. 288). 

There are signs on specific auricular points used to diagnose other cardiovascular status' such as normal blood pressure; fluctuating blood pressure (systolic vs. diastolic); abnormally low or high blood pressure; bundle branch blocks (partial and complete); tachyarrythmias and bradyarrythmias. 

Integrative Medicine Tip: The Kidney is the mother of the Liver in the Generating (Sheng) Cycle. Demonstration of this in Western pathophysiology is how chronic renal failure and nephrotic syndromes cause dyslipidemias. The loss of albumin through the urine triggers low density lipoprotein (LDL) synthesis by the liver. Plus uremia decreases lipolytic activity and HDL production in the Liver.  The result is a high LDL: HDL ratio (Huether, S. & Forshee, 2010, p. 1385, 1395). A high LDL:HDL ratio is a determinant risk factor for CAD, myocardial infarction, and stroke.

References

Huang, Li-Chun. (2005). Auricular medicine; A complete manual of auricular diagnosis and
     treatment. Orlando, FL: Auricular International Research & Training Center. 
Huether, S. & Forshee, B.  (2010).  Alterations of renal and urinary tract function.  In K. L.
     McCance, S. E. Huether, V. L. Brashers, & N. S. Rote (Eds.), Pathophysiology:  The biologic basis
     fordisease in   adults  and children. (pp. 1354- 1419). St. Louis, MO:  Mosby Elsevier.
Luria, U., & Zelicha, K. (2009). Cholesterol and Chinese medicine. Journal of Chinese Medicine
     89 30-35.

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