Hyperlipidemia

Author: Cai Shutao (Editor) / Country:
Publisher:
Publishing Date: 2001-08-01
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1. Causes of hyperlipidemia
(1) Improper diet: Irregular eating habits, excessive food intake, or indulging in greasy, sweet, and rich foods lead to an excessive amount of fat entering the body. If the distribution and transformation of fat are insufficient, it accumulates in the blood, causing elevated blood lipid levels. Long-term improper diet or excessive alcohol consumption can damage the spleen and stomach, disrupt their normal function, and lead to improper digestion of food. As a result, the body cannot transform and store the essential nutrients from food, but instead converts them into lipid turbidity, which mixes into the blood, causing elevated blood lipid levels. The former is an excess pattern, while the latter is a deficiency pattern with an excess component, which is the difference between the two.
(2) Constitutional predisposition: If parents are obese, the individual may have a naturally fatty constitution from a young age. As they grow older, their body becomes even more plump, and they often suffer from insufficient yang qi and delayed transformation of fluids and fat. Excessive fat accumulates in the blood. Alternatively, they may have a chronic body Yin deficiency with hyperactive yang. The transformation of fat into lipid occurs, dissolving into the blood and causing elevated blood lipid levels. Congenital deficiency, prolonged illness damaging the kidneys, or excessive sexual activity can lead to kidney deficiency and fluid retention turning into phlegm. Kidney deficiency can also fail to warm the spleen, leading to the generation of phlegm turbidity, which further exacerbates the condition. The stagnation of phlegm turbidity in the blood vessels is a significant factor in causing hyperlipidemia, and the formation of phlegm turbidity is primarily attributed to the spleen and kidneys. The level of high-density lipoprotein (HDL) or high-density lipoprotein cholesterol is closely related to the strength of kidney qi. When kidney qi is strong, HDL cholesterol levels are high, blood lipid levels are less likely to rise, and the ability to resist atherosclerosis is strong. Conversely, when kidney qi is weak, HDL cholesterol levels are low, blood lipid levels are more likely to rise, and the ability to resist atherosclerosis is weak.
(3) Emotional stress: Depression and impaired liver qi flow can lead to liver qi stagnation. The liver prefers smoothness and dislikes depression. When liver qi is stagnant, it disrupts the harmony between the liver and spleen, impairing spleen function and leading to the generation of phlegm turbidity. Alternatively, liver qi stagnation can turn into heat, which cooks fluids into phlegm. Or, emotional fire can damage the yin essence of the liver and kidneys, leading to internal heat and the transformation of fluids into phlegm.
(4) Excessive inactivity damaging the spleen, impairing spleen function: Due to excessive rest, the body cannot transform the essence of food into qi, leading to accumulation and stagnation, which turns into phlegm. Preferring rest and avoiding movement, or excessive sitting and lack of walking, disrupts the smooth flow of qi, impairs the distribution of fluids and fat, and leads to the accumulation of fat in the body, which then mixes into the blood, causing elevated blood lipid levels.
(5) Aging and physical decline: As people age, all five zang-fu organs weaken, with the kidneys being particularly affected. The kidneys control the five fluids. Kidney deficiency leads to the loss of control over fluids. The spleen controls transformation and transportation. Spleen deficiency leads to improper digestion of food. The liver controls the smooth flow of qi. Liver weakness impairs the distribution of fluids, all of which disrupt lipid metabolism and cause elevated blood lipid levels. Excessive sexual activity or emotional distress can also lead to premature aging.
(6) Unresolved conditions such as diabetes, edema, costal pain, jaundice, and abdominal masses: The fundamental mechanism of diabetes is Yin deficiency and internal heat. Excessive internal heat consumes the body's essence, leading to excessive thirst and hunger, but the essence from food cannot be transformed and stored. Instead, the body's fat is converted into lipid and mixed into the blood, causing elevated blood lipid levels. Chronic edema damages the spleen and kidneys. Kidney deficiency fails to control fluids, and spleen deficiency impairs transportation, disrupting lipid metabolism. Costal pain, jaundice, and abdominal masses are all conditions related to the liver and gallbladder. Liver qi stagnation impairs the distribution and transformation of fat, while gallbladder dysfunction prevents the purification and transformation of lipid, causing elevated blood lipid levels.
2. The relationship between hyperlipidemia and phlegm turbidity and blood stasis in traditional Chinese medicine (TCM): In TCM, elevated blood lipid levels are primarily caused by excessive intake of fat, insufficient transformation and utilization, and impaired purification. The root cause is the dysfunction of zang-fu organs. The main harm of elevated blood lipid levels is the generation of phlegm turbidity and blood stasis, which obstructs blood vessels and damages internal organs. Improper digestion of food and impaired fluid transformation lead to this condition, with the disease primarily affecting the spleen, liver, and kidneys. TCM has long held the theory that "obese people have excess fat" and "obese people have phlegm." Once phlegm turbidity forms, if qi flows smoothly and fluids circulate properly, it can be transformed and utilized. However, if phlegm turbidity accumulates over time without resolution, it can stagnate in the blood vessels, forming phlegm stasis. This can lead to the mutual binding of phlegm and stasis, obstructing blood vessels and impairing the smooth flow of qi, fluid distribution, and the harmony of the five zang-fu organs, causing various disorders. If the brain's blood vessels are obstructed, it can lead to dizziness, headaches, and even stroke. If the heart's blood vessels are obstructed, it can cause chest pain, heart disease, and palpitations. If limb blood vessels are obstructed, it can cause numbness and weakness. If liver blood vessels are obstructed, it can cause costal pain and masses. Therefore, phlegm stasis further contributes to elevated blood lipid levels, driving the progression and development of the disease. Additionally, phlegm turbidity can turn into heat or wind, causing various complications. This condition typically progresses slowly, and the prognosis depends on the severity of complications. In severe cases, patients may develop life-threatening conditions such as angina pectoris and stroke. Phlegm turbidity and blood stasis are pathological products formed during the disease process. After formation, they can directly or indirectly affect specific zang-fu organs, causing various disorders. Common conditions caused by phlegm turbidity and blood stasis include dizziness, chest pain, stroke, and headaches. Clinical and experimental research has also confirmed that hyperlipidemia shares many similarities with phlegm turbidity and blood stasis. Phlegm is defined as "the body's fluids are all transformed from water and grain." The spleen controls transformation, not only transforming the essence of water and grain into qi and blood but also regulating the absorption and excretion of body fluids. Although the causes of hyperlipidemia are related to the dysfunction of zang-fu organs, they primarily involve the spleen and stomach's ability to receive and transform. The body's postnatal needs for fat and essential nutrients rely on the spleen and stomach's transformation and transportation. This naturally includes the production and transportation of lipids and lipoproteins. Under normal conditions, lipids are part of the body's qi, blood, and fluids, participating in normal nutrition and metabolism. If the spleen and stomach are damaged, impaired transportation leads to the transformation of part of the essence into turbid fat, which enters the blood and causes elevated blood lipid levels. Weak spleen and stomach function are unable to effectively metabolize and excrete existing lipids, leading to their accumulation in the blood. This, in turn, obstructs the spleen and stomach's qi flow, further promoting the formation of new turbid fat. This cycle of mutual influence leads to increasing accumulation, preventing proper resolution and turning into phlegm turbidity in the blood. This is the process of phlegm turbidity formation in TCM. Fluids, qi, and blood are essential substances in the body. When all zang-fu organs function normally, the essence of water and grain transforms into qi, blood, and fluids, circulate throughout the body, and nourish the body. However, if the spleen's yang qi is deficient, phlegm turbidity can stagnate; if kidney deficiency leads to fluid retention; or if emotional distress disrupts qi and blood flow; or if excessive consumption of greasy, sweet, or alcoholic foods impairs the normal transformation and transportation of water and grain, phlegm can form, turning qi and blood into phlegm turbidity. Blood flows through blood vessels, relying on the of heart qi, the control of spleen qi, the storage of liver qi, the regulation of lung qi, and the warming of kidney qi to function properly. If zang-fu organ function is unregulated, qi and blood flow becomes obstructed, leading to stasis. Blood stasis obstructing the heart's blood vessels causes chest pain; obstructing the brain's blood vessels causes stroke. Therefore, treating hyperlipidemia based on phlegm turbidity and blood stasis using syndrome differentiation and treatment is an ideal approach.
3. TCM classification of hyperlipidemia: TCM research on treating hyperlipidemia has advanced rapidly, with many methods for syndrome differentiation. Based on common clinical symptoms, hyperlipidemia can be classified into the following patterns: spleen deficiency with dampness excess, damp-heat internal accumulation, liver fire excess, Yin deficiency with hyperactive yang, qi and blood stasis, and liver and kidney Yin deficiency.
(1) Spleen deficiency with dampness excess: Symptoms include pale yellow complexion, plump body, fatigue in limbs, heavy head and body, puffy eyelids, or edema in lower limbs, abdominal distension, poor appetite, cough with phlegm, loose and intractable stools, pale tongue with greasy or slippery white coating, and slippery pulse.
(2) Damp-heat internal accumulation: Symptoms include pale complexion, restlessness, dry mouth with thirst but no desire to drink, or discomfort after drinking, abdominal fullness and distension, edema, heavy body, constipation or loose stools with foul odor, red tongue with yellow greasy coating, and wiry or rapid slippery pulse.
(3) Liver fire excess: Symptoms include red face and eyes, bitter taste, irritability, distended chest and hypochondria, yellow and dark urine, dry stools, red tongue with yellow coating, and wiry rapid pulse.
(4) Yin deficiency with hyperactive yang: Symptoms include dizziness and vertigo, tinnitus, insomnia and frequent dreams, numbness in limbs, thirst, red tongue with yellow coating, and wiry pulse.
(5) Qi and blood stasis: Symptoms include chest tightness and shortness of breath, or pain in the precordium, chest tightness and discomfort, purple and dark tongue with petechiae or ecchymoses, and wiry pulse.
(6) Liver and kidney Yin deficiency: Symptoms include advanced age, dizziness and tinnitus, thinness, dry mouth, soreness in waist and knees, numbness in limbs, red tongue with little or no coating, and thin weak pulse.
For the treatment of hyperlipidemia, TCM believes that...