High Cholesterol & Dietetics, Part 3
Course Excerpt
Overview of Acupuncture CEU Course
This course details the medicinal properties of Chinese herbs and their relationship to lowering serum lipid levels. Modern research is presented in addition to Chinese medicine theoretical principles. Individual herbs and herbal formulas are presented to make the clinical application of this material helpful to a licensed acupuncturist for the treatment of hyperlipidemia. Learn how to lower cholesterol and triglyceride levels with Chinese medicinal herbs.
Outline of Acupuncture CEU Course
3.3 Herbal Therapy
Introduction
3.3.1 Individual Medicinal Herbs
3.3.1.1 Transform Phlegm and Direct Turbidity Downward Medicinals
3.3.1.2 Reduce and Guide Out, Direct Turbidity Downward Medicinals
3.3.1.3 Transform Blood Stasis and Direct Turbidity Downward Medicinals
3.3.1.4 Supplement the Liver and Direct Turbidity Downward Medicinals
3.3.1.5 Clear, Drain, and Direct Turbidity Downward Medicinals
3.3.1.6 Boost the Qi, Strengthen the Spleen, and Direct Turbidity Downward also
3.3.2 Treatment Strategies and Herbal Formulas
3.3.2.1 Treatment of the Spleen
I. Strengthen the Spleen and Transform Damp
II. Regulate the Spleen and Transform Damp
3.3.2.2 Treatment of the Liver
I. Course the Liver and Strengthen the Spleen Method
II. Clear the Liver and Transform Phlegm Method
III. Course the Liver and Nourish the Blood Method
IV. Pacify the Liver, Extinguish Wind, Invigorate the Blood, and Transform Blood Stasis Method
V. Harmonize Shaoyang Method
3.3.2.3 Treatment of the Kidney
I. Boost the Kidney, Drain Turbidity, and Transform Blood Stasis Method
II. Warm the Kidney, Drain Turbidity, and Transform Blood Stasis Method
III. Boost the Qi, Nourish the Yin, and Transform Blood Stasis Method
3.3.2.4 Treatment of the Heart
I. Boost the Qi and Invigorate the Blood Method
II. Free the Yang, Drain Turbidity, and Invigorate the Blood Method
3.3.2.5 Treating Phlegm and Blood Stasis
I. Invigorate the Blood and Transform Blood Stasis Method
Comparison of Blood Invigorating Formulas
I. Draining Dampness, Transforming and Expelling Phlegm, Guiding Out
3.3.2.5 Concluding Remarks
Conclusion
High Cholesterol and Dietetics, Pt. 3
About the author:
Dr. Greg Livingston is an advisor and contributing author for the Healthcare Medicine Institute. Dr. Livingston received his Ph.D. in Chinese Internal Medicine and the Clinical Application of Shang Han Lun at Zhejiang University of Chinese Medicine, China. He is one of the few westerners to have completed his Ph.D. in Chinese Medicine in China entirely in the Chinese language. Dr. Livingston has served as a Chinese Medicine Physician at the North American International Hospital, Hangzhou, China. He is a lecturer at Zhejiang University Medical School and is currently a Chinese Medicine Physician at the Shanghai East International Medical Center, Shanghai Pudong.
SAMPLE OF COURSE MATERIAL
3.3 Herbal Therapy Course - Hyperlipidemia
Introduction
There are copious amounts of literature in Chinese discussing Chinese herbal medicine and dyslipidemia. There are the prevalent theories and some novel theories, interesting applications of classical formulas and many new formulas, as well as discussion of the effects of individual herbs. Following is a distillation of some of the literature, including discussion of single herbs and formulas. While many of the formulas are of interest and could possibly be used as-is, it is the author’s opinion that the objective should be to better understand the theories behind them, and work toward a finer understanding of the unique qualities of each medicinal. Then this knowledge can be flexibly applied in to create unique formulas for each clinical encounter.
3.3.1 Individual Medicinals Section
3.3.1.1 Transform Phlegm and Direct Turbidity Downward Medicinals
1. Hai Zao 海藻 Herba Sargassii
(Internet Note: If there are question marks or unusual notations insteaed of Chinese characters beside the pinyin/English name of the herb, your web browser does not have the Chinese language loaded. However, the actual course materials will visualize the Chinese characters correctly.)
Nature: salty, cold.
Channels entered: Liver and Kidney.
Functions:
Dissolves phlegm and softens hardness, promotes water and reduces swelling.
Indications:
Goiter, scrofula, phlegm-drink (tan-yin), testicular swelling and pain, leg-qi, edema, etc. Recently used to treat hyperlipidemia, chronic bronchitis, hepatosplenomegaly, and hypertension.
Modern research:
Hai zao has been shown in animal studies to control the rise in serum cholesterol levels that is usually accompanied by intake of fatty foods, increase HDL levels, improve HDL/TG ratio, and prevent atherosclerosis.
Clinical application:
Hai zao can expel phlegm and move water, and is useful to reduce serum lipids. It also softens hardness, and can speed up the dissolution of atherosclerotic plaque. It is used in cases of coronary artery disease, dyslipidemia, obesity, and hypertension presenting with phlegm dampness and blood stagnation.
2. Kun Bu 昆布 Ecklonia Kurome
Nature: salty, cold.
Channels entered: Liver, Kidney.
Functions:
Dissolves phlegm and softens hardness, moves water and reduces swelling.
Indications:
Goiter, scrofula, leg-qi, edema, dyslipidemia, hypertension, atherosclerosis.
Modern research:
Shown to reduce serum lipids, inhibit intestinal absorption of lipids, and increase lipid excretion. Also shown to reduce blood pressure and slow heart rate, possibly via inhibition of adrenaline.
Clinical application:
Kun bu is salty and can dissolve phlegm, soften hardness, and disperse nodules. It removes phlegm turbidity from the blood, therefore reducing serum lipids, speeds up the dissolution of atherosclerotic plaque, and reduces blood pressure. It is well suited to treat dyslipidemia presenting with phlegm and blood stagnation, and is often combined with Hai Zao for this and other purposes.
Comparison of Kun Bu and Hai Zao:
Both these substances are salty and cool, go to the Liver and Kidney, dissolve phlegm and soften hardness, and move water and reduce swelling. They both reduce phlegm nodules, and are commonly used together to treat lymph nodules and thyroid nodules. They also both soften the blood vessels, reduce uric acid, and reduce serum lipids. However, hai zao goes more to the blood level, while kun bu goes more to the qi level.
3. Xie Bai 薤白 Bulbus Allii
Nature: spicy, bitter, warm.
Channels entered: Lung, Heart, Stomach, Large Intestine.
Functions:
Regulates qi and loosens the chest, frees the yang and dissipates binding.
Indications:
Dyslipidemia, hypertension, coronary artery disease, chest-impediment (xiong-bi 胸痹)
Modern research:
Increases fibrinolysis, reduces arterial plaque and serum lipids, and inhibits platelet aggregation and serum lipid oxidization.
Clinical application:
Xie bai has long been considered a longevity herb due to its ability to regulate the qi, disperse blood stagnation, and loosen the chest. It is spicy and thus opens the circulation, warming and thus can free the yang qi and allow it to penetrate and move, and bitter and draining so can remove phlegm turbidity. It disperses yin-cold natured phlegm turbidity stagnation, frees the yang qi of the chest, and treats cold, phlegm, damp, turbid stagnation in the blood vessels with symptoms such as stuffy chest, angina pectoris, shortness of breath, etc. For this purpose it is commonly combined with medicinals that transform phlegm and disperse binding, invigorate blood and transform stasis, and disperse cold and stop pain, such as Gua Lou, Dan Shen, Wu Ling Zhi, Pu Huang, Ban Xia, Chen Pi, Yu Jin, Jiang Huang, etc.
4. Bai Jiang Can 白僵蚕 Bombyx Batryticatus
Nature: spicy, salty, neutral.
Channels entered: Heart, Liver, Spleen, Lung.
Functions:
Extinguishes wind and stops tremors, expels wind and stops pain, transforms phlegm and disperses binding.
Indications:
Dyslipidemia, arteriosclerosis, elevated blood sugar.
Modern research:
Bai Jiang Can has been shown to be effective in the prevention and treatment of dyslipidemia. It can increase serum albumin, decrease serum globulin and cholesterol, prevent arteriosclerosis, and lower blood sugar.
Discussion:
Bai Jiang Can is an important herb to extinguish wind, transform phlegm, and stop tremor. Its nature is neutral and its traditional application is extremely broad. Like most animal substances, Jiang Can enters the collaterals, where it removes phlegm stagnation from this deep space. Ye Tian-Shi said, “disease of long-duration enters the collaterals”, implying that chronic disease moves from the superficial layers (the main channels/jing/经, and the qi level) to a deeper layer (the collaterals/luo/络, the grandson-vessels/sun-mai/孙脉, and the blood level). Disease at this level is more stubborn, and requires the use of substances that can reach this space. Jiang Can effectively enters the collaterals and grandson-vessels to remove the phlegm stagnation that has settled here due to chronic illness.
Dose and precautions:
3 to 10 grams, or 1.5 to 3 grams as a powder. Normally it is dry fried. A small number of people may develop a skin rash after taking Bai Jiang Can, but this resolves within a couple days after ceasing administration. Some individuals will become nauseas from the strange smell and taste of Bai Jiang Can.
3.3.1.2 Reduce and Guide Out, Direct Turbidity Downward Medicinals
1. Da Huang 大黄 Radix Et Rhizoma Rhei
Nature: bitter, cold.
Channels entered: Stomach, Large Intestine, Spleen, Liver.
Functions:
Drains downward and unblocks the bowels, clears heat and resolves toxin, invigorates blood and transforms blood stasis, clears and resolves damp heat.
Indications:
Dyslipidemia presenting with heat, damp, and blood stagnation.
Modern research:
Inhibits the intestinal absorption of cholesterol, reduces blood viscosity, and regulates lipid metabolism. Da Huang contains anthraquinones which are largely responsible for its downward draining function (although heat/cooking reduces the strength of this function), and which increase intestinal peristalsis, and reduce absorption and increase elimination of cholesterol.
Clinical application:
Da Huang’s application is very broad, but its function is largely dependent on processing/pao-zhi/炮制. There are many different forms of Da Huang, including raw/unprocessed, steamed, wine-fried, vinegar-fried, scorch-fried, char-fried, etc. Raw Da Huang retains all of its downward draining function, especially if added to the decoction in the last 5 minutes, or ground to powder and added to the strained decoction. Raw Da Huang is generally used for serious, acute conditions, such as Yangming Fu excess syndrome, is not generally suited for long-term use, and therefore not the first choice for lowering serum lipids. The following forms are better tolerated, can be taken for longer periods of time, and are thus more suitable for treating dyslipidemia. Steamed Da Huang (Shu Da Huang, or Jiu Zhi Da Huang) is milder than raw Da Huang but still retains more of its downward draining function than the next two forms, and can remove heat and dampness, and invigorate the blood. Scorch-fried Da Huang (Jiao Da Huang) is 10-15% blackened, goes to the blood level and is good for heat and dampness in the blood. Char-fried Da Huang (Da Huang Tan) is 80-90% blackened, is milder than Jiao Da Huang, also goes to the blood level but even deeper, and removes heat and damp from deep in the blood. It is very mild and can be taken even in cases of Spleen deficiency, and for extended periods of time. Another preparation, called Qing Ning Wan, consists of steamed Da Huang and is used to reduce cholesterol, blood sugar, triglycerides, and uric acid levels.
2. Shan Zha 山楂 Fructus Crataegi
Nature: sour, sweet, slightly warm.
Channels entered: Spleen, Stomach, Liver.
Functions:
Dissolves food stagnation and strengthens the Stomach, transforms blood stasis and disperses binding.
Indications:
Dyslipidemia with presence of food stagnation (particularly meat stagnation), and blood stagnation.
Modern research:
A large amount of research has been done on the lipid-lowering properties of Shan Zha in recent years. Shan Zha has been shown to increase HDL levels, reduce LDL levels, and increase elimination of cholesterol. It also has significant effects on the cardiovascular system, increasing coronary artery perfusion and reducing myocardial oxygen consumption, and is therefore useful in cases of decreased myocardial blood and oxygen flow. It can also reduce blood pressure.
Clinical application:
Shan Zha is particularly useful in cases of dyslipidemia with food stagnation, blood stagnation, obesity, coronary artery disease, and hypertension. It is commonly combined with herbs such as Yu Zhu, Ju Hua, Yan Hu Suo, Jin Yin Hua, Mai Ya, Dan Shen, He Ye, etc.
Raw Shan Zha goes to the blood, and is better for dispelling blood stagnation. Jiao/scorch-fried Shan Zha is better for food stagnation. Shan Zha is very sour, so not suitable in cases with excessive stomach acidity. However, the acidity can be neutralized to some extent by the addition of Shen Qu or roasted Gu Ya/Mai Ya.
3. Lai Fu Zi 莱菔子 Semen Raphani Sativi
Nature: spicy, sweet, neutral.
Channels entered: Spleen, Stomach, Lung, Large Intestine.
Functions:
Dissolves food and guides out stagnation, descends qi and transforms phlegm.
Indications:
Dyslipidemia with food and phlegm stagnation.
Modern research:
Lai Fu Zi has been shown to reduce serum cholesterol, prevent atherosclerosis, and treat coronary artery disease.
Clinical application:
Lai Fu Zi has both ascending and descending functions, and is particularly useful to remove phlegm and regulate qi. It is sweet, neutral, and non-toxic, and can be taken for extended periods of time without damage to the organs. It is particularly suitable for cases of dyslipidemia in the elderly with concurrent hypertension and/or coronary artery disease, especially when stagnation of phlegm, food, and qi are present.
Dry-fried Lai Fu Zi is better for food stagnation. Raw Lai Fu Zi is stronger to remove damp-phlegm and descend the Lung qi.
4. Ze Xie 泽泻 Rhizoma Alismatis
Nature: sweet, bland, cold.
Channels entered: Kidney, Urinary Bladder.
Functions:
Promotes water and leaches dampness, drains heat and unblocks painful urinary dribbling.
Indications:
Dyslipidemia with dampness and yin deficiency with deficient heat.
Modern research:
Shown to increase serum HDL and HDL/TG ratio, prevent atherosclerosis, prevent fatty liver, and promote weight loss.
Clinical application:
Shen Nong Ben Cao Jing states that Ze Xie can not only “dissolve water, but can also nourish the five viscera, boost qi, and that long term consumption can benefit the eyes and ears, increase longevity, and make the body lighter.” Therefore, Ze Xie is not just an herb for clearing heat and draining dampness, mainly from the Urinary Bladder, but rather can also supplement the body, primarily the Kidney yin. It is particularly useful in cases of dyslipidemia with phlegm and damp accumulation and yin deficiency heat, with elevated blood sugar and/or hypertension, and where its ability to prevent fatty liver and premature aging are desired. It is commonly paired with Shan Zha, and 6-9 grams of each can be boiled in one liter of water and sipped as a tea over the course of the day to help prevent and treat dyslipidemia when stagnation of food, dampness and blood are present.
Cautions:
Large doses of Ze Xie in animal studies have caused liver and kidney damage, however, there are no known clinical reports of significant side effects in humans. A small number of patients may experience mild diarrhea, borborygmus, or other GI discomfort, slight and temporary elevation of ALT, or skin rash. Should be avoided in cases of polyuria. There are reports that long-term use at high doses can lead to electrolyte imbalance, therefore it is not recommended to use it at high doses or for extended periods of time. However, there are also reports of using large doses of Ze Xie (up to 42 grams per day) for up to three months in the treatment of hyperlipidemia with no adverse effects.
5. Yin Chen Hao 茵陈蒿 Herba Artemisiae Yinchenhao
Nature: slightly bitter, slightly spicy, slightly cold.
Channels entered: Liver, Gall Bladder, Spleen, Stomach, Urinary Bladder.
Functions:
Clears heat and resolves dampness, benefits the Gall Bladder and removes jaundice.
Indications:
Dyslipidemia presenting with damp-heat or damp-cold stagnation in the Liver and Gall Bladder.
Modern research:
Shown to promote the production and excretion of bile, reduce blood pressure, reduce serum cholesterol, reduce atherosclerosis, and reduce fatty deposit on the internal organs.
One study using 15 grams of Yin Chen Hao per day (taken as a tea over the course of the day) for one month showed significant reduction in serum cholesterol. Another report claims good results in reducing serum lipids using syrup made from Yin Chen Hao 30 grams, Shan Zha and Mai Ya each 15 grams.
Clinical application:
Yin Chen Hao is traditionally used to benefit the Gall Bladder and clear jaundice. Zhang Xi-Chun said, “Yin Chen (Hao) excels at clearing heat from the Liver and Gall Bladder and regulating Liver and Gall Bladder stagnation. Once heat is removed and stagnation opened, the bile can enter the Small Intestine without obstruction.” Modern research shows that Yin Chen Hao increases production and excretion of bile and thus can reduce serum cholesterol, reduce lipid deposit on the internal organs, and reduce blood pressure.
Yin Chen Hao is most often used in cases of damp-heat obstructing the Liver and Gall Bladder giving rise to yang-jaundice, in which case it clears heat and removes the dampness through the urine. However, in cases of cold-damp yin-jaundice it can be combined with warm herbs, as in Yin Chen Zhu Fu Tang, Yin Chen Si Ni Tang, etc. Therefore, in treating dyslipidemia it can also be flexibly applied to a variety if etiologies.
3.3.1.3 Transform Blood Stasis and Direct Turbidity Downward Medicinals
1. Hu Zhang 虎杖 Radix Et Rhizoma Polygoni Cuspidati
Nature: bitter, sour, slightly cold.
Channels entered: Liver, Gall Bladder.
Functions:
Invigorates the blood and disperses blood stasis, expels wind and unblocks the collaterals, clears heat and removes dampness, resolves toxins and disperses binding, transforms phlegm and stops cough.
Indications:
Dyslipidemia presenting with damp-heat, toxin, and blood stasis.
Modern research:
Animal studies have show Hu Zhang can significantly reduce serum triglycerides, total cholesterol, and LDL, as well as increase HDL/TC and HDL/LDL ratios.
Clinical application:
Hu Zhang and Da Huang both belong to the polygonaceae family, substantially drain downward and unblock the bowels, clear heat and resolve toxins, invigorate the blood and stop bleeding, benefit the Gall Bladder and remove jaundice. Hu Zhang, however, primarily enters the Liver (while Da Huang also strongly affects Yangming) and additionally transforms phlegm and stops cough. In recent years Hu Zhang’s lipid reducing function has undergone significant research, showing it is well suited to treat dyslipidemia in cases of phlegm turbidity and blood stasis.
Hu Zhang primarily acts on the Liver, and is well suited to treat viral hepatitis (in this capacity it can help reduce viral load and liver enzymes), cholecystitis, and jaundice. It is often combined with Yin Chen Hao to clear heat and toxin and remove dampness.
Cautions:
Contraindicated in pregnancy.
Hu Zhang is traditionally considered non-toxic, and modern reports tell of patients taking 30 grams per day continuously for thirty days with no obvious side effects. However, with the same regiment a small number of patients have reported decreased appetite, nausea, vomiting, diarrhea, and dizziness. This is in part due to its relatively cold and bitter nature, which can obstruct the Stomach. Therefore, it is not recommended to use in large dose or long-term. 6 to 9 grams per day is sufficient, and at this dose it can be taken for extended periods of time without problem.
2. San Qi 三七 Radix Pseudoginseng
Nature: sweet, slightly bitter, warm.
Channels entered: Liver, Stomach, Heart, Lung, Large Intestine.
Functions:
Disperses blood stagnation and stops bleeding, reduces swelling and stops pain.
Indications:
Dyslipidemia with blood stagnation and bleeding due to cold and deficiency.
Modern research:
San Qi has been show to reduce serum cholesterol and prevent and treat arteriosclerosis. It can inhibit platelet aggregation, decrease blood viscosity, increase coronary artery perfusion, reduce myocardial oxygen consumption, increase cardiac output, and promote development of collateral blood circulation in cases of coronary artery occlusion.
Clinical application:
San Qi can stop bleeding without causing blood stasis, and can dissipate blood stasis without causing bleeding or damaging the Zheng qi. Zhang Xi-Chun stated, “San Qi excels at transforming blood stasis as well as stopping bleeding, and is an important herb to treat nose bleeding, after recovery from which it will not have led to stasis of blood in the vessels and collaterals….It transforms blood stasis without damaging new blood, and is a miraculous blood-regulating substance.”
San Qi and Ren Shen both belong to the araliaceae family, and like Ren Shen, San Qi can improve cardiovascular system function, quicken recovery from exercise fatigue, and strengthen and tonify the body’s constitution. Therefore, it is particularly suitable to treat dyslipidemia with weak constitution and/or blood stagnation. It is however, on the warm side, and most suitable when cold and deficiency are the underlying causes of bleeding and stasis.
Reports on the use of San Qi in the treatment of coronary artery disease and angina pectoris are numerous. In one study, San Qi was combined with Quan Gua Lou and Xie Bai. Another study combined San Qi with ginseng root and Hu Po (amber). Both reported good results.
Cautions:
Contraindicated in pregnancy. A small number of patients may experience nausea, vomiting, or skin rash.
More in the actual course material.....
