Blood lipids are composed of cholesterol, triglyceride, phospholipid and free fatty acid. Hyperlipemia mainly implies the elevations of cholesterol and triglyceride in the plasma and is closely related to atherosclerosis. As blood lipids are transported in the form of lipoprotein, hyperlipemia also manifests as hyperlipoproteinemia. It is included in the categories of "xuan yun" (vertigo), "tan zhuo" (phlegm syndrome) and others in TCM.  

Main Points of Diagnosis

1. Inquire closely about positive family history, diabetes, gout, hepatic diseases, nephroses and juvenile coronary heart disease.

2. During physical examination, pay attention to yellowish papules, xanthomas, premature corneal arcus and peripheral vascular disorders.

3. Hyperlipoproteinemia can be divided into 5 types.

Type I is chylomicronemia, a rare disorder due to congenital deficiency of lipoprotein lipase.

Type II is hyperbetalipoproteinemia, which is commonly seen with marked elevation of plasma cholesterol and the disorder closely related to atherosclerosis and coronary heart disease. Some patients are inherited and others are due to high-cholesterol diet or secondary to myeloma, nephrotic syndrome, hepatic disease, etc. Type II is subdivided into Type IIa and Type IIb.

Type III is an autosomal dominant disorder in which the plasma concentrations of cholesterol and triglyceride are both elevated. The disease occurs mostly after middle age. Patients usually have obesity, disturbance of carbohydrate metabolism, etc.

Type IV is the most common disorder, in which endogenous plasma triglyceride is elevated due to the disturbance of carbohydrate metabolism which plasma cholesterol is not necessarily elevated.

Type V is very rare, a combination of Type I and Type IV and of little clinical significance.  

Differentiation and Treatment of Common Syndromes     

1. Deficiency of the Liver-Yin and Kidney-Yin

Main Symptoms and Signs: Dizziness, tinnitus, blurred  vision, irritability, amnesia, soreness and weakness of the loins and knees, red tongue with little fur, taut and thready pulse.

Therapeutic Principle: Nourishing the liver-yin and kidney-yin.

Recipe: Modified Pill of Fleece-Flower for Longevity.

fleece-flower root

sesame seed

mulberry

glossy privet fruit

eclipta

honeysuckle flower

chrysanthemum

loranthus mulberry mistletoe

Cherokee rose-hip

siberian solomonseal rhizome

curcuma root

All the above herbs are to be decocted in water for oral administration.

In addition to the above herbs, supplementary ingredients are to be employed with respect to certain symptoms: cassia seed 30g, uncaria stem with hooks 20g and pueraria root 20g for the case complicated with hyperactivety of liver-yang marked by obvious headache and feeling of distension in the head; astragalus root 15g and Chinese agnelica 1g for the case with deficiency of both qi and blood marked by palpitation, insomnia, lassitude and anorexia; gastrodia tuber 12g, mulberry twigs 30g and spatholobus stem 30g for the case with numbness and soreness of the limbs.

2. Retention of Damp-Heat in the Interior

Main Symptoms and Signs: Dizziness, heavy sensation in the chest, fatigue and listlessness, bitter taste, dry throat, fat stature, or dry stools, slightly red tongue with yellow and greasy fur, and smooth pulse.

Therapeutic Principle: Eliminating pathogenic dampness and heat.

Recipe: Modified Decoction of Gentian for Purging Liver-Fire.

plantain herb

water-plantain tuber

bupleurum root

oriental wormwood

cassia seed

poria

rhubarb root (parched in wine)

hawthorn fruit

All the above herbs are to be decocted in water for oral administration.

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