Managing High Cholesterol and Fatty Liver: Integrating Western and Traditional Medicine

Hello, doctor. I have questions regarding hyperlipidemia and fatty liver disease?

Hello, Director Lin.
A few days ago, I brought my mother to your clinic for treatment.
Thank you for your attentive and patient care in explaining her condition.
I have browsed most of your responses online and have gained a deeper understanding of Traditional Chinese Medicine.
Thank you.

Currently, my father, who is 53 years old, has issues with hyperlipidemia and fatty liver.
I have a few questions I would like to ask the doctor:
1.
He is currently taking Western medication to manage his condition and has been on it for three months.
Should we wait for a significant improvement before incorporating Traditional Chinese Medicine, or can we start treatment together at this stage?
2.
If he starts taking Chinese medicine, should it be taken two hours apart from the Western medication, or can they be taken together without any issues?
Thank you, doctor.

Mr. Huang, 20~29 year old female. Ask Date: 2011/05/07

Dr. Lin Qingzhong reply Traditional Chinese Medicine

Dear Mr.
Huang / 25 / Online User,
Hello,
1.
The definition of fatty liver is when the fat content in liver cells exceeds 5%.
Diagnosis must be confirmed through examinations such as abdominal ultrasound by Western medicine.
Many factors can cause fatty liver, including hepatitis B and C, alcohol consumption, overwork, obesity, hyperlipidemia, diabetes, and improper medication use.
These factors often lead to fat accumulation and fibrosis in liver cells, which can progress to cirrhosis in severe cases.
Currently, the prevalence of fatty liver among adults in Taiwan is approximately 25%, significantly higher than that of hepatitis B and C, making it the most common liver disease in the country.
If diagnosed with fatty liver disease, treatment is necessary to prevent progression to cirrhosis.
Treatment should address the underlying causes, such as abstaining from alcohol if it is due to excessive drinking; treating hepatitis B or C if those are the causes; and controlling weight if obesity is a factor.
If hyperlipidemia is the cause, lipid levels need to be managed.
Liver function tests such as GOT and GPT may be elevated in fatty liver but not excessively so, and blood tests will not detect hepatitis B or C.
2.
In Traditional Chinese Medicine (TCM), there is no corresponding disease name for fatty liver.
However, based on clinical manifestations such as distension and pain in the liver area, it may be classified under "hypochondriac pain" or "accumulation." TCM attributes the causes to external pathogenic factors, internal emotional disturbances (such as prolonged stress and emotional tension), or lifestyle factors such as overconsumption of rich foods or excessive drinking.
Since fatty liver can damage organs such as the liver, gallbladder, spleen, and stomach, TCM considers the pathogenesis to be related to disharmony between the liver and gallbladder, dysfunction of the spleen and stomach, damp-heat phlegm obstruction, and qi stagnation with blood stasis.
This means that patients, due to unrestrained eating and drinking, have harmed their liver, gallbladder, spleen, and stomach, leading to improper transformation and transportation by the spleen and stomach, resulting in dampness and phlegm accumulation, and impaired blood circulation, which contributes to the disease.
3.
The principles of TCM treatment for fatty liver focus on addressing the characteristics of qi and blood stagnation and phlegm-dampness.
The treatment should aim to soothe the liver and benefit the gallbladder, harmonize the spleen and stomach, resolve phlegm and eliminate dampness, and invigorate qi and promote blood circulation, with an emphasis on lowering lipids and protecting the liver.
In TCM treatment, it is essential to differentiate the syndrome based on the patient's clinical manifestations.
This can be categorized as:
a.
Qi stagnation type: Patients often experience fatigue, discomfort in the right hypochondrium, and emotional distress.
Treatment should focus on soothing the liver, relieving depression, and regulating qi.
b.
Blood stasis type: Patients may experience fatigue, chest tightness or pain, and sharp pain in the liver area, with a dark purple tongue or signs of bruising.
Treatment should focus on soothing the liver, nourishing the blood, and promoting blood circulation to resolve stasis.
c.
Damp-heat type: Patients often experience fatigue, distension in the hypochondrium and abdomen, fullness in the epigastric area, a thick greasy tongue coating, heaviness in the limbs and body, a sticky mouth, and loose stools.
Women may experience increased vaginal discharge and pale complexion.
Treatment should focus on aromatic transformation of dampness and clearing turbidity.
TCM believes that patients with fatty liver should pay attention to the following lifestyle adjustments:
1.
Emotional regulation, stress reduction, and appropriate exercise: TCM holds that the liver governs the smooth flow of qi throughout the body.
Fatty liver patients should regulate their emotional activities, reduce stress, and engage in appropriate exercise, focusing on positive leisure activities to maintain a cheerful disposition.
Anger can harm the liver, and only love and tolerance can mitigate the anger of "not forgiving those who are right." Otherwise, "rage harms the liver," worsening the fatty liver condition.
2.
Adequate sleep and balanced work and rest: TCM believes that "when a person lies down, blood returns to the liver." Work should be appropriate, and good sleep is essential for the liver to rest properly, reducing the chances of recurrent inflammation in fatty liver.
3.
Self-massage: Alternately use both palms to massage the liver area and abdomen in a clockwise direction, once in the morning and once before bed for 10 minutes each time.
This helps to regulate liver qi, improve blood circulation in the liver area, and promote gastrointestinal motility and digestion.
4.
Careful dietary adjustments, protecting the spleen and stomach, controlling blood lipids, and weight loss: Since the liver's function is closely related to the spleen and stomach, fatty liver patients should consume "light and nutritious" foods, strictly avoiding alcohol.
Foods that promote fluid production and support spleen function should be prioritized, based on the specific symptoms.
Patients should avoid "spicy, hot, and rich foods," as well as fried and high-fiber foods.
Weight control, lipid management, and liver function monitoring are essential to reduce the risk of progression to cirrhosis.
When cirrhosis leads to edema, moderate protein supplementation is recommended.
Clinically, patients with chronic hepatitis and fatty liver must receive treatment based on their specific symptoms, avoiding excessive tonification that could burden the liver and spleen.
Fatty liver can evolve over many years, with a significant risk of progressing to cirrhosis.
However, through proactive treatment from either Western or Traditional Chinese Medicine, there is a chance to improve inflammatory liver function indices and reduce the risk of cirrhosis.
Therefore, both TCM and Western medicine have their unique characteristics and preferred patient populations, and the best approach is often a combination of both.
If taking Chinese herbal medicine, it should be spaced one hour apart from Western medications.
Finally, I wish you well.
Dr.
Lin Qingzhong
Director of the Traditional Chinese Medicine Department, Fengyuan Hospital
Assistant Professor, Nursing Department, Hungkuang University

Reply Date: 2011/05/07

More Info

Managing high cholesterol and fatty liver disease is a multifaceted challenge that often requires an integrated approach combining both Western and Traditional Chinese Medicine (TCM). Your father's situation, with high cholesterol and fatty liver, is not uncommon, especially considering the increasing prevalence of these conditions in modern society.

Western Medicine Perspective
In Western medicine, the management of high cholesterol typically involves lifestyle modifications and pharmacological interventions. Statins are the most commonly prescribed medications for lowering cholesterol levels. They work by inhibiting the enzyme HMG-CoA reductase, which plays a central role in cholesterol synthesis in the liver. While statins are effective, they can sometimes lead to elevated liver enzymes, which is a concern for patients with fatty liver disease. Regular monitoring of liver function tests is essential for patients on statins, especially if they have pre-existing liver conditions.

For fatty liver disease, the primary treatment focuses on lifestyle changes, including weight loss, dietary modifications, and increased physical activity. A low-calorie diet rich in fruits, vegetables, whole grains, and lean proteins is recommended. Reducing saturated fats and sugars can help improve liver function and lower cholesterol levels. If lifestyle changes are insufficient, medications such as pioglitazone or vitamin E may be considered, particularly for non-alcoholic fatty liver disease (NAFLD).

Traditional Chinese Medicine Perspective
From a TCM perspective, fatty liver and high cholesterol may be viewed through the lens of imbalances in the liver, spleen, and gallbladder. TCM practitioners often focus on restoring harmony within the body through herbal remedies, acupuncture, and dietary therapy. Common TCM approaches for treating fatty liver include:
1. Herbal Formulas: Formulas such as Xiao Yao San (Free and Easy Wanderer) or Ping Wei San (Calm the Stomach Powder) may be used to promote liver function, improve digestion, and reduce dampness and phlegm accumulation.

2. Dietary Recommendations: TCM emphasizes a balanced diet that avoids greasy, spicy, and overly rich foods. Instead, it encourages the consumption of foods that support liver health, such as green leafy vegetables, legumes, and whole grains.

3. Lifestyle Modifications: Stress management and regular physical activity are also crucial in TCM. Practices such as Tai Chi or Qi Gong can help improve circulation and liver function.

Integrating Both Approaches
1. Concurrent Treatment: It is generally acceptable to integrate TCM with Western medicine. However, it is crucial to consult with both your father's Western medical doctor and a qualified TCM practitioner to ensure that the treatments do not interfere with each other. In many cases, patients can benefit from both approaches simultaneously.
2. Timing of Medications: If your father is taking both Western medications and TCM herbs, it is advisable to space them out. A common recommendation is to take TCM herbs at least two hours apart from Western medications to avoid any potential interactions. This allows for optimal absorption and efficacy of both treatments.

3. Monitoring Progress: Regular follow-ups with healthcare providers are essential to monitor liver function tests and cholesterol levels. Adjustments to treatment plans can be made based on these results.

Conclusion
In summary, managing high cholesterol and fatty liver disease effectively requires a comprehensive approach that includes lifestyle changes, pharmacological treatment, and possibly TCM. Your father's current regimen of Western medications can be complemented with TCM, provided that both practitioners are aware of the treatments being administered. This integrative approach can lead to improved health outcomes and a better quality of life. Always ensure to maintain open communication with healthcare providers to tailor the best treatment plan for your father's specific needs.

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