If left untreated, high cholesterol can lead to atherosclerosis, characterized by plaque buildup in the arteries. This increase in plaque raises the risk of heart disease, stroke, and other serious health complications.

Traditional Chinese Medicine (TCM) offers a unique perspective on managing high cholesterol through the use of herbal formulas.

High Cholesterol and Its Complications

When discussing various manifestations of atherosclerosis, the following three patient stories illustrate how this progressive condition can affect different parts of the circulatory system, leading to serious health complications that require prompt medical intervention.

Case 1: Coronary Artery Disease

A 58-year-old woman who was overweight and had a history of diabetes began experiencing chest pain, particularly during physical activity. A medical examination revealed that her low-density lipoprotein (LDL) cholesterol—commonly known as “bad cholesterol”—was extremely high. Further testing with a coronary angiography confirmed that she had coronary artery disease.

As part of her treatment, she underwent angioplasty, a minimally invasive procedure used to open blocked or narrowed arteries to improve blood flow, was prescribed statins, and received guidance on weight management. Following the procedure, her symptoms improved significantly, and both her cholesterol and blood sugar levels were under control.

It is worth noting that cholesterol-lowering medications can sometimes raise blood sugar levels. However, in her case, weight and dietary management played a key role in stabilizing her blood sugar.

Case 2: Ischemic Stroke

Mr. Wang, a 70-year-old man with a history of hypertension (high blood pressure) and high cholesterol, experienced sudden facial numbness, difficulty speaking, and weakness on one side of his body. His family rushed him to the hospital, where he was diagnosed with an ischemic stroke.

Ischemic strokes vary in severity.

Transient ischemic attacks (TIAs) typically resolve within 24 hours, while reversible ischemic neurological deficits (RINDs)—when a temporary disruption of blood flow to the brain causes neurological symptoms—may take up to 48 hours to recover. More severe cases can lead to permanent ischemic stroke, with recovery often being lengthy and challenging.

Thrombolytic therapy—injecting medications to dissolve blood clots—is commonly used for treatment, but if the affected area is extensive, rehabilitation can be prolonged.

Case 3: Peripheral Arterial Disease

A 60-year-old woman reported persistent soreness in both legs while walking. A medical examination revealed that she had peripheral arterial disease, a circulatory problem in which blood flow to the limbs is restricted, in this case by atherosclerosis.

Her symptoms worsened during physical activity due to increased blood flow demand.

Further tests showed that she also had high cholesterol and hypertension. In such cases, managing cholesterol levels and controlling blood pressure is essential for preventing further complications.

How Atherosclerosis Affects Multiple Organs

Excess cholesterol can build up on blood vessel walls, restricting blood flow and contributing to atherosclerosis. This condition can affect different arteries in the body, resulting in various complications.

• Coronary Arteries: Increased risk of coronary artery disease and heart attacks.


• Cerebral Arteries: Potential for stroke.


• Peripheral Arteries: Risk of peripheral artery disease.

Beyond these risks, atherosclerosis can impair kidney function by reducing blood flow, subsequently leading to high blood pressure. Additionally, severe atherosclerosis can cause narrowing and blockages in blood vessels, which may worsen hypertension.

Recognizing these warning signs is crucial, as they may indicate underlying issues with the heart, brain, or circulation. These signs are often associated with hypertension, diabetes, hyperlipidemia (high cholesterol), or a combination of these conditions.

TCM’s Perspective on High Cholesterol

Unlike Western medicine, TCM does not rely on biochemical indicators for diagnosis, meaning the concept of high blood lipids does not exist in TCM theory. So how does TCM view and manage high cholesterol?

According to TCM, meridians are the channels through which energy flows in the human body. They are responsible for transporting qi and blood throughout the body. Qi is the energy or force that constitutes life within the body, and in TCM, all nutrients that supplement the body are collectively referred to as blood. The circulation of qi and blood maintains the balance and stability of various tissues and organs. When there is an imbalance or deficiency of qi and blood in the body, diseases or other conditions may occur.

Sudden cardiovascular and cerebrovascular diseases, for example, are viewed as consequences of energy flow disturbances. Two common imbalances that may contribute to these conditions are:

• Qi stagnation and blood stasis: When qi fails to circulate smoothly, blood flow becomes obstructed.


• Endogenous Wind of Liver: Liver dysfunction disrupts the movement of qi and blood, hindering proper circulation.

When qi, which comes from breathing and food intake and is also inherited from one’s parents, is deficient, blood flow is compromised. Dysfunction in the lungs, spleen, or kidneys can lead to severe qi deficiency.

Additionally, when qi flows in the wrong direction (rebellious qi), it moves erratically, further disrupting blood circulation.

TCM Links Liver Health to Stroke, Heart Disease

Stroke, acute heart disease, and even peripheral facial palsy are all linked to liver function in TCM. Additionally, TCM considers external environmental factors—such as wind, cold, heat, dryness, dampness, and fire—as contributors to illness.

The liver plays a central role in cholesterol metabolism, regulating both its production and elimination.

A study published in Nature Cardiovascular Research in March of this year highlighted the liver’s key role in the development of atherosclerotic cardiovascular disease. The study found that liver macrophages—immune cells in the liver—help regulate and break down atherogenic lipoproteins (lipid-carrying proteins that contribute to plaque buildup in arteries).

They also secrete atherosclerosis-modulating factors into the bloodstream, thereby altering lipid concentrations in both the blood and liver.

The Link Between Emotions and High Cholesterol

In Traditional Chinese Medicine (TCM), qi stagnation and blood stasis describe conditions where the natural flow of energy and blood is disrupted, leading to poor circulation and potential clotting.

TCM believes that emotional disturbances—such as anger, resentment, fear, sadness, and anxiety—can cause qi stagnation, which in turn leads to blood stasis and impacts overall cardiovascular health. When the liver’s function of qi regulation is impaired due to stress or unresolved emotions, it may result in impaired lipid metabolism and contribute to high cholesterol levels.

Modern medicine also acknowledges that chronic stress and emotional distress can alter lipid profiles by increasing cortisol and adrenaline levels, which promote higher triglycerides, LDL cholesterol (bad cholesterol), and lower HDL cholesterol (good cholesterol).

A 2017 cohort study indicated that psychological stress is a risk factor for lipid disorders, contributing to elevated triglycerides and LDL cholesterol while reducing HDL cholesterol.

Additional Insights from TCM on Emotions and Cholesterol

• Anger & the Liver: In TCM, anger is associated with the liver, which governs the smooth flow of qi and blood. Chronic anger or frustration can lead to liver qi stagnation, impairing lipid metabolism and increasing cholesterol levels.


• Fear & the Kidneys: Fear and chronic stress weaken the kidney system, which in TCM is believed to play a role in water metabolism and overall homeostasis. When kidney function declines, the body may struggle to regulate fluids and fats, potentially leading to dyslipidemia (abnormal levels of fats in the blood).


• Worry & the Spleen: Excessive worrying impacts the spleen, which is responsible for digestion and nutrient absorption. Spleen qi deficiency can contribute to dampness and phlegm accumulation, which in TCM is linked to high cholesterol and arterial plaque formation.


• Sadness & the Lungs: Long-term sadness or grief weakens the lung qi, reducing oxygenation of the blood and contributing to poor circulation and sluggish metabolism, which may lead to increased lipid levels.

Traditional Chinese Herbal Therapies

TCM commonly employs herbal formulas to address cholesterol-related conditions. Examples include:

• Formulas that soothe the liver and regulate qi, such as Shugan Wan.


• Formulas that promote blood circulation and dispel stasis, such as Xuefu Zhuyu Tang.


• Formulas that replenish qi, such as Buzhong Yiqi Tang and Erchen Wan.

Buzhong Yiqi Tang has been used for over 700 years. Both clinical and animal studies suggest that it can help protect against cerebral ischemic injury, reduce the volume of cerebral infarctions, prevent stroke recurrence, and alleviate post-stroke sequelae.

Similarly, Xuefu Zhuyu Tang is an ancient herbal formula that has been used for centuries. A clinical trial found that the formula (in pill form) improves blood stasis syndrome in patients with atherosclerosis and may help lower risk factors for the disease, including high cholesterol and oxidized LDL levels.

Different medical systems have distinct approaches to understanding and treating disease. Modern medicine focuses on structural and biochemical mechanisms, while TCM views health through the lens of energy balance. Integrating both systems can offer a more comprehensive approach to maintaining health.

Some herbs mentioned in this article may be unfamiliar, but they are generally available in health food stores and Asian grocery stores. It is important to note that treatment methods may vary depending on the individual. Please consult with a health care professional for a specific treatment plan.