arteriosclerosis.jpg


Arteriosclerosis, or "hardening of the arteries," commonly shows its effects first in the legs and feet. The narrowing of the arteries may progress to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness.
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Western Diagnosis

the arterial wall becomes thickened and loses elasticity
1. arteriosclerosis is general term for any process that causes the above to occur
B. leading cause of morbidity and mortality in US & West
--Atherosclerotic Heart dx and stroke #1 killer
--33% of all deaths
C. between 35-44, 6x > in white men than white women
D. inc in postmenopausal women to match men

etiology

athroma.jpg--hypertension
--elevated serum lipids - inc LDL, dec HDL
--cigarette smoking
--Diabetes
--Obesity
--Male gender
--Family hx of early athersclerosis
--Hyperhomocysteinemia
--physical inactivity
--Personality type
--Chlamydia pneumoniae


Pathophysiology

Arteries

a. intima: endothelium, basement membrane, elastic lamina
b. media: smooth muscle, elastic lamina
c. externa: elastic and collagen fibers
2. AS affects medium and large arteries
3. thickening of intima that dec lumen size
4. AS plaque: lipids, smooth muscle cells, ct, glycosaminoglycans
5. begins as fatty streak: lipid laden cells in intima
6. fibrous plaque: smooth muscle cells surrounded by connective tissue and lipid
7. decreased elasticity

2 major hypotheses

lipid hypothesis

i. inc LDL
ii. LDL into arterial wall with accumulation of lipid in smooth muscle cells and in macrophages, which result from monocytes that have attached to intima (foam cells)
iii. LDL oxidized by endothelial cells & becomes more atherogenic
iv. inc smooth muscle cell hyperplasia
v. chemotactic to monocytes
vi. cytotoxic to endothelial cells

endothelial injury hypotheisis

i. endo injury produces loss of endo
ii. platelet adhesion & aggregation
iii. monocyte chemotaxis
iv. factors that induce migration of smooth muscle into intima where they replicate
v. ct & proteoglycan synthesis
vi. fibrous plaque formation

9. oxidized LDL may induce endo injury, so both hypo may be occurring at same time
10. plaque may grow slowly over years
a. calcification
b. spontaneous rupture stimulating thrombosis: may embolize, block lumen, or be incorporated into plaque
11. monoclonal hypothesis
a. plaque from benign monoclonal neoplastic growth initiated by mutation

sxs & sns

1. none until critical level of stenosis
2. sx from dec blood flow to an area
a. thrombosis, embolism, aneurysm, CVA, MI

Lab

1. serum lipids: triglycerides, cholesterol, HDL, LDL, apolipoproteins
2. homocysteine
3. CRP

Imaging

1. angiography

Treatment

1. prevention
2. diet
-low fat and cholesterol diet
-avoid oxidized fats and hydrogenated oils [heated], [egg yolk is best soft boiled or poached]
-avoid sucrose (sugar) [clearly athrogenic]
-eat water soluble fiber - pectin (apples/pears), oat bran, legumes [binds to bile acids and excretes it from the body, requiring more cholesterol to create more bile]
-eat soy protein
-eat cold water fish - salmon, mackerel, herring [farmed salmon is among most contaminated foods, if choice is farmed salmon or no salmon - choose no salmon, EPA levels are also a fraction of wild salmon]
3. EPA - 5 gm/d [some studies show that higher DHA levels may be more beneficial]
4. garlic, onions
5. vit. C - 3 gm/d
6. vit. E - 800 IU/d
7. Magnesium - 500 mg/d
8. Cromium - 200-1,000 mcg/d [raises HDL levels slightly
9. Copper - 2 mg/d [esp. if history of aneurysm]
10. pantethine - 1200 mg/d
11. carnitine - 3 gm/d
12. exercise: yoga, aerobics - 30-60 mins 3-7x/wk [some studies say interval training may be best, esp. on persons own schedule. best for weight loss also]
13. meditation
14. visualization
15. crataegus [western Hawthorne berries - peripheral vasodilator]
16. Niacin 3 gm/d - hepatotoxic
17. Folic Acid - 1-2 mg/day [lowers homosysteine, and perhaps CRP levels]
18. Vitamin B12 - 300-500 mg/day
19. Vitamin B6 - 50 mg/day
20. Zhi Bi Tai has been equally as efficacious in lowering cholesterol as atorvastatin [Focus on Alternative and Complementary Therapies Vol. 16, Issue 2]

2 best things to lower CRP levels: weight loss & exercise

Studies

-Pregnant women who when either overweight or under significant stress can increase risk markers in their children
-Walnuts when eaten with a high fat meal was shown to cause the lipid levels to not rise
-Red Yeast Rice contains lobostatin [a natural statin, essentially lipitor] and lowers cholesterol 300mg TID, take CoQ10 in conjuncture
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Treatment

-Epsom Salts Bath

Dietary Recommendations

Recomended detoxification-stimualtion according to intestinal function.
Stimulate liver.
Take vitamin E because certain researchers have shown that it can help prevent blood clots.
Pay attention to emotional states.


Healthy eating habits can help reduce high blood cholesterol, high blood pressure, and excess body weight -- three of the major risk factors for heart disease. The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease. The main goal of these guidelines is to promote an overall healthy eating pattern, maintain an appropriate body weight, and reach desirable cholesterol and blood pressure levels. The AHA does not recommend very low-fat diets as these diets may lead to deprivation of essential fatty acids as well as an undesired reduction in HDL ("good") cholesterol levels. The AHA also advises against high-protein diets due to the lack of scientific evidence supporting their weight-loss effectiveness or any other claims of health benefits. In general, Western diets are considered to be too high in protein, particularly animal protein (which is high in fat and cholesterol). In adults, high levels of protein can cause kidney damage and bone loss.
The AHA recommends the following to prevent the development or progression of atherosclerosis:
  • A variety of fruits and vegetables (5 to 9 servings/day)
  • A variety of grain products, with an emphasis on whole grains (6 or more servings/day)
  • At least 2 servings of fish per week
  • Limit total fat intake to <30% and saturated fat to <10% of energy. Replace dietary saturated fats and trans fatty acids with monounsaturated and polyunsaturated fats (including foods rich in omega-3 fatty acids). Food sources of omega-3 fatty acids include fatty fish (such as salmon), flaxseed and flaxseed oil, soybean oil, canola oil, and nuts.
  • Limit dairy products to low-fat or fat free items (2 to 4 servings/day)
  • Limit sodium intake to 6 grams per day
  • Limit alcohol intake to 2 drinks/day for men and 1 drink/day for women
  • Maintain a healthy body weight by matching calorie intake to energy needs; this includes a moderate level of regular physical activity (30 to 60 minutes within target heart range most days per week)
In addition to the recommendations listed above, the AHA suggests that individuals who have heart disease or are at a high risk of developing heart disease consider the more specialized diets below:
Diets for People with High Cholesterol
The National Cholesterol Education Program (NCEP) recommends saturated fat intake of no more than 7% of total calories, cholesterol limited to less than 200 mg/day, little to no trans fatty acids (such as fried foods), intake of both plant stanols/sterols (2 grams/day) and soluble fiber (10 to 25 grams/day), weight loss, and exercise. Studies have also shown that replacing dietary animal protein with soy protein may reduce total cholesterol, LDL ("bad") cholesterol, and triglycerides (a major form of fat in the blood) without affecting HDL ("good") cholesterol levels. The AHA also recommends a diet high in unsaturated fat diet rather than a very low-fat diet for individuals with atherogenic dyslipidemia (a condition marked by high triglycerides, low HDL cholesterol, obesity, high blood pressure, and/or diabetes).
Diets for People with High Blood Pressure
The Dietary Approaches to Stop Hypertension (DASH) diet emphasizes a diet rich in fruits, vegetables, and low-fat or non-fat dairy products to provide high intake of potassium, magnesium, and calcium sources. Sodium intake should be less than 6 g/day. Weight loss, regular physical activity, and limiting of alcohol intake are also very important factors for lowering blood pressure.
Mediterranean Diet
The Mediterranean Style Diet is comprised of whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. Unlike the AHA diets, the Mediterranean Style Diet is not low in all fats; it is low in saturated fat but high in monounsaturated fatty acids. In a long-term study of 423 patients who suffered a heart attack, those who followed a Mediterranean Style Diet had a 50% to 70% lower risk of recurrent heart disease compared with controls who received no special dietary counseling. The intervention diet emphasized bread, root and green vegetables, daily intake of fruit, fish and poultry, olive and canola oils, margarine high in alpha-linolenic acid (an omega-3 polyunsaturated fatty acid found in flaxseed, walnuts, and canola oil), along with discouragement of ingestion of red meat and total avoidance of butter and cream.
Supplements and Vitamins
Folic Acid, Vitamin B6, Vitamin B12, Betaine
Many studies indicate that patients with elevated levels of the amino acid homocysteine are roughly 1.7 times more likely to develop coronary artery disease and 2.5 times more likely to suffer from a stroke than those with normal levels. Homocysteine levels are strongly influenced by dietary factors, particularly vitamin B9 (folic acid), vitamin B6, vitamin B12, and betaine. These substances help break down homocysteine in the body. Some studies have even shown that healthy individuals who consume higher amounts of folic acid and vitamin B6 are less likely to develop atherosclerosis than those who consume lower amounts of these substances. Despite these findings, the AHA reports that there is insufficient evidence to suggest that supplementation with betaine and B vitamins reduce the risk of atheroscerlosis or that taking these supplements prevents the development or recurrence of heart disease. The AHA does not currently recommend population-wide homocysteine screening, and suggests that folic acid, as well as vitamin B6, B12, and betaine requirements be met through diet alone. Individuals at high risk for developing atherosclerosis however, should be screened for blood levels of homocysteine. If elevated levels are detected, a healthcare practitioner may recommend supplementation.
Omega-3 Fatty Acids
There is strong evidence that omega-3 fatty acids (namely EPA and DHA) found in fish oil can help prevent and treat atherosclerosis by inhibiting the development of plaques and blood clots. In one study of 223 patients with coronary artery disease, those who received fish oil supplements daily for 2 years demonstrated a significant improvement in symptoms compared to those who did not receive the supplements. A second study of heart attack survivors found that daily supplementation with omega-3 fatty acids dramatically reduced the rate of death, subsequent heart attacks, and stroke.
L-Carnitine
Studies suggest that patients who take L-carnitine supplementation soon after suffering a heart attack may be less likely to suffer a subsequent heart attack, die of heart disease, and experience chest pain and abnormal heart rhythms. In addition, people with coronary artery disease who use L-carnitine along with standard medication may be able to sustain physical activity for longer periods of time.
Antioxidants
Evidence suggests that antioxidants may play a role in the prevention of atherosclerosis. Antioxidants are believed to prevent fatty buildup in the arteries by suppressing the oxidation of LDL ("bad") cholesterol. They may also reduce the likelihood of blood clot formation and may help relax blood vessels thereby improving blood flow. Currently, however, combined data from epidemiologic studies and clinical trials do not provide convincing evidence for the benefits of antioxidant supplementation, as opposed to intake from dietary sources.
Vitamin E
Population-based studies suggest that vitamin E supplements may help prevent the development and progression of heart disease. Several recent well-designed, large-scale studies comparing vitamin E to placebo, however, have not confirmed these findings. More research is currently underway to determine whether vitamin E helps protect against atherosclerosis.
Vitamin C
A few studies suggest that consuming high levels of vitamin C may protect against heart disease, but not all studies confirm this relationship. It is recommended that people who have low levels of this nutrient should take vitamin C (either through diet or supplements) to prevent atherosclerosis and its complications.
Beta-carotene and other carotenoids
Despite beliefs by the scientific community and the general public, beta-carotene does not appear to protect against atherosclerosis and may even increase the risk of atherosclerosis complications in people who smoke. There is some preliminary evidence, however, that other carotenoids (such as lutein and zeaxanthin), particularly from dietary sources, may prevent plaque buildup in carotid blood vessels. More research is needed to determine whether these carotenoids may be helpful in the prevention of atherosclerosis.
Selenium
Low blood levels of this antioxidant may worsen atherosclerosis. Cigarette smoking and alcohol ingestion are believed to contribute to selenium deficiency. It is not known, however, whether selenium supplementation has any influence on the development or progression of atherosclerosis.
Coenzyme Q10 (CoQ10)
Researchers believe that CoQ10 inhibits blood clot formation and boosts levels of antioxidants. One study found that people who received daily CoQ10 supplements within 3 days of a heart attack were significantly less likely to experience subsequent heart attacks and chest pain and were also less likely to die of the condition than those who did not receive the supplements.
Flavonoids
Test tube, animal, and some population-based studies suggest that the flavonoids quercetin, resveritrol, and catechins (all found in high concentration in red wine) may help reduce the risk of atherosclerosis. By acting as antioxidants, there nutrients appear to protect against the damage caused by LDL cholesterol. Rigorous studies in humans are needed to confirm these findings.
Vitamin D
Low levels of vitamin D may increase the risk of calcium build-up in the arteries, a significant component of atherosclerotic plaque. Atherosclerotic plaque build up in blood vessels can lead to a heart attack or stroke. More research is needed to understand the practical implications of this possible relationship between low vitamin D levels and atherosclerosis.
Melatonin
Low levels of melatonin in the blood have been associated with heart disease, but it is not clear, whether melatonin levels are low in response to having heart disease or if low levels of melatonin predispose people to developing this condition. In addition, several studies in rats suggest that melatonin may protect the hearts of these animals from the damaging effects of ischemia. It is not known from this information, however, whether melatonin supplements may help prevent or treat heart disease in people. More research and scientific information is needed before conclusions can be drawn.


Herbal Supplementation


  • Hawthorn (Crataegus monogyna): Used traditionally as a remedy for cardiovascular diseases. Animal and laboratory studies demonstrate that this herb has antioxidant properties that help protect against the formation of plaques and may help control high cholesterol and high blood pressure.
  • Garlic (Allium sativum): Clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque.
  • Green Tea (Camellia sinensis): Population studies indicate that the antioxidant properties of green tea may prevent atherosclerosis, particularly coronary artery disease.
  • Gugulipid (Commiphora mukul): Used in Ayurvedic medicine to treat high cholesterol levels. Certain ingredients in this herbal remedy may have antioxidant properties and may therefore convey health benefits similar to hawthorn, garlic, and green tea.
  • Pseudo ginseng root/notoginseng root (Panax notoginseng): Used in Traditional Chinese Medicine to treat chest pain and coronary artery disease. Laboratory studies suggest this herb may help prevent blood clots and protect against the formation of plaques.
*

Recommended Minerals

-Selenium
-Zinc

Orthomolecular Treatment

-Methionine
-Omega-6
-Resveratrol
-Chondroitin
-Squalene

Contraindications

Swedish Respiratory Exercises

Source: http://www.healthandage.com/html/res/com/ConsConditions/Atherosclerosiscc.html#NutritionDiet
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IBIS

Definition:

Intimal thickening of one or many arteries due to localized accumulation of fatty material (atheromas).

Etiology:

There are several types of arteriosclerosis, the global term for formation of atheromas in the arteries. Atherosclerosis is the most important kind of arteriosclerosis. Atherosclerosis sequelae are the major cause of mortality from illness in the U.S. (at least 33%). The disease seems to favor blood vessels of high importance (cardiac, kidney, cerebral), and the peripheral arteries (causing much morbidity). The mechanism of atheromatous development is still theoretical, but suggests that injury to the lining of the blood vessel from turbulence, hypertension, hypoxia, hyperglycemia or free radicals causes smooth muscle cells to proliferate at the lesion site to initiate regrowth of tissues. LDL attaches to the smooth muscle cells to stimulate them to multiply. But the uptake of cholesterol (a major component of LDL) into the intima leads to the formation of an atheroma that is later hardened by calcium deposits.

Other implicated factors include the following:

Homocysteine is believed to contribute directly to the early stages of atherosclerosis by damaging the intima, the cells that line blood vessels. Elevated serum homocysteine levels are found in 20 - 40% of the population. Patients with even slightly elevated homocysteine have more than three times the risk of suffering a heart attack compared to those showing normal homocysteine levels. (Stampfer, MJ, et al. JAMA 1992;268:977-981. Many cardiovascular patients have mild elevations. (Franken, DG, et al. Amer J Clin Nutr 1993; 57:47-53). Studies have revealed that homocysteine levels strongly correlated with blood and dietary folic acid and dietary intake of Vitamin B-6. (Selhub, J, et al. JAMA 1993;270:2693-8.) Likewise, similar, though weaker, inverse correlations were found for blood levels of Vitamins B-12 and B-6 and homocysteine. The lowest homocysteine levels corresponded with dietary intakes of folic acid and Vitamin B-6 well above the RDA.

Hydrogenated oils (including partially hydrogenated oils) are significantly atherosclerotic. Ironically, hydrogenated oils such as margarine were for man years believed to be healthier because they were cholesterol-free. However, the rise of myocardial infarctions and heart disease in general can be traced back to the 1920s and 1930s, when hydrogenated oils were first being introduced and used in foods. Hydrogenated oils are unsaturated oils which are heated, pressurized and then chemically altered with nickel (or a similar metal), changing the biochemical formation from the natural "cis" formation (liquid state at room temperature) into the synthetic "trans" formation (solid state at room temperature). It is now suggested that the synthetic and foreign quality of the trans oil creates damage to body tissues causing atherosclerotic formation and cancer. Furthermore, polyunsaturates allow significant formation of free radical compounds, thought to cause endothelial damage and predispose to formation of atheromas. Epidemiological research shows that people were eating high cholesterol diets for hundreds or thousands of years (meat, cream, butter, eggs, lard), and yet the epidemic of heart disease began only earlier this century, after the introduction of hydrogenated oils. Of course, this is one among many other contemporary factors related to heart disease, including pollution, sedentary lifestyle, refined sugar and flour products, and poor meat quality due to chemicals, hormones, antibiotics and other additives. Almost all the long-lived, healthy communities where degenerative disease and heart disease were unknown included significant meat or dairy in their diets (Schmid). It seems that the argument that cholesterol alone is the villain in heart disease falters at the evidence of those communities. It now seems that use of monounsaturated oils such as olive an canola, and moderate use of short-chain fatty acids (butter) may be the best way of maintaining "healthy" fat intake.

Risk factors for atherosclerosis include: high blood pressure, cigarette smoking, diabetes mellitus (hyperglycemia), obesity, family history, increased serum lipids, diet high in fats (unsaturated, hydrogenated and hydrogenated oils), sedentary lifestyle, aging, men in general, and women after menopause.

Somatic Therapies:

• regular aerobic exercise: Regular exercise contribute to higher levels of HDL cholesterol and reduce the risk of heart disease. Individuals over 40 and those who have not been engaged in vigorous activity on a regular basis should consult with their physician and consider starting with less strenuous activities such as walking.
(Duncan JJ, et al. JAMA 1991;266:3295-3299; Pekkanen J, et al. Lancet 1987;1:1473-1477; Reaven PD, et al. J Am Geriatr Soc 1990;38:847-854; Willich SN, et al. N Engl J Med 1993;329:1684-1690.)
• qigong
• tai qi chuan

Nutrition:

eating principles:
• Lifestyle Heart Trial by Dean Ornish, et al: Intensive lifestyle changes consisting of 10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support for a period of 5 years. Researchers found more regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.
(Ornish D, et al. JAMA 1998 Dec 16;280(23):2001-2007.)
• low sugar, low cholesterol
• low fat diet of unsaturated fats
• calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18%
• high fiber
• low Sodium/Sodium-restricted diet
• vegetarian cleansing diet or short fasts
• see Materia Medica: Diet for Lowering Cholesterol, Fasting, General Sample Diet, General Guidelines for Eating, Sample Vegetarian Diet

therapeutic foods:
• Garlic, onions and ginger exert a beneficial effect on platelet aggregation
• garlic, wheat germ, liquid chlorophyll, alfalfa sprouts, buckwheat, watercress, rice polishings, apple, celery, cherries (Ni, 120.)
• foods high in water-soluble fiber: flax seed, pectin, guar gum, oat bran
• onions, beans, legumes, soy, ginger, alfalfa, yogurt (Marz)
• increase omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, salmon, herring, mackerel, sardines, walnuts, flaxseed oil, evening primrose oil, black currant oil

fresh juices:
• carrot and pineapple with honey
• liquid chlorophyll (Jensen, 51.)
• parsley, alfalfa, and pineapple (Jensen, 51.)
• carrot, celery, parsley, and spinach (Walker, p. 123.)
• carrot and spinach (Walker, 123.)
• carrot, beet, and celery (Walker, 123.)
• celery, lettuce, and spinach (Walker, 123.)
• asparagus and honey (Ni, 120.)

avoid:
• trans-fatty acids, hydrogenated oils (margarine, vegetable shortenings, imitation butter spreads, most commercial peanut butters) oxidized fats (deep fried foods, fast food, ghee, barbequed meats)
• simple carbohydrates: sucrose, refined flours

Botanicals

• Allium cepa: aids blood cholesterol levels (NCNM Botanicals)
• Allium sativum: (NCNM Botanicals)
• Commiphora mukul (Guggul)
• Crataegus oxyacantha: aids circulation, arteriosclerosis
(Weiss, p. 162; British Herbal Pharmacopoeia, p. 75)
• Dioscorea spp.: (Anderson Geller)
• Drosera rotundifolia (Weiss, p. 210)
• Ginkgo biloba (standardized extract): for intermittent claudication, impaired mental performance (NCNM Botanicals)
• Olea europaea (NCNM Botanicals)
• Scutellaria spp.: decreases elevated serum cholesterol (Anderson Geller)
• Selenicereus grandiflorus (toxic): cardiac weakness with atheroma or arteriosclerosis, with Crataegus spp. (Priest and Priest, p. 91)
• Strophanthus hispidus (Ellingwood, p. 221)
• Taraxacum officinale: aids liver function (NCNM Botanicals)
• Tilia platyphyllos: arteriosclerotic hypertension; with Crataegus oxyacantha (British Herbal Pharmacopoeia, p. 214)
• Viscum album (toxic): arteriosclerosis, heart conditions, high blood pressure
(British Herbal Pharmacopoeia, p. 236; Ellingwood, p. 153)

Chinese Formulae

» Shi (Excess):
• Trichosanthes, Bakeri and White Wine C. (Gua Lou Xie Bai Ban Jiu Tang); Hai Zao Wan (Haiodin) (patent): Heart Yang Xu (Deficiency) causing Phlegm Accumulation: pain in the chest, shortness of breath, thick, greasy tongue coat
(Trichosanthes, Bakeri and White Wine C.: Hsu, 1980, p. 388; Yeung, p. 109; Bensky and Barolet, p. 292; Hai Zao Wan: Zhu, p. 82)
• Tao Hong Si Wu Tang plus Dan Shen Yin; Cir Q (patent): Xue Yu (Blood Stasis).
(Tao Hong: Yeung, p. 220; Bensky and Barolet, p. 250; Dan Shen: Yeung, p. 71; Bensky and Barolet, p. 318; Cir Q: (Fratkin, p. 276)
• Mao Dong Qing (patent): Xue Yu (Blood Stasis) with Internal Heat (Zhu, p. 242)
• Jiang Ya Ping Pian (Hypertension Repressing Tablets) (patent): Liver Wind Arising from Liver Yang Rising. (Zhu, p. 174)

» Xu (Deficiency):
• Sheng Mai San: Lung Qi Xu (Deficiency) and Lung Yin Xu (Deficiency): shortness of breath, spontaneous sweating
(Yeung, p. 207; Bensky and Barolet, p. 245)
• Rehmannia 8 F. (Jin Gui Shen Qi Wan); Du Zhong Pian (Compound Cortex Eucommia Tablets) (patent): Kidney Yang Xu (Deficiency): low back pain, weakness of lower limbs, coldness, pale swollen tongue
(Rehmannia: Hsu, 1980, p. 250; Yeung, p. 138; Dharmananda, 1986, p. 173; Bensky and Barolet, p. 275; Du Zhong: Zhu, p. 177)

Acupuncture

after assessing the person and palpating, consider these patterns:
Heart Yang Xu (Deficiency) causing Phlegm Accumulation; Xue Yu (Blood Stasis); Xue Yu (Blood Stasis) with Internal Heat; Liver Wind Arising from Liver Yang Rising; Lung Qi Xu (Deficiency) and Lung Yin Xu (Deficiency); Kidney Yang Xu (Deficiency)

» illustrative combinations:
• PC-6, UB-15, PC-4 and CV-17 (also consider LI-11, St-36, UB-16 and UB-14) for atherosclerosis (Liu, p. 295)

Homeopathy

• Adrenalinum: with hypertension, roaring in the ears
• Arnica montana: cerebral atherosclerosis, vertigo, heaviness and cerebral affection; plethoric people with tendency to hemorrhage
• Arsenicum iodatum: senile hearts with arteritis, myocarditis, and fatty degeneration
• Aurum muriaticum: hypertrophy of heart, congestion to chest and head; strong palpitation, abnormal sensation in heart
• Baryta muriaticum: in large blood vessels and aorta; headache (heaviness) < at night and lying down, dizziness; threatened apoplexy with ringing in the ears; give for a long time
• Cholesterolinum: if necessary, with regular lab work every three months; starting with higher potencies and descending (Eizayaga)
• Ergotinum: beginning of atherosclerosis; cardiac irritation with hard heart sound; use 1X-2X in advanced cases and 3X-6X in early cases
• Natrum iodatum: high arterial tension in 1X potency; later 3X when pulse is softer
• Plumbum metallicum: with hypertension

Subtle Support

• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

cardiovascular:
• The Barcarole
• The Blue Danube
• Chopin's A minor Waltz
• Tango music
• Humoresque
• Cui's Orientale
• Song of India
• Donna e Mobile
• Oley Speak's Sylvia
(Heline, p. 18)

Mind/Body

• Coronary artery disease is associated with type A behavior pattern. (Gentry, p. 55)
• Among the multiple factors having to do with occlusion, gradually mounting stress of emotional origin may be significant. Evidence for gradually mounting tension will often be denied by the patient, but suggested by a member of the family, often the spouse. (Locke, 1986, p. 120)
• involves being heart-sick, having a heart-ache, eating your heart out (Epstein, p.79)
• guilt feelings that eventually harden; guilt and fear relating to disappointing the expectations of others (Shealy, p. 163)
• Common psychologic responses to chest pain and diagnosis of coronary artery disease include mild to severe depressive reactions, marked hypochondriasis, and denial that the illness exists. The symbolic meaning of coronary artery disease also varies greatly in patients. The most common problem is the 'hard driver' who has depended on his activity level for his self-esteem. A principle of management is making the patient aware of the neurotic character of some of the activity patterns, and helping him to gratify his drives in alternative ways. Sexual activity is an area of great concern. Drugs are of limited usefulness. (Locke, 1985, p. 120)
• resistance; tension; hardened narrow-mindedness; refusing to see good; Arteries carry the joy of life. (Hay, 1984, p. 153)
• Patients gather strength more quickly and so avoid post-operative coronary bypass shock when there is an affinity between the patient, a doctor, and a particular nurse. There is a reason why patients seem to get better more easily under one nurse than another; perhaps a healing gift. (Locke, 1986, p. 215)
• "hardened and stony" hearts. The vessels leading to the heart have become hardened and constricted, so that it no longer receives nutrients. Fear of activity forces these patients to constantly observe their hearts and to subordinate their entire lives to the needs of their hearts. One can see the wisdom and irony with which the illness operates. (Dethlefsen, p. 200)

• Reduce stress and maintain regular exercise: Stress reduction and regular exercise contribute to higher levels of HDL cholesterol and reduce the risk of heart disease. Individuals over 40 and those who have not been engaged in vigorous activity on a regular basis should consult with their physician and consider starting with less strenuous activities such as walking.
(N Engl J Med 1988;318:110-112; Jiang W, et al. JAMA 1996;275:1651-1656; Kawachi I, et al. Circulation 1996.)


Chinese psychophysiology:
• Heart ~ Xin houses the Shen (Spirit); governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; and relates to the integration of the organs and the personality.
» Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy.
» Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep.
» The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel balanced and centered.
» Healthy expressions are fairness, openness, deep thinking, and reminiscence; » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation.
» The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

• Liver ~ Gan is the residence of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); and reflects emotional harmony and movement.
» Healthy expressions are kindness, spontaneity, and ease of movement.
» Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)
» Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; and displays the effects of aging, chronic degenerative processes, and extreme stress.
» Healthy expressions are gentleness, groundedness, and endurance.
» Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch.
» Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Integrative Therapies

Atherosclerosis is the most common form of heart disease. It mainly affects the arteries of the brain and heart, although other arteries may be involved. It is due to the buildup of cholesterol and other deposits on the walls of the arteries. This buildup causes the artery walls to become hardened and clogged. The blood flow becomes restricted, clots form, and the arteries deteriorate.

The symptoms of atherosclerosis include high blood pressure, chest pains that spread to the left arm and shoulder, feelings of tightness in the chest, leg cramps, mental confusion, weakness, and dizziness. Some people develop a characteristic diagonal crease on the earlobe caused by the collapse of blood vessels. This can be one of the earliest signs that a person is developing heart disease. However, atherosclerosis may develop over a period of several years without showing any outward symptoms.

Atherosclerosis is most likely to develop in individuals with poor eating and lifestyle habits such
as smoking or alcohol abuse. The most effective treatment for atherosclerosis is prevention and changes in diet and lifestyle.

THE FOLLOWING SUPPLEMENTS ARE USED FOR ATHEROSCLEROSIS AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE:
1. Psyllium seed, guar gum, or pectin – 1 tablespoon mixed in 1 cup of water at night before bedtime. This fiber will bind cholesterol in the intestines so it can be excreted.
2. Flaxseed oil – 1 to 2 tablespoons per day.
3. A multi-vitamin sipplement – daily and according to the product label.
4. Carnitine – 1,000 milligrams per day.
5. Pantothenic acid – 1,000 milligrams per day.
6. Magnesium – 400 milligrams per day.
7. Vitamin E – 400 to 800 Units a day.
8. Vitamin C – 1, 000 milligrams, 3 times a day.

THE PROPER DIET FOR ATHEROSCLEROSIS WILL INCLUDE:
1. It is important to maintain an overall healthy diet. A healthy diet should include daily servings of leafy green vegetables, whole grains (such as brown rice and millet), fruit, and proteins with a minimum of animal fat.
2. As much as possible, avoid sugar foods such as candy, cake, cookies, and refined carbohydrates such as white flour products and white rice. Use, instead, whole grains such as brown rice, oatmeal, and whole wheat bread.
3. Eliminate or greatly reduce animal products in your diet such as meat, organ foods such as liver, and eggs, cheese, milk, sour cream, and other dairy products.
4. Eat an ample amount of dietary fiber. Eat at least 2 of the following foods daily: 1 bowl of salad, 1 cup of cooked leafy green vegetables, 1 apple, 1 tablespoon of oat bran, or 2 carrots.
5. Fish that is rich in essential fatty acids such as mackerel, herring, and salmon – at least twice per week. Also take a salmon oil supplement – 2 capsules with each meal.
6. Eliminate or at least greatly reduce consumption of coffee and alcohol.
7. Avoid fried foods.
8. Add soy products to the diet, such as tofu, tempeh, soy milk, and soy beans.
9. Eat 4 ounces of nonfat yogurt each day, and take 1 Lactobacillus capsule with each meal.

HERBS USED FOR ATHEROSCLEROSIS:
Onions, Garlic, and Ginger are recommended for their ability to counteract the effects of atherosclerosis. Include them – raw as well as cooked – in your diet a often as possible.

PHYSICAL THERAPY MEASURES ARE AS FOLLOWS:
1. Regular exercise is essential. At least 30 minutes 3 times per week should be engaged in physical exercise that will get your heart working vigorously. Brisk walking, aerobics, swimming, tennis, and racquetball are all excellent forms of exercise. If you have been sedentary for awhile, consult your physician before starting a rigorous exercise program.
2. Stress should be effectively dealt with through stress management techniques such as visualization and meditation.