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Cardiovascular diseases are among the most important causes of morbidity and mortality in the world. One of the important risk factors of cardiovascular disease is hyperlipidemia especially high levels of serum cholesterol. Due to the importance of hypercholesterolemia, being a serious condition, various treatments are used to control it, regardless of the cause, most of treatments, focused on reducing the level of serum lipids. This study aims to determine various view points for hypercholesterolemia in Iranian traditional medicine. We used several Iranian traditional medicine resources and literatures; then based on these texts; a pilot study was designed to assess their effects in 10 patients with high plasma cholesterol. The sign and symptoms in main digestive organs Stomach and liver were also evaluated.

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Cardiovascular diseases are among the most important causes of morbidity and mortality in the world. One of the important risk factors of cardiovascular disease is hyperlipidemia especially high levels of serum cholesterol. Due to the importance of hypercholesterolemia, being a serious condition, various treatments are used to control it, regardless of the cause, most of treatments, focused on reducing the level of serum lipids. This study aims to determine various view points for hypercholesterolemia in Iranian traditional medicine.

We used several Iranian traditional medicine resources and literatures; then based on these texts; a pilot study was designed to assess their effects in 10 patients with high plasma cholesterol. The sign and symptoms in main digestive organs Stomach and liver were also evaluated. Some patients showed hepatic temperament but all patients had gastric temperament. With reference to Iranian traditional medical texts and literatures, the organs involved in the process of digestion, particularly the stomach and the liver play the most important role.

Yet the proper function of stomach as the first step involved in the digestion chain should be emphasized. Lipids are body components which play important roles in energy storage and in the structure of the cell membranes, hormones and secondary mediators.

Plasma lipid concentration depends on the balance between production, consumption and deposition of lipids. The important point in atherosclerosis disorder is to modify the level of lipids; because improved lipid levels to prevent atherosclerosis is the foundation. Several studies indicated diet therapy not to be very promising[ 24 ] and drug therapy may have different complications.

But apart from being effective, most of them induce adverse side effects. Therefore, search for safe and effective cholesterol lowering methods was the main motivating factor behind this study. Today the world is moving towards integrating traditional and complementary medicine[ 28 ] with the mainstream medicine to increase efficacy and to decrease side effects and costs.

To understand this perspective, it is necessary to explain some principles. The Iranian traditional medicine system makes effort to propose the best possible ways by which a person can lead an optimum healthy life with least illness.

The Iranian traditional medicine framework is based on some principals. One of the important principles is "Umore Tabiya". These elements are so meticulously intermixed with each other that they lie in a very intimate relationship to one another.

Their opposite powers intermittently conquer and are conquered until a state of balance is reached which is uniform throughout the whole. This result was given the name of temperament Mizaj. Mizaj is one of the most important canons of Iranian traditional medicine system.

It has an important function in maintaining the ideal healthy state of an individual. Vulnerability of its altered temperament which is called dystemperament Sui' e Mizaj leads to several different types of diseases. Each of the humors was related with pairs of qualities including cold and wet, hot and wet, hot and dry, and cold and dry, respectively.

In the Iranian traditional medicine texts, there is no concept of hypercholesterolemia as such; but in many cases has been described it as a disorder.

As far as the presence of fat Lipids is concerned in blood, Ibn Sina Avicenna an ancient Iranian traditional physician[ 45 ][ 46 ][ 47 ][ 48 ] has reported its existence in blood, produced from "Dosoomat Al-Dam". Dosoomat of blood or the oily substance could be the lipids but as the biochemical analysis of blood was not available and they could not describe it as per modern parameters.

Thus to clarify this issue, it is necessary to describe the production path of the humors. Based on available evidences and the detailed descriptions of the Iranian traditional medicine resources, ingested food undergoes various stages of digestion before reaching the tissues.

Each stage of the digestion is composed of specific processing of the food material that must be carried on until it becomes suitable for used by the body. In each digestion process, the following actions take place Figure 1 :[ 55 ]. In the gastric digestion, some of the traits and characteristics of food material changes and appropriate absorbable material named "Chylous" is absorbed via the mesenteric vessels to the liver for further digestion.

In the hepatic digestion stage, the chylous is changed in to the "Chymous" that is composed of four humors blood, phlegm, yellow and black bile , which will circulate in the vessels. During the tissue digestion stage, food becomes quite similar to the end organ tissue. As it was expressed, the humors are the final products of the hepatic digestion and in order for the humors, to be of good quality two conditions must be met including i Normal liver function for proper digestion and ii The Gastric chylous , which is used by the liver for the production of humors that must have an appropriate composition.

The second condition would not be present unless the stomach function properly and the ingested food is of good quality. According the book "The Qanon of Medicine" by Avicenna , the foundation of Iranian traditional medicine system was based on the balancing humors in the human body.

As it was expressed previously, the continuity between the stages of digestion and even the organs involved is such that any disorder in one of them would bring about a disorder in other organs and stages. Abnormal vascular content may be a consequence of hepatic maldigestion.

Also the hepatic maldigestion, itself may be a consequence of gastric maldigestion. In other word, abnormal gastric chylous results in abnormal hepatic chymous and abnormal hepatic chymous results in abnormal humors Figure 2. It should also be noted that even a healthy liver does not have the ability to convert abnormal chylous into normal chymous and then normal humors.

Different pathways of causing abnormal blood composition including hypercholesterolemia. The most important point is that due to the close relationship between different organs that contribute to the digestive chain, the impairment in each of the stages of digestion will ultimately cause production of abnormal humor.

This abnormal humor does not have the quality to become the desired end product. In later stages of digestion, the abnormal humor affects the function of organs consuming it and furthermore may gradually cause dysfunction of the next responsible organ in the digestion chain.

Based on the above hypothesis, to find the responsible organ causing hypercholesterolemia and to provide scientific basis for deeply studying the relation between body humors and hypercholesterolemia, a pilot study was designed to assess 10 patients with high plasma cholesterol.

The sign and symptoms of the dystemperament Sui' a Mizaj of the main digestive organs Stomach and liver were obtained. Our study indicated that only some of the patients had hepatic dystemperament Sui' a Mizaj and surprisingly all of the patients had gastric dystemperament.

The significant difference between the results of gastric and hepatic dystemperament in our patients, suggests that the responsible organ involved in hypercholesterolemia is the stomach.

Furthermore; the hepatic dysfunction, if not considered to be a consequence of gastric failure, will be the second responsible organ. Results of this study provide information for using Iranian traditional medicine in clinic and developing Iranian traditional medicine. With reference to Iranian traditional medical texts, one can reach the basic point that organs involved in the process of digestion, particularly the stomach and the liver play the most important role in determining the blood composition.

However, the proper function of stomach as the first step involved in the digestion chain should be emphasized. If the gastric digestion is impaired, the rest of the organs involved in digestion like the liver, blood vessels and tissues cannot be provided with the necessary qualified raw material chylous and therefore may suffer dysfunction, thus causing abnormal product formation such as abnormal humors and blood composition.

It can be concluded that the first and best action in the treatment of hypercholesterolemia is to treat the stomach dystemperament Stomach Sui' a Mizaj and if then the disorder persists, the dystemperament of the liver should be considered. Further clinical study is recommended to investigate this issue. Conflict of interest: None declared. National Center for Biotechnology Information , U. Iran Red Crescent Med J. Author information Article notes Copyright and License information Disclaimer.

Received Oct 26; Accepted Jan This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Background Cardiovascular diseases are among the most important causes of morbidity and mortality in the world. Methods We used several Iranian traditional medicine resources and literatures; then based on these texts; a pilot study was designed to assess their effects in 10 patients with high plasma cholesterol.

Results Some patients showed hepatic temperament but all patients had gastric temperament. Conclusion With reference to Iranian traditional medical texts and literatures, the organs involved in the process of digestion, particularly the stomach and the liver play the most important role. Introduction Lipids are body components which play important roles in energy storage and in the structure of the cell membranes, hormones and secondary mediators. The Digestion Pathway: Humor Production Based on available evidences and the detailed descriptions of the Iranian traditional medicine resources, ingested food undergoes various stages of digestion before reaching the tissues.

Open in a separate window. Abnormal Humour Production Results in Lipid Disorders According the book "The Qanon of Medicine" by Avicenna , the foundation of Iranian traditional medicine system was based on the balancing humors in the human body.

Clinical Support Based on the above hypothesis, to find the responsible organ causing hypercholesterolemia and to provide scientific basis for deeply studying the relation between body humors and hypercholesterolemia, a pilot study was designed to assess 10 patients with high plasma cholesterol. Results Our study indicated that only some of the patients had hepatic dystemperament Sui' a Mizaj and surprisingly all of the patients had gastric dystemperament.

Discussion With reference to Iranian traditional medical texts, one can reach the basic point that organs involved in the process of digestion, particularly the stomach and the liver play the most important role in determining the blood composition.

Footnotes Conflict of interest: None declared. References 1. Kamal R, Aleem Sh. Clinical evaluation of the efficacy of a combination of zanjabeel Zingiber officinale and amla Emblica officinalis in hyperlipidaemia.

Indian Journal of Traditional Knowledge. Goldman L AD, editor. Internal Medicine. Cecil Medicine. Philadelphia, PA: Saunders Elsevier; Cholesterol screening in school children: is family history reliable to choose the ones to screen? Acta Paediatr. Complement activation in hypercholesterolemia. Nutr Metab Cardiovasc Dis. Treatment and prevention of coronary heart disease by lowering serum cholesterol levels; from the pioneer work of C. Acta Cardiol. Endothelial dysfunction in African-Americans.

Int J Cardiol. Premature myocardial infarction: clinical profile and angiographic findings. Endothelial cell-specific NF-kappaB inhibition protects mice from atherosclerosis. Cell Metab. Statin treatment and progression of atherosclerotic plaque burden.

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However, the key point is that there are 7 amino acids that enter the TCA at acetyl CoA, and the diagram has been revised to reflect this. Diagram has been updated to show it enters at pyruvate. The diagram has been updated accordingly. Gropper, S.

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