TCM for High Blood Pressure and Cholesterol: Evidence and Safety

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High blood pressure and high cholesterol usually cause no symptoms, so feeling well is not a reason to stop treatment. [1][2] Do not stop or reduce blood pressure medicines or cholesterol medicines because of a herbal product. Sudden chest pain that does not go away, especially with sweating, nausea or shortness of breath, may be a heart attack: call emergency services (911 in the US). [1] Any herb, tea or supplement should be reviewed by your clinician or pharmacist first: see talking with a health professional.

How trials are set up

Chinese herbal trials in this area usually enroll people by a Western measurement (blood pressure or blood lipid level) and test a named product, often added to usual medicine. A review of Chinese patent medicines for high blood pressure, for example, only included trials that compared one patent medicine plus blood pressure drugs against the drugs alone. [3] Traditional pattern language such as "liver yang" is a framework, not a measurement; see traditional frameworks vs biomedical explanations.

High blood pressure

The granule studied above is named after Gastrodia (tian ma); see Gastrodia in Chinese medicine. The reviewers of patent medicines found no severe adverse events reported, but they also noted that quality was low. [3]

High cholesterol and triglycerides

• Cochrane review, cholesterol. 22 randomized trials (2,130 participants), mean treatment length 2.3 months, 20 conducted in China and 18 published in Chinese. Risk of bias was high or unclear, no trial reported heart events or deaths, and no serious adverse events were seen. The authors concluded some herbs may lower cholesterol but results must be interpreted with caution. [5]
• Cochrane review, triglycerides. Three small trials (170 participants, 4 to 6 weeks) favored the herbal treatment, but the authors said no definite conclusion could be reached. [6]
• Label: promising but limited, with an important gap: no evidence on heart attacks, strokes or deaths from these reviews.

Red yeast rice

Xuezhikang is an extract of fermented red yeast rice. [7] Red yeast rice supplements contain monacolin K, which is chemically identical to the drug lovastatin. [8]

• A review of 10 small trials in 905 Chinese people found red yeast rice and simvastatin did not differ significantly on cholesterol measures, but larger and better trials were called for. [9]
• A 12-week placebo-controlled trial in 116 adults found Xuezhikang lowered LDL cholesterol by about 27% versus placebo with no myopathy or marked liver enzyme rise. [7]
• Safety is the catch. Italian surveillance reports of 52 cases linked red yeast rice supplements to muscle pain, one rhabdomyolysis case and 10 cases of liver injury; the authors said the profile may resemble statins. [8] Another review of US and European reporting systems and trial meta-analyses found low reporting rates and no link with muscle or liver events in trials, but noted that the European Food Safety Authority had raised a safety warning and in 2023 approved monacolins from red yeast rice only below a stated daily amount. [10]
• Because of the shared compound, ask a pharmacist before combining a red yeast rice product with any statin.

Berberine

Memorial Sloan Kettering says berberine may lower cholesterol and blood sugar but the effect may be small and not a substitute for lifestyle changes; most meta-analyses for lipids, blood pressure or diabetes found limited-quality studies. [11] Details are in Coptis and berberine.

Safety and quality

NCCIH warns that some Chinese herbal products have been contaminated or contain the wrong herb, with some causing organ damage. [12] Interaction cautions by medicine type are in Chinese herbs with diabetes and blood pressure medicines. Pregnancy, kidney disease and liver disease raise the stakes; see TCM for kidney and liver conditions.

Where evidence is missing

Proper evidence not found for Chinese herbs replacing blood pressure or cholesterol medicines, or lowering heart attack or stroke rates. I searched PubMed for Cochrane reviews and meta-analyses of Chinese herbal medicine in hypertension and found patent medicine reviews and single trials but no Cochrane review of hypertension. Movement practices are covered in Tai Chi and more uses in TCM evidence by use.