Exploring on the role of “Lipophagy Imbalance” in atherosclerosis based on the “Turbid Pathogen Impairing Clarity” theory

Objective: This study systematically elucidates the role of “Lipophagy Imbalance” in the pathological progression of atherosclerosis (AS) from the perspective of the traditional Chinese medicine (TCM) theory of “Turbid Pathogen Impairing Clarity.” It aims to reveal the biological correlation between TCM’s concept of “turbid pathogen” and modern lipid metabolism, thereby providing theoretical support for the collaborative prevention and treatment of AS through integrated traditional Chinese and Western medicine. Methods: Through literature analysis, we examined the connotation and extension of the “Turbid Pathogen Impairing Clarity” theory. Integrating the TCM pathogenesis characteristics of AS and advances in the molecular mechanisms of “Lipophagy Imbalance,” we dissected the interplay between “Turbid Pathogen Impairing Clarity” and “Lipophagy Imbalance” during AS development. Results: The accumulation of pathological products in the body, such as phlegm, dampness, and lipid turbidity, which are considered “turbid pathogens,” obstructs the flow of qi, leading to the failure of “clear yang to ascend,” a manifestation of “Turbid Pathogen Impairing Clarity.” This disruption of qi-blood circulation manifests in vessels as vessel impediment, a mechanism closely linked to lipid metabolism dysregulation in atherosclerosis. Lipophagy, as a key form of cellular autophagy, maintains lipid homeostasis by degrading lipid droplets through lysosomes. However, “Lipophagy Imbalance” leads to dysfunction in lipid metabolism, directly promoting the formation of foam cells and the progression of plaques. The two concepts present multiple associations in AS: Traditional Chinese medicine often regards “phlegm turbidity,” or “turbid pathogens,” as one of the core pathological factors of AS, while modern medicine considers “Lipophagy Imbalance” to be an important material basis for the onset of AS. The macroscopic pathology of “vessel occlusion” aligns closely with the microscopic mechanism of lipid droplet accumulation caused by “Lipophagy Imbalance.” The clinical manifestations of “impairing clarity” correspond to the pathological outcome of ischemia events triggered by plaque rupture. Traditional Chinese medicine can block the pathological process of “turbid pathogens obstructing the vessels” by adjusting the state of “Lipophagy Imbalance,” improving lysosomal function, and inhibiting the inflammatory microenvironment. Conclusion: The “Turbid Pathogen Impairing Clarity” theory provides a new interpretive perspective on the pathogenesis of AS. Lipophagy, as a modern medical target, can serve as one of the scientific connotations supporting the treatment of atherosclerosis in TCM.