Vascular Ageing and Endothelial Dysfunction

Jul 15

A Traditional Chinese Medicine Approach

Inflammaging—the chronic, low-grade inflammation that accompanies ageing—is now widely recognised as a key contributor to vascular stiffening, endothelial dysfunction, and microvascular deterioration. This pro-inflammatory state is driven by oxidative stress, cellular senescence, and dysregulated cytokine activity (e.g. IL‑6, TNF‑α, CRP), and is strongly associated with:

Elevated systolic blood pressure
Impaired vasodilation
Slower wound healing
Cerebral hypoperfusion

Even in relatively healthy older adults, these changes lead to reduced cardiovascular reserve, impaired oxygen delivery, and diminished capacity for tissue repair.

A Traditional Chinese Medicine Perspective on Vascular Decline

In Traditional Chinese Medicine (TCM), vascular dysfunction reflects an interrelated breakdown in Spleen qi, Heart blood circulation, and Kidney essence:

The Spleen governs blood containment. When Spleen qi is deficient, vessel walls lose integrity, leading to bruising, fluid retention, and microvascular fragility. Modern research has shown a correlation between spleen dysfunction and altered aquaporin regulation, contributing to increased vascular permeability (Li, Wang and Cai, 2011).
The Heart governs blood flow and the vessels. Heart qi or yin deficiency can lead to stagnation, impaired circulation, and reduced vascular responsiveness—particularly under stress.
The Kidneys support vessel elasticity and structural resilience through their relationship with jing (essence). As jing declines with age, vascular tissue becomes stiffer and more susceptible to inflammatory damage.

TCM does not treat these changes symptomatically. Instead, it works systemically—restoring the functional relationships between organs, enhancing microcirculation, and addressing the root causes of degenerative vascular change.

Herbal Formulas for Vascular Support

Several classical formulas are clinically relevant for supporting endothelial function, perfusion, and vascular integrity:

Gui Pi Tang tonifies Spleen qi and Heart blood, improving capillary strength and preventing blood leakage. It is especially useful for patients experiencing fatigue, palpitations, or bleeding symptoms (Chung, Chen and Ko, 2016).
Sheng Mai San supports Heart qi and yin, improves myocardial energy metabolism, and reduces oxidative injury. It has been shown to enhance mitochondrial integrity and cardiac function post-myocardial infarction (Yu et al., 2017).
Xue Fu Zhu Yu Tang addresses chest blood stasis, a common TCM diagnosis in patients with vascular congestion. It improves nitric oxide–mediated vasodilation, enhances tissue perfusion, and reduces thrombosis risk (Liu et al., 2025).

Acupuncture and Microvascular Regulation

Acupuncture enhances vascular health not only through systemic regulation but also by directly influencing endothelial function and microcirculatory flow.

Studies have demonstrated that acupuncture at ST36 (Zusanli) increases nitric oxide (NO) production via stimulation of endothelial nitric oxide synthase (eNOS), leading to vasodilation and improved local perfusion(Kimura et al., 2002; Longhurst, 2010).
NO is a key endothelial mediator—it relaxes smooth muscle in vessel walls, improves blood flow, inhibits platelet aggregation, and reduces inflammation. Acupuncture’s ability to upregulate NO represents a mechanistically plausible pathway for reducing vascular stiffness and improving microvascular health.
Additional research supports the use of points such as PC6, SP10, and LI4, which have been shown to modulate autonomic tone and improve peripheral circulation (Zhou et al., 2021).

This growing body of evidence supports what TCM has long recognised: acupuncture enhances blood movement, clears stagnation, and nourishes vessel integrity—not only symptomatically, but at a physiological level.

Conclusion

Vascular ageing is not simply an inevitable outcome of growing older—it is a dynamic, reversible process when underlying dysfunction is identified and addressed early. While Western medicine focuses on controlling cardiovascular symptoms and risk factors, Traditional Chinese Medicine targets the root dysfunctions—including impaired blood containment, stagnation, and tissue undernourishment.

By combining herbal medicine and acupuncture, TCM enhances tissue perfusion, vessel elasticity, and endothelial resilience—offering a multi-layered, evidence-supported model of care. As research continues to validate TCM’s effects on nitric oxide regulation, inflammation, and vascular tone, its role in cardiovascular ageing is not only complementary, but increasingly essential.

References:

Chung, Y., Chen, J. and Ko, K. (2016) ‘Spleen function and blood containment in Traditional Chinese Medicine: A Western medicine perspective’, Chinese Medicine, 7, pp. 110–123.

Li, Z.H., Wang, J. and Cai, L.L. (2011) ‘A review on research progress of relationship between diseases caused by dampness and aquaporin’, Journal of Chinese Integrative Medicine, 9, pp. 5–10.

Liu, Y., Zhang, X., Wang, J. and Li, H. (2025) ‘Efficacy and safety of a traditional Chinese medicine formula (modified Xuefu Zhuyu Tang) in improving endothelial dysfunction and reducing thrombotic risk in hypertensive rats’, Medicine, 104(22), e37540.

Yu, J., Chen, Y., Li, D. and Zhang, H. (2017) ‘Sheng-Mai-San improves cardiac function after myocardial infarction by modulating Ca²⁺–Drp1 signaling and enhancing mitochondrial integrity in rats’, International Journal of Molecular Sciences, 18(9), 1825.

Kimura, Y., Sumiya, E., Wakayama, I. et al. (2002) ‘Increased nitric oxide levels in acupuncture point ST36 during low-frequency electroacupuncture in humans’, Acupuncture & Electro-Therapeutics Research, 27(3), pp. 177–184.

Longhurst, J. (2010) ‘Defining meridians: a modern basis of understanding’, Journal of Acupuncture and Meridian Studies, 3(2), pp. 67–74.

Zhou, W., Benharash, P., Fonarow, G. C. and Longhurst, J. (2021) ‘Electroacupuncture at Pericardium 6 reduces sympathetic activity and improves circulation in patients with hypertension: A mechanistic study’, American Journal of Physiology–Heart and Circulatory Physiology, 320(1), pp. H108–H117.

Sinead Dee