Traditional Chinese Medicine in the Prevention and Treatment of Cardiovascular Diseases
Traditional Chinese Medicine (TCM), including Chinese herbal medicines and acupuncture, has been used in the prevention and treatment of cardiovascular diseases in China since the 1950s. Through research by the integration of TCM and Western Medicine (WM), many of the classic herbal formulas that effectively treat cardiovascular diseases have been screened out, and many new herbal formulas have been designed and created (depending on mechanisms of the cardiovascular disease). This integration of TCM and Western medicine has developed new concepts, methods, and strategies for the prevention and treatment of cardiovascular diseases. Presently in China, Chinese herbal medicine treatment for cardiovascular diseases includes single herbs, herbal formulas and extracted agents of herbs.
Clinical research on the TCM treatments of cardiovascular diseases focus on common cardiovascular problems such as coronary heart disease, angina, myocardial infarction, arteriosclerosis, restenosis after percutaneous transluminal coronary angioplasty, cardiac arrhythmias, congestive heart failure, hypertension, hypotension, cardiomyopathy, hypercholesterolemia, viral myocarditis, peripheral vascular disorders, Raynaud’s phenomenon and disease, thromboangitis obliterans, venous thrombosis, etc.
Mechanisms of TCM for the treatment of cardiovascular disease work to engage with multiple levels of disease and simultaneous therapeutic targets, including anti-ischemic injury, such as impacting myocardial apoptosis and apoptosis related gene bcl-2 and bax expression; influencing RNA synthesis and gene expression related to nitric oxide synthase; effecting myocardial energy metabolism, protecting mitochondrial ultrastructural damage; effecting ventricular remodeling after acute myocardial infarction; promoting angiogenesis; protecting vascular endothelial cells and inhibiting vascular smooth muscle cell proliferation; preventing restenosis after percutaneous transluminal coronary angioplasty; inhibiting thrombosis by effecting the microcirculation, anti-platelet, influencing lipid metabolism, and thus anti-atherosclerosis, and so on.
Detailed historical information about treatments:
1) Treatment of Coronary Heart Disease (CHD) and Angina
The earliest clinical articles of TCM treatment of CHD are found in China beginning in 1955. They introduced case-by-case clinical discussions and very little basic research. Clinical data in the 1960s gradually increased and elaborated on the etiology and pathogenesis of the disease, treatment rules, classification type, treatment principles, and determinations of preliminary efficacy. In the 1970s, clinical data and theory increased significantly. The Chinese herbal medicines that are used to treat CHD and angina are from decoctions developed into a variety of formulations such as tablets, patches, pills, soft pills, oral liquids, granules, aerosols, extracted agents and injections, as well as mouth sprays which are suitable to relieve angina. These medicines have greatly improved the clinical value of TCM treatments for coronary artery disease. For example, when Fu Fang Dan Shen Wan is applied sublingually, it can relieve pain of angina within 4 to 5 minutes for most patients; it is one of the most commonly applied Chinese herbal medicines for the treatment of CHD in China.
It was reported (with a larger group of patients with angina pectoris in clinical observation) that the patients usually needed to take dozens of tablets, up to nearly 100, of nitroglycerin in a week, but after administration of Chinese herbs the patients could stop taking nitroglycerin or reduce to a small dose, and many patients returned to normal condition.
Presently, there are millions of patients with CHD in China that are treated effectively with TCM yearly. Herbal medicines are used in both Western Medicine hospitals, Chinese Medicine hospitals and clinics everywhere, with very small and infrequent side effects.
There are experiments and clinical research currently exploring the potential mechanisms of the Chinese herbs for CHD. This research is finding that Chinese herbs could regulate blood lipids, anti-platelet aggregation thrombosis, anti-ischemic injury, improve endothelial function, act as anti-atherogenics, stabilize vulnerable plaque, and protect microvascular integrity.
2) Benefits to Acute Myocardial Infarction (AMI)
TCM is not only applied to the prevention and treatment of CHD and Angina, but also for the treatment of AMI. In the 1970s, through the application of TCM with Western medicine, AMI mortality rate decreased from 20% – 30% to about 10% (or even below 7%). Research found that Chinese herbs that quicken the blood and dispels stasis also increase coronary blood flow, reduce myocardial oxygen consumption, inhibit platelet aggregation and anticoagulant thrombolytic protection of the ischemic myocardium; the studies also show that Chinese herbs improve platelet functions, increase inhibition of thrombosis, scavenge free radicals and reduce myocardial infarction size and thrombolysis.
3) Preventing Restenosis after Percutaneous Transluminal Coronary Angioplasty (PTCA) and Arteriosclerosis (AS)
Percutaneous Transluminal Coronary Angioplasty (PTCA) is one of the effective treatments for CHD but chance of restenosis is very high. Since 1991, there have been clinical studies on Chinese herbs and formulas for the prevention and treatment of restenosis after PTCA in China. The studies indicated that the Chinese herbal formulas and extracted agents of the Chinese herbs are effective and safe as therapeutic agents in preventing restenosis after PTCA. According to the research results, Chinese herbal formulas and extracted agents of the Chinese herbs prevented the stenting localized vascular regeneration and reduced the chance of restenosis.
Dr. Chen KeJi’s team reported that using classical herbal formula Xue Fu Zhu Yu Tang (XFUYT) for therapeutic intervention inhibits percutaneous endovascular angioplasty smooth muscle cell proliferation, reduces arterial intima-media thickness, and regulates gene expression and other roles. Other research, using capsules made with ChuanXiong and ChiShao (CXCS) (as the main ingredients in XFUYT) prevent coronary restenosis after balloon injury on porcine subjects. The data showed that CXCS can effect gene and protein expression of smooth muscle cell proliferation and apoptosis, effect transmembrane signaling, and effect accumulation of collagen; all of which can prevent restenosis formation.
Further, CXCS is used for preventing restenosis after Percutaneous Coronary Intervention (PCI) in senior patients with Coronary Heart Disease (CHD). A randomized, double-blind, placebo-controlled trial reported a total of 335 CHD patients were randomly assigned to treatment with oral administration of CXCS or a placebo for 6 months after successful PCI. A clinical follow-up was performed at the 1st, 3rd and 6th month after PCI and an angiographic follow-up was scheduled at the 6th month. Results showed that the incidence of recurrent angina at the 3rd and 6th month after PCI was significantly reduced in the CXCS group (4.11% and 12.33%) as compared with those in the placebo group (17.72% and 43.04%). No significant adverse reactions occurred within the 6-month follow-up period in the CXCS group. Researchers concluded that administration of CXCS in addition to standardized Western medication for 6 months is safe and effective in reducing post-PCI recurrent angina and inhibits luminal restenosis after PCI in senior patients with CHD.
4) Treatment of Arrhythmia
There is a long history of treating the main symptoms of arrhythmia with classical herbal formulas. Experimental research has shown that Chinese herbs and herbal formulas are effective treatments for arrhythmia since the 1970s, but the clinical research suggests a weak role for TCM in the treatment of serious arrhythmias. At that time, the majority of clinical research focused on the TCM treatment for sick sinus syndrome. The utilization of herbs and herbal formulas to warm yang and tonify qi can increase the heart rate and improve the symptoms of sick sinus syndrome. Some pharmacological medicine experiments showed the potential mechanisms of these classical herbal formulas. For example, the warm-yang herbs such as Aconite can excite β-receptors and increase heart rate; Cinnamon and Cistanche may change the structure of the nucleus, regulate synthesis of DNA, RNA, and protein, improve SA node conductivity and increase heart rate.
Since the 1990s, new theories and methods focusing on the balance of Yin and Yang for regulation of the SA node have been developed. Chinese herbal formulas were designed to adjust heart rate to the normal rate by reducing fast rate while enhancing slow rate. One formula that consists of many Chinese herbs exhibited its greatest feature as a broad spectrum control of arrhythmia functions and was shown to control the various types of fast and slow heart rate.
The typical example is Shen Song Yang Xin Capsule (SSYXC). The evidence based medical research about the anti-arrhythmic function of SSYXC was expanded to 36 Western medical hospitals across the country in China with more than 500 medical experts participating. The study results showed that SSYXC is beneficial to non-organic premature ventricular contractions, paroxysmal atrial fibrillation, brady-arrhythmias such as sinus bradycardia, sick sinus block, slow-fast syndrome, and sinus sick sinus syndrome. There are no known side effects. SSYXC has the characteristic of integrated adjustments to anti-arrhythmic conditions. SSYXC can improve myocardial metabolism disorders, adjust cardiac pacing conduction system function, regulate cardiac autonomic function, and improve myocardial blood supply by regulation of the sodium, calcium, potassium and other cardiac ion channels. The components and functions of SSYXC, along with its advantages of multi-ion channel blockade and non-ion channel regulation, provided the electrophysiological basis for anti-arrhythmia in clinical trials.
5) Treatment of Hypertension
The goal of TCM research in China for the treatment of hypertension since the 1950s has been to find effective Chinese herbs and herbal formulas to prevent and/or treat hypertension. The results of the research suggest that many single Chinese herbs have a positive effect on reducing hypertensive symptoms as well as high blood pressure. Herbs with these positive effects include Tetrandrinium, Folium Apocyni Veneti (leaf of dogbane, Luo Bu Ma), Radi Puerariae (root of lobed kudzu vine, Ge Gen), Uncariarynchophlla (gambir plant, Gou Teng), Cortex Ducommiae (eucommia bark, Du Zhong), Radix Astragali (root of Mongolian milkvelch, Huang Qi), Ramulus Loranth (twig of Chinese taxillus, Sang Ji Sheng), among others. Results of research also showed that many Chinese herbal formulas have a therapeutic effect on hypertension and its symptoms. For instance, Tian Ma Gou Yin, Er Xian Tang, Lui Wei Di Huang Tang are formulas which are still used in TCM clinics for the treatment of hypertension.
Further investigations indicated the advantages of TCM in the treatment of hypertension have resulted in a number of intriguing findings. 1)TCM can decrease blood pressure, improve symptoms of hypertension and patients’ quality of life. 2) TCM is especially suitable to prevent and treat Stage I hypertension. 3) It provides treatment for senile patients with hypertension. 4) It provides treatment for the patients who need anti-hypertensive medicine but cannot tolerate the side effects from Western medicines. 5) Using TCM can help reduce the use or dosage of anti-hypertensive medicines. 6)TCM can reduce side effects of Western medications. For example, TCM can improve erectile dysfunction (ED) due to taking anti-hypertension medicine for extended periods in male patients. We have treated more than twelve patients with ED resulting from anti-hypertensive medicines during the past three years. All of them obtained improvement after five to six weeks of TCM treatments.
Researchers explored the mechanisms of TCM to treat hypertension, and found roles for TCM related to reducing sympathetic activity and inhibit sympathetic activation, improving renal sodium and water retention, inhibiting the renin-angiotensin system and effecting calcium channel function, and improving insulin resistance.
6) Treatment of Congestive Heart Failure (CHF)
TCM has been used for the treatment of symptoms similar to CHF such as edema, scanty urination and dyspnea for over two thousand years. The earliest reports of TCM for the treatment with CHF in China appeared in the 1970s. The commonly used classic Chinese herbal formulas to treat CHF are therapeutically effective and still in use in China today. This TCM formula is used in combination with Western medicine for the treatment of acute heart failure (AHF) as well as chronic heart failure. For example, Sheng Mai injections were developed from decoctions of the classic formula Sheng Mai San (powder for pulse activating) is applied in acute heart failure, such as AMI and other AHF. Further, single herbs and extracted agents of Chinese herbs are developed and utilized effectively for the treatment of heart failure.
Clinical observation shows that TCM treatment of CHF can enhance heart function, improve symptoms, and increase the quality of life of patients. One of the greatest features of TCM diuretics in the treatment of CHF is not causing dehydration and electrolyte imbalance. TCM treatments of CHF are particularly suitable for those patients in the early stages of CHF who cannot tolerate the serious side effects of Western medicines or who have severe heart failure with cardiac diuretic vasodilators which are ineffective. TCM treatments are also suitable for senile patients with CHF, who usually only use small dosages of similar medicines to digitalis because of hypoxia, reduced kidney function, and side effects of digitalis, where the dosages limit the degree to which the efficacy can be satisfactory.
Recently reported findings showed that TCM treatments that tonify Qi (pronounced Chee, meaning energy) and quicken blood in the treatment of CHF can significantly reduce the heart wall thickness, essentially blocking the occurrence of ventricular remodeling. The TCM treatments make for a strong heart, initiate diuretic action and the dilation of blood vessels, and can inhibit excessive activation of the neuroendocrine system, reducing myocardial remodeling, and improving the heart functions of patients with CHF.
7) Treatment of Dilated Cardiomyopathy (DCM)
Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy, and has non-specific treatments. There have been reported of TCM combining with Western medicine since 1985. Understanding of TCM for the disease’s treatment is in continuous development, and has also achieved positive effects. There is great advantage for TCM combining with Western medicine for improving the DCM patients’ symptoms and signs, adjustment of cardiac function, improving patient survival, and increasing their quality of life. For example, a classical Chinese herbal formula Zhi Gan Cao Decoction (ZGCD) has been used for the treatment of DCM with heart failure and arrhythmia.
Results of research have shown that the Integrative Medicine (IM) approach of a combination of ZGCD and Western medicines is more effective than routine Western medicine therapies alone after a treatment period of twelve months. The IM group saw improvement in the left ventricular end-diastolic diameter (LVIDD), left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF). It was concluded that Integrative Medicine for DCM can effectively improve the cardiac function and clinical symptoms, inhibit myocardial fibrosis and reverse ventricular remodeling, and reduce readmission rates. Further animal experiments also confirmed that ZGCD in the treatment of DCM SD rats can improve heart function, inhibit excessive activation of the RAAS system, and reduce animal mortality.
We treated a patient, a 38 year old female, diagnosed with DCM in China in 1995. Along with the usual method of treating DCM, we additionally used a special Chinese herb San Qi (Radix Notoginseng). With regular IM treatments and San Qi, it was found that the recurrence interval of heart failure was extended, hospitalization was not necessary, and oral medicine was sufficient. After five years of treatment for the disease, the patient had continued the herb San Qi and had stopped taking all western medicines. She had no obvious clinical symptoms, and was able to recuperate enough to do housework. As of 2001, the patient was asymptomatic of DCM and was living a normal, happy life. Her activity level had returned to normal, and she had no recurrence of symptomatology associated with her original diagnosis of DCM. This is especially noteworthy since the average survival rate is approximately five years from diagnosis to death.
8 ) Treatment of Hyperlipidemia
Hyperlipidemia is the primary risk factor for atherosclerosis related to many cardiovascular, cerebrovascular and a variety of other diseases that are directly related to the incidence of coronary heart disease, myocardial infarction and stroke. Aggressive treatment of hyperlipidemia can significantly reduce the morbidity and mortality of cardiovascular and cerebrovascular disease. Western medicine in research and treatment of this disease has achieved great results, but these treatments tend to require large doses of medication in order to maintain long-term efficacy of their lipid-lowering effects. Unfortunately, however, long-term medication are likely to cause adverse liver and kidney function, and blood lipids rebound after discontinuing the use of these medications. TCM has undergone research in the treatment of hyperlipidemia in China since 1980. The results of research has shown that the lipid-lowering herbs and herbal formulas of TCM for the treatment of HLP has weaker roles than Western medicine in some respects. However, the markedly lower incidence of side effects during long-term use provides a substantial advantage; moreover, their effects were not insubstantial: these herbal treatments significantly improved symptoms in clinical research in China.
The TCM formulations used in clinical to treatment of hyperlipidemia include single herbs, extracted agents of herb and herbal formulas. They are also effectively used to treatment of atherosclerosis, coronary heart disease and angina in China. For example, Di Ou Xin Xue Kang (DOXXK) is extracted from a Chinese herb that quickens blood and dispel stasis. Studies have shown it regulates heart function, increases coronary blood flow, improves myocardial blood supply, and reduces myocardial oxygen consumption with remarkable efficacy for the treatment of ischemic heart disease. This herbal formula simultaneously lowers blood lipids and blood viscosity, enhances red blood cell deformability and improves microcirculation, so that it improves the whole body’s oxygen carrying capacity. DOXXK has been used for the treatment of hyperlipidemia, atherosclerosis, coronary heart disease and angina in China.
Xue Zhi Kang (XZK) is another lipid regulator refined and extracted from specially made red yeast. In recent years a large number of clinical observations proved its reliable efficacy and lower incidence of side effects. This extracted agent has been used in the treatment of hyperlipidemia in China as well.
Commonly used Chinese herbs for effectively treating hyperlipidemia are Dan Shen, Pu Huang, Shan Zha, Ha Zhang, He Shu Wu, Ju Ming Zi and Ze Xia; and Chinese herbal formulas are Xu Fu Zhu Yu Tang, Fu Fang Den Shen Wan, Er Chen Tang.
Pharmacological studies have shown that these single herbs and Chinese herbal medicine can positively regulate lipid metabolism, inhibit lipid absorption, affect the circulation of bile acids, inhibit lipid synthesis, act as anti-peroxide agents, raise HDL, lower LDL, and lower blood lipids.
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