Classical Chinese Herbal Formulas in the Treatment of Coronary Heart Disease: A Narrative Review

Objective:To summarize the current evidence for 8 frequently prescribed Chinese herbal formulas(CHF)as treatments for angina pectoris in patients with coronary heart disease(CHD)and the associated adverse reactions.Methods:Seven electronic databases were screened from their inception through July 2018 for all evidence related to classical CHF for the treatment of patients with CHD.Results:CHF improves CHD outcomes in terms of angina pectoris,electrocardiogram results,Chinese medicine syndromes and biomarkers iomarkers.The combination of CHF and Western medicine(WM)is more effective on CHD than WM alone.The use of CHF to treat CHD shows the same or better clinical effects as the use of WM alone.The 8 investigated CHF do not induce hepatic and renal toxicity or other serious adverse effects.Conclusions:The safety and efficacy of 8 frequently prescribed herbal formulas for treating CHD have been confirmed in many studies.The findings of these studies are positive but should be interpreted cautiously due to the poor methodological quality of the randomized controlled trials(RCTs)and meta-analyses.Additional high-quality,multi-center,large-sample RCTs should be performed to confirm these results.     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

Immune Homeostasis: Effects of Chinese Herbal Formulae and Herb-Derived Compounds on Allergic Asthma in Different Experimental Models

Allergic asthma is thought to arise from an imbalance of immune regulation, which is characterized by the production of large quantities of Ig E antibodies by B cells and a decrease of the interferon-γ/interleukin-4(Th1/Th2) ratio. Certain immunomodulatory components and Chinese herbal formulae have been used in traditional herbal medicine for thousands of years. However, there are few studies performing evidence-based Chinese medicine(CM) research on the mechanisms and efficacy of these drugs in allergic asthma. This review aims to explore the roles of Chinese herbal formulae and herb-derived compounds in experimental research models of allergic asthma. We screened published modern CM research results on the experimental effects of Chinese herbal formulae and herb-derived bioactive compounds for allergic asthma and their possible underlying mechanisms in English language articles from the Pub Med and the Google Scholar databases with the keywords allergic asthma, experimental model and Chinese herbal medicine. We found 22 Chinese herb species and 31 herb-derived anti-asthmatic compounds as well as 12 Chinese herbal formulae which showed a reduction of airway hyperresponsiveness, allergen-specific immunoglobulin E, inflammatory cell infiltration and a regulation of Th1 and Th2 cytokines in vivo, in vitro and ex vivo, respectively. Chinese herbal formulae and herbderived bioactive compounds exhibit immunomodulatory, anti-inflammatory and anti-asthma activities in different experimental models and their various mechanisms of action are being investigated in modern CM research with genomics, proteomics and metabolomics technologies, which will lead to a new era in the development of new drug discovery for allergic asthma in CM.     

Chinese herbal medicine in the treatment of nonalcoholic fatty liver disease

Chinese herbal medicine has developed new therapies for nonalcoholic fatty liver disease (NAFLD) based on its unique theory system and substantial herb remedies.In this review,21 traditional Chinese herbs were introduced for their potential benefit in the treatment of NAFLD.Majority of them are evaluated by experimental studies and few by multicenter clinical trials.Herbal monomers as berberine and resveratrol,extracts from Polygonum hypoleucum Ohwi,and Artemisia sacrorum Ledeb.,and formulae including Yinchenhao Decoction(茵陈蒿汤,YCHD),Qushi Huayu Decoction(祛温化瘀汤,QSHYD),and Danning Tablet (胆宁片) were discussed in detail on their therapeutic potentials.Most of these herbal medicines were proved to improve biochemical and histological changes of NAFLD both in vitro and in vivo.Also,their therapeutic activities were associated with inhibiting lipid accumulation through adenosine monophosphate-activated protein kinase activation or upregulating low-density lipoprotein receptor(LDLR) expression,alleviating lipid peroxidation,and reducing the production of inflammatory cytokines.Although the efficacy and safety of these herbal medicines needed to be evaluated in multicenter large-scale clinical trials,Chinese medicine is promising and effective for preventing and treating NAFLD disease.     

The add-on effect of a Chinese herbal formula for patients with resistant hypertension:study protocol for a pilot cohort study

BACKGROUND: Despite a recent American Heart Association(AHA) consensus statement emphasizing the importance of resistant hypertension(RH), its control is still a challenge for conventional medicine. The Chinese herbal formula, Qutan Huayu Fang, has been used effectively to assist antihypertensive agents in blood pressure control, but its effect for RH patients is still unclear. This pilot study aims to explore the effects of taking the formula in addition to antihypertensive medication in the management of RH.METHODS/DESIGN: A prospective cohort study will be conducted in two first-class hospitals of traditional Chinese medicine(TCM). Eligible RH patients will be classified as the experimental group(n = 100) and the control group(n = 100) based on the interventions they receive. Participants taking antihypertensive agents and the Chinese herbal formula will be in the experimental group and those taking antihypertensive agents alone will be in the control group. The whole study will last 24 weeks, including an 8-week observation and follow-up at 24 weeks. The primary outcomes, assessed against patient baseline conditions, will be the reduction of systolic blood pressure and diastolic blood pressure as well as changes in TCM symptoms and signs. These outcomes will be assessed at weeks 2, 4, 6, and 8. The reductions of blood pressure will also be assessed at week 24. Cardiac events and mortality rate will be secondary outcomes and will be assessed at weeks 8 and 24. Any adverse reactions will be recorded during the study. The causal inference method will be used to assess the effectiveness of the inclusion of TCM herbal medicine in the management of patients with RH.DISCUSSION: This study will determine whether the Chinese herbal formula is helpful for RH patients treated with antihypertensive agents and the findings will provide a basis for further confirmatory studies.     

TREATMENT OF DISCOGENIC BACK AND LEG PAIN BASED ON DIFFERENTIATION OF SYMPTOM-COMPLEX ACCORDING TO TRADITIONAL CHINESE MEDICINE

Discogenic pain refers to lumbago and ra-diating pain in the legs caused by injury,ruptureor protrusion of lumbar intervertebral disc(LIDP).We treated 1289 patients of this type(28% of all patients with lumbar and leg pain)be-tween July 1978 and July 1983.To study the the-rapeutic efficacy of Chinese therapeutic manipu-lation and Chinese herbal drugs,271 patients for     

血瘀证诊断标准：标准化模式识别的思考

Pattern identification(PI),also called Bian Zheng(辨证),syndrome differentiation,pattern diagnosis,or pattern classification,is the basic principle and the key concept of Chinese medicine(CM).The core of PI is CM syndrome,on which CM theory,therapeutic method,prescribing formula and the use of Chinese herbal medicine are basically based.PI,in fact,is another classification method anticipated to improve the clinical efficacy.How to make an exact PI seems to be very important for taking full advantage of PI in clinical practice.Therefore,the establishment of diagnostic criterion of pattern has been the prerequisite for the standardization of PI.In recent years,a lot of diagnostic criteria of different CM patterns have been formulated.Taking the diagnostic criteria for blood-stasis syndrome as a model,the methodologies and considerations in establishing a pattern diagnostic criterion were discussed in this paper,which might be of great reference value in future PI standardization research.     

Effects of Ligustrazine on the Contraction of Isolated Rabbit Corpus Cavernosum Strips

Ligustrazine(tetramethylpyrazine,TMP)is avasoactiveingredient that has beenisolated and pu-rified fromLigusticum Chuanxiong Hort.(Um-belliferae)behind an ancient Chinese herbal reme-dy.It has been widely used for the treat ment of avariety of vascular diseases such as occlusive cere-bral arteriolar diseases,notable ischemic strokeand pul monary hypertension secondary to chronicobstructive pul monary disease(COPD)due to itsvasodilatory actions.Ligustrazine has previouslybeen shown to be eff…     

Erxian Tang (二仙汤)—Introduction of a Chinese herbal formula, clinical practice, and experimental studies

Erxian Tang (二仙汤,EXT) is a Chinese herbal formula developed for the treatment of menopausal syndrome in women. In the past 50 years, EXT has shown positive efficacy in the treatment of many chronic diseases in TCM, involving syndrome types of Shen (肾) yin-yang deficiency, yin-deficiency caused yang-flourishing, and disharmony of Chong-Ren meridian. Experimental studies have revealed that EXT has multiple pharmacological actions on such multiple targets as hypothalamus-pituitary-target gland axis, immune function and free radical metabolism, etc.     

Efficacy of hepatitis B immunoglobulin in relation to the gene polymorphisms of human leukocyte Fcγ receptor III (CD16) in Chinese liver transplant patients

Background Although the use of hepatitis B immunoglobulin (HBIG) may lead to a significant reduction in recurrent hepatitis B virus (HBV) infection and improve the survival of patients who have undergone liver transplantation (LT) for hepatitis B-related diseases, the recurrence of the disease still remains at a lower level. Different clinical curative effects were observed in patients with the same HBV-related diseases and the same therapy. This study was undertaken to investigate whether the efficacy of HBIG is associated with FCGR3A gene polymorphisms in Chinese liver transplant patients.Methods Altogether 77 patients who had received liver transplantation for hepatitis B-related diseases with more than one-year survival after surgery were studied. The recurrence of HBV was characterized by the appearance of HBsAg in serum after the operation. The FCGR3A genotyping was performed using genomic DNA sequencing (ABI 3037). Single nucleotide polymorphism at nucleotide 559 was detected by Polyphred. Results Of the 77 patients, 14 were complicated with HBV recurrence post-transplant. The FCGR3A at nucleotide 559 TT was observed in 35 (45.5％) subjects, whereas TG in 31(40.3％) and GG in 11(14.3％). In the 559G carrier group (n=42, 54.5%), the risk of HBV recurrence was 9.5%, and 1- and 2-year recurrence-free survival rates were 95.2% and 88.7%, respectively. In the 559G noncarrier group (n=35, 45.5%), the risk of HBV recurrence was 28.6%, and 1- and 2-year recurrence-free survival rates were 74.3% and 69.3%, respectively. The risk of HBV recurrence and the recurrence-free survival rate were both statistically different between the 559G carrier and noncarrier groups (P<0.05).Conclusions A single nucleotide polymorphism（T/G）at position 559 of the FCGR3A gene was found in Chinese patients. The efficacy of HBIG in prophylaxis of HBV recurrence after LT is associated with the gene polymorphism, so detecting FCGR3A genotypes can be a clinical reference of the HBIG administration.     

Research on frequency of application with modern Chinese herbal medicine

Objective:To study the relationship between 500 kinds of commonly used Chinese herbal medicine and the classification of their efficacies in Chinese Materia Medica in relation to the common diseases listed in Internal Medicine.Methods:Database retrieval frequency of the quantitative statistical method was adopted.First,the 8 980 kinds of Chinese herbal medicine recorded in Chinese Materia Medica were used as the original search objects,and 4 493 kinds which were cited in more than five articles were picked out and then rechecked for further title citations.Second,as judged based on the Criterion,the numbers of articles which included the medicines in the line of standards were examined.As a result,500 species of Chinese herbal medicine were singled out based on their retrieval frequency and were then used for compilation of the classification statistics according to their efficacy and the common diseases in Internal Medicine.Results:From the classification of Chinese medicines,herbs with wide efficiency and a meek nature had higher frequencies, but those which were not appropriate as decoctions had relatively lower frequencies.However,according to the average frequency,the Chinese herbal medicine for nourishing qi and tonifying blood,at 36 346 times and 34 544 times,respectively,were the most commonly used.Analyzed from the frequency of application of the Chinese medicine in the treatment of common diseases,most of the top 10 kinds of Chinese herbal medicine with the highest frequencies generally coincided with the 500 selected medicines.In addition,the Chinese medicines with clear pharmacological efficiency were easily isolated and purified to be made into injections, although other forms are more commonly used.Conclusion:The results of the research objectively reflected the current applications of Chinese herbal medicine,and could be used as references in teaching,research,clinical applications,and in compiling and increasing the drugs in textbooks and Pharmacopoeia.     

Progress of research in treatment of hyperlipidemia by monomer or compound recipe of Chinese herbal medicine

Hyperlipidemia （HLP） is the No.1 risk factor for patients with atherosclerosis （AS） and is directly related to the occurrence of coronary artery disease （CAD） and cerebrovascular disease. Therefore, prevention and treatment of AS is of great importance and of practical significance in controlling the incidence and mortality of CAD. With its peculiar syndrome-dependent therapy, traditional Chinese medicine （TCM） has accumulated abundant practical experiences in this field and good clinical effects have been achieved. Chinese herbal medicine, with its particularly unique advantages and high potentials yet to be tapped, displays its huge strength in HLP prevention and treatment. The progress of studies concerning prevention and treatment of HLP by Chinese herbal medicines, in the form of monomers or compound recipes, is reviewed in this paper.     

Integrative oncology meets immunotherapy: New prospects for combination therapy grounded in Eastern medical knowledge

<正>As cancer rates rise globally,standard care is being questioned; new approaches involving immune therapies are emerging.With this shift comes a corresponding shift in the use and potential of herbal medicines and extracts.The focus of this article,which has evolved from a presentation at the Second Beijing International Symposium on Integrative Medicine(BISIM May 19-20,2012),is particularly on Chinese medicine,but is generalizable to Eastern medicine more broadly and to other herbal traditions.Until recently,herbal and related treatments have been used as adjuvants to conventional care - for reducing side-effects, enhancing cytotoxicity,and sometimes,undesirably counteracting the efficacy of chemotherapy and radiation.Now,in the context of a new class of immune-based cancer therapies,herbal and other complementary modalities are looked at as enhancers of the body's immunity.     

计算机辅助设计抗感染中药复方的实验研究

Objective To study the feasibility of artificial immune system (AIS) in assistant designing of computer for new Chinese herbal compounds with anti-infectious function. Methods A group of Chinese herbal drug compounds from Treatise on Exogenous Febrile and Miscellaneous Diseases[WTBZ] were selected as training samples. Serum was obtained from mice which were infected by Staphylococcus aureus and ig administrated with the various Chinese herbal compounds. The inhibition ability against S. aureus of the serum was tested and input into an artificial neural network (ANN) together with the characters of the every Chinese herb included in those compounds. The ANN was optimized using AIS so that it can predict the inhibitory ability against S. aureus of the Chinese herbal compounds according to the characters of Chinese herbs included in those compounds. After that the computer generated a number of Chinese herbal compounds randomly, calculated their inhibitory ability against S. aureus and output those among the top levels, so as to verify whether the predictions were correct or not. Results After verification, the Chinese herbal drug compounds designed by computer could significantly raise the serum′s inhibitory ability against S. aureus. Conclusion The computer can be an assistant for designing new Chinese herbal compounds with anti-infectious function.     

Chinese Medicine Might Be A Promising Way for A Solution to Arsenic Nephrotoxicity

Arsenic from environmental contamination is a risk factor for kidney disease, and the clinical use of arsenic also triggers a new concern that the potential kidney damage caused by exposure to clinical doses of arsenic trivalent. So far, the undergoing mechanisms contributing to arsenic nephrotoxicity mostly remain unclear, and universally accepted methods for preventing this complication are limited too. Ancient Chinese medical scientists recognized the toxicity of arsenic long ago, and there were some records of Chinese herbs against arsenic poisoning in ancient books of Chinese medicine. In the past decade, several herbal formulations, as well as some potentially active compounds extracted from Chinese herbs, have been employed to prevent arsenic nephrotoxicity both in vivo and in vitro and showed better therapeutic effects. The present paper thus summarizes and discusses these Chinese medicine methods in preventing such a public health problem. In addition, we call for large, well-designed, randomized, and controlled clinical trials to be performed to further assess the efficacy and safety of these potential methods of Chinese medicine againstvarsenic nephrotoxicity.     

Herbal Medicine in the Treatment of Alzheimer’s Disease

Associated with the aging of our world population is a sharp increase in the incidence of Alzheimer’s disease,which not only poses a significant health issue but also presents a serious social problem.Although pharmacological treatments were developed based on existing hypotheses,the disease pathogenesis remains to be fully elucidated.Given the complexity of Alzheimer’s disease,Chinese herbal medicine appears to have therapeutic potential for Alzheimer’s disease through multi-target and multi-pathway approach at cellular and molecular levels and holistic adjustment of the body at organ system levels.Recently,a significant breakthrough has been made in the research of Chinese medicine for Alzheimer’s disease.In this article,we review the experimental research progress in understanding how Chinese medicine could be used for the treatment of Alzheimer’s disease.     

Advances in Clinical Pharmacokinetics of Herbal Medicines

Herbs have been used for treating various ailments since medicine began. The belief that natural products are much safer than synthetic drugs has led to dramatic growth of herbal medicine usage. Like synthetic drugs, herbal preparations also have potential to cause adverse effects and drug interactions. Knowledge of herbal pharmacokinetics is needed to explain and predict various events related to the efficacy and toxicity of herbal preparations. However, Pharmacokinetics and drug interactions of herbal preparation have not been yet systematically studied. Especially, the clinical phannacokinetic studies on herbal preparations are limited to some widely used herbs such as St.John＇s Wort and Gingko biloba. In this review, clinical pharmacokinetics studies that have been conducted for herbal medicine products since 2001 are evaluated. Scientifically controlled clinical studies on various herb-drug interactions are also discussed.