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Current clinical application of traditional chinese medicine for the treatment of hypertension

Huai Wang

Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China

Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou, Fujian 350122, China

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Li-ya Bao

Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China

Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou, Fujian 350122, China

Xue-ling Zhou

Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China

Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou, Fujian 350122, China

You-qin Chen

Case Western Reserve University School of Medicine, Rainbow Babies and Children’s Hospital, Cleveland, OH 44106, USA

Chang-geng Fu

Cardiovascular Diseases Center, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China

Jian-feng Chu

Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China

Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou, Fujian 350122, China

Chen Keji Academic Thought Heritage Studio, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China

Jun Peng

Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China

Fujian Key Laboratory of Integrative Medicine on Geriatrics, Fuzhou, Fujian 350122, China

Chen Keji Academic Thought Heritage Studio, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China

DOI: 10.15761/JIC.1000264

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Abstract

Background: Hypertension is the most common type of chronic non-communicable diseases, as well as being the single most important risk factor for cardiovascular disease. The use of TCM has long been used in the prevention and treatment of hypertension and is associated with effective outcomes.

Objective: Determine the current status in the clinical application of Traditional Chinese medicine(TCM) for the treatment of hypertension within the past 5 years.

Search Strategy: Seven electronic databases (PubMed, EMbase, Cochrane library, QVID, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data ) were systematically searched from 2012-2016 using MeSH terms such as “hypertension, high blood pressure “and “Traditional Chinese medicine, Chinese medicinal herb, Chinese herbal medicine.”

Inclusion Criteria: Clinical randomized controlled trials, case-control studies, and case studies.

Data Extraction and Analysis: All statistics were retrieved based on the type of clinical study, type of prescription and type of treatment. Subsequently, the medicine meridian, efficacy of prescription and type of syndromes were summarized.

Results: Tianma Gouteng decoction and Zhengan Xifeng decoction were used 7 times, reinforcing deficiency was used 23 times, Calming the Liver was used 22 times and Removing Blood Stasis was used 14 times. Uncaria was used 24 times, Achyranthes and Tuckahoe were used 20 times, there are 50 kinds of drugs in the liver meridian. The main common clinical symptoms of hypertension were Hyperactivity of liver Yang and Yin deficiency and Yang Hyperactivity.

Conclusion: Recent clinical application of TCM for the treatment of hypertension most frequently involve the prescriptions Tianma Gouteng decoction and Zhengan Xifeng decoction, and the components Uncaria, Achyranthes and Tuckahoe. In TCM, occurrence of hypertension is mainly attributed to Hyperactivity of liver Yang, as well as Yin deficiency and Yang Hyperactivity, and treatment of hypertension most commonly involve reinforcing deficiency, Calming the Liver and Removing Blood Stasis.

Key words

Hypertension, Traditional Chinese Medicine, Clinical Application

Introduction

Current treatment of hypertension is significantly dominated by Western medicine. In comparison, TCM only plays an auxiliary function in the prevention and control of hypertension. However, TCM often demonstrates greater effectiveness during prehypertension, by inhibiting the development of high blood pressure, and other clinical symptoms such as dizziness, insomnia, and chest tightness, as well as providing improved treatment of refractory hypertension. Although TCM is commonly used for the clinical prevention and treatment of hypertension, there are often significant variations in the treatment effects in relation to the specific disease, pathogenesis, and type of medication. Thus, there is a lack of normative evaluation of various TCM prescriptions in relation to their curative treatment effects. This article examines the various controlled clinical trials of TCM within the past 5 years and analyzes the current TCM prescriptions in the prevention and treatment of hypertension.

Methods

We analyzed recent literatures involving TCM and clinical application of hypertension treatment using literature retrieval. Seven electronic databases (PubMed, EMbase, Cochrane library, QVID, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data ) were systematically searched from 2012-2016 using MeSH terms such as “hypertension, high blood pressure”and “Traditional Chinese medicine, Chinese medicinal herb, Chinese herbal medicine.” and retrieved studies which used TCM in the treatment of hypertension, with the inclusion criteria for clinical randomized controlled trials, case-control studies, and case studies, and the exclusion criteria for non-clinical research involving in vitro and animal experiments. All statistics were retrieved based on the type of clinical study, type of prescription and type of treatment. Subsequently, the medicine meridian, efficacy of prescription and type of syndromes were summarized. In total, a total of 19 clinical TCM prescriptions were selected for the treatment of hypertension. Finally, we analyzed the composition, efficacy and indications of the different prescriptions. Based on these collected data, a database was setup and subsequent statistical analyses were performed.

Results

Article retrieval and categorization

A total of 32 articles were retrieved which met the criteria, including 29 clinical randomized controlled trials, 1 case-control study, and 2 case studies. In addition, 17 articles investigated well known TCM prescriptions (Tianma Gouteng decoction, Zhengan Xifeng decoction, Banxia Baizhu Tianma decoction, Xuefu Zhuyu decoction), whereas 15 articles investigated self-made prescriptions (Table 1) [1-32].

Characteristics of TCM treatment prescriptions

The frequency of use of compound TCMs in treatment of hypertension included: Tianma gouteng decoction-7 times, Zhengan Xifeng decoction-7 times, Banxia baizhu tianma decoction-2 times, and other formulae-1 time (Table 1). The most common treatment prescription characteristics included: reinforce deficiency-23 times, Calm the Liver-22 times, Remove Blood Stasis-14 times, Clear heat-12 times, expel dampness-6 times, regulate flow of qi-4 times, tranquilize endogenous wind-3 times, and Tranquilize-1 times (Table 2).

Table 1.  Prescription, Usage Counter, Study Types.

Prescription

Usage Counter

Study Types

Prescription

Usage Counter

Study Types

Tianma Gouteng decoction [1-7]

7

7 Clinical Randomized Controlled Trial

Compound TCM [28]

1

Clinical Randomized Controlled Trial

Zhengan Xifeng decoction [8-14]

7

5 Clinical Randomized Controlled Trial,1 Case Study,1 Case-control Studies

Antihypertensive Tea [30]

1

Clinical Randomized Controlled Trial

Banxia Baizhu Tianma  decoction [16,17]

2

2 Clinical Randomized Controlled Trial

Pingshen Tongluo Jiangya granula [22]

1

Clinical Randomized Controlled Trial

Xuefu Zhuyu decoction [18]

1

Clinical Randomized Controlled Trial

Xinnao Xikang [24]

1

Clinical Randomized Controlled Trial

Qingxuan Jiangya decoction [19]

1

Clinical Randomized Controlled Trial

Zhengan Xifeng Huatan Quyu TCM [26]

1

Clinical Randomized Controlled Trial

Sancao Jiangya decoction [20]

1

Case Study

Compound TCM [27]

1

Clinical Randomized Controlled Trial

Bushen Heluo fang [21]

1

Clinical Randomized Controlled Trial

Naoqingtong Granule [29]

1

Clinical Randomized Controlled Trial

Huayu Xiezhuo decoction [23]

1

Clinical Randomized Controlled Trial

Pingganjiangya Granule [31]

1

Clinical Randomized Controlled Trial

TCM Tea[25]

1

Clinical Randomized Controlled Trial

Sangji Mixture[32]

1

Clinical Randomized Controlled Trial

Self-made TCM[15]

1

Clinical Randomized Controlled Trial

 

 

 

Table 2.  Efficacy Prescription, Usage Counter, Syndromes.

Efficacy Prescription

Usage Counter

Syndromes

Occurrence Number

Reinforcing deficiency

23

Hyperactivity of liver Yang

10

Calming the Liver

22

Yin deficiency and Yang Hyperactivity

9

Removing Blood Stasis

14

Blood stasis

7

Clearing heat

12

Phlegm-damp resistance

6

Expelling dampness

6

Zangfu Qi-Xue and Yin-Yang deficiency

5

Regulating flow of qi

4

Overabundant liver-fire

3

Tranquilizing endogenous wind

3

Stagnated heat of liver meridian

2

Tranquilization

1

 

 

Characteristics of hypertension

The common clinical syndromes of hypertension included: Occurrences of Hyperactivity of liver Yang-10 times, Occurrences of Yin deficiency and Yang Hyperactivity-9 times, Occurrences of Blood stasis-7 times, Occurrences of Phlegm-damp resistance-6 times, Occurrences of Zangfu Qi-Xue and Yin-Yang deficiency- 5 times, Occurrences of Overabundant liver-fire-3 times, and Occurrences of Stagnated heat of liver meridian-2 times (Table 2).

Characteristics of TCM components

There was a total of 74 different types of TCM components used for the treatment of hypertension. Among these, the top three most commonly used TCM components were: Uncaria-24 times, Achyranthes-20, and Tuckahoe-20 times (Table 3).

Table 3.  TCM Name, Usage Counter.

TCM Name

Usage Counter

TCM Name

Usage Counter

TCM Name

Usage Counter

TCM Name

Usage Counter

Uncaria

24

Tortoise plastron

7

Fructus Aurantii

2

Rhizoma Dioscoreae

1

Achyranthes

20

Hematite

7

Fructus Ligustri Lucidi

2

Scorpion

1

Tuckahoe

20

Pinellia

7

Fructus Arctii

2

Lignum Sappan

1

Scutellaria baicalensis

18

Fossil fragments

6

Flos Chrysanthemi Indici

2

Vervain

1

Danshen Root

15

Oyster

6

ginger

2

Medulla Tetrapanacis

1

Capejasmine

13

Crataegus pinnatifida

4

Fructus Jujubae

2

Pine needle

1

Gastrodia elata

12

Chrysanthemum

4

Broadleaf holly leaf

1

Citron

1

Parasitic loranthus

12

Radix Paeoniae Rubra

4

Rhizoma Coptidis

1

Greenbrier

1

Rehmanniae

11

Alisma

3

Earthworm

1

Officinal Magnolia Bark

1

Licorice

11

Rhubarb

3

Radish Seed

1

Integripetal rhodiola herb

1

Chuanxiong

11

Tangerine peel

3

Rhizoma Polygonati

1

Citron fruit

1

Large-headed atractylodes

10

Selfheal

2

Fushen

1

Bile Arisaema

1

Radix Paeoniae Alba

9

Radix Puerariae

2

Chinese Angelica

1

Medicated leaven

1

Motherwort

9

Pearl shell

2

Fructus Aurantii Immaturus

1

Grassleaf Sweetflag Rhizome

1

Sickle senna seed

9

Herba Epimedii

2

Semen Persicae

1

Barbary Wolfberry Fruit

1

Figwort

9

Leech

2

Radix Platycodi

1

Pipewort

1

Concha Haliotidis

8

Radix Astragali

2

Chinese thorowax

1

Cassia

1

Caulis polygoni multiflori

8

Folium Mori

2

Rough gentian

1

 

 

Eucommia

8

Caulis Bambusae

2

Safflower

1

 

 

The most common organ targets of TCM meridian included: 50 liver, 25 heart, 32 spleen, 30 lung, 18 kidney, 3 pericardial, 9 bile, 0 small intestine, 25 stomach, 9 large intestine, 5 bladder, and 1 triple energizer meridian (Table 4). When TCM usage was expanded to used more than 10 times, the most common organ targets of TCM meridian included: 9 liver, 10 heart, 5 kidney, 4 spleen, 4 lung, 2 pericardial, 3 bile, 0 small intestine, 3 stomach, 1 large intestine, 1 bladder, and 1 triple energizer meridian (Table 5). Subsequently, when TCM usage was further expanded to used more than 20 times, the most common organ targets of TCM meridian included: 2 liver, 2 heart, 2 kidney, 1 spleen, 1 lung, 0 pericardial, 0 bile, 0 small intestine, 0 stomach, 0 large intestine, 0 bladder, and 0 triple energizer meridian (Table 6).

Table 4.  Medicine Meridian.

Medicine Meridian

Usage Counter

Medicine Meridian

Usage Counter

Liver

50

Bile

9

Heart

25

Small Intestine

0

Spleen

32

Stomach

25

Lung

30

Large Intestine

9

Kidney

18

Bladder

5

Pericardial

3

Triple Energizer

1

Table 5.  Medicine Meridian, using more than 10 times (Contains 10).

Medicine Meridian

Usage Counter

Medicine Meridian

Usage Counter

Liver

9

Bile

3

Heart

10

Small Intestine

0

Kidney

5

Stomach

3

Spleen

4

Large Intestine

1

Lung

4

Bladder

1

Pericardial

2

Triple Energizer

1

Table 6.  Medicine Meridian, using more than 20 times (Contains 20).

Medicine Meridian

Usage Counter

Medicine Meridian

Usage Counter

Liver

2

Bile

0

Heart

2

Small Intestine

0

Kidney

2

Stomach

0

Spleen

1

Large Intestine

0

Lung

1

Bladder

0

Pericardial

0

Triple Energizer

0

Discussion

Hypertension is the most common type of chronic non-communicable diseases, as well as being the single most important risk factor for cardiovascular disease [33,34]. In TCM, hypertension is categorized as the Vertigo and Headache class of disease. The basic pathogenesis of hypertension in TCM is the result of Yin deficiency and Yang Hyperactivity, as well as the general symptom of asthenia. The main cause of hypertension is emotional disturbance, improper diet, blood stasis, phlegm interference, as well as occurrence of Zangfu Qi-Xue and Yin-Yang deficiency in the liver and kidneys. The use of TCM has long been used in the prevention and treatment of hypertension and is associated with effective outcomes.

The antihypertensive effects of TCM meridian was previously summarized by Huang Xiaojin [35], in particular the efficacy of TCM in the treatment of hypertension. The TCM notion for treatment of hypertension generally involves the five organs Yin principle, while its etiology and pathogenesis is mainly based on phlegm, blood stasis and heat accumulation. The law of frequency in the use of TCM for treatment of primary hypertension was outlined by Cai Yongmin [36] and involves the 6 common applications of TCM including: Reinforce deficiency, Remove Blood Stasis, Clear heat, Calm the Liver with Tranquilize endogenous wind, diaphoresis relieving superficies and Expel dampness. Studies by Lan Hongbin [37] and Chen Jianxin [38] analyzed 864 and 310 different compounds, respectively, for the treatment of hypertension, which includes 231 and 84 different kinds of TCM, respectively, whereby the most frequently used characteristics were: Reinforce deficiency, Remove Blood Stasis, Calm the Liver and Expel dampness.

Our present study demonstrated that based on the choice of prescriptions for the treatment for hypertension, Tianma gouteng decoction and zhengan Xifeng decoction were the preferred options, whose characteristics mainly include: Reinforce deficiency, Calm the liver and Remove blood stasis. In addition, based on the choice of TCM components for the treatment for hypertension, Uncaria, Achyranthes and Scutellaria baicalensis, were the most widely used, and are mainly dominated by the TCM liver meridian. Similarly, the three most commonly used TCM meridians include the liver, heart and kidney meridian drugs. Furthermore, the main clinical syndromes of hypertension were: Hyperactivity of liver Yang, Yin deficiency and Yang Hyperactivity.

Conclusion

In conclusion, Hyperactivity of liver Yang and Yin deficiency, and Yang Hyperactivity are the two major syndromes of hypertension, while TCM treatments mainly focus on reinforcing deficiency, Calming the Liver and Removing Blood Stasis in the treatment of hypertension. The most commonly used formulas for clinical treatment of hypertension are Tianma Gouteng decoction and Zhengan Xifeng decoction, whereas Uncaria, Achyranthes and Tuckahoe are the most commonly used TCM components for clinical treatment of hypertension. TCM drugs belong mainly to the liver meridian, while TCM drugs for the treatment of hypertension mostly belong to the liver, heart and kidney meridians.

Source(s) of financial support of the study

1. Fujian Provincial Health and Family Planning Commission, 2018-CX-42.

2. Fujian Provincial Department of Science and Technology, 2018J01884.

3. National Natural Science Foundation of China, 81774135.

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Editorial Information

Editor-in-Chief

Massimo Fioranelli
Guglielmo Marconi University

Article Type

Research Article

Publication history

Received date: December 05, 2018
Accepted date: December 17, 2018
Published date: December 19, 2018

Copyright

© 2018 Wang H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Wang H, Bao L, Zhou X, Chen Y, Fu C, et al. (2018) Current clinical application of traditional chinese medicine for the treatment of hypertension. J Integr Cardiol 4: DOI: 10.15761/JIC.1000264

Corresponding author

Chu Jianfeng

Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, 1 Qiuyang Road, Minhou Shangjie, Fuzhou, Fujian 350122, P.R. China

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Table 1.  Prescription, Usage Counter, Study Types.

Prescription

Usage Counter

Study Types

Prescription

Usage Counter

Study Types

Tianma Gouteng decoction [1-7]

7

7 Clinical Randomized Controlled Trial

Compound TCM [28]

1

Clinical Randomized Controlled Trial

Zhengan Xifeng decoction [8-14]

7

5 Clinical Randomized Controlled Trial,1 Case Study,1 Case-control Studies

Antihypertensive Tea [30]

1

Clinical Randomized Controlled Trial

Banxia Baizhu Tianma  decoction [16,17]

2

2 Clinical Randomized Controlled Trial

Pingshen Tongluo Jiangya granula [22]

1

Clinical Randomized Controlled Trial

Xuefu Zhuyu decoction [18]

1

Clinical Randomized Controlled Trial

Xinnao Xikang [24]

1

Clinical Randomized Controlled Trial

Qingxuan Jiangya decoction [19]

1

Clinical Randomized Controlled Trial

Zhengan Xifeng Huatan Quyu TCM [26]

1

Clinical Randomized Controlled Trial

Sancao Jiangya decoction [20]

1

Case Study

Compound TCM [27]

1

Clinical Randomized Controlled Trial

Bushen Heluo fang [21]

1

Clinical Randomized Controlled Trial

Naoqingtong Granule [29]

1

Clinical Randomized Controlled Trial

Huayu Xiezhuo decoction [23]

1

Clinical Randomized Controlled Trial

Pingganjiangya Granule [31]

1

Clinical Randomized Controlled Trial

TCM Tea[25]

1

Clinical Randomized Controlled Trial

Sangji Mixture[32]

1

Clinical Randomized Controlled Trial

Self-made TCM[15]

1

Clinical Randomized Controlled Trial

 

 

 

Table 2.  Efficacy Prescription, Usage Counter, Syndromes.

Efficacy Prescription

Usage Counter

Syndromes

Occurrence Number

Reinforcing deficiency

23

Hyperactivity of liver Yang

10

Calming the Liver

22

Yin deficiency and Yang Hyperactivity

9

Removing Blood Stasis

14

Blood stasis

7

Clearing heat

12

Phlegm-damp resistance

6

Expelling dampness

6

Zangfu Qi-Xue and Yin-Yang deficiency

5

Regulating flow of qi

4

Overabundant liver-fire

3

Tranquilizing endogenous wind

3

Stagnated heat of liver meridian

2

Tranquilization

1

 

 

Table 3.  TCM Name, Usage Counter.

TCM Name

Usage Counter

TCM Name

Usage Counter

TCM Name

Usage Counter

TCM Name

Usage Counter

Uncaria

24

Tortoise plastron

7

Fructus Aurantii

2

Rhizoma Dioscoreae

1

Achyranthes

20

Hematite

7

Fructus Ligustri Lucidi

2

Scorpion

1

Tuckahoe

20

Pinellia

7

Fructus Arctii

2

Lignum Sappan

1

Scutellaria baicalensis

18

Fossil fragments

6

Flos Chrysanthemi Indici

2

Vervain

1

Danshen Root

15

Oyster

6

ginger

2

Medulla Tetrapanacis

1

Capejasmine

13

Crataegus pinnatifida

4

Fructus Jujubae

2

Pine needle

1

Gastrodia elata

12

Chrysanthemum

4

Broadleaf holly leaf

1

Citron

1

Parasitic loranthus

12

Radix Paeoniae Rubra

4

Rhizoma Coptidis

1

Greenbrier

1

Rehmanniae

11

Alisma

3

Earthworm

1

Officinal Magnolia Bark

1

Licorice

11

Rhubarb

3

Radish Seed

1

Integripetal rhodiola herb

1

Chuanxiong

11

Tangerine peel

3

Rhizoma Polygonati

1

Citron fruit

1

Large-headed atractylodes

10

Selfheal

2

Fushen

1

Bile Arisaema

1

Radix Paeoniae Alba

9

Radix Puerariae

2

Chinese Angelica

1

Medicated leaven

1

Motherwort

9

Pearl shell

2

Fructus Aurantii Immaturus

1

Grassleaf Sweetflag Rhizome

1

Sickle senna seed

9

Herba Epimedii

2

Semen Persicae

1

Barbary Wolfberry Fruit

1

Figwort

9

Leech

2

Radix Platycodi

1

Pipewort

1

Concha Haliotidis

8

Radix Astragali

2

Chinese thorowax

1

Cassia

1

Caulis polygoni multiflori

8

Folium Mori

2

Rough gentian

1

 

 

Eucommia

8

Caulis Bambusae

2

Safflower

1

 

 

Table 4.  Medicine Meridian.

Medicine Meridian

Usage Counter

Medicine Meridian

Usage Counter

Liver

50

Bile

9

Heart

25

Small Intestine

0

Spleen

32

Stomach

25

Lung

30

Large Intestine

9

Kidney

18

Bladder

5

Pericardial

3

Triple Energizer

1

Table 5.  Medicine Meridian, using more than 10 times (Contains 10).

Medicine Meridian

Usage Counter

Medicine Meridian

Usage Counter

Liver

9

Bile

3

Heart

10

Small Intestine

0

Kidney

5

Stomach

3

Spleen

4

Large Intestine

1

Lung

4

Bladder

1

Pericardial

2

Triple Energizer

1

Table 6.  Medicine Meridian, using more than 20 times (Contains 20).

Medicine Meridian

Usage Counter

Medicine Meridian

Usage Counter

Liver

2

Bile

0

Heart

2

Small Intestine

0

Kidney

2

Stomach

0

Spleen

1

Large Intestine

0

Lung

1

Bladder

0

Pericardial

0

Triple Energizer

0