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Traditional Chinese medicine Traditional Chinese medicine in treating hypertensionin treating hypertension
Fang Geng, Li Yang, LiLi Ji, Zhengtao Wang and Christopher J.
Branford-White , Ondina Leon Diaz
Key Laboratory of Standardization of Chinese Medicines of Mini
stry of Education, Shanghai University of Traditional Chinese M
edicine, 1200 Cailun Road, Zhangjiang Hi-tech Park, Shanghai 2
01203, P R China
Institute for Health Research and Policy, London Metropolitan U
niversity, 166-220 Holloway Road, London N7 8DB, UK
CENSA, National Center for Plant and Animal Health, San Jose
de las Lajas, La Habana, Cuba
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Traditional Chinese Medicine/TCM(Herbal Medicine focus)
Overview:Introduction to TCMModernisation issues/applied
research/market place potentialGlobal approachesCollaborative links/how do they work
(Shanghai, CENSA/Cuba, London)TCM study using Chinese herbs
relating to hypertension
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Background to TCM
TCM been practiced for 4000 years (currently 2 billion people practice TCM)
Culture & Science (some debate)Whole body model concept (not a
‘’one pill per ill’’ model, western approach)
Four basic elements (acupuncture, diet, massage & herbs)
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TCM Modernisation
Issues: Identification, validation and
authentication Farming, herbal sources, processing,
quality assurance/distribution issues Health & safety Legislation/risk assessment Government/professional bodies Practitioners/professional
status/acceptability
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TCM/Why modernisation?
Expanding world market in TCM products
Natural/green drug alternativeUK/USA; 20% drugs sold are from
natural sources (expanding consumer demand)
UK – market now worth £170k/rising to £200k by 2010
Growing international support (WHO, EU, medical charities, US/NIH funding)
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TCM/Chinese Government
PR China investing $5-6 billion worldwide in TCM
Recent EU/UK trade & economic (including health)links/agreements
Beijing International declaration on TCM (December 2007)
Developing a rapid modernisation program (national centres/Shanghai)
Engaging in isolating/characterising medically active compounds
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HYPERTENSION/UK PROSPECTIVE
Some Factors:High salt concentrations (processed
foods, pressure on food industry)Obesity (fears/50% population obese in 10
years especially in the young)Race (e.g. Asian women type 2 diabetes
and hypertension)Current health intervention strategies
(unsuccessful/need addressing)HTA conference covering these points
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Contents
Review of TCM of anti-hypertensionReview of TCM of anti-hypertension 1
Categorization of anti-hypertension herbsCategorization of anti-hypertension herbs2
Anti-hypertension herbs mechanism and Anti-hypertension herbs mechanism and clinical application clinical application
3
Prospect and conclusionProspect and conclusion4
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Part onePart one—— —— Review of TCM of Anti-hypertensionReview of TCM of Anti-hypertension
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42.5%42.5%
HypertensionHypertension
Death due to hypertension
( heart failure, renal failure, cerebral
infarction, coronary heart disease )
Number of fatality Number of fatality
Hypertension is Hypertension is poorly controlledpoorly controlled
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Two types of high blood pressure Two types of high blood pressure
HypertensionHypertension
essential essential (primary) (primary) hypertension hypertension
secondary secondary hypertension hypertension
Most common Most common (90%) and (90%) and dangerousdangerous
Treatable or Treatable or reversiblereversible
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Conventional and TCM therapy of Conventional and TCM therapy of hypertensionhypertension
Conventional therapy principleConventional therapy principle TCM therapy principleTCM therapy principle
1. Beta-blockers
2. Diuretics
3. ACE inhibitors
4. Calcium-channel blockers
1.Global and dialectical treatment
2. multi-routes, multi-links, multi-targets
3. Safe and no drug dependency
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Part twoPart two—— —— Categorization of Categorization of AAnti-hypertension nti-hypertension HHerbserbs
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Categorization of antihypertension Categorization of antihypertension herbs herbs
TCM considered hypertension to be liver-fire ascendi
ng and Yin-Deficiency with Shenic-Yang syndrome
So herbs calming the liver and subdue yang, activati
ng blood circulation that dissipates blood stasis, eli
minating humid heat so relief is applied
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Categorization of antihypertension Categorization of antihypertension herbsherbs
Diaphoresis relieving superficies: Radix Puerariae, Rhizoma cimicifugae,
Florists Chrysanthemum.
Heat-clearing herbs: Spica prunellae, Sophora flavescens Ait, Semen Cas
siae.
Catarrhectic herbs: Radix et rhizoma rhei.
Activating blood circulation to dissipate blood stasis herbs: Salvia milti
orrhiza, Flos Carthami.
Anastaltic herbs: Panax Notoginseng.
Rheumatism herbs: Radix stephaniae tetrandrae, Araliafargesii Franch.
Removing dampness and promoting diuresis herbs: Rhizoma alismatis.
Dissipate phlegm and relieving cough and asthma herbs: mori Cortex.
Dispelling internal cold herbs: Fructus Evodiae.
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Part threePart three
—— —— Anti-hypertension herbal Anti-hypertension herbal mechanisms & clinical applications mechanisms & clinical applications
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1. Ramulus Uncariae cum Uncis1. Ramulus Uncariae cum Uncis
Uncaria rhynchophylla(Miq.) Jacks. Gambir Plant
A. Uncaria rhynchophylla, B. Uncaria sinensis, C. Uncaria macrophylla, D. U.hirsuta
Plant source: Gambir plant is the dried hook-bearing branch of Uncaria rhynchophylla (Miq.) Jacks., Uncaria macrophylla Wall., Uncaria hirsute havil., Uncaria sinensis (oliv.) havil. or Uncaria sessilifructus Roxb. (Fam. Rubiaceae)
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Main and representative compounds of Ramulus UncMain and representative compounds of Ramulus Uncariae cum Uncisariae cum Uncis
HN
N
O
O
O
O
HN
N
O
O
O
O
mitrinermine Isorhynchophylline
(more effective than mitrinermine)
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Activity of Ramulus Uncariae cum UncisActivity of Ramulus Uncariae cum Uncis
Mechanism of Ramulus uncariae cum Uncis: inhibits the vasomo
tor center, extends extension of peripheral vessels, blocks adrenergi
c nerve, and inhibits nerve ending transmitter releasing
Effect: blood pressure of spontaneous hypertension rats (SHR) was
decreased by daily administration of Ramulus Uncariae cum Uncis
water exaction for 5 weeks.
Mechanism of Isorhynchophylline: reduction in total peripheral va
scular resistance and cardiac output induced by lowered heart rate
Compatibility: together with Rhizoma gastrodia was more active th
an single use; a blended approach/mixed biomedical components
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2. Radix Astragali 2. Radix Astragali
Plant of Radix Astragali
A. Astragalus membranaceus (Fisch.) Bunge var. mongholicus (Bunge) HsiaoB. Astragalusmembranaceus (Fisch.) Bunge.
Radix Astragali producted in different areas:
A. Anhui B. Hebei C. Guangzhou D. Jiangxi
Plant source: Milkvetch Root is the dried root of Astragalus membranaceus (Fisch.) Bge var. mongholicus (Bge.) Hsiao or Astragalus membranaceus (Fisch.) Bge (Fam. Leguminosae).
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Main and representative compounds of Radix AstragaMain and representative compounds of Radix Astragalili
astragaloside Soyasaponin I
O
OH
HO
O
OH
OCH3
O
Glu
O
Glu
OH
O
OH
OH
OH
Rha-ara-glc-O
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Activity of Radix Astragali Activity of Radix Astragali
Effective compounds: Aminobutyric acid and astragaloside are considered to be effective to extend vessel, anti hypoxia, reduce the collagen
Mechanism: extend vessel directly, not by bilineurin system and adnephrin receptor
Bilateral effect: When circulatory collapse pressure, Milkvetch Root will increase blood pressure to keep pressure balance
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3. Radix Puerariae Lobatae 3. Radix Puerariae Lobatae
Pueraria lobata (Willd).Ohwi Radix Puerariae Lobatae
Plant source: Kudzuvine Root is the dried root of Pueraria lobata (Wild). Ohwi (Fam. Leguminosae).
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Main and representative compounds of Radix PuerariMain and representative compounds of Radix Puerariae Lobatae ae Lobatae
OH
OH
OOH
O
Genistein
O
O
OHO
Kakkonein
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Activity of Activity of Radix Puerariae Lobatae Radix Puerariae Lobatae
Mechanism of Kakkonein: extend periphery vascellum, reduce content of rennin and angiotensin and blocks β- adnephrin receptor
Effect of Radix Puerariae Lobatae : decrease high blood pressure enduced by aleudrin
Bilateral effect: decrease or increase blood pressure, was also a bilateral herb in blood pressure. This is a particular feature of Chinese Medicine anti-hypertension herbs, getting the right herbal balance
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ProspectProspect and Conclusion
Up to now, more than 100 Chinese herbs have been proved to be anti-hypertensiv
e, however there are 11146 species of herbs in China, curative effect of most of th
em are unknown and waiting to be explored. We wish to demonstrate that Chines
e medicine is a modern potential source and route for treating hypertension
Examples for treating hypertension in China include: Tian ma gou teng Yin, Shen
mai injection, Zhen ju tablet
Side effects (low pressure, drug dependency, glyco-metabolic disorders) have b
een avoided through the development of a standardized national program that ha
s also addressed endocrine secretion and anti-aging issues
We recommend; promotion of a healthy life styles (stress management), good die
t, low salt intake, regular exercise, reduce smoking and reduce alcohol intake
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Thank youThank youTse TseTse Tse
Muchas GraciasMuchas Gracias