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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

www.themegallery.comwww.themegallery.com Company LogoCompany Logo

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


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)


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


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)


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


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


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


Part onePart one—— —— Review of TCM of Anti-hypertensionReview of TCM of Anti-hypertension


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


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


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


Part twoPart two—— —— Categorization of Categorization of AAnti-hypertension nti-hypertension HHerbserbs


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


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.


Part threePart three

—— —— Anti-hypertension herbal Anti-hypertension herbal mechanisms & clinical applications mechanisms & clinical applications


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)


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)


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


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).


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


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


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).


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


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


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

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