Abstract
Objective:
To analyze the patterns and differences of Chinese herbs in the treatment of coronary heart disease (CHD) in different time periods and different regions in recent 20 years.
Design:
The literature of controlled clinical trials that focuses on Chinese herbs treating CHD published in China National Knowledge Internet and Wanfang database from January 1, 1996 to December 31, 2015 were screened to analyze the patterns of herb utilization using SPSS 21.0.
Results:
A total of 1250 articles were enrolled in total covering 29 regions. There were 242 kinds of single herbs, 18 categories, mentioned a total of 11,594 times. In Northeast China, North China, South China, Central China, and Southwest China the most frequently used herb was Radix Salviae Miltiorrhizae, but in East China and Northwest China, the most frequently used herb was Rhizoma Chuanxiong. The most frequently used herb category in North China, Central China, Southwest China, and Northwest China was herbs to invigorate blood, but in Northeast China, East China, and South China the most frequently used herb category was herbs to tonify.
Conclusion:
Single herbs and herb categories to treat CHD in Traditional Chinese Medicine differed from time to time and from region to region.
Introduction
C
Methods
Literature sources
Retrieval of the periodical literature published in China National Knowledge Internet (CNKI) and Wanfang database from January 1, 1996 to December 31, 2015: Using advanced retrieval in CNKI, “Traditional Chinese Medicine + Traditional Chinese and Western Medicine + Herbs + The Study of Traditional Chinese Medicine” as the primary search keywords, “Coronary Heart Disease + Angina Pectoris + Myocardial Infarction” as secondary search keywords. Using advanced retrieval in WanFang databaseas, keywords are “Coronary Heart Disease + Angina Pectoris + Myocardial Infarction.” A total of 1250 articles were retrieved for manual screening according to the inclusion and exclusion criteria.
Inclusion criteria
(1) The clinical controlled study on treatment of CHD with TCM or combined traditional Chinese and Western medicine; (2) There are clear and complete records of TCM prescriptions; (3) The result was statistically significant in experimental group.
Exclusion criteria
(1) Data sources are not clear, inconsistent data when compared before and after; (2) Duplicate content or duplicate data; (3) Literature related to the study of complications of CHD; (4) Theoretical discussion, expert experience report, and case report.
Division of research factors
Time division
On the basis of publication time, literature was divided into two groups, January 1, 1996 to December 31, 2005 and January 1, 2006 to December 31, 2015. Because each time group is 10 years, this article named January 1, 1996 to December 31, 2005 as the past 10 years and January 1, 2006 to December 31, 2015 as the recent 10 years.
Region division
The regions were divided into the Northeast (Liaoning, Jilin, and Heilongjiang); North China (Beijing, Tianjin, Hebei, Shanxi, and Inner Mongolia); East China (Shandong, Jiangsu, Zhejiang, Anhui, Shanghai, Fujian, and Jiangxi); South China (Guangdong, Guangxi, and Hainan); Central China (Hubei, Hunan, and Henan); Northwest (Ningxia, Xinjiang, Qinghai, Shanxi, and Gansu); and Southwest (Sichuan, Yunnan, Guizhou, Tibet, and Chongqing).
Input method
Data were entered into the Excel 2003 table in a certain format (name, publication date, number of cases, area, decoction, herbs), database was then established. Herbs were recorded only if they were originally included in the formula. The name of the herb and classification of the herb refer to Chinese Pharmacy and Chinese Pharmacopoeia 2015 Edition. 4,5
Statistical method
The name of the herb and classification of the herb refer to Chinese Pharmacy and Chinese Pharmacopoeia 2015 Edition. 4,5 Rate and composition ratio were calculated. (Rate = frequency/the number of cases, Composition Ratio = frequency/total frequency of use). Data were analyzed using software of SPSS 21.0, χ2 test, p < 0.05 as statistically significant.
Results
Single herb analysis
Analysis of single herb
A total of 1250 articles were enrolled, 242 single herbs that showed up 11,594 times. Table 1 shows that most frequently used herbs for CHD is Radix Salviae Miltiorrhizae with the rate of 64%.
Analysis and Comparison of single herb of past and recent decades
There are 329 articles in the past 10 years with total of 3284 times of herb utilization and Table 2 shows that the most frequently used herbs for CHD is Radix Salviae Miltiorrhizae both in the past (with the rate of 74%) and recent 10 years (with the rate of 69%). However, in recent years, rate of herb utilization for Radix Salviae Miltiorrhizae, Rhizoma Chuanxiong, and Radix Astragali decreased (p < 0.05) when compared with that of the past 10 years.
Compared with the rate of Radix Salviae Miltiorrhizae in the past 10 years, * p < 0.05.
Compared with the rate of Rhizoma Chuanxiong in the past 10 years, ** p < 0.05.
Compared with the rate of Radix Astragali in the past 10 years, *** p < 0.01.
January 1, 1996 to December 31, 2005.
January 1, 2006 to December 31, 2015.
Analysis of herb category
The herbs mentioned in the articles were classified into 18 categories, the most frequently used 5 categories are herbs to invigorate the blood, herbs to tonify, herbs to regulate QI flow, herbs to clear heat, herbs to resolve phlegm. Table 3 shows that the most frequently used category is herbs to tonify in the past 10 years and the recent 10 years is herbs to invigorate the blood. Herbs to invigorate the blood increased in the recent 10 years when compared with the past 10 years (*p < 0.01).
Compared with the past 10 years of using herbs for invigorating blood, * p < 0.05.
January 1, 1996 to December 31, 2005.
January 1, 2006 to December 31, 2015.
Analysis of herb used in different regions
Analysis of the using of single herb in different regions
There were 29 provinces in the articles that were divided into 7 regions. The times of herb utilization in each region are as follows: 153 articles and 2208 herbs in Northeast China; 155 articles and 2611 herbs in North China; 223 articles and 3239 kinds of herbs in East China; 77 articles and 1351 kinds of herbs in South China; 361 articles and 5780 kinds of herbs in Central China; 109 articles and 1564 kinds of herbs in Northwest China; and 67 articles and 1130 kinds of herbs in Southwest China. Table 4 shows that the most frequently used single herb in Northeast China, North China, East China, Central China, and Southwest China is Radix Salviae Miltiorrhizae; in South China and Northwest China it is Rhizoma Chuanxiong.
Analysis of herb used in different regions
Frequency and rate of most frequently used five categories in each region are showed in Table 5. The most frequently used category in Northeast China, East China, and South China was herbs to tonify, but in North China, Central China and Southwest China, and Northwest China it was herbs to invigorate blood.
Past 10 years is defined as January 1, 1996 to December 31, 2005.
Recent 10 years is defined as January 1, 2006 to December 31, 2015.
Analysis of the herbs used in different regions in recent 20 years
Tables 6 and 7 shows that single herb utilization is different in different regions. In the recent 10 years, utilization of Radix Salviae Miltiorrhizae and Rhizoma Chuanxiong in Northeast China significantly decreased (p < 0.05); the utilization of Radix Salvia Miltiorrhiza and Radix Astragali in East China also decreased (p < 0.05). The utilization of Radix Salviae Miltiorrhizae in South China significantly increased (p < 0.05).
Past 10 years is defined as January 1, 1996 to December 31, 2005.
Recent 10 years is defined as January 1, 2006 to December 31, 2015.
Compared with respective corresponding group in the past 10 years, * p < 0.05.
Discussion
With significant changes in recent years in economy, fast pace working environment, and lifestyle, the disease spectrum has changed. Combining Chinese and Western medicine to diagnose and treat CHD is one of the hot spots in 21st century, which has made great progress in improving people's physical endurance and symptom relief, so it is increasingly accepted by doctors and patients. 6,7 To treat in accordance with time and region factors is an important feature of TCM. Clinical medicine will change when disease spectrum changes; so studying and understanding the changes and patterns of herb utilization for the treatment on CHD are essential to treat CHD using a combination of Traditional Chinese Medicine and Western medicine.
Analysis of single herb
This research found out that the most frequently used herbs were Radix Salviae Miltiorrhizae, Rhizoma Chuanxiong, Radix Astragali, and Angelica sinensis. Radix Salviae Miltiorrhizae is an important herb to invigorate the blood circulation for treating CHD, which belongs to Heart and Liver meridian. Compendium of Materia Medica states Radix Salviae Miltiorrhizae could invigorate the circulation and is belonged to Chinese medicine Xinbao-meridian. There is a saying that “The Radix Salviae Miltiorrhizae equals to Si Wu Tang,” as it invigorates and nourishes blood and plays an important role in clinical application.
In recent 10 years, the rate of herb utilization of Rhizoma chuanxiong, Radix Salviae Miltiorrhizae, and Radix Astragali decreased. With the development of science and technology, research on frequently used herbs and its derivatives for CHD treatment has made great progress. For example, experimental study by Guo 8 proved that Salviae Miltiorrhizae and Ligustrazine with hydrochloride injection (Beit Guizhou Pharmaceutical Co., Ltd., Guizhou, China) combined with trimetazidine could significantly improve clinical efficacy in the treatment of CHD. Zhang 9 believes that astragalus polysaccharides have effectively protected hepertrophic cardiomyocytes induced by isoproterenol. With the development of the combination of Traditional Chinese Medicine and Western Medicine, more and more medicines or derivatives partially replaced the use of pure Chinese herbs, which promoted further development of the Combination of Traditional Chinese Medicine and Western Medicine.
Analysis of herb categories
There are some statements in Chinese classic literature mention CHD. As in Shengji Record: Cardiodynia, “The feeling just like [being] pricked by a sharp needle.” Synopsis of Golden Chamber states that “The weak caused chest pain”; Treatise on Three Categories of Pathogenic Factors states that “It is all because of Qi in viscus disorder and emotion changes.” General Treatise on the Cause and Symptoms of Diseases records that “The Yang Qi is stagnated by Xie and then produce heat.” Confucians' Duties to Their Parents states “The stomach stayed with drink and felt distending and sour.” The most frequently used herb categories were herbs to invigorate blood, tonify, regulate QI flow, clear heat, and resolve phlegm, which count for 80%, and this is also consistent with the ancient literature. The research by Tian 10 shows that the most common TCM syndrome elements of CHD are blood stasis, deficiency, phlegm, Qi stagnation, which is also consistent with our study.
In the recent 10 years, the utilization of herbs to invigorate blood increased, while the rate of other categories did not change. It is considered that the blood stasis theory of chest disease is increasingly popular with the vigorous development of integrative medicine. As for the other herbs, it is implemented on the basis of diagnosis and treatment by syndrome differentiation, which also reflects the important features of TCM.
Analysis of herb utilization in different regions
This study found out that the frequency of use of a single herb is different in different regions. The single herb most frequently used in Northeast China, North China, East China, Central China, and Southwest China was Radix Salviae Miltiorrhizae; in South China and Northwest China it was Rhizoma Chuanxiong. The most frequently used category in Northeast China, East China, and South China was herbs to tonify; in North China, Central China, Southwest China, and Northwest China it was herbs to invigorate the blood. In recent 10 years, the frequency of Radix Salviae Miltiorrhizae and Rhizoma Chuanxiong use increased in Northeast China; the frequency of Radix Salvia Miltiorrhiza and Radix Astragali use increased in North China; and Radix Salvia Miltiorrhizae use increased in South China.
The difference of herb utilization reflects the feature of TCM to treat according to different regions with different environment, people's life style, and local customs. Huangdi Neijing states “(Therapeutic regimen should) determined by local circumstances.” In TCM east is related to Mu, so herbs to regulate QI flow were largely used to make visceral QI flow orderly in East China. Although the herbs used in different region were different, herbs to invigorate blood and herbs to tonify were both very important. This reflected deficiency and blood stasis were the main TCM Syndromes in CHD at this stage.
Conclusion
The results of this study showed that the single herb and herb category used was different in different times or different regions, so we should study the different individuals to discover the medication use rules of CHD. Pay attention to the using and researching of the most frequently used herbs as Radix Salviae Miltiorrhizae, and the most frequently used categories as Herbs to invigorate the blood is benefit to the clinical. This research to probe into the rules of Chinese herb therapy is necessary, which could provide references for further study on treatment of CHD. The research on herbs used in different areas and at different periods could provide guidance to us when treating with herbs in different individuals, regions, and times.
Footnotes
Acknowledgments
The authors thank Yang Jing for kind assistance in editing the article. This study was supported by the National Natural Science Fund Project of China (Grant No. 81273959) and Fund Project of Shanghai Traditional Chinese Medicine Heritage Research (Grant No. ZY3-CCCX-1-1001).
Author Disclosure Statement
No competing financial interests exist.