Efficacy and Advantages of Traditional Chinese Medicine in Treating Cardiovascular Diseases

Author: Wong Linhong, BTCM, Ph.D (TCM IM Cardiology)

Cardiovascular diseases are among the leading threats to human health, with hypertension, arrhythmia, and chronic heart failure being some common clinical conditions. Traditional Chinese Medicine (TCM) offers unique advantages and significant efficacy in treating these diseases. We explore the advantages and efficacy of TCM in managing these common cardiovascular diseases from the perspectives of modern pharmacological research and TCM theory.

Hypertension (High Blood Pressure)

Disease Overview

Hypertension is a chronic condition characterized by persistently elevated arterial blood pressure. Poor management can lead to damage in target organs such as the heart, brain, and kidneys.

Hypertension is generally classified into three stages:

• Stage 1 (Mild Hypertension): BP: 140-159 mmHg/90-99 mmHg.
• Stage 2 (Moderate Hypertension): BP: 160-179 mmHg/100-109 mmHg.
• Stage 3 (Severe Hypertension): BP: ≥180 mmHg/≥110 mmHg.

Clinical Manifestations

• Symptoms: Dizziness, headache, palpitations, and fatigue.
• Complications: Stroke, myocardial infarction, and renal failure.

Mechanisms of Action

• Regulating Vascular Tone: Herbs like Uncaria (Gouteng) dilate blood vessels, reduce peripheral resistance, block sympathetic nerve excitation, and inhibit calcium ion (Ca2+) channels, thereby stabilizing blood pressure [1].
• Inhibiting the Renin-Angiotensin System (RAAS): Herbs such as Kudzu Root (Gegen), Cassia Seed (Juemingzi), and Lycium Root Bark (Digupi) suppress RAAS overactivation, reducing the production of angiotensin II and achieving antihypertensive effects [2].
• Holistic Regulation: TCM not only lowers blood pressure but also alleviates symptoms such as dizziness, headache, and insomnia, improving quality of life.

Commonly Used TCM Herbs and Formulas

• Tianma Gouteng Decoction: Calms the liver and extinguishes wind, blocks the renin-angiotensin-aldosterone system (RAAS), inhibits calcium channels, and antagonizes sympathetic nervous system activity, thereby lowering blood pressure [3].
• Banxia Baizhu Tianma Decoction: Resolves phlegm and extinguishes wind, dilates peripheral small blood vessels, and slows heart rate, contributing to blood pressure reduction [4].

Arrhythmia (Irregular Heart Beat)

Disease Overview

Arrhythmia refers to abnormalities in the frequency, rhythm, origin, or conduction velocity of the heart’s electrical activity, resulting in a heartbeat that is too fast, too slow, or irregular. It is a common cardiovascular condition that may be asymptomatic or lead to severe hemodynamic disturbances, even life-threatening situations.

Clinical Manifestations

Palpitations, dizziness, syncope, chest tightness, pain, fatigue, and shortness of breath.

Classification of Arrhythmia

• Tachyarrhythmias: Heart rate > 100 beats per minute.
• Sinus tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia, ventricular fibrillation.
• Bradyarrhythmias: Heart rate < 60 beats per minute.
• Sinus bradycardia, atrioventricular block, sick sinus syndrome.
• Irregular Rhythms:
• Premature beats (atrial, ventricular), atrial fibrillation.

Mechanisms of Action

• Regulating Autonomic Nervous Function: Herbs like Ziziphus (Suanzaoren) and Polygala (Yuanzhi) balance the sympathetic and parasympathetic nervous systems, improving heart rhythm [5].
• Improving blood flow: Herbs such as Salvia (Danshen) and Pseudoginseng (Sanqi) improve myocardial blood supply, reducing the occurrence of arrhythmias [6].
• Symptomatic treatment: TCM can relieve palpitations, insomnia, and anxiety.

Commonly Used TCM Herbs and Formulas

• Zhigancao Decoction: Replenishes qi and nourishes yin, regulating heart rhythm [7].
• Tianwang Buxin Dan: Nourishes the heart and calms the mind, alleviating palpitations [8].

Chronic Heart Failure

Disease Overview

Chronic Heart Failure (CHF) is a clinical syndrome characterized by reduced cardiac output or elevated ventricular filling pressure due to structural or functional abnormalities of the heart, leading to an inability to meet the body’s metabolic demands. It is often caused by coronary heart disease, hypertension, or cardiomyopathy. As the end stage of many cardiovascular diseases, it is associated with high morbidity, mortality, and healthcare burden.

Staging and Classification

NYHA Functional Classification

Class I: No limitation of physical activity; ordinary activity does not cause symptoms.
Class II: Slight limitation of physical activity; comfortable at rest but ordinary activity causes fatigue, palpitations, or dyspnea.
Class III: Marked limitation of physical activity; comfortable at rest but minor activity causes symptoms.
Class IV: Symptoms present even at rest; any physical activity worsens discomfort.

Clinical Manifestations

• Symptoms: Fatigue, shortness of breath, peripheral edema (especially in the lower limbs), and paroxysmal nocturnal dyspnea.
• Complications: Pulmonary edema and cardiogenic shock.

Mechanisms of Action

• Enhancing Myocardial Contractility: Herbs like Astragalus (Huangqi) improve myocardial energy metabolism and enhance contractility [9].
• Improving Myocardial Microcirculation: Herbs such as Salvia (Danshen) and Pseudoginseng (Sanqi) dilate coronary arteries and increase myocardial blood supply [10].
• Diuretic and Anti-Edema Effects: Herbs like Poria (Fuling) and Alisma (Zexie) promote diuresis and reduce edema [11].

Commonly Used TCM Herbs and Formulas

• Shengmai San: Replenishes qi and nourishes yin, improving cardiac function [12].
• Zhenwu Decoction: Warms yang, transforms qi, promotes diuresis, reduces edema, enhances myocardial contractility (heart muscle contraction), and inhibits cardiac remodeling [13].

Post-Percutaneous coronary intervention (PCI) related complications

Percutaneous coronary intervention (PCI), or stent placement, is a key treatment for coronary heart disease, effectively reopening narrowed or blocked blood vessels to restore cardiac blood supply. However, post-PCI patients may face complications such as in-stent restenosis, thrombosis, and cardiac dysfunction. TCM offers unique advantages and significant efficacy in preventing and treating these complications.

Restenosis (Re-narrowing of blood vessel)

Restenosis occurs due to vascular intimal hyperplasia (blood vessel thickening), leading to narrowing of the stent lumen, which may cause recurrent angina or myocardial ischemia.

Mechanisms of Action

• Inhibiting Vascular Smooth Muscle Cell Proliferation: Active components in herbs such as Salvia (Danshen) including tanshinone, inhibit excessive proliferation of vascular smooth muscle cells, reducing the risk of restenosis [14].
• Antioxidant Effects: Polyphenols and flavonoids in herbs like Scutellaria (Huangqin) and Salvia (Danshen) scavenge free radicals, protect vascular endothelium, and reduce oxidative stress damage to blood vessels [15, 16].

Commonly Used TCM Herbs and Formulas

• Danshen Yin (Salvia Decoction): Promotes blood circulation and removes blood stasis, improving myocardial blood supply [17].
• Xuefu Zhuyu Tang (Blood Mansion Stasis-Expelling Decoction): Activates blood circulation and unblocks collaterals, inhibiting vascular intimal hyperplasia [18].

Stent Thrombosis

Platelet aggregation on the stent surface may lead to thrombosis after PCI, causing acute myocardial infarction or stent occlusion (blockage).

Mechanisms of Action

• Inhibiting Platelet Aggregation: Herbs like Spatholobus (Jixueteng) and Ligusticum (Chuanxiong) inhibit platelet activation, reducing the risk of thrombosis [19].
• Improving Blood Circulation: Herbs like Peach Kernel (Taoren) improve blood viscosity and promote blood circulation [20].
• Improving Cardiac Function: Astragalus (Huangqi) enhances myocardial contractility and improves myocardial blood supply [9].

Commonly Used TCM Herbs and Formulas

• Taohong Siwu Tang (Peach Kernel and Carthamus Four-Substance Decoction): Promotes blood circulation and removes blood stasis, preventing thrombosis [21].

Psychological Disorders (Anxiety, Depression)

After stent placement, some patients may experience psychological disorders such as anxiety and depression due to disease-related stress or postoperative recovery challenges.

Mechanisms of Action

• Regulating Neurotransmitters: Herbs like Bupleurum (Chaihu) and White Peony (Baishao) regulate neurotransmitters such as serotonin (5-HT), alleviating anxiety and depression [22, 23].
• Calming the Mind and Improving Sleep: Herbs like Ziziphus (Suanzaoren) and Polygonum (Yejiaoteng) improve sleep quality and relieve psychological stress [5, 24].

Commonly Used TCM Herbs and Formulas

• Chaihu Shugan San (Bupleurum Liver-Soothing Powder): Soothes the liver and relieves depression, alleviating anxiety [25].
• Suanzaoren Tang (Ziziphus Decoction): Nourishes the heart and calms the mind, improving sleep [26].

Overall Advantages of TCM in Prevention and Treatment

1. Multi-Target Regulation: TCM works through multiple mechanisms to treat diseases and prevent complications.
2. Holistic Regulation: TCM not only addresses the disease itself but also regulates overall bodily functions, improving quality of life.
3. Fewer Side Effects: TCM herbs are natural and have fewer side effects, making them safe for long-term use.
4. Personalized Treatment: TCM tailors treatments based on the patient’s constitution and syndrome, enhancing efficacy.

Traditional Chinese Medicine demonstrates significant efficacy and unique advantages in treating common cardiovascular diseases. Through multi-target regulation, holistic treatment, and personalized care, TCM not only alleviates symptoms but also prevents complications and improves patients’ quality of life. Patients with cardiovascular diseases may benefit from TCM, combined with modern medical treatments, to achieve better long-term outcomes.

References

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