LOGO Traditional Chinese medicine in treating hypertension Fang

LOGO Traditional Chinese medicine in treating hypertension Fang Geng, Li Yang, Li. Li Ji, Zhengtao Wang and Christopher J. Branford-White , Ondina Leon Diaz Key Laboratory of Standardization of Chinese Medicines of Ministry of Education, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Zhangjiang Hi-tech Park, Shanghai 201203, P R China Institute for Health Research and Policy, London Metropolitan University, 166 -220 Holloway Road, London N 7 8 DB, UK CENSA, National Center for Plant and Animal Health, San Jose de las Lajas, La Habana, Cuba

Traditional Chinese Medicine/TCM (Herbal Medicine focus) Overview: v Introduction to TCM v Modernisation issues/applied research/market place potential v Global approaches v Collaborative links/how do they work (Shanghai, CENSA/Cuba, London) v TCM study using Chinese herbs relating to hypertension www. themegallery. com Company Logo

Background to TCM v TCM been practiced for 4000 years (currently 2 billion people practice TCM) v Culture & Science (some debate) v Whole body model concept (not a ‘’one pill per ill’’ model, western approach) v Four basic elements (acupuncture, diet, massage & herbs) www. themegallery. com Company Logo

TCM Modernisation Issues: v Identification, validation and authentication v Farming, herbal sources, processing, quality assurance/distribution issues v Health & safety v Legislation/risk assessment v Government/professional bodies v Practitioners/professional status/acceptability www. themegallery. com Company Logo

TCM/Why modernisation? v Expanding world market in TCM products v Natural/green drug alternative v UK/USA; 20% drugs sold are from natural sources (expanding consumer demand) v UK – market now worth £ 170 k/rising to £ 200 k by 2010 v Growing international support (WHO, EU, medical charities, US/NIH funding) www. themegallery. com Company Logo

TCM/Chinese Government v PR China investing $5 -6 billion worldwide in TCM v Recent EU/UK trade & economic (including health)links/agreements v Beijing International declaration on TCM (December 2007) v Developing a rapid modernisation program (national centres/Shanghai) v Engaging in isolating/characterising medically active compounds www. themegallery. com Company Logo

HYPERTENSION/UK PROSPECTIVE Some Factors: v High salt concentrations (processed foods, pressure on food industry) v Obesity (fears/50% population obese in 10 years especially in the young) v Race (e. g. Asian women type 2 diabetes and hypertension) v Current health intervention strategies (unsuccessful/need addressing) v HTA conference covering these points www. themegallery. com Company Logo

Contents 1 Review of TCM of anti-hypertension 2 Categorization of anti-hypertension herbs 3 Anti-hypertension herbs mechanism and clinical application 4 www. themegallery. com Prospect and conclusion Company Logo

v. Part one —— Review of TCM of Anti-hypertension www. themegallery. com Company Logo

Hypertension Number of fatality Death due to hypertension 42. 5% ( heart failure, renal failure, cerebral infarction, coronary heart disease ) Hypertension is poorly controlled www. themegallery. com Company Logo

Two types of high blood pressure Most common (90%) and dangerous essential (primary) hypertension Hypertension secondary hypertension Treatable or reversible www. themegallery. com Company Logo

Conventional and TCM therapy of hypertension Conventional therapy principle 1. Beta-blockers 2. Diuretics TCM therapy principle 1. Global and dialectical treatment 3. ACE inhibitors 2. multi-routes, multi-links, multi-targets 4. Calcium-channel blockers 3. Safe and no drug dependency www. themegallery. com Company Logo

v. Part two —— Categorization of Anti-hypertension Herbs www. themegallery. com Company Logo

Categorization of antihypertension herbs v TCM considered hypertension to be liver-fire ascending and Yin-Deficiency with Shenic-Yang syndrome v So herbs calming the liver and subdue yang, activating blood circulation that dissipates blood stasis, eliminating humid heat so relief is applied www. themegallery. com Company Logo

Categorization of antihypertension herbs v Diaphoresis relieving superficies: Radix Puerariae, Rhizoma cimicifugae, Florists Chrysanthemum. v Heat-clearing herbs: Spica prunellae, Sophora flavescens Ait, Semen Cassiae. v Catarrhectic herbs: Radix et rhizoma rhei. v Activating blood circulation to dissipate blood stasis herbs: Salvia miltiorrhiza, Flos Carthami. v Anastaltic herbs: Panax Notoginseng. v Rheumatism herbs: Radix stephaniae tetrandrae, Araliafargesii Franch. v Removing dampness and promoting diuresis herbs: Rhizoma alismatis. v Dissipate phlegm and relieving cough and asthma herbs: mori Cortex. v Dispelling internal cold herbs: Fructus Evodiae. www. themegallery. com Company Logo

v. Part three —— Anti-hypertension herbal mechanisms & clinical applications www. themegallery. com Company Logo

1. 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) www. themegallery. com Company Logo

Main and representative compounds of Ramulus Uncariae cum Uncis mitrinermine Isorhynchophylline (more effective than mitrinermine) www. themegallery. com Company Logo

Activity of Ramulus Uncariae cum Uncis v Mechanism of Ramulus uncariae cum Uncis: inhibits the vasomotor center, extends extension of peripheral vessels, blocks adrenergic nerve, and inhibits nerve ending transmitter releasing v Effect: blood pressure of spontaneous hypertension rats (SHR) was decreased by daily administration of Ramulus Uncariae cum Uncis water exaction for 5 weeks. v Mechanism of Isorhynchophylline: reduction in total peripheral vascular resistance and cardiac output induced by lowered heart rate v Compatibility: together with Rhizoma gastrodia was more active than single use; a blended approach/mixed biomedical components www. themegallery. com Company Logo

2. Radix Astragali Plant of Radix Astragali A. Astragalus membranaceus (Fisch. ) Bunge var. mongholicus (Bunge) Hsiao. B. Astragalusmembranaceus (Fisch. ) Bunge. Plant source: Milkvetch Root is the dried root of Astragalus membranaceus (Fisch. ) Bge var. mongholicus (Bge. ) Hsiao or Astragalus membranaceus (Fisch. ) Bge (Fam. Leguminosae). www. themegallery. com Radix Astragali producted in different areas: A. Anhui B. Hebei C. Guangzhou D. Jiangxi Company Logo

Main and representative compounds of Radix Astragali OH Rha-ara-glc. O OH astragaloside www. themegallery. com Soyasaponin I Company Logo

Activity of Radix Astragali v Effective compounds: Aminobutyric acid and astragaloside are considered to be effective to extend vessel, anti hypoxia, reduce the collagen v Mechanism: extend vessel directly, not by bilineurin system and adnephrin receptor v Bilateral effect: When circulatory collapse pressure, Milkvetch Root will increase blood pressure to keep pressure balance www. themegallery. com Company Logo

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). www. themegallery. com Company Logo

Main and representative compounds of Radix Puerariae Lobatae Kakkonein www. themegallery. com Genistein Company Logo

Activity of Radix Puerariae Lobatae v Mechanism of Kakkonein: extend periphery vascellum, reduce content of rennin and angiotensin and blocks β- adnephrin receptor v Effect of Radix Puerariae Lobatae : decrease high blood pressure enduced by aleudrin v 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 www. themegallery. com Company Logo

Prospect and Conclusion v Up to now, more than 100 Chinese herbs have been proved to be antihypertensive, however there are 11146 species of herbs in China, curative effect of most of them are unknown and waiting to be explored. We wish to demonstrate that Chinese medicine is a modern potential source and route for treating hypertension v Examples for treating hypertension in China include: Tian ma gou teng Yin, Shen mai injection, Zhen ju tablet v Side effects (low pressure, drug dependency, glyco-metabolic disorders) have been avoided through the development of a standardized national program that has also addressed endocrine secretion and anti-aging issues v We recommend; promotion of a healthy life styles (stress management), good diet, low salt intake, regular exercise, reduce smoking and reduce alcohol intake www. themegallery. com Company Logo

LOGO Thank you Tse Muchas Gracias