Abstract: This paper summarizes four types of Chinese herbal medicines with pharmacological effects of calcium antagonism, renin-angiotensin-aldosterone system (RASS) antagonism, diuretic antihypertensive effect and central antihypertensive effect for the treatment of hypertension by Chinese medicine.
Keywords: hypertension; calcium antagonists, RAAS antagonists, diuretic antihypertensive agents, central antihypertensive agents; traditional Chinese medicine
Antihypertensive drugs, also known as antihypertensive drugs, are mainly used clinically to treat hypertension and prevent the occurrence and development of complications such as stroke, chronic cardiac insufficiency and renal insufficiency. As the physiological regulation of human blood pressure is extremely complex, among the many neurohumoral regulatory mechanisms, the sympathetic nervous system, renin-vasoprenalin-aldosterone system and intracellular ion concentration of vascular smooth muscle play an important role. Many anti-hypertensive drugs tend to exert their antihypertensive effects by affecting these links. Proper application of these drugs can not only control blood pressure, but also reduce the occurrence of various cardiac, cerebral and renal complications, reduce mortality and prolong life expectancy.
With the widespread use of various antihypertensive drugs, their side effects also follow their therapeutic effects, such as constipation, nausea, dizziness, headache, vertigo, ankle edema, increased heart failure, sinus bradycardia and hypotension, sinus or atrioventricular block, etc. caused by calcium antagonists; cough caused by RASS antagonists, high potassium, contraindicated in pregnant women (due to fetal malformations), contraindicated in patients with bilateral renal artery stenosis, and contraindicated in patients with severe renal failure. It is contraindicated in patients with bilateral renal artery stenosis, and avoided in patients with severe renal failure and progressive decrease in glomerular filtration rate. To a certain extent, it affects its further promotion and application.
Chinese medicine anti-hypertensive drugs are natural drugs with few side effects, and their efficacy and safety are relatively high after long-term use and testing. At the same time, Chinese medicine has a moderate antihypertensive effect, consolidates the efficacy, improves various symptoms, and can effectively reduce the side effects of Western medicine.
However, in the process of combining Chinese and Western medicine in clinical treatment, there is a simple case of Chinese medicine plus Western medicine, which makes the clinical efficacy of the two not only fail to obtain synergy, but even appear antagonistic effect. Therefore, it would be a meaningful work to follow the spirit of traditional Chinese medicine evidence-based treatment effectively, but also to draw on the modern research results of Chinese medicine, so that the evidence-based and disease-based treatment can be fully combined, and better reproduce the individualized treatment principles, so as to achieve better clinical efficacy.
According to the different pharmacological effects of Chinese medicines, we have summarized a total of 70 Chinese medicines with calcium antagonism, RASS antagonism, diuretic antihypertensive and central antihypertensive effects. In this paper, we summarize and analyze their properties, aromas, and efficacy to explore their patterns and provide better reference for clinical and scientific use and development of these herbal medicines.
1. About the nature and taste
The pharmacological properties of herbs with hypotensive effects are: 41 cold herbs, 20 warm herbs, and 9 flat herbs, with the proportion of cold herbs being greater than that of warm herbs.
The cold herbs are: Scutellaria baicalensis, Huang Lian, Huang Bai, Lian Zi Xin, Dan Shen, Peony Skin, White Peony, Red Peony, Rhubarb, Tiger Balm, Xuan Shen, Honeysuckle, Mulberry Leaf, Chrysanthemum, Pueraria Mirifica, Di Long, Di Bone Bark, Bayberry, Scapularia, Qian Hu, Ze Di, Yi Mao Cao, Che Qian Cao, Q Cao, Fang Ji, Hooked Vine, Antelope’s horn, Gentian Cao, Cassia, Trapezium, Bitter Ginseng, Seaweed, Northern Dou Ge, Western Ginseng, Mouton, Gan Sui, and Ginseng. Chinese rooibos, rooibos, chicory, lettuce, hogweed.
warming herbs: ginseng, astragalus, eucommia, epimedium, dogwood, angelica, chuanxiong, safflower, panax ginseng, atractylodes, houpo, schisandra, fenugreek, almonds, turmeric, cyperus, centipede, garlic, cumin.
Plain medicines: Poria, Poria, Lycopodium, Cornus, Zizyphus, Sour date palm, Green wind vine, Leech, Ginkgo biloba, Rhodiola.
Li Wu et al. studied the pharmacological characteristics and chemical composition of cold medicines and concluded that the main chemical components of cold medicines can be broadly categorized into two major groups: alkaloids and glycosides. Chen Suhong concluded that most of the cold medicines can inhibit the excitability of central nervous system, weaken the respiratory, circulatory, metabolic and muscle activity functions, and weaken the organism’s ability to respond to pathogenic stimuli. By measuring the balance of phytoconstituents before and after treatment and systematically measuring CAs and 17-OHCS in urine in 28 patients with hot and 12 patients with cold symptoms, Yuehua Liang et al. showed that the weakening and enhancement of sympathetic and adrenal system functional activities were important factors in the formation of cold and hot symptoms, respectively. Experiments with cold and warm Chinese herbal medicine compound fed to rats to observe the effects on heart rate, CAs and 17-OHCS oxygen consumption showed that cold medicine had the effect of weakening the functional activity of sympathetic-adrenal (cortical and medullary) system and decreasing the metabolic process. These all provide corresponding supporting evidence for the treatment of hypertension with cold medicine.
2.About the meridian
Pharmacologically, the pharmacological effects of herbal medicines with hypotensive effects are mainly concentrated in the following order: 38 flavors of the Foot Convulsive Yin Liver Meridian, 26 flavors of the Hand Tai Yin Lung Meridian, 23 flavors of the Foot Tai Yin Spleen Meridian, 21 flavors of the Foot Shao Yin Kidney Meridian, 18 flavors of the Hand Shao Yin Heart Meridian, 18 flavors of the Foot Yang Ming Stomach Meridian, 11 flavors of the Hand Yang Ming Large Intestine Meridian, 11 flavors of the Foot Sun Bladder Meridian, 6 flavors of the Foot Shao Yang Gall Bladder Meridian, 4 flavors of the Hand Convulsive Yin Pericardium Meridian, 2 flavors of the Hand Sun Small Intestine Meridian, and the Hand Shao Yang San Jiao Meridian. Not available at the moment. Most of the herbal medicines for hypertension are mainly concentrated in the Yin meridians of the six meridians, with the Liver meridian being the majority.
Foot Conjunctive Yin Liver meridian: Angelica sinensis, Chuanxiong, Danshen, Panax notoginseng, Huanglian, Peony skin, Red peony, North bean root, White fenugreek, Hooked vine, Epimedium, White peony, Safflower, Curcuma longa, Radix et Rhizoma, Leucomatium, Pantotrichum, Bitter ginseng, Ground bark, Seaweed, Antelope horn, Centipede, Rhubarb, Atractylodes, Cornus officinalis, Semen cassia, Gentian grass, Plantago ovata, Cornus officinalis, Dioscorea, Lobelia, Eucommia, Mulberry leaf, Cumin. sour date seeds, chrysanthemum, hogweed.
Foot Taiyin Spleen meridian: ginseng, astragalus, angelica, fangji, northern bean root, houpo, geranium, white peony, western ginseng, turmeric, nigella, rhodiola, centipede, poria, atractylodes, lycopodium, dogwood, garlic, tiger scepter, dioscorea, cumin, chicory, sour date.
Foot Shao Yin Kidney meridian: peony bark, lotus seed heart, anti-helper, schisandra, Epimedium, Radix et Rhizoma, Radix et Rhizoma Polygonatum, Radix et Rhizoma Polygonatum, seaweed, centipede, Poria, Cornu Cervi Pantotrichum, Cornu Cervi Pantotrichum, Plantago ovata, Poria, Zelenia, Eucommia, Gansui, Cumin, Chicory, Yuan Zhi, Phellodendron.
Hand Shao Yin Heart meridian: Radix Angelicae Sinensis, Salviae Miltiorrhiza, Cortex Eucommiae, Peony Bark, Lotus Heart, Ginkgo Biloba, Fructus Schisandrae, Radix et Rhizoma Ginseng, Radix et Rhizoma Safflower, Radix et Rhizoma Polygonatum, Radix et Rhizoma Phellodendron, Poria, Mouton, Radix et Rhizoma Polygonatum, Radix Ziziphi.
Hand Yangming Large Intestine Meridian: Scutellaria baicalensis, Huang Lian, Bei Dou Ge, Hou Pei, Bitter Ginseng, Almond, Rhubarb, Cassia, Gan Sui, Lettuce, Phellodendron.
Foot solar bladder meridian: Fangji, Yimoucao, Bitter ginseng, Scrophularia, Mouton, Poria, Zeligia, q Cunningham, Cornus, Dilong, Phellodendron.
Foot Shaoyang Gallbladder meridian: Chuanxiong, Scutellaria, Taraxacum officinale, gentian, tiger scepter, sour date.
Hand Conjunctive Yin Pericardium meridian: Chuanxiong, Hooked Vine, Salviae Miltiorrhiza, Rhubarb.
Hand Sun Small Intestine meridian: Moutong, Plantago ovata.
The Heart is the Sun in Yang, the Lung is the Shao-Yin in Yin, the Liver is the Shao-Yang in Yin, the Spleen is the Supreme Yin in Yin, and the Kidney is the Tai-Yin in Yin.” The “Spiritual Pivot – Ying San Hui” says “Tai Yin is the main internal, the Sun is the main external”, the “Yin” of “Tai Yin” refers to Ying Qi, “main internal The “yin” of “taiyin” refers to ying qi, and the “main internal” refers to the veins in which it travels. The six yin channels of the twelve meridians are located on the inner side of the extremities and the chest and abdomen, with the three yin channels of the hand following the inner side of the upper extremities and the three yin channels of the foot following the inner side of the lower extremities. Therefore, “main internal” is also an interpretation of the location of the Yin meridians in the whole body. However, in general, the understanding of the therapeutic role of the Yin meridians in classical ancient texts is mainly focused on the Ying and Blood channels.
Yu Zhongyi et al. used 4C-deoxyglucose metabolism assay and other methods to study the effects of 60 herbal medicines covering all medicinal properties on the functions of various tissues and organs by clustering and analyzing the effects of different meridians at 2h and 4h at a time, and concluded that herbal medicines belonging to the Yin meridian (dirty meridian) mainly affected the brain, mesencephalon, heart, and partly the cerebellum.
3. Regarding the efficacy of drugs belonging to
The pharmacological effects of herbal medicines with hypotensive effects are concentrated in the following order: 12 herbal medicines for activating blood circulation and eliminating blood stasis, 12 herbal medicines for clearing heat, 9 herbal medicines for resolving phlegm and relieving cough and asthma, 8 herbal medicines for promoting water and permeating dampness, 7 herbal medicines for tonicity, 5 herbal medicines for pacifying the liver and quenching wind, 4 herbal medicines for warming the lungs, 3 herbal medicines for dispelling wind-dampness, 2 herbal medicines for resolving dampness, 2 herbal medicines for diarrhea, and 1 herbal medicine for dispersing wind-heat.
Blood-activating and stasis-removing drugs: Chuanxiong, Salvia, Safflower, Rhodiola, Turmeric, Radix et Rhizoma, Panax Ginseng, Leech, Yimou, Tiger Balm, Rhubarb, Angelica.
Clearing heat: Scutellaria baicalensis, Radix Scutellariae, Paeonia lactiflora, Pleurotus oleraceus, Radix et Rhizoma ginseng, Radix et Rhizoma cassiae, Radix et Rhizoma bitter, Radix et Rhizoma lotus, Radix et Rhizoma gentianae, Radix et Rhizoma peony, Radix et Rhizoma genus
Phlegm-relieving and cough-suppressing herbs: Bayberry, Seaweed, Qian Hu, Mulberry Bark, Scapularia, Almonds, White Herba, Qian Hu, Ginkgo biloba.
Tonics: Ginseng, Astragalus, Radix et Rhizoma, Paeonia lactiflora, Angelica, Eucommia, Epimedium.
diuretics: Poria, Poria, Zeligia, Cang, Plantago, Fructus, Mouton, Cornus.
Liver pacifying and wind-relieving drugs: Dilong, Centipede, Hooked vine, Antelope’s horn, Lobelia.
Warming herbs for the lining of the liver: wu hui, cumin, chicory, lettuce.
dispelling wind-dampness herbs: northern bean curd root, bangji, green wind vine.
Dampness-transforming herbs: Atractylodes macrocephala, Hou Pao.
diaphoretics: rhubarb, glycyrrhiza.
Wind-heat dispersing herbs: Pueraria lobata.
Most studies have concluded that the etiology of hypertension is mainly based on phlegm, stasis, and heat, and with the development of the disease and the ageing of hypertensive patients, it is often accompanied by the presence of long-standing deficiency of the disease. According to Li Shilin et al, phlegm and blood stasis are both pathogenic factors and pathological products of hypertension, and fluids and blood are physiologically homologous and pathologically related. Based on the epidemiological characteristics of simple diastolic hypertension (IDH is mostly seen in young and middle-aged men) with a concentration of risk factors such as obesity, smoking, alcoholism, high-fat diet and low physical activity, Zhang Fuli formulated the “General Formula” for the treatment of IDH by clearing heat, removing stasis and subduing rebellion. The “General Formula” is based on warm gall bladder soup and white atractylodes tianma soup with the addition of fried hawthorn, panax quinquefolium, scutellaria baicalensis and wine peony. The total effective rate was as high as 92.86% ,and the audience for the use of clearing heat and removing stasis and subduing rebellion was mainly focused on young and middle-aged men. According to Jin Lili [11], the main pathogenesis of hypertension in the elderly is qi deficiency and phlegm turbidity, because this type of patients have deficiency of vital energy in old age, weakness of the spleen and stomach, inability to transport and transform, resulting in internal production of phlegm and dampness; deficiency of kidney qi, irregular warming and qi-transformation, then water and dampness stagnate internally; deficiency of the spleen results in fatigue, and dampness blocking the middle jiao results in nausea, vomiting, chest tightness, and dullness; deficiency of the spleen and kidney, clear yang does not rise, then the brain turns to whimper, shin acidity and vertigo, and phlegm and dampness clouding the head, so the head is heavy and headache. Qi deficiency and phlegm turbidity is the main pathogenesis.
For a long time, the treatment of hypertension from the liver has been very prevalent, and the number of herbal medicines attributed to the liver meridian for the treatment of hypertension is also high. Ye Liang [12] et al. used correlation rules and correspondence analysis to statistically analyze 8828 Chinese herbal medicines with respect to their flavor and meridians to discover the distribution characteristics of flavor and meridians and their interrelationships. The results showed that the most “attributed meridians” were liver meridians. However, the author believes that the total number of drugs attributed to the liver meridian in traditional Chinese medicine is large, so it is doubtful that the most drugs attributed to the liver meridian in traditional Chinese medicine for hypertension should be used as the basis for the treatment of hypertension from the liver. The liver is an important organ for metabolizing drugs, and the chance of drugs passing through the liver in the human body is higher than that of other organs. In the clinical treatment of hypertension, the use of liver-balancing and wind-quenching drugs alone often does not yield good results.
Among the herbal medicines for hypertension summarized here, there are many herbal medicines that act on multiple pathogenic mechanisms of hypertension to lower blood pressure, such as Huang Qi, Angelica sinensis, Du Zhong, Chuan Xiong, Dan Shen, Panax notoginseng, Semen, Radix cassiae, Bitter ginseng, Lotus heart, Hooked vine, Poria, Puerariae, Cornu Cervi Pantotrichum and so on. From the perspective of multiple mechanisms for the treatment of hypertension, these drugs are mainly among the drugs that tonify qi and blood and invigorate blood stasis. Therefore, in the clinical treatment of hypertension where the effect of purely pacifying the liver and quenching the wind is not obvious, they can be used in combination with drugs that tonify qi and blood, kidney qi, and invigorate blood and invigorate blood stasis.
According to Tu et al, the method of tonifying kidney qi can reduce aortic collagen content and type I and type III collagen expression, thus improving arterial elasticity. The therapeutic goal of hypertension is not only to bring down blood pressure, but more importantly, to reverse target organ damage. In addition to blood pressure factors, other non-blood pressure mechanisms are also involved in influencing the prognosis of hypertensive patients, such as impairment of aortic function and abnormalities in collagen metabolism are important factors. In large arteries, reduced vascular compliance is directly related to increased collagen content of the vessel wall, while collagen synthesis and breakdown processes are also involved in the remodeling of small arteries. The main components of vascular wall collagen are type I and type III, which are distributed in the subintimal space, mesentery and epicardium. In patients with hypertension and its target organ damage, collagen synthesis increases due to enhanced stimulation of collagen production by the renin-angiotensin-aldosterone system and endothelin; collagen degradation decreases due to weakened matrix metalloproteinase activity, and collagen degradation inhibition increases due to increased action of MMP inhibitory factors, resulting in collagen accumulation in the body and causing pathological fibrosis. Increased age can lead to a decrease in elastic fibers in the middle layer of the aorta, increased collagen content, narrowing of the arterial lumen, increased vascular stiffness and decreased elasticity. One of the mechanisms of action of this method for the treatment of hypertension in the elderly may work by improving arterial elasticity function.
Yin Wenhui observed the clinical efficacy of the treatment of primary hypertension from deficiency identification and typing. Fifty-three cases of hypertension were classified into spleen deficiency, phlegm-dampness type, qi-blood deficiency type, and liver-kidney yin deficiency type for evidence-based treatment, and the treatment was observed. In addition to the common Yin deficiency type (liver and kidney), there are also Spleen deficiency and Qi and Blood deficiency types. The total effective rate of antihypertensive treatment was 81.1%, and the effective rate of symptom treatment was 92.4%. At the same time, it is believed that the clinic should not be bound by the name of the disease in Western medicine, and readily use the products to clear the liver and fire, so as not to damage the yin of the liver and kidneys, and the use of Western diuretics in elderly and frail patients should also pay attention to prevent injury to yin.
The combination of tonic agents for hypertension with blood circulation and blood stasis can also enhance the therapeutic effect. Hypertension occurs mainly due to disorders of lipid metabolism caused by high blood lipid, high blood sugar, high salt diet, excessive peroxides, abnormal blood rheology, and dysfunction of self-regulation, resulting in disorders of qi, blood and fluid metabolism, with fluid stopping as phlegm, blood remaining as stasis, phlegm and stasis intertwining, damaging the ligaments and gradually affecting the vascular system, causing damage to the ligament system and causing lesions. Therefore, it can be considered that phlegm and stasis blocking the ligaments and liver and kidney deficiency are the core pathogenesis of hypertension. Guo Weicong’s experiments showed that blood viscosity, erythrocyte aggregation rate and erythrocyte deformability were significantly improved in hypertensive rats treated with the method of activating blood stasis and tonifying the liver and kidney, and blood viscosity, erythrocyte aggregation rate and deformability were tested by blood taken from the jugular vein, which could achieve the effect of lowering blood pressure.
In conclusion, the treatment of hypertension is mainly based on cold medicines, which are generally classified as Yin meridians of the five viscera, and the etiology of the disease is mainly based on phlegm, stasis and heat, and the development of the disease is accompanied by the existence of a long-standing deficiency of the disease. In this study, we have gained a preliminary understanding of the nature and taste of Chinese herbal medicines for lowering blood pressure and the classes of medicines they belong to, and we have also summarized the herbal medicines for treating hypertension to present a new challenge to the previous treatment of hypertension by pacifying the liver and quenching the wind.
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