1 bottle Tian ma gou teng wan pills for headache, High blood pressure, insomnia,Buy 2 get 1 for free!

1 bottle Tian ma gou teng wan pills for headache, High blood pressure, insomnia,Buy 2 get 1 for free!

1 bottle Tian ma gou teng wan pills for headache, High blood pressure, insomnia,Buy 2 get 1 for free!

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1 bottle Tian ma gou teng wan pills for headache, High blood pressure, insomnia,Buy 2 get 1 for free!


Functions and indications:

 Liver Yang syndrone caused by headache, dizziness, tinnitus, giddiness, tremor, insomnia; High blood pressure.

Ingredients: gastrodia elata, uncaria, haliotis, gardenia, radix scutellariae, twotooth achyranthes root, eucommia bark (salt), motherwort, mulberry parasitism, radix polygoni multiflori cane, poria cocos

Usage: oral 9 g each time, 3 times a day, warm boiled water on an empty stomach

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About the it:

Review Article

Tianma Gouteng Yin as Adjunctive Treatment for Essential Hypertension: A Systematic Review of Randomized Controlled Trials

Jie Wang,1 Bo Feng,1 Xiaochen Yang,1 Wei Liu,1 Yongmei Liu,1 Yun Zhang,1 Gui Yu,1 Shengjie Li,2 Yuqing Zhang,3 and Xingjiang Xiong1

1Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China

2School of Life Sciences, Tsinghua University, Beijing 100084, China

3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8S 4L8

Received 11 December 2012; Revised 28 March 2013; Accepted 31 March 2013

Academic Editor: Aiping Lu

Copyright © 2013 Jie Wang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Tianma Gouteng Yin (TGY) is widely used for essential hypertension (EH) as adjunctive treatment. Many randomized clinical trials (RCTs) of TGY for EH have been published. However, it has not been evaluated to justify their clinical use and recommendation based on TCM zheng classification. Objectives. To assess the current clinical evidence of TGY as adjunctive treatment for EH with liver yang hyperactivity syndrome (LYHS) and liver-kidney yin deficiency syndrome (LKYDS). Search Strategy. 7 electronic databases were searched until November 20, 2012. Inclusion Criteria. RCTs testing TGY combined with antihypertensive drugs versus antihypertensive drugs were included. Data Extraction and Analyses. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. Results. 22 RCTs were included. Methodological quality was generally low. Except diuretics treatment group, blood pressure was improved in the other 5 subgroups; zheng was improved in angiotensin converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), and “CCB + ACEI” treatment groups. The safety of TGY is still uncertain. Conclusions. No confirmed conclusion about the effectiveness and safety of TGY as adjunctive treatment for EH with LYHS and LKYDS could be made. More rigorous trials are needed to confirm the results.

1. Introduction

Cardiovascular disease (CVD) is the leading cause of death worldwide [1, 2]. High blood pressure (BP) is the major independent risk factors for CVD [3–5]. Therefore, hypertension and blood-pressure-related disease have become an emerging epidemic and important worldwide public-health challenge [6–12]. Oral antihypertensive drugs are a milestone in the therapy of hypertension and other CVDs. However, the control rates of hypertension are still far from optimal currently [13, 14]. What is more, although treated with intensive medication, uncontrolled hypertension related symptoms (including headache, dizziness, and fatigue) and the side effects of antihypertensive drug therapy (including headache, flushing, dry cough, edema, and sexual dysfunction) are still the major problems confronting modern medicine [15–18]. Effective treatment of hypertension is limited by availability, cost, and adverse effects of conventional western medicine treatment. Thus, a certain proportion of the population has turned to complementary and alternative medicine (CAM), including traditional Chinese medicine (TCM) [19–23], for lowing BP and improving its related symptoms worldwide [24, 25].

Within Asia, TCM is widely used about 3,000 years ago [26–28]. It has formed a unique theoretical system and control methods [29–31]. TCM zheng (also called as syndrome or zheng differentiation or pattern classification) is the basic unit and the key concept in TCM theory [32–35]. Currently combination of zheng classification and biomedical diagnosis has become a hot topic both in diagnostics and treatment for the basic and clinical research [36–39]. Recently, increasing number of clinical trials and systematic reviews (SRs) showed that, as compared to antihypertensive therapy alone, Chinese herbal formula combined with antihypertensive drugs (also known as combination therapy) appear to be more effective in improving BP and symptoms in hypertensive patients with certain syndrome [40–43]. There is no doubt that, with more and more rigorous research evidences of effectiveness and safety about combination therapy, clinical studies linking TCM zheng classification and biomedicine diagnosis will lead to personalized therapeutic strategies and innovation in medical sciences [44, 45].

According to TCM theory, liver yang hyperactivity syndrome (LYHS) and liver-kidney yin deficiency syndrome (LKYDS) are the most important and common TCM zheng of essential hypertension (EH) [46]. LYHS is characterized by vertigo, tinnitus, headache, flushing, red eyes, irritability, insomnia, lassitude in lion and legs, bitter mouth, red tongue, and wiry pulse. LKYDS is always characterized by dizziness, tinnitus, headache, low fever, flushing, burning sensation of five centres, hypochondriac pain, hypopsia, lassitude in lion and legs, red tongue with scanty coating, and wiry-rapid pulse. It is worth noting that LYHS is usually caused by LKYDS. And these syndromes often appear together in EH. Molecular mechanism of LYHS and LKYDS in EH may be related to the hyperexpression of tyrosine hydroxylase (TH), and fifteen compounds of the structure and metabolic pathways mainly including amino acids, free fatty acids, and sphingosine by high performance liquid chromatography coupled with time of flight mass spectrometry (HPLC-TOFMS) [47–49]. Our previous studies showed that LYHS and LKYDS are the most important pathogenesis of EH in TCM, which could be well treated by Tianma Gouteng Yin (TGY) [46]. TGY, containing eleven commonly used herbs (Gastrodia elata, Uncaria, abalone shell, Eucommia ulmoides Oliv, achyranthes root, Loranthus parasiticus, Gardenia, Scutellaria baicalensis Georgi, Leonurus japonicus, Poria cocos, and caulis polygoni multiflori), is a classical Chinese herbal formula noted in Za Bing Zheng Zhi Xin Yi (New Meanings in Syndrome and Therapy of Miscellaneous Diseases). It has been widely used to treat hypertension-related symptoms and signs in clinical practice for decades [46]. The most common symptoms include headache, dizziness, insomnia, and lassitude in lion and legs, red tongue with scanty coating, and wiry-rapid pulse, which belong to LYHS and LKYDS in TCM [46]. The mechanism of the formula may be suppressing liver yang hyperactivity and nourishing the liver and kidney. Recently, modern researches showed that TGY could not only improve hypertension-related symptoms and signs, but also lower BP in vitro and in vivo [50–60]. Biochemically, TGY appears to have good effect in inhibiting vascular smooth muscle cell proliferation and promoting apoptosis by decreasing TGF-β1 and Bcl-2, improving vascular remodeling, inhibiting left ventricular hypertrophy and myocardial fibrosis, regulating rennin-angiotensin system (RAS) and Ca2+ overload in vascular smooth muscle cells, improving SOD, nitric oxide and insulin resistance, and decreasing endothelin, MDA, and IGF-1, so as to lower the arterial pressure [50–60].

Currently, a number of clinical trials have been published in Chinese language by TGY used alone or combined with antihypertensive drugs for EH. However, there is no critically appraised evidence such as SRs or meta-analyses to assess clinical efficacy and safety of TGY combined with antihypertensive drugs as an adjunct therapy for hypertensive patients based on TCM zheng classification. The PAPER aims to evaluate the beneficial and harmful effects of TGY for EH in randomized trials. To our knowledge, this is the first zheng classification-based systematic English review on TGY for EH.

2. Methods

2.1. Database and Search Strategies

Literature searches were conducted in the Cochrane Library (July, 2012), PubMed, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang data. The reference list of retrieved papers was also searched. Since TGY was mainly used and researched in China, four main databases in Chinese were searched to retrieve the maximum possible number of trials of TGY combined with antihypertensive drugs for EH. All of those searches ended on November 20, 2012. Ongoing registered clinical trials were searched in the website of Chinese clinical trial registry and international clinical trial registry by US national institutes of health . The following search terms were used individually or combined: “Tianma Gouteng yin,” “Tianma Gouteng decoction,” “Tianma Gouteng tang,” “hypertension,” “essential hypertension,” “clinical trial,” and “randomized controlled trial.” The bibliographies of included studies were searched for additional references.

2.2. Inclusion Criteria

All the parallel randomized controlled trials (RCTs) of all the prescriptions based on “Tianma Gouteng yin” combined with antihypertensive drugs compared to antihypertensive drugs for EH with LYHS and LKYDS were included. According to the principle of the similarity of TCM formula [42, 61], the number of modified herbs should not be more than 5, so that to ensure the similarity is greater than or equal to 0.5. And the key herbs in the modified Tianma Gouteng yin should include Gastrodia elata, Uncaria, and abalone shell, according to the theory of TCM. There were no restrictions on population characteristics, language and publication type. Duplicated publications reporting the same groups of participants were excluded.

2.3. Data Extraction and Quality Assessment

Two authors conducted the literature searching (X. J. Xiong, W. Liu), study selection (X. J. Xiong, B. Feng), and data extraction (X. J. Xiong, X. C. Yang) independently. The extracted data included authors, title of study, year of publication, study size, age and sex of the participants, details of methodological information, name and component of Chinese herbs, treatment process, details of the control interventions, outcomes, and adverse effects for each study. Disagreement was resolved by discussion and reached consensus through a third party (J. Wang).

Criteria from the Cochrane Handbook for Systematic Review of Interventions, Version 5.1.0 were used to assess the methodological quality of trials (X. J. Xiong, Y. Zhang) [62]. The items included random sequence generation (selection bias), allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), and other bias. The quality of all the included trials was categorized to low/unclear/high risk of bias (“Yes” for a low of bias, “No” for a high risk of bias, “Unclear” otherwise). Then trials were categorized into three levels: low risk of bias (all the items were in low risk of bias), high risk of bias (at least one item was in high risk of bias), unclear risk of bias (at least one item was in unclear risk of bias).

2.4. Data Synthesis

Revman 5.1 software provided by the Cochrane Collaboration was used for data analyses. Dichotomous data were presented as risk ratio (RR) and continuous outcomes as mean difference (MD), both with 95% confidence interval (CI). Heterogeneity was recognized significant when  ≥ 50%. Fixed effects model was used if there is no significant heterogeneity of the data; random effects model was used if significant heterogeneity existed (50% <  < 85%). Publication bias would be explored by funnel plot analysis if sufficient studies were found.

3. Result

3.1. Description of Included Trials

A flow chart depicted the search process and study selection (as shown in Figure 1). After primary searches from the seven databases both in Chinese and English, 1243 articles were retrieved: Cochrane Library (), Pubmed (), EMBASE (), CNKI (), VIP (), CBM (), and Wanfang data (). 505 articles were screened after 746 duplicates were removed. After reading the titles and abstracts, 317 articles of them were excluded. Full texts of 188 articles were retrieved, and 166 articles were excluded with reasons listed as the following: participants did not meet the inclusive criteria (), duplication (), no control group (), the intervention included other Chinese herbal formula (), and no data for extraction (). In the end, 22 RCTs [63–84] were included. All the RCTs were conducted in China and published in Chinese. The characteristics of included trials were listed in Table 1.


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