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Objective:To evaluate the clinical efficacy of Tianma Gouteng Decoction combined with amlodipine besylate tabletsin treating patients with hypertension of liver-yang hyperactivity complicated with left ventricular hypertrophy (LVH).Methods:A total of 80 patients with hypertension of liver-yang hyperactivity complicated with LVH, who met the inclusion criteria and were treated in the hospital between June 2019 and January 2021, were divided into two groups, with 40 in each group according to the random number table method. The control group was treated with amlodipine besylate tablets orally, and the observation group was treated with granules of Tianma Gouteng Decoction on the basis of the control group. Both groups were treated for 2 months. Before and after treatment, the TCM syndromes were scored and the office blood pressure was measured with sphygmomanometer, and color Doppler ultrasonic diagnostic apparatus was adopted to detect the interventricular septum thickness (IVST), left ventricular posterior wall thickness (PWT), left ventricular end diastolic diameter (LVDd) and left ventricular mass index (LVMI), and the levels of homocysteine (Hcy) and Cystatin C (Cys-C) were determined by ELISA and the level of uric acid (UA) was determined by fully automatic biochemical analyzer. The clinical efficacy was evaluated.Results:The total effective rate was 95.0% (38/40) in the observation group and that of the control group was 77.5% (31/40) ( χ2=5.17, P=0.023). After treatment, the scores of dizziness, headache, insomnia and dreaminess and vexation and forgetfulness and total score of the observation group were significantly lower than those in the control group ( t=10.06, 14.47, 15.47, 8.74, 14.50, all Ps<0.001), and the systolic blood pressure and diastolic blood pressure were significantly lower than those in the control group ( t=6.30, 8.79, P<0.001). The IVST [(9.36±1.32) mm vs. (11.23±1.07) mm, t=6.96], PWT [(8.89±1.14)mm vs. (10.03±1.02)mm, t=4.71], LVDd[(40.36±4.29) mm vs. (47.62±4.19) mm, t=7.66] and LVMI [(112.39±22.29) g/m 2vs. (148.26± 21.39) g/m 2, t=7.34] were significantly lower compared to the control group ( P<0.01). The levels of Hcy[(12.87±3.11) μmol/L vs. (19.85±3.67) μmol/L, t=9.18], UA [(276.29±19.56) μmol/L vs. (338.52±17.07) μmol/L, t=16.65] and Cys-C [(0.86±0.15) mg/L vs. (1.10±0.17) mg/L, t=6.70] were significantly lower than those in the control group ( P<0.01). Conclusion:The Tianma Gouteng Decoction can improve the clinical symptoms, control the blood pressure, relieve the left ventricular hypertrophy and improve the renal function of patients with hypertension of liver-yang hyperactivity complicated with LVH.
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Hypertension is a global major public health problem. Early intervention and timely blocking are necessary for newly-diagnosed hypertensive and young hypertensive patients. Tianma Gouteng Decoction recorded in Zabing Zhengzhi Xinyi written by HU Guangci has the major functions in treating excess syndrome and wind-Yang disturbance syndrome with effects in calming liver-wind, clearing heat and activating blood, and nourishing liver and kidney. As we known, Tianma Gouteng Decoction is a classical formula for treating hypertension. However, due to the limitation of historical conditions, some problems impede Tianma Gouteng Decoction from being handed down successfully, such as uncertain diagnosis, uncertain antihypertensive efficacy and treatment-course. In this case, we ask whether Tianma Gouteng Decoction can be used as antihypertensive therapy and the exactly decrease of systolic and diastolic blood pressure, and wonder the half-life of Tianma Gouteng Decoction and the relationship with Western medicine. Therefore, defined prescription and syndrome, efficacy, treatment-course are important in clinical practice. According to the findings, ① previously, we thought that hypertension was a liver-Yang hyperactivity and liver-wind stirring syndrome, and the liver-based therapy theory was effective. However, based on our study, long-term treatment with Western medicine could block disease progression, control the increased blood pressure and change the pathogenesis and syndrome of traditional Chinese medicine. Therefore, the frequency of liver-Yang hyperactivity syndrome "fire syndrome" decreased sharply, and the main syndrome was fluid-retention syndrome and deficiency syndrome. The etiology and pathogenesis of hypertension was prone to deficiency syndrome accompanied with excess syndrome. Therefore, it was necessary to intervene hypertension in "liver-wind" and "liver-Yang" excess syndrome stage, and the early intervention and treatment are important. ② The newly-diagnosed hypertensive and young hypertensive patients usually had no Western medicine intervention. Thus, the etiology and pathogenesis of hypertension were free from Western medicine, which maintained the initial stage of hypertension in line with the liver-Yang hyperactivity syndrome. ③ The pathological mechanisms of newly-diagnosed and young hypertension were mainly increase in sympathetic activity, active renin-angiotensin-aldosterone system, change in morphology of vascular smooth muscle cells and endothelial cell dysfunction. ④ According to the syndrome of Tianma Gouteng Decoction, in modern medicine, Tianma Gouteng Decoction was widely used to treat the early-stage hypertension and the early-intervention of hypertension without Western medicine, particularly newly-diagnosed, young hypertension, Ⅲ hypertension, hypertensive crisis and hypertensive emergency. Tianma Gouteng Decoction can treat such symptoms as headache, dizziness, fullness of head, slurring of speech; facial flushing, conjunctival congestion and blurred vision; dysphoria, anxiety, palpitation, insomnia, mental disorder and hot flushes; dry-mouth with bitter taste and sweeting; myasthenia of limbs and lassitude in loin and legs; brown urine with burning sensation during urination; a solid or liquid stool consistency; red tongue, slippery and rapid pulse, wiry and rapid pulse over to Cunkou. ⑤ After treatment with Tianma Gouteng Decoction for three to six months, the blood pressure was decreased, and the symptoms were improved with reduction or even discontinuance of Western medicine. ⑥ According to recent studies, Caul is Polygoni Multiflori of Tianma Gouteng Decoction induced certain hepatotoxicity and increased the risk of long-term treatment. However, with the regular monitoring of biomedical index, long-term treatment with Caulis Polygoni Multiflori(3-10 g·d~(-1) for 3 to 6 months) didn't show hepatic dysfunction. ⑦ The pharmacological activity of Tianma Gouteng Decoction coincided with the pathology and disease mechanism of newly-diagnosed and young hypertension. Therefore, Tianma Gouteng Decoction was the specific recipe for newly-diagnosed and young hypertension. Therefore, further studies of efficacy, safety and molecular mechanism of Tianma Gouteng Decoction may make a medical breakthrough for hypertension treatment.
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Humans , Antihypertensive Agents , Therapeutic Uses , Drugs, Chinese Herbal , Hypertension , Drug Therapy , Medicine, Chinese TraditionalABSTRACT
AIM:To observe the mechanism of Tianma Gouteng Decoction on the protein molecular level in the optic nerve crush model rats.METHODS:Totally 36 participants 36 male Wistar rats were divided randomly into six groups(6 in every group):normal control group,negative control group,Tianma Gouteng Decoction treatment groups (con-centrations were 0.6g/mL,1.2g/mL,2.4g/mL respictively) and ginkgo biloba tablets positive control group (concentrations was 1.2mg/mL).Nothing was done in the normal control group.The optic nerve of right eye in the other groups was done with the optic nerve crush model.Normal control group and negative control group was treated only with water.The average grey scale values of the N-methyl-D-aspartic acid receptor 2B (NMDA2B) receptor protein,beta-amyloid protein (Aβ) in the average grey scale values were detected.RESULTS:The average grey scale value of Tianma Gouteng Decoction in low,medium and high dose groups about NMDA2B receptor protein was significantly less than that of the negative control group (all P＜0.001),and there was no significant difference with the positive control group (P=0.092,0.411,0.676),the difference between normal control group and negative control group was significant (P＜0.001).The high dose group of betaamyloid's average grey scale value reduced significantly than the negative control group (P=0.030,0.001).The low dose group than the negative control group was not obviously (P=0.614).The high dose group was not significantly different from the positive control group (P=0.927),the difference between normal control group and negative control group was significant (P＜0.001).CONCLUSION:Tianma Gouteng Decoction can go through the decrease of the NMDA2B receptor protein expression and the control of beta-amyloid deposition to reduce the retinal ganglion cell injury and apoptosis.
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Objective To observe clinical efficacy of Tianma Gouteng Decoction combined with Western medicine for early onset severe pre-eclampsia. Methods Sixty patients were randomly divided into treatment group with 30 cases and control group with 30 cases. Two groups were both given the routine Western therapy, while the treatment group was added with Tianma Gouteng Decoction. Indicators were observed and compared between two groups including blood pressure, 24 h UAE, D-dimer, fibrinogen and their effects on pregnancy. Results Compared with the control group, the blood pressure, 24 h UAE, fibrinogen, D-dimer, hypoproteinemia, and liver and kidney function were reduced obviously in the treatment group (P<0.05);fibrinogen and D-dimer of control group were not changed significantly;gestational weeks of treatment group were extended (15.2 ± 4.8)d, and neonatal asphyxia was 7 cases;gestational weeks of control group were extended (9.3 ± 2.2)d, and neonatal asphyxia was 11 cases. There was no significant difference about cesarean section rate between the two groups. Conclusion Tianma Gouteng Decoction combined with Western medicine for treatment of early onset severe pre-eclampsia have better clinical efficacy.
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Objective To investigate the effect of Tianma Gouteng Decoction(TGD) on myocardial fibrosis in spontaneously hypertensive rats(SHR) and to explore its possible mechanism. Methods Twenty-four male SHR with 8 weeks old were equally randomized into three groups: TGD(20g/kg) group,captopril(100mg/kg)positive group and the model group.Eight Wistar Kyoto rats(WKY) with the same age served as the controls.The systolic blood pressure(SBP),left ventricular mass(LVM),left ventricular mass index(LVMI),myocardial collagen(MC) content in left ventricle of three groups were determined after treatment for 24 weeks.Meanwhile,the expression of myocardial insulin-like growth factor 1(IGF-1) was determined by reverse transcription-polymerase chain reaction(RT-PCR) assay.Results TGD had an effect on decreasing the SBP,LVM,LVMI,MC content and IGF-1 expression(P
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Objective To investigate the effect of Tianma Gouteng Decoction and Captopril on blood pressure and its mechanism in the senile patients with essential hypertension(EH) in the pattern of ascendant liver yang.Methods Eighty cases with EH were ran- domly divided into two groups,with 40 cases in each group.Treatment group was given Tianma Gouteng Decoction and Captopril and the control group was given only Captopril.The treatment was lasted for 4 weeks.Observed were the changes in blood pressure and serum hs-CRP,TNF-?and IL-6.Results There was significant difference in blood pressure change and improvement of clinical symptoms after treatment between the two groups.The level of serum hs-CRP,TNF-?and IL-6 decreased significantly in the treat- ment group.Conclusion Tianma Gouteng Decoction and captopril can decrease blood pressure and serum hs-CRP,TNF-?and IL-6, and the effect was superior to captopril simply.
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0.05). Conclusion Tianma Gouteng Decoction can reverse left ventricular hypertrophy and myocardial fibrosis,and its mechanism may be related to the inhibition of TGF-? 1 expression in cardiac muscle tissue.
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Objective To investigate the effect of Tianma Gouteng Decoction on myocardial fibrosis in renovascular hypertensive rat (RHR). Methods RHR models were established by occlusion of renal artery with artery forceps. The collagen concentration and the contents of collagen type I,III were measured. Meanwhile, the weight of heart and left ventricle was determined. Results (1)Both Tianma Gouteng Decoction and Captopril could reduce the left ventricle weight index (LVI) and collagen contents (P
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AIM:To observe the effects of Tianma Gouteng Decoction on mRNA expression of L-Type Calcium Channel ?1 C subunit (CaL-?1C) and plasma membrane calcium-ATPase (PMCA1) in vascular smooth muscle cells of spontaneously hypertensive rat (SHR). METHODS:Twelve-week-old SHRs were assigned randomly to 5 groups:group A (treated with Tianma Gouteng Decoction),group B (treated with Tianma Gouteng Decoction excluded concha haliotidis),group C (treated with Nifedipine),group D (treated with concha haliotidis),group E (treated with normal sodium,NS),each group consisted of 9 rats was adminstrated,once a day for 4 weeks and mRNA expression of CaL-?1C and PMCA1 was measured with RT-PCR half-fix-quantify method. RESULTS:After 4-week-treatment,both Tianma Gouteng Decoction,Tianma Gouteng Decoction excluded concha haliotidis and Nifedipine could regulate downward mRNA expression of CaL-?1C in vascular smooth muscle cells and regulate upward mRNA expression of PMCA1 in vascular smooth muscle cells,concha haliotidis has no effect on mRNA expression of CaL-?1C and PMCA1. CONCLUSION:Tianma Gouteng Decoction can regulate downward expression of CaL-?1C,and regulate upward expression of PMCA1 at the same time,and meliorate the Ca 2+ overload in vascular smooth muscle cells with hypertension.