Tongmai Yangxin Pills in treatment for angina pectoris of coronary heart disease: a systematic review of randomized clinical trails / 中国中药杂志

To systematically review the efficacy and safety of Tongmai Yangxin Pills in treatment for angina pectoris of coronary heart disease. CNKI, WanFang, VIP, SinoMed, PubMed, EMbase and the Cochrane Library databases were retrieved online to collect randomized controlled trials(RCTs) of Tongmai Yangxin Pills for angina pectoris of coronary heart disease since the establishment to November 2018. Two investigators screened out literatures independently, extracted data and assessed the risk of bias of included studies. The risk assessment of included references was made according to criteria recommended by Cochrane Handbook 5.3. Meta-analysis was then performed by RevMan 5.3 software. A total of 9 RCTs were included. The results of Meta-analysis showed that compared with the single application of chemotherapy, the combined administration with Tongmai Yangxin Pills and Western medicine could significantly improve the clinical efficacy of angina(RR=1.22, 95%CI[1.13, 1.31]), the improvement rate of electrocardiogram(RR=1.31, 95%CI[1.21, 1.42]), and the clinical efficacy of traditional Chinese medicine(TCM) syndrome(RR=1.17, 95%CI[1.02, 1.35]). Only one study reported adverse events, while 5 studies reported no adverse event. According to current evidences, in the treatment of angina pectoris of coronary heart disease, Tongmai Yangxin Pills has a better clinical efficacy in the treatment of angina pectoris of coronary heart disease in terms of the improvement rate of electrocardiogram and the clinical efficacy of TCM syndrome. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Intervening effects of Tongmai Yangxin Pills on miniature pigs with syndrome of deficiency of both qi and yin in later stage of myocardial ischemia reperfusion injury / 中草药

Objective: To observe the intervening effects of Tongmai Yangxin Pills on miniature pigs with syndrome of deficiency of both qi and yin in later stage of myocardial ischemia reperfusion injury. Methods: A total of 24 miniature pigs were randomly divided into the sham-operated group, the model group (syndrome of deficiency of both qi and yin in myocardial ischemia), the Shengmai Capsules group (0.14 g/kg), and Tongmai Yangxin Pills groups (0.36 g/kg) with six pigs in each group. Except for the sham-operated group, the left anterior descending artery in other groups had been occluded for 30 min by inflation balloons and arterial reperfusion injury was acquires by withdraw balloons. After the operation, the groups were administered with drugs for four weeks. The parameters of noninvasive hemodynamics were measured at the end of study. The tongue color was recorded by digital camera. The tongue and pulse manifestation of the miniature pigs were evaluated according to the symptom-graded scoring method. The size of myocardial ischemia and infarction was analyzed by Evens and TTC staining. Results: Compared with the sham-operated group, the area of myocardial ischemia and necrosis in the model group increased significantly. The noninvasive hemodynamics showed a reduction in cardia coutput (CO) and stroke volume (SV), an augment in systemic vascular resistance (SVR) and left cardiac woke (LCW) of the model group compared with the sham-operated group. Moreover, the scores of tongue and pulse manifestation were also significantly increased in the model group with abnormal color of tongue (P < 0.05, 0.01). Compared with the model group, Shengmai Capsules and Tongmai Yangxin Pills reduced the area of myocardial ischemia and infarction, increased the values of CO and SV, decreased the scores of tongue and pulse manifestation and improved tongue color (P < 0.05, 0.01). In addition, Tongmai Yangxin Pills also reduced SVR (P<0.01). Conclusion: The syndrome of deficiency of both qi and yin in mini pigs could be partly manifested in later stage of myocardial ischemia reperfusion injury. Tongmai Yangxin Pills can improve tongue and pulse signs, protect myocardial tissue, and recover abnormal hemodynamics, which can establish foundation for the further clinical application.

Vasodilation effect and mechanism of extraction of Tongmai Yangxin Pills (TMYX) on isolated rat mesenteric artery / 中国中药杂志

The aim of the present study is to evaluate the vasodilation effects of Tongmai Yangxin Pills (TMYX) on rat mesenteric artery as well as its mechanism of action. The relaxation effects of TMYX extracts with different concentrations were determined on isolated rat mesenteric artery in normal condition as well as pretreating by phenylephrine and KCl. Vascular relaxation effects of TMTX were also determined in mesenteric artery preincubated with L-ANME and indomethacin or in endothelium denuded mesenteric artery. Moreover, effects of TMYX by 50 mg·L⁻¹ on NO secretion and the phosphorylation of eNOS in a cellular model of human umbilical vein endothelial cell (HUVEC) pretreated with or without L-NAME were also observed. The experimental results showed that TMYX has no obvious effect on vasodilation of arteries in normal or KCl pretreated condition, while it can dose-dependently relax the rat mesenteric artery with intact endothelium stimulated with phenylephrine at a maximal diastolic rate of (64.71±10.03)%. After preincubating with L-NAME for 15 min or removal of mesenteric artery endothelium, the maximal diastolic rate was decreased to (35.77±8.93)% and (25.85±10.84)% respectively. However, preincubating with indomethacin had no inhibitory effect on TMYX induced vascular relaxation. Meanwhile, TMYX at 50 mg·L⁻¹ could increase the expression of P-eNOS and the secretion of NO in HUVEC. L-NAME significantly inhibited NO release and phosphorylation of eNOS induced by TMYX. The results suggested TMYX exerted endothelium-dependent relaxation effects against PE-induced contractions of isolated rat mesenteric artery through NO-cGMP signaling pathway.