It is estimated that the number of heart failure patients in mainland China is nearly 9 million!! The China Cardiovascular Health and Disease Report 2022[1] reveals this staggering number, and it is still growing at a high rate.
The main causes of heart failure are hypertension and coronary heart disease. There are now more than 340 million hypertensive patients in mainland China [2], and the number of coronary heart disease patients has exceeded 10 million [1], and the increasing number of high-risk groups such as senile valvular disease and diabetes has also made the "reserve army" of heart failure grow day by day, resulting in an increase in heart failure incidence and mortality year by year. Many patients are repeatedly hospitalized but still suffering and have a poor prognosis. The prevention, control and treatment of heart failure in mainland China is facing major challenges.
Previous guidelines recommended heart failure treatment drugs with reduced ejection fraction were mainly Western medicines, including β blockers, ACEs, diuretics, etc. [2], but with the increasing demand for individualization and integration of cardiovascular disease diagnosis and treatment, people have turned their attention to traditional Chinese medicine based on "dialectical treatment". With the blessing of modern evidence-based medicine and science and technology, TCM theories and traditional formulas have increasingly shown their unique advantages in the field of heart failure, especially chronic heart failure treatment.
01
diagnosis
Modern medicine (Western medicine) to diagnose heart failure requires a comprehensive medical history, physical examination, electrocardiogram, X-ray, etc. to determine whether there is a possibility of heart failure, and then confirm the diagnosis by serological indicators (BNP/NT-proBNP) and echocardiography. Its advantage lies in its accuracy, which can assess the severity and prognosis of patients with heart failure, and can dynamically monitor the risk of cardiovascular events.
However, at present, the overall attention of modern medicine to patients still needs to be further improved. Traditional Chinese medicine, on the other hand, starts from the type and symptoms of the symptom to diagnose and treat the patient as a whole. Taking chronic heart failure as an example, the basic symptoms of traditional Chinese medicine can be summarized by qi deficiency and blood stasis, on this basis, it is divided into three basic types of qi deficiency and blood stasis, qi and yin deficiency blood stasis, and yang deficiency blood stasis, and all of them can be combined with phlegm and drinking [3] (Table 1). It can be seen that although different types of chronic heart failure are mainly characterized by "shortness of breath/wheezing, fatigue, palpitations", the secondary symptoms and tongue pulse are very different, which is due to the patient's basic situation, comorbid diseases, and different degrees of heart failure, which leads to the situation of "different symptoms of the same disease".
Table 1.TCM differentiation of chronic heart failure[3]
02
combine
For a long time, people generally had stereotypes about TCM, thinking that TCM is pure empirical medicine and lacks objective evidence of modern medicine. Some people also feel that the theoretical systems of Chinese and Western medicine are different and cannot be integrated and interconnected. In recent years, more and more researchers have found that in addition to the correspondence in epifacial symptoms, TCM symptom types and syndromes and modern medicine have a strong correlation and even correspondence in the fields of imaging, laboratory tests and omics [4]: for example, the echocardimetric indexes of patients with TCM symptom type of heart failure have different specific changes, and with the emergence and superposition of sputum turbidity and water arrest, it shows a trend of increasing the enlargement rate of left ventricle, right ventricle and atrium and decreasing rate of diastolic dysfunction of the left atrium. Serum NT-proBNP in patients with heart failure will also increase with the increase of the severity of symptoms (cardiac deficiency evidence→ qi deficiency evidence→ qi deficiency and sputum stasis evidence→ heart and kidney yang deficiency).
Therefore, on the basis of retaining the basic idea of "dialectical treatment", TCM has increasingly introduced objective indicators such as NYHA cardiac function grading, BNP/NT-proBNP, and left ventricular ejection fraction (LVEF) to evaluate the severity of heart failure in patients and the effectiveness of TCM/TCM in the treatment of heart failure [5].
03
evolution
Western medicine is characterized by rapid onset of action and rapid relief of clinical symptoms in patients with heart failure; Traditional Chinese medicine, on the other hand, is mild and long-term, with outstanding comprehensive effects, so it is also accepted by many patients. For example, the research and development and manufacture of Qi Ginseng Yiqi Drop Pills reflect the value of traditional Chinese medicine in dealing with cardiovascular diseases.
Qi Ginseng Yi Qi Drop Pill is mainly used for patients with angina pectoris with coronary heart disease with chest deficiency and blood stasis type chest palsy and chest tightness, shortness of breath, fatigue, palpitations, self-sweating, and less complexion. Chinese medicine researchers, from hundreds of medicinal materials, selected astragalus, danshen, Panax notoginseng, Xiangxiang and other medicinal and food homologous Chinese medicinal materials, on the basis of "compound danshen" to develop "Qi Drop Pills", and approved for marketing in 2003 - the core of this team is Academician Zhang Boli of Tianjin University of Chinese Medicine.
The multi-component contained in the drug comprehensively exerts the effect of invigorating qi and channeling pulses, activating blood and relieving pain, which can significantly improve the state of "qi deficiency does not practice blood" and "qi deficiency does not solidify", thereby improving ischemia, reperfusion injury and symptoms of heart qi deficiency caused by hypertensive myocardial hypertrophy. Clinical trials have shown that the proportion of effective and effective patients in patients with ischemic heart failure after 90 days of treatment with Western drugs alone is 48.63%, and the addition of Qi Ginseng Yiqi Drop Pills on the basis of Western drugs can increase the effective rate to 71.45% (Figure 2), in addition, the quality of life of patients is also significantly improved, and the safety is good [6].
Figure 1.Western medicine combined with Qi ginseng Yiqi drop pill can effectively improve the treatment efficiency of patients with ischemic heart failure
In addition, multiple studies have confirmed [7-10] that Qi Ginseng Yiqi Drop Pill can improve LVEF, reduce BNP levels, improve cardiac function, reduce the incidence of terminal events and rehospitalization rates after myocardial infarction, and improve quality of life in patients with chronic heart failure. At present, the drug has been recommended by many clinical guidelines/consensus recommendations, such as "Guidelines for the Clinical Application of Proprietary Chinese Medicines in the Treatment of Heart Failure (2021)", "Guidelines for the Diagnosis and Treatment of Traditional Chinese Medicine in Chronic Heart Failure (2022)", "Guidelines for the Diagnosis and Treatment of Angina (After Coronary Revascularization) Integrated Traditional Chinese and Western Medicine".
04
Pharmaceutical
Prescription alignment theory, pharmacy is the key.
As an example, the drop pill preparation extracted from the active ingredients in the four flavors of Chinese medicine extracted by modern science and technology is the crystallization of the combination of traditional Chinese medicine theory and modern preparation technology.
But in fact, it is not simple to make traditional Chinese medicine into "drop pills".
According to Tasly, pill drops are rarely used in Western medicine, it is in a high temperature of 80 °C, the components of traditional Chinese medicine and pharmaceutical excipients are melted, evenly dispersed, and dropped into the inmiscible, non-interacting condensing medium made of spherical or spherical preparations.
The drop pill has a fast onset of action, and it quickly melts in about 5 minutes after reaching the body, and the active ingredients are separated; Moreover, the quality is stable, and its grid-like structure can avoid the mutual migration and transformation of traditional Chinese medicine components, as well as air oxidation and environmental influences; Most importantly, the drop pill is easy to use, its volume is small, and water is not even needed when using it.
If the production of drop pills is a very wonderful process, the acquisition of raw materials is full of the combination of classical Chinese herbal medicine and modern technology.
In fact, in the whole industrial chain from the cultivation of medicinal materials to extraction to preparation, and then to clinical use, Tasly has laid out 200 data collection points, and a batch of production has formed 200,000 big data, which is used for product quality management and forms a smart ecosystem of quality digitalization.
According to Tasly, in recent years, Tasly has implemented digital and intelligent integration to drive development, advocated the new concept of "digital wisdom of Chinese medicine", interpreted the code of traditional Chinese medicine with modern science, based on data, and used artificial intelligence big data platform to promote the reform of innovative Chinese medicine research and development, decrypt the scientific connotation of drug safety and effectiveness, and at the same time create an intelligent manufacturing system of traditional Chinese medicine with "quality digitalization" as the core, so as to realize the digitalization and intelligence of the whole process of traditional Chinese medicine research and development, production and application.
Health, longevity and happiness are important issues for the future of mankind, and the collision of traditional Chinese medicine wisdom and modern technology carries great energy and mission, and we are convinced that digital intelligence technology is changing the world.
Resources:
[1]Outline of Chinese Cardiovascular Health and Disease Report 2022[J].Chinese Journal of Interventional Cardiology,2023,31(07):485-508.)
[2] Work report of China Heart Failure Center (2021)——Current status of diagnosis and treatment of heart failure patients[J].Chinese Journal of Interventional Cardiology,2022,30(05):328-336.)
Guidelines for the diagnosis and treatment of chronic heart failure in traditional Chinese medicine (2022)[J].Journal of Traditional Chinese Medicine,2023,64(07):743-756.)
FAN Yadong, BAI Liding, CHANG Jun, et al. Research Progress on Objectification of TCM Syndrome of Cardiovascular Diseases[J]. Chinese Journal of Traditional Chinese Medicine, 2021, 39(10):5.
[5] Guidelines for the clinical application of proprietary Chinese medicines in the treatment of heart failure(2021)[J].Chinese Journal of Integrated Traditional and Western Medicine,2022,42(03):261-275.)
[6] Wang Shuai, Zhao Zhiqiang, Wang Xianliang, et al. A multicenter, prospective cohort study of Qi Shenyi Qi Drop Pills in the treatment of ischemic heart failure[J].Journal of Traditional Chinese Medicine,2022,63(07):635-643.)
[7] Wang M, Shan Y, Wu C, et al. Efficacy and Safety of Qishen Yiqi Dripping Pill for Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. Front Pharmacol. 2021 Feb 9;11:626375.
[8] Bai R, Yang Q, Xi R, et al. The effectiveness and safety of Chinese Patent Medicines based on syndrome differentiation in patients following percutaneous coronary intervention due to acute coronary syndrome (CPM trial): A nationwide Cohort Study. Phytomedicine. 2023 Jan;109:154554.
[9] GE Zhao, LIU Chunxiang, LIN Shanshan, et al. A systematic review of the efficacy and safety of Qi ginseng Yiqi drop pills in the treatment of heart failure reduction in ejection fraction[J].Hunan Journal of Traditional Chinese Medicine,2022,38(01):115-123.)
[10] Zhao Xujie, Liao Pengda, Mao Shuai, et al. Effect of Qi Ginseng Yiqi Drop Pill on Cardiac Function and Quality of Life after Acute Myocardial Infarction Reperfusion--A multicenter randomized double-blind placebo-controlled trial[J].Chinese Journal of Integrated Traditional and Western Medicine First Aid, 2022, 29(5):5.)