Clinical Application of Gaofang (Medicated Paste) in Cardiovascular Disease : Chinese Medicine and Culture

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Clinical Application of Gaofang (Medicated Paste) in Cardiovascular Disease

Nian, Hua1; Zhang, Qun-Qun2; Ma, Ming-Hua3; Zhang, Yi-Jun1; Wu, Tie-Jun1; Liu, Jing1; Fu, De-Yu4; Xu, Ling-Ling1; Wang, Ke5,✉

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doi: 10.1097/MC9.0000000000000029
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Abstract

1 Introduction

Gaofang (膏方 medicated paste) is a Chinese medicine prescription with special composition and preparation methods. It plays a unique role in clinical practice and reflects the concept that “when there is Zhengqi (healthy qi) inside the body, Xie (evil) cannot invade the body”1 recorded in Huangdi Neijing (《黄帝内经》 The Yellow Emperor’s Inner Classic) as well as the treatment idea of “tonifying the body and reinforcing healthy qi, while removing pathogenic factors.” Gaofang has unique advantages in disease prevention, that is, preventing the development of a disease before it occurs, the progression of a disease after it occurs, and the relapse of a disease after recovery. Therefore, Gaofang is deeply loved by common people.2 Growing evidence indicates that Gaofang has significant health benefits against chronic diseases, particularly cardiovascular disease3 that is one of the major diseases threatening the lives of human beings, especially the middle-aged and elderly people in the world. As the aging population continues to grow, there has been a significant rise in the prevalence of cardiovascular disease in China. This article summarizes features of Gaofang and its clinical application incardiovascular diseases based on the relevant literature and clinical experience in recent years, thus providing reference for the clinical use of Gaofang to treat cardiovascular diseases.

2 General situation of Gaofang

Gaofang, also known as gaoji (膏剂) or gaozi (膏滋), is one of the eight dosage forms of traditional Chinese medicine (TCM) (Fig. 1). Gaofang is a semi-fluid dosage form prepared by fully soaking and decocting ingredients of the herbal formula in water for a long time. After removing the dregs of the decoction, the solution is concentrated by continuous evaporation, along with the addition of proper amount of dissolved gum, sugar, honey, or xylitol. The decoction is then kept stirring until it reaches a state that “a small amount of decoction is dipped into water and the droplets disperse and then gather again.” After that, the decoction is sterilized into Gaofang. Gaofang is mainly divided into two types. One type is made from a patent Chinese herbal formula and the other type is made upon individualized body constitution, yin, yang, qi, and blood after the four diagnostic methods (inspection, listening and smelling, inquiry, and palpation), that is, “one prescription for one person.”4

F1
Figure 1:
Gaofang-making process. (A) soak herbs in water; (B) “hang up a flag” (the paste solidifies in midair, forming an inverted triangle or rectangle like a flag); (C) pour the decoction into separate containers; (D) condense the decoction; (E) Gaofang after processing; (F) automatic packaging machine.

The basic composition of Gaofang is the same as that of a decoction, which can be divided into four groups, “monarch, minister, envoy and courier.” In the chapter Zhizhenyao Dalun (至真要大论 Discussion on the most important and abstruse theory) of Su Wen (《素问》 Basic Questions), there is the records that “the drugs for treating disease are mornarch drugs; the drugs for assisting the monarch drugs are called the minister drugs; and the drugs for corresponding to the minister drugs are called the envoy drugs.”1 This principle also applies to Gaofang. Unlike the decoction, the composition of Gaofang is more complex, often consisting of 30 to 40 ingredients (twice the number of ordinary decoction formulas) categorized into monarch, minister, envoy, and courier.

Gaofang has fewer limitations than that of decoction. It can increase or decrease the ingredients according to the patient’s individual conditions. Due to complex etiology and pathogenesis, non-infectious cardiovascular diseases require long-term treatment. Since long-period use of medicines for cardiovascular diseases may affect the gastrointestinal function, the long-time boiling during the preparation of Gaofang is beneficial to the release of active ingredients. In addition, it is easy to carry, store, and use, with a long shelf life, which can increase the patients’ compliance (Table 1).

Table 1 - Common Gaofang for cardiovascular diseases
Examples of common cardiovascular diseases Effective chemical composition Common Chinese medicines Basic formula of Gaofang
Hypertension Alkaloids, saponins, etc. Gou Teng (钩藤 Ramulus Uncariae Cum Uncis), Wu Zhu Yu (吴茱萸 Fructus Evodiae), Tian Ma (天麻 Rhizoma Gastrodiae), Chuan Xiong (川芎 Rhizoma Chuanxiong), Dan Shen (丹参 Radix et Rhizoma Salviae Miltiorrhizae), etc. Tian Ma Gou Teng Decoction (天麻钩藤饮), Zhen Gan Xi Feng Decoction (镇肝熄风汤), Liu Wei Di Huang Pill (六味地黄丸), Er Zhi Pill (二至丸), Long Dan Xie Gan Decoction (龙胆泻肝汤), Ban Xia Bai Zhu Tian Ma Decoction (半夏白术天麻汤), Bu Yang Huan Wu Decoction (补阳还五汤), Xue Fu Zhu Yu Decoction (血府逐瘀汤), etc.
Coronary heart disease Flavonoids, saponins, alkaloids, volatile oil, etc. Yin Xing Ye (银杏叶 Folium Ginkgo), Hong Jing Tian (红景天 Radix et Rhizoma Rhodiolae Crenulatae), Dan Shen, Ren Shen (人参 Radix et Rhizoma Ginseng), Mai Dong (麦冬 Radix Ophiopogonis), etc. Bao Yuan Decoction (保元汤), Jin Kui Shen Qi Pill (金匮肾气丸), Er Xian Decoction (二仙汤), Dan Shen Decoction (丹参饮), Sheng Mai Powder (生脉散), Xiao Xian Xiong Decoction (小陷胸汤), etc.

2.1 Clinical application to cardiovascular diseases

Cardiovascular diseases can be divided into two categories: infectious and non-infectious diseases. The former includes infective endocarditis and infective myocardial inflammation; the latter includes coronary heart disease and hypertension. Nowadays, hypertension and coronary heart disease are common and primary risk factors for cardiovascular diseases, often complicated with hyperlipidemia, hyperglycemia, hyperviscosity, and arteriosclerosis. These diseases often have a longer duration. According to the TCM theory, factors contributing to cardiovascular diseases include age, improper diet, emotional disturbances and overexertion. These factors may cause disorders of qi and blood and imbalance of yin and yang.5 In TCM, cardiovascular diseases often result from deficiency of yin, yang, qi, or blood but exhibit excess symptoms due to blood stasis, phlegm dampness, and yin cold.

Cardiovascular diseases commonly affect the middle-aged and elderly population. In TCM, as a person ages, the kidney essence becomes deficient, the essential qi gradually weakens, and the sea of marrow gradually becomes insufficient, eventually resulting in deficiency of zang-fu organs. In addition, due to the long duration, cardiovascular diseases require comprehensive treatment for a long period.6 In this regard, Gaofang is a good option.

Before using Gaofang, two points should be taken into consideration. First, cardiovascular diseases with chronic duration may cause deficiency, kidney impairment, collateral disorder, qi stagnation and accumulation of dampness and phlegm. Second, traditional Gaofang focuses on supplement. It is thick and strongly flavored. The reason is that Gaofang generally contains glue or gelatin medicines such as donkey-hide gelatin, tortoise plate gum, antler gum. Therefore, after the decoction is condensed, it is difficult to digest, which is not suitable for the patients with phlegm and blood stasis. In this regard, the treatment principles are to reinforce healthy qi and also remove pathogenic factors, and for different constitutions and illnesses, the degree of these two aspects should be considered.4 The prescription should nourish qi and blood while regulating blood circulation, disperse pathogenic factors while supplementing healthy qi, warm and tonify yang while generating body fluids, and promote bowel movements while harmonizing the spleen and the stomach.

The clinical application of Gaofang to cardiovascular diseases is based on disease differentiation, pattern differentiation, constitution differentiation and emotion differentiation.7

2.1.1. Disease differentiation

Changes in cardiovascular disease are rapid and complicated. Many other diseases are risk factors for cardiovascular diseases, such as diabetes and hyperlipidemia. Therefore, in clinical diagnosis and treatment, it is necessary to combine disease differentiation and pattern differentiation, and pay attention to long-term curative effect. For hypertension, the medicines with antihypertensive effects are commonly used, such as Tian Ma (天麻 Rhizoma Gastrodiae), Gou Teng (钩藤 Ramulus Uncariae Cum Uncis), Bai Ji Li (白蒺藜 Fructus Tribuli), dry Di Long (地龙 Pheretima), and Qing Xiang Zi (青葙子 Semen Celosiae). For diabetes, the medicines with hypoglycemic effects are commonly used, such as Huang Lian (黄连 Rhizoma Coptidis), Feng Wei Cao (凤尾草 Herba Petridis Multifidae), and Yu Zhu (玉竹 Rhizoma Polygonati Odorati).7

2.1.2. Pattern differentiation

The process of pattern differentiation is a comprehensive examining process of the internal and external environment of the human body. Formulas should be composed according to different symptoms and patterns of the disease. This principle should be followed in prescribing a formula. Since blood stasis due to qi stagnation, internal obstruction of phlegm, and dampness, as well as liver and kidney deficiency are the most common patterns of cardiovascular diseases, the formula should be modified based on these patterns.7

2.1.3. Constitution differentiation

TCM emphasizes treating diseases according to the individual conditions. In addition to pattern differentiation, the patient’s constitution should also be taken into consideration. Before prescribing a formula, it is necessary to clarify the patient’s susceptibility to different diseases. For example, depression or anger may impair liver qi and subsequently cause the constitution of blood stasis due to qi stagnation. Over ingestion of fatty and sweet food may accumulate dampness and produce phlegm, thus resulting in the constitution of phlegm and dampness. These constitutions are closely related to the occurrence of cardiovascular disease. Therefore, paying attention to the patient’s constitution is beneficial to the prevention and treatment of the disease.7 Dcotor Jin Minglan (金明兰)8 is good at selecting medicines according to the constitutions of patients. For constitution of qi deficiency, she uses Huang Qi (黄芪 Radix Astragali) and Sheng Shai Shen (生晒参 Radix et Rhizoma Ginseng Cruda). For phlegm and dampness, she uses Bai Zhu (白术 Rhizoma Atractylodis Macrocephalae) and Fu Ling (茯苓 Poria). For blood stasis, she uses Tao Ren (桃仁 Semen Persicae) and Hong Hua (红花 Flos Carthami). For depression, she uses Chai Hu (柴胡 Radix Bupleuri) and Zhi Qiao (枳壳 Fructus Aurantii).

2.1.4. Emotion differentiation

Cardiovascular diseases are closely interrelated with emotional disturbances. Emotional disturbances are clinical manifestations of qi and blood dysfunctions of zang-fu organs, and can also become pathogenic factors for emotional diseases. Emotional factors have a strong impact on such cardiovascular diseases as hypertension, coronary heart disease, arrhythmia, blood lipids, and hemorheology. Correcting the excess of the five emotions can balance yin, yang, qi and blood, and restore the coordination of zang-fu functions.7

2.2 Clinical application of Gaofang to hypertension

Professor Zhou Duan (周端) reflected the nourishment nature of Gaofang in treating hypertension.9 He sets great store by promoting blood circulation and submerging yang. He suggests tonifying the five zang organs by following their characteristics and discharging the pathogenic factors by defying their characteristics. The treatment of cardiovascular disease should focus on nourishing yin (or supplementing qi and nourishing yin). For yin deficiency, doctors should adopt such yin-nourishing medicines as Mai Men Dong (麦门冬 Radix Ophiopogonis), Wu Wei Zi (五味子 Fructus Schisandrae Chinensis), Sheng Di Huang (生地黄 Radix Rehmanniae), Bai Shao Yao (白芍药 Radix Paeoniae Alba), Huang Jing (黄精 Rhizoma Polygonati), Bai He (百合 Bulbus Lilii), Shi Hu (石斛 Caulis Dendrobii), Yu Zhu (玉竹 Rhizoma Polygonati Odorati), Gou Qi (枸杞 Fructus Lycii), Dang Gui (当归 Radix Angelicae Sinensis), and He Shou Wu (何首乌 Radix Polygoni Multiflori), and add Bai Zhu, Fu Ling, Bei Shu Mi (北秫米 Sorghum Husked), and Yi Yi Ren (薏苡仁 Semen Coicis) to invigorate stomach qi, relieve dampness, resolve phlegm, and avoid obstruction of the Middle jiao caused by the yin-nourishing medicines. Patients with qi deficiency, dampness and phelgm are often overweight and easy to catch a common cold. Meanwhile, they often have a pale or enlarged tongue with teeth marks. The treatment should focus on strengthening the spleen, supplementing qi, eliminating dampness, and transforming phlegm. For such patients, Professor Zhou often adds the medicines to nourish kidney essence. Dan Shen (丹参 Radix et Rhizoma Salviae Miltiorrhizae), Chuan Xiong (川芎 Rhizoma Chuanxiong), Ze Lan (泽兰 Herba Lycopi), Pu Huang

(蒲黄 Pollen Typhae), E Zhu (莪术 Rhizoma Curcumae), San Qi (三七 Radix et Rhizoma Notoginseng), Tao Ren, Hong Hua, Shui Zhi (水蛭 Hirudo), and Chuan Shan Jia (穿山甲 Squama Manitis) are commonly used to promote blood circulation and transform stasis. This treatment can help adjust the body’s metabolic function, strengthen the immune system, promote blood circulation, and unblock the meridians. Therefore, it can be applied to treat the existing cardiovascular symptoms and prevent the potential symptoms. The spleen and stomach function of the elderly is weak. Thus, Gaofang for the elderly patients is often accompanied by the medicines that can regulate qi and strengthen the spleen, such as Lv E Mei (绿萼梅 Flos Mume), Chuan Lian Zi (川楝子 Fructus Toosendan), Yan Hu Suo (延胡索 Rhizoma Corydalis), Xuan Fu Geng (旋覆梗 Caulis Inulae), Mai Ya (麦芽 Fructus Hordei Germinatus), and Ji Nei Jin (鸡内金 Endothelium Corneum Gigeriae Galli). These medicines can either soothe the liver and regulate qi or harmonize the stomach to smooth the downbearing. In addition, they can eliminate the sticky nature of tonics and help the spleen to transport and absorb nutrients.

Professor Chen Jingwei (陈竞纬)10 has rich experience in treating hypertension with Gaofang, and his prescriptions have shown remarkable efficacy. Chen thinks that Gaofang has its unique indications for treating hypertension and the following three points should be taken into consideration: 1) tonifying and securing kidney qi to nourish the liver, which can remove the excessive pathogenic factors; 2) strengthening the spleen and stomach to prevent the invasion of excessive liver-qi; 3) regulating the imbalance of zang-fu organs by coordinating the condition of the whole body. The medicines must follow the nature of zang-fu organs, and overdose of tonic must be prevented. As for pattern differentiation, doctors should first identify the nature of deficient root, then the nature of excessive tip, followed by the patient’s general physical conditions such as diet, sleep and bowel movements, and finally, identify the patient’s disease. In the treatment, the paired medicines are used as the monarch medicines, supplemented by the minister and envoy medicines.

Professor Gu Guolong (顾国龙)11 believes that the choice of medicines for hypertension has something in common, for example, choosing Jia Wei Si Wu Decoction (加味四物汤) as the basic prescription. This formula can relieve the symptoms of hypertension, lower blood lipids, reduce blood viscosity, and prevent the damage of important organs and deterioration of disease. In the selection of medicine, attention should be paid to both the proportion and the dosage of the medicines for reinforcing healthy qi and removing pathogenic factors. In the clinical settings, the proportion and the dosage of the medicines for removing pathogenic factors is much more than that of the medicines for reinforcing healthy qi. Since most of the patients have an improper diet structure that may cause excessive calories, the proportion of the medicines for removing pathogenic factors can be increased. To reduce fire, Da Huang (大黄 Radix et Rhizoma Rhei), Huang Qin (黄芩 Radix Scutellariae), Huang Lian and Huang Bai (黄柏 Cortex Phellodendri Chinensis) can be selected; to promote urination, Da Fu Pi (大腹皮 Pericarpium Arecae), Fu Ling, Zhu Ling (猪苓 Polyporus) and Ze Xie (泽泻 Rhizoma Alismatis) can be selected; to submerge yang, Sheng Long Gu (生龙骨 Os Draconis), Xuan Shen (玄参 Radix Scrophulariae), Gou Teng and Shi Hu can be selected; to transform turbidity, Jiang Ban Xia (姜半夏 Rhizoma Pinelliae Praeparatum), Tian Ma, Bei Mu (贝母 Bulbus Fritillaria) and Gua Lou (瓜蒌 Fructus Trichosanthis) can be selected; to unblock collaterals, Di Long, Jiang Huang (姜黄 Rhizoma Curcumae Longae), Luo Shi Teng (络石藤 Caulis Trachelospermi) and Bai Hua She (白花蛇 Agkistrodon) can be selected; to eliminate stasis, Chi Shao (赤芍 Radix Paeoniae Rubra), Chuan Xiong, Tao Ren and Hong Hua can be selected. At the same time, attention should be paid to the dosage of the medicines that are dry, hot, and stimulating in nature. For example, overdose of such qi-supplementing medicines as Ren Shen (人参 Radix et Rhizoma Ginseng), Xi Yang Shen (西洋参 Radix Panacis Quinquefolii), Huang Qi and Ci Wu Jia (刺五加 Radix et Rhizoma seu Caulis Acanthopanacis Senticosi) may cause fire. Besides, we should try to avoid adopting the medicines that contain high calorie, fat, cholesterol, or purine.

Professor Fu Deyu (符德玉) learned from many famous TCM experts. She has rich experience in treating hypertension and its target organ damage. She mainly adopts Tian Ma Gou Teng Decoction (天麻钩藤饮), Zhen Gan Xi Feng Decoction (镇肝熄风汤), or Gou Ju Di Huang Decoction (枸菊地黄汤) as the basic prescription, and modifies it with such blood-circulating and phlegm-resolving medicines as Dan Shen, Chuan Xiong, Yi Mu Cao (益母草 Herba Leonuri), San Leng (三棱 Rhizoma Sparganii), E Zhu, Di Long, Di Bie Chong (地鳖虫 Eupolyphaga seu Steleophaga), Yu Mi Xu (玉米须 Stigma Maydis), He Ye (荷叶 Folium Nelumbinis), and Bian Dou (扁豆 Semen Lablab Album). Heavy medicines such as Long Gu, Mu Li (牡蛎 Concha Ostreae), and Zhen Zhu Mu (珍珠母 Concha Margaritiferae Usta) are also used. Since hypertension patients usually suffer from insomnia and palpitations, such medicines as Chai Hu, Yu Jin (郁金 Radix Curcumae), and Mei Hua (梅花 Flos Mume) are used to sooth the liver; Suan Zao Ren (酸枣仁 Semen Ziziphi Spinosae), Huai Xiao Mai (淮小麦 Triticum aestivum L.), Wu Wei Zi, Ling Zhi Cao (灵芝草Ganoderma), Tie Luo (铁落 Frusta Ferri), and Hu Po Fen (琥珀粉 Succinum) are used to nourish the blood and calm the mind. The treatment principles are to treat the root and also the excessive tip including blood stasis, yang hyperactivity, and phlegm turbidity.

2.3 Clinical application of Gaofang to coronary heart disease

Professor Yan Dexin (颜德馨)12 held that “Disharmony of qi and blood is the leading cause of diseases. Chronic and intractable diseases must manifest blood stasis and qi stagnation.” Based on his clinical experience, he advocated harmonizing blood and qi as the treatment principle to promote blood circulation and qi movements, and subsequently dispel the pathogenic factors. Under the guidance of this principle, he mainly adopted the medicines that can promote blood circulation and qi movements. He thought that the pathological features of coronary heart disease were dysfunctions and chronic consumptive conditions of zang-fu organs, and its nature is deficient root and excessive tip caused by qi deficiency and blood stasis. Yan Shi Yi Xin Decoction (颜氏益心汤) is a representative formula to treat coronary heart disease, with the ingredients of Huang Qi, Dang Shen (党参 Radix Codonopsis), Chi Shao, Jiang Xiang (降香 Lignum Dalbergiae Odoriferae), Dan Shen, Ge Gen (葛根 Radix Puerariae Lobatae), etc.

Professor Pang Min (庞敏) believes that the key pathogenesis of coronary heart disease is disharmony of qi and blood coupled with dysfunctions of zang-fu organs.13 The treatment principles of Gaofang are to remove the invading pathogenic factors, reinforce healthy qi and prevent stagnation and stasis. In the adoption of Gaofang, he learned from many predecessors and established his own academic thoughts based on the theories of yin, yang, qi, and blood to prevent and treat diseases. The treatment method of Gaofang to coronary heart disease should focus on balancing yin and yang, benefiting qi and nourishing blood, supplemented by promoting blood circulation, unblocking meridians, and relieving pain.

3 Chinese medicines commonly used in Gaofang for cardiovascular diseases

Chinese medicines have unique strengths in treating cardiovascular diseases,14 for example, clear efficacy and strong activity with few side effects.15 The treatment principles are to promote blood circulation, remove blood stasis, nourish yin, and supplement qi. Commonly used Chinese medicines include Dan Shen, Ren Shen, Huang Qi, Mai Dong (麦冬 Radix Ophiopogonis), Yin Xing (银杏 Ginkgo), San Qi, and Ge Gen. This article mainly discusses the following four medicines.

3.1 Huang Qi

Huang Qi is the root of Astragalus Membranaceus (Fisch.) Bge. var. Mongholicus (Bge.) Hsiao or Astragalus Membranaceus (Fisch.) Bge. of the family Leguminosae. It is a traditional, well-known and commonly used Chinese medicine. According to TCM, Huang Qi can tonify qi, ascend yang, secure the exterior, stop sweating, remove toxins, drain the pus, induce urination, resolve edema, astringe wound, and regenerate flesh. Pharmacological studies have shown that Huang Qi can strengthen the immune system, strengthen the heart, and reduce blood pressure and blood sugar. It can also promote urination, delay aging, and combat tumors, fatigue, and virus.16

As for dealing with cardiovascular diseases, Huang Qi mainly shows strengths in the following two aspects.

  • (1) Protection for the cardiovascular system. Huang Qi can regulate blood pressure, reduce pulmonary artery pressure, promote peripheral vascular dilation, improve heart function, and directly dilate the coronary artery. Huang Qi can increase and decrease blood pressure by dilating blood vessels and increasing stroke volume. This medicine can significantly reduce the level of inflammatory mediators in patients with hypertension, prevent and relieve the symptoms of atherosclerosis, and delay the damage to target organs. Astragaloside has a significant positive inotropic effect and can increase the amplitude and output of myocardial contraction. Besides, Huang Qi can improve myocardial oxygen consumption and protect myocardial cells by improving ventricular diastolic and systolic function. It has significant protective effects on drug-induced myocarditis, myocardial hypoxia, and ischemia–reperfusion injury.17
  • (2) Improvement in blood rheology. Huang Qi can effectively reduce blood viscosity, improve the supply of nutrient and blood to tissues and organs, reduce the risk and the severity of microvascular diseases, and thus contribute to the prevention and treatment of cardiovascular diseases.18

3.2 San Qi

San Qi, with an extensive history in disease treatment, belongs to the genus Acanthopanax. It is warm in nature, sweet and slightly bitter in taste, and enters the liver and the stomach meridians. It can transform stasis, promote blood circulation, stop bleeding, and resolve swelling.19 It is widely used in treatment of ischemic cardiovascular and cerebrovascular diseases in the clinical settings. Panax notoginseng saponins is the main effective component of San Qi.20

San Qi can shorten bleeding and coagulation time and has effects of anti-platelet aggregation and thrombolysis. It can also promote the proliferation of multifunctional hematopoietic stem cells and has hematopoietic functions. In addition, San Qi can reduce blood pressure, slow the heart rate, and shows protective effects on arrhythmia induced by various drugs. It can also reduce myocardial oxygen consumption and oxygen utilization, dilate cerebral vessels, and enhance cerebral vascular flow.21

3.3 Ren Shen

Ren Shen is the dried root and rhizome of Panax ginseng C. A. Mey. of the family Araliaceae. Known as the king of herbs, it is an important medicine for supplementing qi. Ren Shen is sweet and slightly bitter in taste, warm in nature, and enters the spleen, the lung, and the heart meridians. It can tonify the kidney and the spleen, supplement qi, generate fluids, alleviate thirst, and calm the mind. It is used for qi deficiency, weak pulse, and qi deficiency of the lung and the spleen. It can also be used for fever, qi stagnation, diabetes, palpitations, insomnia, forgetfulness, and convulsions.22

Ren Shen is a famous tonic. In recent years, studies have shown that Ren Shen has certain cardiotonic effects, and thus, it is widely used in patients with cardiac insufficiency. However, excessive dosage of Ren Shen may weaken myocardial contractility. Among the ingredients of Ren Shen, saponin plays a major cardiotonic role. Saponin also has the function of promoting phosphate synthesis and enhancing lipoproteinase activity, which can accelerate the hydrolysis of fat and chylomicrons, thereby promoting lipid metabolism; it can also promote blood cholesterol conversion and reduce cholesterol levels. Its effect is mainly manifested in its clear dilating effects on the blood vessels of the brain, pulmonary arteries, and coronary arteries. It can effectively improve the blood circulation of organs.22

3.4 Dan Shen

Dan Shen is the dried root and rhizome of Salvia miltiorrhiza of the family Labiatae. Dan Shen is bitter in taste, slightly cold in nature, and enters the heart and the liver meridians. This medicine can promote blood circulation, remove blood stasis, cool blood, unblock meridians, alleviate pain, clear heart-fire, relieve restlessness, and resolve abscesses. Clinically, it is commonly used to treat angina pectoris, irregular menstruation, and dysmenorrhea.23,24

In addition, Dan Shen can improve cardiovascular functions. Modern pharmacological studies have shown that Dan Shen can protect vascular endothelial cells, improve microcirculation, protect the myocardium, and exert anti-arrhythmic and anti-atherosclerotic effects.25 It is widely used in the treatment of cardiovascular diseases. Dan Shen extract can reduce the occurrence of ventricular fibrillation and death caused by ventricular fibrillation. Salvianic acid A can block L-type calcium current, shorten the action potential duration of myocardial single cells, and reduce calcium influx, thus avoiding arrhythmia.

Other medicines including Chai Hu, Rou Gui (肉桂 Cortex Cinnamomi), Wu Zhu Yu (吴茱萸 Fructus Evodiae), and Hu Zhang (虎杖 Rhizoma Polygoni Cuspidati) are also commonly used to treat cardiovascular diseases. Most of them can invigorate blood, remove blood stasis or replenish qi.

4 Conclusion

In conclusion, Gaofang is the cream of TCM, and the crystallization of clinical experience of famous doctors. Compared with the TCM decoction, the dosage form, packaging and taste of Gaofang are more in line with the needs of modern people, as it is easier to carry, transport, and more convenient to take. It has shown a marked effect in the prevention and management of cardiovascular diseases,26 because of its action in tonifying heart qi and blood. The idea that Gaofang can benefit the health and wellness has been extensively accepted by all walks of life. Cardiovascular diseases can greatly affect the patients’ quality of life. Hopefully, Gaofang can be helpful in the treatment of cardiovascular diseases.

Funding

This study was financed by the grants from Shanghai Traditional Chinese Medicine Expert Heritage Studio Construction Project (No. 2020ZYGZS-002), Project of Traditional Chinese Medicine Processing and Inheritance Base of Shanghai Health and Wellness Committee (No. 30304118220), and Chinese Medicine Research Project of Shanghai Health and Wellness Committee (No. 2020YP001).

Ethical approval

This study does not contain any studies with human or animal subjects performed by any of the authors.

Author contributions

Qun-Qun Zhang drafted and revised the article. Hua Nian was responsible for conception and supervision. Ming-Hua Ma participated in the writing of the first draft. Yi-Jun Zhang and Tie-Jun Wu participated in the proofread. Jing Liu was responsible for the correction. De-Yu Fu participated in the article topic selection. Ling-Ling Xu participated in the overall design of the article. Ke Wang was the correspondent and chief planner of this article.

Conflicts of interest

The authors declared no financial or other conflicts of interest.

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Keywords:

Cardiovascular disease; Clinical application; Coronary heart disease; Gaofang (medicated paste); Hypertension

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