CLINICAL APPLICATIONS

* Cardiovascular disorders: coronary heart disease, angina pectoris, ischemia, and atherosclerosis

* Circulatory disorders: poor cerebral and body circulation, numbness of the limbs, peripheral neuropathy and similar problems

 

WESTERN THERAPEUTIC ACTIONS

* Vasodilating action to increase blood perfusion and decrease peripheral resistance

* Positive cardiotonic property to strengthen cardiac contraction and improve blood circulation

* Antiplatelet and anticoagulant effects to reduce the risk of blood clots

* Antihyperlipidemic function to lower plasma cholesterols and triglycerides

 

CHINESE THERAPEUTIC ACTIONS

* Invigorates blood circulation in the upper jiao and eliminates blood stasis

* Unblocks meridians and relieves pain

* Warms Heart yang and dispels damp and phlegm

 

DOSAGE

Take 2 to 4 capsules three times daily on an empty stomach with warm water. This formula is to be taken on a daily basis for maintenance of cardiovascular and circulatory health. Do not use this formula to treat acute myocardial infarction.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Chuan Xiong (Rhizoma Chuanxiong)

Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae)

Dang Gui (Radix Angelicae Sinensis)

Ge Gen (Radix Puerariae Lobatae)

Gui Zhi (Ramulus Cinnamomi)

Hong Hua (Flos Carthami)

Hou Po (Cortex Magnoliae Officinalis)

Jiang Xiang (Lignum Dalbergiae Odoriferae)

Mao Dong Qing (Radix Ilicis Pubescentis)

Ren Shen (Radix et Rhizoma Ginseng)

Sha Ren (Fructus Amomi)

Xie Bai (Bulbus Allii Macrostemonis)

Zhi Shi (Fructus Aurantii Immaturus)

 

BACKGROUND

Heart disease is the number one cause of death in the United States, according to a report by CDC published in January 11, 2012.[1] Heart disease refers to a class of diseases that involves the heart and/or blood vessels, such as coronary heart disease and atherosclerosis. Risk factors that contribute to coronary heart disease include hypercholesterolemia, hypertension, obesity, smoking, and physical inactivity. As a result, blood flow to the heart is impaired, leading to ischemia, angina, and in severe cases, myocardial infarction and sudden death. Therefore, proper management of heart disease requires integration of preventative and treatment measures, such as lifestyle changes, diet modifications, and medical intervention.

 

FORMULA EXPLANATION

Cardiovascular and circulatory disorders, such as coronary heart disease, angina pectoris, ischemia, and atherosclerosis, are characterized by Heart yang deficiency with blood stagnation and damp and phlegm accumulation. To effectively treat these disorders, treatment must focus on warming Heart yang, dissolving damp, eliminating phlegm, and invigorating blood circulation.

        Ren Shen (Radix et Rhizoma Ginseng) replenishes the vital qi and mimics the effect of cardiac glycosides, making the heart beat stronger and more rhythmically. Xie Bai (Bulbus Allii Macrostemonis) disperses painful obstructions due to turbid-phlegm congealing in the chest. Xie Bai (Bulbus Allii Macrostemonis) and Gui Zhi (Ramulus Cinnamomi) warm and facilitate the flow of yang qi in the chest to improve the function of the heart. Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) improves microcirculation, strengthens myocardial contraction, and adjusts the heart rate. Mao Dong Qing (Radix Ilicis Pubescentis) dilates the blood vessels, lowers blood pressure and reduces the oxygen consumption of cardiac muscles. Ge Gen (Radix Puerariae Lobatae) dilates blood vessels to lower blood pressure. Hong Hua (Flos Carthami), Dang Gui (Radix Angelicae Sinensis), Jiang Xiang (Lignum Dalbergiae Odoriferae) and Chuan Xiong (Rhizoma Chuanxiong) invigorate general blood circulation and dispel blood stasis. Bai Shao (Radix Paeoniae Alba) nourishes the blood and relieves pain. Gui Zhi (Ramulus Cinnamomi) promotes the peripheral blood circulation and unblocks stagnation in the channels and collaterals. Sha Ren (Fructus Amomi) regulates qi and dissolves dampness. Zhi Shi (Fructus Aurantii Immaturus) and Hou Po (Cortex Magnoliae Officinalis) regulate qi, expand the chest, and relieve congestion.

        Together, these herbs effectively treat cardiovascular and circulatory disorders that affect the heart.

 

CAUTIONS & CONTRAINDICATIONS

* Acute myocardial infarction is a medical emergency. Call 911 to send patients to emergency room as soon as possible. Monitor their condition until emergency medical personnel arrive.

* Do not use this formula to treat acute myocardial infarction. Circulation is to be used to promote cardiovascular and circulatory health, not to treat acute heart attacks.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis) and Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[2]^,[3],[4]

* Circulation is contraindicated during pregnancy and nursing.

 

CLINICAL NOTES

* Maintenance of the herbal treatment is necessary for approximately six months in order to stabilize the condition. One should always address the secondary causes and/or complications of coronary artery disease.

* Patients with high risk of cardiovascular disorders may benefit from preventative treatments by taking low doses of Circulation. Risk factors of cardiovascular disorders include family history, obesity, sedentary lifestyle, and cigarette smoking.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Pulse within a pulse on the left cun. A pulse within a pulse feels like there is a bundle of electric wires, which are thin, straight, and tight, within the artery.

 

SUPPLEMENTARY FORMULAS

* For cardiovascular or circulatory disorders affecting the entire body, add Circulation (SJ).

* For hypertension with dizziness or vertigo, combine with Gastrodia Complex.

* For hypertension with anger or flushed face, combine with Gentiana Complex.

* For edema and water accumulation, add Herbal DRX.

* For high cholesterol and triglycerides, add Cholisma.

* For high cholesterol and triglycerides with fatty liver and obesity, add Cholisma (ES).

* For diabetes mellitus, add Equilibrium.

* For obesity, Herbalite may be used to suppress appetite and facilitate weight loss.

* For excess heat accumulation, add Gardenia Complex.

* For excess damp/phlegm in the body, add Pinellia Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Liangqiu (ST 34), Renzhong (GV 26), Xinshu (BL 15), Tongli (HT 5), Qihai (CV 6), Fenglong (ST 40)

¡± Acute: Needle Ximen (PC 4). Bleed Quze (PC 3) or the vein nearby.

¡± Chronic: Shanzhong (CV 17), Neiguan (PC 6)

 

Classical Master Tung's Points:

* Arteriosclerosis: Fuding (T 44.04), Houzhi (T 44.05), Luotong (T 44.14), Zhitong (T 44.13), Xinling (T 33.17)*, Linggu (T 22.05), Jianzhong (T 44.06), Dizong (T 44.09)

* Coronary heart disease: Huofu (T 88.41)*, Huoliang (T 88.42)*, Huochang (T 88.43)*, Mufu (T 88.38)*, Muliang (T 88.39)*, Muchang (T 88.40)*, Tongshan (T 88.02), Tongtian (T 88.03), Tongguan (T 88.01)

* Angina pectoris: Xinmen (T 33.12), Xinling (T 33.17)*, Sihuashang (T 77.08), Sihuawai (T 77.14), Sihuazhong (T 77.09), Sihuali (T 77.13), Sihuafu (T 77.10), Sihuaxia (T 77.11), Huobao (T 55.01), Xinchang (T 11.19), Dizong (T 44.09), Shangqi (T 88.44)*, Xiaqi (T 88.45)*, Tongtian (T 88.03), Neiguan (PC 6) towards the heart or penetrate through to Waiguan (TH 5), Sanling (T 44.18)*. Bleed the HT and LU area in the upper back T3 ¡V T6 with cupping. Bleed visible dark veins in the elbow and back of the knee. Do not use cupping methods here. Bleed before needling for best result.

* Peripheral neuropathy: Erjiaoming (T 11.12), Wanshunyi (T 22.08), Wanshuner (T 22.09), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Zhengshi (T 77.03), Zhengjin (T 77.01), Zhengzong (T 77.02). Bleed Weizhong (BL 40), Sihuashang (T 77.08), Sihuawai (T 77.14), Sihuazhong (T 77.09), Sihuali (T 77.13), Sihuafu (T 77.10), Sihuaxia (T 77.11) or dark veins nearby. Bleed before needling for best result.

* Palpitation: Dizong (T 44.09), Xinling (T 33.17)*, Tongtian (T 88.03), Tongguan (T 88.01), Sihuashang (T 77.08), Sihuawai (T 77.14), Sihuazhong (T 77.09), Sihuali (T 77.13), Sihuafu (T 77.10), Sihuaxia (T 77.11), Huochuan (T 33.04), Tianshi (T 33.15), Dishi (T 33.14), Renshi (T 33.13), Xinchang (T 11.19)

* Arrhythmia: Xinling (T 33.17)*, Tongguan (T 88.01), Dizong (T 44.09), Xinmen (T 33.12), Neiguan (PC 6), Tongtian (T 88.03), Tianshi (T 33.15), Dishi (T 33.14), Renshi (T 33.13), Tongshan (T 88.02). Bleed dark veins visible on ST channel on the lower limb. Bleed before needling for best result.

 

Master Tung¡¦s Points by Dr. Chuan-Min Wang:

* Coronary artery disease

¡± Acute: Bleed Houxin (T DT.11) on the left. Needle bilaterally Shuixiang (T 66.14), Huoying (T 66.03), Huosan (T 66.12), Shangbai (T 22.03).

¡± Chronic or prevention: Tongguan (T 88.01), Tongshan (T 88.02), Tongtian (T 88.03)

 

Balance Method by Dr. Richard Tan:

* Left side: Neiguan (PC 6), Tongli (HT 5), Zusanli (ST 36), Yanglingquan (GB 34), Weizhong (BL 40) or ah shi points nearby

* Right side: Sanjian (LI 3), Hegu (LI 4), Houxi (SI 3), Sanyinjiao (SP 6), and Ligou (LR 5), Fuliu (KI 7) or ah shi points nearby

* Needle Heart point on the ear.

* Alternate sides between treatments.

 

Ear Acupuncture:

* Main points: Heart, Small Intestine, Sympathetic, Carotid Artery, Anterior Pituitary, Subcortex

* Adjunct points: Brain Stem, Lung, Liver, Chest, Occipital

* Needle every other day three to five points for an hour. Twelve treatments equal one course.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Coronary heart disease: Heart, Liver, Chest, Small Intestine, Sympathetic, Coronary Vascular Subcortex

* Reducing heart rate: Occiput, Heart, Chest, Small Intestine, Shenmen, Coronary Vascular Subcortex, Reduce Heart Rate Point. Bleed Ear Apex.

* Arrhythmia: Heart, Chest, Small Intestine, Sympathetic, Coronary Vascular Subcortex

* Tachycardia, fibrillation: Shenmen, Small Intestine, Heart, Chest, Occiput, Reduce Heart Rate, Coronary Vascular Subcortex. Bleed Ear Apex.

* Bradycardia: Sympathetic, Heart, Chest, Adrenal Gland, Coronary Vascular Subcortex

 

NUTRITION

* Individuals with arteriosclerosis should eat foods high in fiber (fruits and vegetables) and low in fat and cholesterol. Avoid sweets, chips, fried and greasy foods, junk foods, ice cream, and alcohol. Stay away from smoking and exposure to second-hand smoke. Regular exercise with close monitoring of weight is recommended.

* Increase intake of garlic and onions, as they can reduce serum cholesterol levels. Raw nuts (except peanuts), olive oil, pink salmon, trout, tuna, Atlantic herring, and mackerel are also rich in essential fatty acids that are good for patients with cardiovascular disorders.

* Eliminate sodium, MSG, baking soda, canned vegetables, diet soft drinks, preservatives, meat tenderizers, saccharin, and softened water from the diet.

* Patients on anticoagulants drugs, such as Coumadin (warfarin), should not fluctuate their daily consumption of vitamin K, which is found in alfalfa, cauliflower, liver, and in all dark green vegetables including broccoli and spinach.

* Increase the intake of niacin, which can lower total cholesterol levels by up to 18%, increase HDL cholesterol by up to 32%, and lower triglycerides by up to 26%. Slow release form of niacin is preferred to minimize side effects such as flushing and stomach pain.

* Other supplements that are beneficial include vitamin B5, vitamin C, vitamin E, chromium picolinate, lecithin, and coenzyme Q10.

* Give the body two to three hours between the last meal of the day and bedtime. During sleep, the digestive system slows down. Make sure the body has adequate time to digest the food before going into sleep mode.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Coronary heart disease

¡± Increase the intake of American ginseng, brown rice, black fungus, sea cucumber, vinegar, shiitake mushrooms, celery, seaweed, lotus root, cassia seeds, jelly fish, chrysanthemums, hawthorn berries, water chestnuts, mung beans, pearl barley, peach kernels, ginger, soy sprouts, mung sprouts, other sprouts, wheat bran, persimmons, bananas, watermelon, sunflower seeds, and lotus seeds.

¡± Avoid fatty foods, stimulating foods, spicy foods, coffee, smoking, alcohol, simple carbohydrates (sugar and white flour), salt, stress, tension, worrying, emotional stimulation, and lack of sleep.

 

LIFESTYLE INSTRUCTIONS

* Exercise helps blood circulation and is the key to keeping the blood vessels elastic, flexible, and unclogged.

* Avoid the use of alcohol and exposure to tobacco. They increase cholesterol buildup and hardening of arteries.

* Healthy diet and lifestyle changes can reverse arteriosclerosis and its complications. However, they must be applied daily and continuously for a long time, without interruptions.

 

CASE STUDIES

* W.Y., a 62-year-old male, presented with insomnia due to stress and anxiety, which caused him to wake 2 to 3 times per night. Objective findings included red cheeks and purple lips. The TCM diagnosis was blood stagnation with Liver fire. For treatment, Circulation was prescribed to treat blood stagnation and Calm (ES) was prescribed to treat anxiety. Both were prescribed at a dosage of 2 capsules two times a day. Within the first week of taking the herbs, the patient¡¦s sleep had improved to waking up only once during the night. His legs were still blue so the dosage of Circulation was increased. Submitted by M.P., Muskego, Wisconsin.

* A 58-year-old male presented with symptoms of chest oppression and a dry unproductive cough. Swelling was noted on the hands as well as around the eyes. Pain was felt at Dabao (SP 21) especially during movement. Other signs and symptoms included bright red blood in the stool, epistaxis, abdominal bloating, and tremors upon slight exertion. The tongue appeared swollen, pale, scalloped, and wet with a thin coat and red tip. The pulse was superficial and forceful. The TCM diagnosis was phlegm retention in the Heart with an underlying deficiency of Spleen qi and Heart blood. The treatment protocol included the combination of three herbal formulas: Circulation at 1 capsule twice daily, Gui Pi Tang (Ginseng and Longan Combination) at 2 capsules twice daily, and a special formula at 1 capsule once daily. In addition, Cactus Comp [a homeopathic product] was used as needed, and magnet 10,000 gs was applied at the site of discomfort nightly. The practitioner recommended this protocol for long-term treatment. Note: The special formula included ingredients such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae), Chuan Xiong (Rhizoma Chuanxiong), Di Huang (Radix Rehmanniae), Bai Shao (Radix Paeoniae Alba), Fu Ling (Poria), Tao Ren (Semen Persicae), Niu Xi (Radix Achyranthis Bidentatae), Hong Hua (Flos Carthami), Jie Geng (Radix Platycodonis), Chai Hu (Radix Bupleuri), Gan Cao (Radix et Rhizoma Glycyrrhizae), Ge Gen (Radix Puerariae Lobatae), and Yuan Zhi (Radix Polygalae). Submitted by I.B., Miami, Florida.

* F.L., a 53-year-old female patient, presented with recent history of TIA (transient ischemic attack). Objective findings included right-sided pulling and numbness of the face with difficulty smiling and closing the right eye, as well as drooping of facial muscles on the right side when smiling, and partial facial flaccidity. Treatment using three capsules of Circulation, three times daily, was successful: no recurring episodes were noted during subsequent follow-up visits. This patient also had constipation with hard, difficult to move stools, abdominal pain, and cramps with bloating. All these gastrointestinal symptoms were resolved with Gentle Lax (Deficient) taken at four capsules, three times daily. Submitted by C.L., Chino Hills, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Circulation is formulated to treat cardiovascular and circulatory disorders. It contains herbs with vasodilating effects to increase blood perfusion and improve blood circulation, cardiotonic effects to strengthen cardiac contraction, antiplatelet and anticoagulant effects to reduce the risk of blood clots, and antihyperlipidemic effects to lower plasma cholesterols and triglycerides.

        One of the fastest and most effective ways to increase and improve blood circulation is to dilate the blood vessels and strengthen the heart contraction. Dilated blood vessels allow the blood to flow smoothly with decreased resistance, and strong heart contraction enables the blood to reach peripheral parts of the body. In this formula, many herbs have a strong vasodilating effect, such as Bai Shao (Radix Paeoniae Alba), Chuan Xiong (Rhizoma Chuanxiong) and Mao Dong Qing (Radix Ilicis Pubescentis). Bai Shao (Radix Paeoniae Alba) has demonstrated a marked action to dilate aorta and peripheral blood vessels, and cause a slight decrease in blood pressure.[5]^,[6] Chuan Xiong (Rhizoma Chuanxiong) dilates blood vessels to lower blood pressure, increases blood perfusion to coronary arteries, and decreases oxygen consumption by the cardiac muscle.[7] Mao Dong Qing (Radix Ilicis Pubescentis) has shown marked effectiveness to dilate blood vessels and increase blood perfusion to the coronary arteries.[8] Lastly, Dang Gui (Radix Angelicae Sinensis) has a positive inotropic effect to strengthen cardiac contraction and improve overall blood circulation.[9]^,[10]

        Blood clot formation is a significant risk of coronary heart disease. Blood clots may be prevented and treated with herbs that have antiplatelet and anticoagulant effects. Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) has antiplatelet, anticoagulant, and thrombolytic effects, and is also one of the most effective herbs to improve blood circulation.[11]^,[12] Dang Gui (Radix Angelicae Sinensis) also has a significant antiplatelet effect, similar to that of aspirin.[13] Chuan Xiong (Rhizoma Chuanxiong) has a marked effect to inhibit thrombus formation and platelet aggregation in a dose-dependent manner.[14] Lastly, Xie Bai (Bulbus Allii Macrostemonis) has been shown to markedly inhibit platelet aggregation and prevent clotting.[15]

        Atherosclerosis is also another cause of coronary heart disease. Therefore, proper precaution must be taken to ensure normal levels of plasma cholesterols and triglycerides. In this formula, Bai Shao (Radix Paeoniae Alba) exerts a significant effect to lower total cholesterol, low-density lipoprotein and triglyceride levels, compared with a control group.[16] Hou Po (Cortex Magnoliae Officinalis) has demonstrated marked effect to prevent and treat atherosclerosis by lowering the plasma lipids, decreasing arterial lesions, and suppressing aortic oxidative stress (measured by free radical, malondialdehyde, and oxidative DNA damage).[17] Administration of Ren Shen (Radix et Rhizoma Ginseng) in humans at 6 grams per day for 8 weeks is associated with increased high-density lipoprotein (HDL) and decreased serum total cholesterol, triglyceride, low-density lipoprotein (LDL) and plasma malondialdehyde (MDA) levels.[18] Lastly, Xie Bai (Bulbus Allii Macrostemonis) has demonstrated marked effectiveness to lower plasma cholesterol and triglyceride levels.[19]

        Clinically, use of herbs in Circulation has been shown to effectively treat various types of coronary heart disease. According to one study, use of Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) was effective to treat 323 patients with coronary artery disease,[20] and use of Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Ge Gen (Radix Puerariae Lobatae) effectively treated 100 consecutive coronary patients (mean age 58 +/- 8 years).[21] According to another study, 106 patients with ischemic heart disease were treated with 99.06% rate of effectiveness using an herbal formula that contained Dang Gui (Radix Angelicae Sinensis), Chuan Xiong (Rhizoma Chuanxiong), Xie Bai (Bulbus Allii Macrostemonis), Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and others.[22] Furthermore, Mao Dong Qing (Radix Ilicis Pubescentis) has been shown to effectively treat cardiovascular diseases, such as coronary artery disease and ischemic stroke. [23]^,[24] Lastly, Chuan Xiong (Rhizoma Chuanxiong) has been used in various formulas to effectively treat angina,[25] coronary artery disease,[26] cerebral embolism,[27] and ischemic stroke.[28]

        In summary, Circulation is an excellent formula that helps to prevent and treat cardiovascular and circulatory diseases.

 

COMPARATIVE ANALYSIS

Cardiovascular and circulatory disorders are complex illnesses that affect various parts of the body. In Western medicine, these disorders are treated with medications such as antiplatelets [aspirin and Ticlid (ticlopidine)] and anticoagulants [heparin and Coumadin (warfarin)]. In emergencies, nitroglycerin and thrombolytic drugs may be used to dilate blood vessels and dissolve blood clots, respectively. Though these drugs have serious side effects, their use can be justified because they offer major benefits, especially in urgent situations.

        Use of herbs is also beneficial to treat cardiovascular and circulatory disorders. In fact, many drugs used for treatment of cardiovascular and circulatory disorders are originally derived from natural sources. Similarly, these herbs have similar pharmacological effects to those of the drugs, such as antiplatelet, anticoagulant, thrombolytic, and vasodilating effects. Furthermore, herbs are much safer than drugs, as they have a regulatory effect on blood hemodynamics, thereby achieving desired effects with minimal side effects.

        Both drugs and herbs are effective for prevention and treatment of mild to moderate cases of cardiovascular and circulatory disorders. Drug therapies are more potent and precise, but do have more side effects. However, drugs are simply the most effective and most reliable therapy in emergency cases such as in acute heart attack. On the other hand, herbs are effective for both prevention and treatment of cardiovascular and circulatory disorders. However, they should not be used in emergencies, as Western medicine is more suitable for crisis management.