Preclinical and clinical examinations of Salvia miltiorrhiza and its tanshinones in ischemic conditions.
Adams JD, Wang R, Yang J, Lien EJ.
Department of Molecular Pharmacology and Toxicology, School of Pharmacy, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089-9121, USA. jadams@usc.edu
Salvia miltiorrhiza (Labiatae, Laminaceae), danshen, is an annual sage mainly found in China and neighboring countries. The crude drug (dried root) and its preparations are currently used in China to treat patients suffering from heart attack, angina pectoris, stroke and some other conditions. The use of S. miltiorrhiza has been increasing in the management of stroke. Pharmacological examinations showed that the plant and its active ingredients, tanshinones and salvianolic acids, have anticoagulant, vasodilatory, increased blood flow, anti-inflammatory, free radical scavenging, mitochondrial protective and other activities. This review discusses the pharmacology, medicinal chemistry and clinical studies published, especially in China, for danshen and tanshinone preparations. Clinical examinations are evaluated in terms of S. miltiorrhiza preparation, dose, double blinding, control, clinical assessments of outcomes and other parameters. Meta-analyses of S. miltiorrhiza are also discussed.
PMID: 17302964 [PubMed]
<input ... >2: Chin J Integr Med. 2006 Mar;12(1):12-8. Related Articles, Links -
Clinical non-inferiority trial on treatment of coronary heart disease angina pectoris of Xin-blood stasis syndrome type with lyophilized Salvia salt of lithospermic acid powder for injection.
Zhang Q, Liu AD, Huang YS.
Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091. zhangq810@263.net
OBJECTIVE: To evaluate the effectiveness and safety of lyophilized Salvia salt of lithospermic acid powder for injection (SSLA) in treating coronary heart diseases angina pectoris (CHD-AP) of Xin-blood stasis syndrome type, and to conduct the non-inferiority trial with Danshen injection (DSI) as positive control. METHODS: An non-inferiority clinical layered, segmented, randomized, and blinded trial on three parallel and multiple centered groups was conducted in 480 patients with stable effort angina grade I, II and III, who had two or more times of attack every week. The 240 patients in test group A were treated with SSLA 200 mg added in 250 ml of 5% glucose solution for intravenous dripping every day; the 120 patients in test group B were treated with SSLA but the dosage doubled; and the 120 patients in the control group were treated with DSI 20 ml daily in the same method as SSLA was given. The clinical effectiveness and safety were evaluated after the patients were treated for 14 days. RESULTS: The results showed that the markedly effective rate in test groups A, B and control group was 37.45%, 36.75% and 30.09% respectively, while the total effective rate in them was 88.09%, 89.74% and 67.26% respectively. Statistical significance was shown in comparisons of the therapeutic effect between control group with test group A and test group B, with that in the two test groups superior to that in the control group, and non-inferiority trial showed eligibility (P < 0.01). Adverse reaction appeared in 8 patients in the test groups and 2 in the control group. CONCLUSION: SSLA has definite therapeutic effect in treating patients with CHD-AP, with its effect not inferior to that of DSI, and no evident toxic-adverse reaction.
Publication Types:
PMID: 16571277 [PubMed - indexed for MEDLINE]
<input ... >3: Med Sci Monit. 2006 Jan;12(1):SR1-7. Epub 2005 Dec 19. Related Articles, Links -
Compound salvia pellet, a traditional Chinese medicine, for the treatment of chronic stable angina pectoris compared with nitrates: a meta-analysis.
Wang G, Wang L, Xiong ZY, Mao B, Li TQ.
Department of Integrated Traditional Chinese & Western Medicine, West China Hospital, Sichuan University, #37 Guoxue Street, Chengdu 610-041, P. R. China.
BACKGROUND: Compound salvia pellet (CSP), consisting of active herbal ingredients extracted from Danshen (salvia miltiorrhiza), Sanqi (panax notoginseng), and Borneol (Cinnamomum camphora), is taken most frequently by patients with angina pectoris in China. To determine the efficacy and safety of CSP for the treatment of stable angina pectoris (SAP), a meta-analysis was undertaken. MATERIAL/METHODS: An extensive search including MEDLINE, EMBASE, BA, Chinese Biomedical Database (CBM), and Chinese Cochrane Centre Controlled Trials Register from 1994 to 2004 was performed. Data were extracted independently from the included trials by two reviewers. Statistical software (RevMan 4.1) provided by the Cochrane Collaboration was applied. RESULTS: Twenty-seven randomized controlled trials (RCTs) (n=3722), regardless of language or publication status, were identified. Generally, the methodological quality of the trials, assessed by the Jadad scale, was low, except for one with 3 points. Statistical pooling of the results showed that, compared with nitrates, CSP treatment had significant effect on the improvement of angina symptoms (RR=1.13, 95%CI=[1.07, 1.20]), showed greater increased effect on the improvement of electrocardiogram (ECG) results (RR=1.39, 95%CI=[1.28, 1.50]), and the percentage of patients with adverse events was significantly decreased in the treatment of CSP in comparison with nitrates (2.4% vs. 29.7%). CONCLUSIONS: CSP has significant effect on the improvement of angina symptoms and ECG results with few adverse events. However, the methodological quality of clinical trials with CSP for SAP needs to be improved, and the outcome measures should include mortality, quality of life, and other end-points.
Publication Types:
PMID: 16369479 [PubMed - indexed for MEDLINE]
<input ... >4: J Clin Pharmacol. 2005 Dec;45(12):1345-59. Related Articles, Links 
Danshen: an overview of its chemistry, pharmacology, pharmacokinetics, and clinical use.
Zhou L, Zuo Z, Chow MS.
Faculty of Medicine, School of Pharmacy and Drug Development Centre, Chinese University of Hong Kong, Shatin, N.T. Hong Kong, PR China.
Danshen, the dried root of Salvia miltiorrhiza, has been widely used in China and, to a lesser extent, in Japan, the United States, and other European countries for the treatment of cardiovascular and cerebrovascular diseases. In China, the specific clinical use is angina pectoris, hyperlipidemia, and acute ischemic stroke. The current review covers its traditional uses, chemical constituents, pharmacological activities, pharmacokinetics, clinical applications, and potential herb-drug interactions based on information obtained in both the English and Chinese literature. Although numerous clinical trials have demonstrated that certain Danshen products in China are effective and safe for the treatment of cardiovascular diseases, most of these lack sufficient quality. Therefore, large randomized clinical trials and further scientific research to determine its mechanism of actions will be necessary to ensure the safety, effectiveness, and better understanding of its action.
Publication Types:
PMID: 16291709 [PubMed - indexed for MEDLINE]
<input ... >5: Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Jun;24(6):500-4. Related Articles, Links -
[Systematic assessment on randomized controlled trials for treatment of stable angina pectoris by compound salvia pellet]
[Article in Chinese]
Wang L, Xiong ZY, Wang G.
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu (610041). wunglei@hotmail.com
OBJECTIVE: To assess the therapeutic effect and safety of compound salvia pellet (CSP) in treating stable angina pectoris (SAP). METHODS: Literatures regarding randomized clinical trials of CSP versus nitrate ester preparation in treating SAP, without any language limitation, were reviewed. Jadad scale was used to assess the methodological quality of the inclusive trials, and Cochrane systematic evaluation was applied for it. RESULTS: Seventeen randomized trials conformed to the inclusion criteria were reviewed, all in Chinese language. The combined results of the two comparing groups on therapeutic effect in symptom of angina and electrocardiogram (ECG) showed that the relative risk (RR) was 1.12 (1.06, 1.19) and the 95% credibility interval (CI) was 1.42 (1.20, 1.57). CONCLUSION: Based on the Cochrane systematic review, CSP showed the therapeutic effect in treating SAP on relieving angina and improving ECG better than that of nitrate ester preparation, and with less adverse reaction and good tolerance. However the conclusion cannot be reached yet due to the low methodological quality of the trials collecting and lacking in some important final markers and relevant criteria for quality of life, more rationally designed and strictly executed randomized trials with large samples are necessary.
Publication Types:
PMID: 15250200 [PubMed - indexed for MEDLINE]
<input ... >6: Acta Pharmacol Sin. 2000 Dec;21(12):1089-94. Related Articles, Links -
Salvia miltiorrhiza and ischemic diseases.
Ji XY, Tan BK, Zhu YZ.
Department of Pharmacology, Faculty of Medicine, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260.
The demonstration of beneficial effects of salvia miltiorrhiza (DanShen) on ischemic diseases has revolutionized the management of angina pectoris, myocardial infarction (MI) or stroke in Chinese society. Experimental studies have shown that DanShen dilated coronary arteries, increased coronary blood flow, and scavenged free radicals in ischemic diseases, so that it reduced the cellular damage from ischemia and improved heart functions. Clinical trials also indicated that DanShen was an effective medicine for angina pectoris, MI, and stroke. This review will focus on DanShen's effects in angina pectoris, MI and stroke.
Publication Types:
PMID: 11603281 [PubMed - indexed for MEDLINE]
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