Selected Herbal Therapies Note: 1.

Danshen (Salvia miltiorrhiza) Grade C: unclear or conflicting scientific evidence (cardiovascular disease/ angina) Mechanism of action Although the potential mechanisms have not been confirmed, danshen may have antioxidant effects and has been shown to decrease endothelin levels, which are elevated in patients with CHD. Danshen may also benefit lipoprotein levels. In animals, treatment with a salvianolic acid B-rich fraction of Salvia militiorrhiza induced apoptosis in the neointima of vascular system. In animal study, danshen increased the coronary flow rate in isolated rat hearts, offering protection. Constituents of danshen root, particularly protocatechualdehyde and 3,4-dihydroxypheanyl-lactic acid, are believed to be responsible for its vascular effects. Scientific evidence of effectiveness As an ancient Chinese medicine, danshen has traditionally been used in combination with other herbs to treat cardiovascular disease. There is limited clinical evidence that danshen may provide benefits in patient with disorder of the heart and blood vassels, including cardiac chest pain (angina). Studies have shown danshen to relieve chest pain, prolog exercise duration, and delay the time of onset of exercise duration, and delay time of onset of exercise angina. Danshen was also reported to be as effective as isosorbide dinitrate (Isordil) in relieving symptoms in patients with chronic stable angina. However, studies have been small and weak methodological strength. Nonetheless, this research provides preliminary evidence that danshen may be beneficial in patients with angina. Dose No specific dose or standardized preparation of danshen is widely accepted for cardiovascular disorders.

2. Dong quai (Angelica sinensis) Grade C: unclear or conflicting scientific evidence (angina pectoris/coronary artery disease) Mechanism of action The mechanism of dong quai in angina is not well understood. The compound n-butylidenephthalide, isolated from Angelica sinensis, has demonstrated vasorelaxation and increased coronary blood flow in animal studies. Scientific Evidence of Effectiveness Preliminary evidence from animal studies suggests that nbutylidenephthalide may be beneficial in the treatment of angina without increasing blood preasure. Human studies are lacking. Dose The dose of dong quai for anghina has not been determined.

3. Ginseng (Panax spp.) Grade C: Unclear or conflicting scientific evidence (coronary artery disease) Mechanism of action Because ginseng has been studied in combination with other agents, it is difficult to extrapolate its mechanism of action for angina. Scientific evidence of effectiveness Several studies from China report that ginseng in combination with various other herbs, including ophiopogon root (Ophiopogonis japonicus) and magnolia vine (Schisandra chinensis), may reduce CAD symptoms (e.g. angina chest pain) and may improve ECG abnormalities. However, because ginseng has not been studied as a monotheraphy for angina, it is difficult to determine if there effects are attributable solely to ginseng. Dose The dose of ginseng for CAD has not been determined. 4. Hawthorn (Crataegus spp.)

Grade C: unclear or conflicting scientific evidence (coronary artery disease/angina) Mechanism of action The mechanism of action by which hawthorn reduces angina is not well understood. Increased myocardial perfusion and performance has been observed in animals after they were exposed to hawthorn. Scientific evidence of effectiveness A randomized, double blind trial of 46 patients was conducted to evaluate the effects of hawthorn of angina. Patients received 100 mg of Crataegus pinnatifida extract orally three times daily or placebo for 4 weeks. With the exception of nitroglycerin (NTG) during angina episodes, no beta blockers, calcium antagonists, or antianginal drugs were used, and digoxin, diuretics, or antihypertensive drugs were continued. After 4 weeks of treatment, angina improved in 91%of patients in the hawthorn group, versus only 37% (p>0.01) in the placebo group. Accordingly, 45% of the hawthorn group completely stopped NTG, versus 25% of the placebo group. An additional 35% of the hawthorn group reduced intake of NTG, versus 11% in the placebo group (p<0.01). ECG findings improved in 46% of hawthorn subjects, versus 3% of placebo group (p<0.01). These results suggested that hawthorn may effectively prevent angina in CAD patients. Hawthorn, most patients did not receive beta blockers of ACE inhibitors regularly, often considered the standard of care, so the result may not be applicable to patients taking these drugs. Dose The dose of hawthorn for angina has not been clearly established.