Treating chronic pulmonary heart disease with traditional Chinese medicine: Systematic evaluation and mechanistic insights into the resolving phlegm and activating blood approach

• Published in: Heart & lung 2025-01, Vol.69, p.111-126
• Main Authors: Meng, Tianwei, Wu, Weidong, Wang, Boyu, Li, Chengjia, Li, Jiarui, Liu, Jiawen, Wang, Jianying, Qie, Rui
• Format: Article
• Language: English
• Subjects: Activating blood; Chronic Disease; Chronic pulmonary heart disease; Drugs, Chinese Herbal - pharmacology; Drugs, Chinese Herbal - therapeutic use; Humans; Medicine, Chinese Traditional - methods; Molecular mechanism; Pulmonary Heart Disease - drug therapy; Randomized Controlled Trials as Topic; Resolving phlegm; Systematic review
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2024.09.017

•This study demonstrates the superior efficacy of combining RPAB with Western medicine over western medicine alone in treating CPHD, through improved clinical outcomes and pulmonary functions.•Through data standardization and association rule analysis, this study identified Astragalus membranaceus (Fisch.) Bunge, Ligusticum chuanxiong Hort. ex S. H. Qiu & al., and Stellaria alsine Grimm as the core herbal combination in the RPAB method.•It reveals the core herbal combination in RPAB targets multiple pathways related to CPHD, offering a scientific basis for its clinical use and potential treatment strategies. Chronic Pulmonary Heart Disease (CPHD) significantly impacts global health, especially among middle-aged and older adults. In China, the Traditional Chinese Medicine (TCM) technique of Resolving Phlegm and Activating Blood (RPAB) is widely used to treat CPHD, although high-quality evidence supporting its efficacy remains limited. The purpose of this study was to rigorously assess the clinical efficacy of RPAB for CPHD and elucidate the mechanisms underlying its primary herbal components. Through a detailed search of literature in both Chinese and English and strict inclusion and exclusion criteria, 18 randomized controlled trials (RCTs) were selected for meta-analysis. We identified RPAB's core herbal combinations using association rule analysis. This method statistically analyzes the frequency and correlation of herbal medicine usage. We then analyzed the chemical components of these combinations and investigated their potential intervention mechanisms on CPHD through network pharmacology. The combination of RPAB with Western medicine was superior to Western medicine alone in improving blood gas analysis and pulmonary function and reducing plasma viscosity in CPHD patients. The core herbal combination identified was Astragalus membranaceus (Fisch.) Bunge, Ligusticum chuanxiong Hort. ex S. H. Qiu & al., and Stellaria alsine Grimm (ALS). This combination targeted 588 therapeutic and 27 core targets. It influenced ten core compounds across 34 pathways, primarily through the chemokine signaling pathway and the JAK-STAT signaling pathway. RPAB with Western medicine significantly improves CPHD treatment outcomes. The study highlights the therapeutic potential of the ALS combination, which operates through multiple pathways to remodel pulmonary arteries, decrease inflammation, and lessen oxidative stress. These insights support the clinical application of RP