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      Modulation by anti-oketsu formulations in Kampo medicine of human arterial stiffness

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          Abstract

          Highlights

          “Oketsu” syndrome is the stagnation and disturbance of microcirculation. This paper focuses on the effect of traditional herbal medicine (Kampo medicine in Japan) on human cardiovascular function. These findings show that the anti-oketsu formulations can exert the ameliorative action for oketsu persons via decreasing augmentation index and central arterial blood pressure.

          Editor’s Summary

          Tokishakuyakusan (TS, Dang-Gui-Shao-Yao-San), Kamishoyosan (KS, Jia-Wei-Xiao-Yao-San), Keisibukuryogan (KB, Gui-Zhi-Fu-Ling-Wan) and Tokakujokito (TJ, Tao-He-Cheng-Qi-Tang) decoctions are the classical ancient formulas used for blood stasis. TS, KB and TJ decoctions first appeared in Shanghan Lun, which was published in the third century A.D. (Eastern Han Dynasty of China). KS decoction first appeared in Zhengzhi Zhunsheng, which was published in 1602 A.D. (Ming Dynasty of China).

          Abstract

          Objective: In traditional herbal medicine (Kampo medicine in Japan), “sho” is diagnosed by the traditional assessments of clinical conditions. Among a variety of the shos, there is an “oketsu” syndrome, which is a stagnation and disturbance of microcirculation. The prompt effects of four anti-oketsu formulations in Kampo medicine on cardiovascular functions were compared in oketsu and non-oketsu persons. Methods: The arterial pulse wave from radial artery is formed by the combination with ejection and reflection pulses. An augmentation index (AI), a ration of the ejection and reflection pulses, indicates a degree of arteriosclerosis. For both seventy-six students with oketsu and thirty-seven students with non-oketsu, Kampo formulations overcoming oketsu of Tokishakuyakusan (TS, Dang-Gui-Shao-Yao-San), Kamishoyosan (KS, Jia-Wei-Xiao-Yao-San), Keisibukuryogan (KB, Gui-Zhi-Fu-Ling-Wan) and Tokakujokito (TJ, Tao-He-Cheng-Qi-Tang) were taken once, and then, the cardiovascular functions including blood pressure, heart rate, central arterial blood pressure (CBP) and AI were examined for 60 min. Results: At 40-60 min after an intake, these formulations decreased the AI almost by 6-18% (n = 76), by 18.3±3.1% ( P < 0.01, n = 15) with TJ. Simultaneously, the CBP was reduced by 9.0±1.8% ( P < 0.05, n = 23) with KS and by 9.1±2.0% ( P < 0.05, n = 15) with TJ. On the other hands, non-oketsu group had less or no effect by any kinds of the formulations. Conclusion: The anti-oketsu formulations can exert the ameliorative action for oketsu persons via decreasing AI and CBP.

          Translated abstract

          目的 比较四种活血化瘀方对瘀血人群和非瘀血人群心血管功能的影响。 方法 发射脉冲和反射脉冲形成桡动脉搏动波,其比值即反射波增强指数 (AI) 反映了动脉硬化的程度。根据瘀血证诊断评分标准把受试者分为瘀血组 (n = 76) 和非瘀血组 (n = 37),均口服抗活血化瘀方(当归芍药散、加味逍遥散、桂枝茯苓丸或者桃核承气汤),之后连续60分钟监测AI、血压、心率和中心动脉压。 结果 在服药后40-60 分钟,瘀血组的AI 降低6-18%,其中桃核承气汤组的AI 降低18.3±3.1% ( P < 0.01, n = 15)。同时瘀血组中心动脉压也降低,其中桃核承气汤治疗组中心动脉血压降低9.1±2.0% ( P < 0.05, n = 15),加味逍遥散组的中心动脉血压降低9.0±1.8% ( P < 0.05, n = 23)。所有处方对非瘀血组AI、血压、心率和中心动脉压没有显著影响。 结论 活血化瘀方能改善瘀血人群的动脉硬化。

          Most cited references41

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          Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function.

          Central aortic pressures and waveform convey important information about cardiovascular status, but direct measurements are invasive. Peripheral pressures can be measured noninvasively, and although they often differ substantially from central pressures, they may be mathematically transformed to approximate the latter. We tested this approach, examining intersubject and intrasubject variability and the validity of using a single averaged transformation, which would enhance its applicability. Invasive central aortic pressure by micromanometer and radial pressure by automated tonometry were measured in 20 patients at steady state and during hemodynamic transients (Valsalva maneuver, abdominal compression, nitroglycerin, or vena caval obstruction). For each patient, transfer functions (TFs) between aortic and radial pressures were calculated by parametric model and results averaged to yield individual TFs. A generalized TF was the average of individual functions. TFs varied among patients, with coefficients of variation for peak amplitude and frequency at peak amplitude of 24.9% and 16.9%, respectively. Intrapatient TF variance with altered loading (> 20% variation in peak amplitude) was observed in 28.5% of patients. Despite this, the generalized TF estimated central arterial pressures to < or = 0.2 +/- 3.8 mm Hg error, arterial compliance to 6 +/- 7% accuracy, and augmentation index to within -7% points (30 +/- 45% accuracy). Individual TFs were only marginally superior to the generalized TF for reconstructing central pressures. Central aortic pressures can be accurately estimated from radial tonometry with the use of a generalized TF. The reconstructed waveform can provide arterial compliance estimates but may underestimate the augmentation index because the latter requires greater fidelity reproduction of the wave contour.
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            Noninvasive determination of age-related changes in the human arterial pulse.

            Arterial pressure waves were recorded noninvasively from the carotid, radial, femoral, or all three of these arteries of 1,005 normal subjects, aged 2-91 years, using a new transcutaneous tonometer containing a high fidelity Millar micromanometer. Waves were ensemble-averaged into age-decade groups. Characteristic changes were noted with increasing age. In all sites, pulse amplitude increased with advancing age (carotid, 91.3%; radial 67.5%; femoral, 50.1% from first to eighth decade), diastolic decay steepened, and diastolic waves became less prominent. In the carotid pulse, there was, in youth, a second peak on the downstroke of the waves in late systole. After the third decade, this second peak rose with age to merge with and dominate the initial rise. In the radial pulse, a late systolic wave was also apparent, but this occurred later; with age, this second peak rose but not above the initial rise in early systole, even at the eighth decade. In the femoral artery, there was a single systolic wave at all ages. Aging changes in the arterial pulse are explicable on the basis of both an increase in arterial stiffness with increased pulse-wave velocity and progressively earlier wave reflection. These two factors may be separated and effects of the latter measured from pressure wave-contour analysis using an "augmentation index," determined by a computer algorithm developed from invasive pressure and flow data. Changes in peak pressure in the central (carotid) artery show increasing cardiac afterload with increasing age in a normal population; this can account for the cardiac hypertrophy that occurs with advancing age (even as other organs atrophy) and the predisposition to cardiac failure in the elderly. Identification of mechanisms responsible offers a new approach to reduction of left ventricular afterload.
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              Methods and devices for measuring arterial compliance in humans.

              This review analyses methods and devices used worldwide to evaluate the arterial stiffness. Three main methodologies are based upon analysis of pulse transit time, of wave contour of the arterial pulse, and of direct measurement of arterial geometry and pressure, corresponding to regional, systemic and local determination of stiffness. They are used in clinical laboratory and/or in clinical departments. Particular attention is given to the reproducibility data in literature for each device. This article summarizes the discussion of the dedicated Task Force during the first Conference of Consensus on Arterial Stiffness held in June 2000 (Paris, France).
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                Author and article information

                Contributors
                Journal
                TMR Editorial Board
                Traditional Medicine Research
                TMR Editorial Board (Jintang road, 99, Hedong district Tianjin,China, 300170 )
                2413-3973
                July 2017
                15 July 2017
                : 2
                : 3
                : 130-138
                Affiliations
                [1-2413-3973-2-3-130] 1Health Life Science, Shitennoji University, Habikino, Osaka, Japan
                Author notes
                *Correspondence to: Hiroyasu Satoh, Health Life Science, Shitennoji University, 3-2-1 Gakuenmae, Habikino, Osaka, Japan. TEL: +81-72-956-3181, FAX: +81-72-956-6011, E-mail: hysat@ 123456shitennoji.ac.jp .
                Article
                2413-3973-2-3-130
                10.12032/TMR201707049
                09f6e318-2d59-4a36-8bce-1abbe8984ff4

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                History
                : 27 April 2017
                Categories
                Orginal Article

                Medicine,Pharmacology & Pharmaceutical medicine,Health & Social care,Complementary & Alternative medicine
                Oketsu,Disturbances of microcirculation,反射波增强指数,Central arterial blood pressure,Augmentationindex,Sho,,微循环障碍,瘀血,Kampo medicine,汉方医学,中心动脉血压

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