Qiliqiangxin
Qiliqiangxin (QLQX, Chinese: 气力强心; pinyin: qī lǐ qiáng xīn; lit. 'strengthening the heart through energy and power') is a traditional Chinese medicine formulation used for the treatment of chronic heart failure.[1][2] It was approved by the Chinese Food and Drug Administration in 2004 and included in the Chinese guidelines for the management of heart failure in 2014.[3][4]
Composition
[edit]Qiliqiangxin consists of a standardized extract derived from eleven medicinal herbs commonly used in traditional Chinese medicine (TCM), including:[5][6]
- Panax ginseng (ginseng)
- Astragalus mongholicus (Mongolian milkvetch)
- Aconitum carmichaelii (Chinese aconite root)
- Salvia miltiorrhiza (red sage)
- Descurainia sophia (flixweed)
- Periploca sepium (Chinese silkvine root bark)
- Alisma plantago-aquatica subsp. orientale (Oriental waterplantain)
- Carthamus tinctorius (safflower)
- Polygonatum odoratum (Angular Solomon's seal)
- Citrus reticulata (dried mandarin peel)
- Cinnamomum cassia (cinnamon twig)
Identified bioactive compounds include astragaloside IV, tanshinone IIA, ginsenosides (Rb1, Rg1, Re), periplocymarin, and nobiletin.[6] These components are associated with various pharmacological properties, including positive inotropic effects, vasodilation, and anti-inflammatory and antifibrotic activity.[5]
Traditional medicine perspective
[edit]In traditional Chinese medicine, chronic heart failure is associated with a deficiency of heart qi and yang, often resulting in symptoms attributed to blood stasis, phlegm accumulation, and impaired fluid transport.[5] Qiliqiangxin is formulated to replenish heart qi, yang, activate blood circulation, and resolve phlegm according to TCM theory.[5][6]
Administration
[edit]Qiliqiangxin is administered orally in the form of capsules or placebo. In clinical use, including the QUEST trial, the standard dosage consisted of 0.3 g capsules taken as four capsules three times daily (a total daily dose of 3.6 g). The capsules were administered alongside standard guideline-directed therapy for chronic heart failure. Dose adjustments, such as reducing to two or three capsules three times daily, or temporary discontinuation, were permitted in response to adverse events.[7]
In preclinical studies, the administration methods varied according to the model organism. In rat models of myocardial infarction, qiliqiangxin was administered at a dose of 1.0 g/kg/day, dissolved in sterile water and given by oral gavage for four weeks. In mouse studies, intragastric administration was employed, with doses ranging from 0.25 to 0.75 g/kg/day. A dose of 0.5 g/kg/day was used in most subsequent mouse experiments, as it was considered pharmacologically equivalent to clinical dosing in humans.[8]
References
[edit]- ^ Hao, Panpan; Jiang, Fan; Cheng, Jing; Ma, Lianyue; Zhang, Yun; Zhao, Yuxia (2017-06-20). "Traditional Chinese Medicine for Cardiovascular Disease: Evidence and Potential Mechanisms". Journal of the American College of Cardiology. 69 (24): 2952–2966. doi:10.1016/j.jacc.2017.04.041. ISSN 1558-3597. PMID 28619197.
- ^ Jia, Qiujin; Wang, Lirong; Zhang, Xiaonan; Ding, Yuejia; Li, Hao; Yang, Yingxi; Zhang, Ao; Li, Yanyang; Lv, Shichao; Zhang, Junping (2020). "Prevention and treatment of chronic heart failure through traditional Chinese medicine: Role of the gut microbiota". Pharmacological Research. 151: 104552. doi:10.1016/j.phrs.2019.104552. ISSN 1096-1186. PMID 31747557.
- ^ Li, Xinli; Zhang, Jian; Huang, Jun; Ma, Aiqun; Yang, Jiefu; Li, Weimin; Wu, Zonggui; Yao, Chen; Zhang, Yuhui; Yao, Wenming; Zhang, Boli; Gao, Runlin; Efficacy and Safety of Qili Qiangxin Capsules for Chronic Heart Failure Study Group (2013-09-17). "A multicenter, randomized, double-blind, parallel-group, placebo-controlled study of the effects of qili qiangxin capsules in patients with chronic heart failure". Journal of the American College of Cardiology. 62 (12): 1065–1072. doi:10.1016/j.jacc.2013.05.035. ISSN 1558-3597. PMID 23747768.
- ^ Chinese Society of Cardiology of Chinese Medical Association; Editorial Board of Chinese Journal of Cardiology (2014). "[Chinese guidelines for the diagnosis and treatment of heart failure 2014]". Zhonghua Xin Xue Guan Bing Za Zhi. 42 (2): 98–122. ISSN 0253-3758. PMID 24735621.
- ^ a b c d Han, Anbang; Lu, Yingdong; Zheng, Qi; Zhang, Jian; Zhao, YiZhou; Zhao, Mingjing; Cui, Xiangning (2018). "Qiliqiangxin Attenuates Cardiac Remodeling via Inhibition of TGF-β1/Smad3 and NF-κB Signaling Pathways in a Rat Model of Myocardial Infarction". Cellular Physiology and Biochemistry. 45 (5): 1797–1806. doi:10.1159/000487871. ISSN 1015-8987.
- ^ a b c Packer, Milton (2023). "Qiliqiangxin: A multifaceted holistic treatment for heart failure or a pharmacological probe for the identification of cardioprotective mechanisms?". European Journal of Heart Failure. 25 (12): 2130–2143. doi:10.1002/ejhf.3068. ISSN 1879-0844. PMID 37877337.
- ^ Cheang, Iokfai; Yao, Wenming; Zhou, Yanli; Zhu, Xu; Ni, Gehui; Lu, Xinyi; Liao, Shengen; Gao, Rongrong; Zhou, Fang; Shen, Jiangang; Leung, Alice Yeuk Lan; Jiang, Meng; Kong, Hong; Bai, Ling; Mahemuti, Ailiman (2024). "The traditional Chinese medicine Qiliqiangxin in heart failure with reduced ejection fraction: a randomized, double-blind, placebo-controlled trial". Nature Medicine. 30 (8): 2295–2302. doi:10.1038/s41591-024-03169-2. ISSN 1546-170X. PMC 11333273. PMID 39095596.
- ^ Tao, Lichan; Shen, Sutong; Fu, Siyi; Fang, Hongyi; Wang, Xiuzhi; Das, Saumya; Sluijter, Joost P. G.; Rosenzweig, Anthony; Zhou, Yonglan; Kong, Xiangqing; Xiao, Junjie; Li, Xinli (2015-02-11). "Traditional Chinese Medication Qiliqiangxin attenuates cardiac remodeling after acute myocardial infarction in mice". Scientific Reports. 5: 8374. doi:10.1038/srep08374. ISSN 2045-2322. PMC 4648480. PMID 25669146.