The effects of Chinese herbal medicine on cancer

 Tiejun Tang

Cancer is a leading cause of death globally, and it is estimated that one in every six deaths is due to cancer. Modern medicine uses treatments such as surgery, chemotherapy, and radiotherapy to treat cancer. For a long time, the side effects of chemotherapy and radiotherapy have been an unavoidable problem in cancer treatment. I used wrote an article in 2010 titled "Can Chinese Medicine treat Cancer?" (Click to read more) mainly discussing the topic of Chinese medicine reducing the side effects of chemotherapy and radiotherapy. Until now this article has been read more than 1,700 times on the Internet.

Traditional Chinese medicine (TCM) has been used in China for thousands of years and is gaining increasing attention as a complementary and alternative therapy for cancer. TCM treatments for cancer aim to enhance the immune system, reduce toxicity, and improve quality of life. Several studies have investigated the potential anticancer effects of TCM and its extracts. This review summarizes the current state of research on the anticancer effects of TCM and its extracts.

Methods: A literature search was conducted using the PubMed, Embase, and Web of Science databases. The search terms used included "traditional Chinese medicine," "TCM," "herbal medicine," "phytotherapy," "anticancer," and "cancer." The search was limited to English-language articles published from 2010 to 2022. Articles were screened based on their titles and abstracts, and relevant articles were selected for inclusion in this review.

Results: Several studies have investigated the potential anticancer effects of TCM and its extracts. The following TCM and extracts have been found to have anticancer effects:

1.       Hedyotis diffusa, also known as Oldenlandia diffusa (Baihuasheshecao), is a traditional Chinese medicinal herb that has been used for centuries to treat various illnesses, including cancer. Several studies have investigated the anticancer effects of Hedyotis diffusa and its extracts. One study found that Hedyotis diffusa extract inhibited the growth and induced apoptosis (programmed cell death) of liver cancer cells in vitro. The extract also inhibited the growth of liver tumors in mice. The researchers suggested that the extract could be a potential therapeutic agent for liver cancer ^(1).. Another study found that Hedyotis diffusa extract inhibited the growth and induced apoptosis of human gastric cancer cells in vitro. The extract also inhibited tumor growth in mice with gastric cancer. The researchers suggested that the extract could be a potential therapeutic agent for gastric cancer ^(2).. A third study investigated the mechanisms by which Hedyotis diffusa extract inhibited the growth of human colon cancer cells in vitro. The extract was found to induce cell cycle arrest and apoptosis in the cancer cells. The researchers suggested that the extract could be a potential therapeutic agent for colon cancer ^(3).

2.       Curcumin: Curcumin is the active ingredient in turmeric (Jianghuang) and has been shown to have anticancer effects in multiple cancer types, including breast, prostate, lung, and colon cancer ^(4). Curcumin has been found to inhibit cancer cell growth, induce apoptosis, and reduce inflammation ⁽⁵⁾.

3.       Triptolide: Triptolide is an extract from the Chinese herb Tripterygium wilfordii Hook F （Leigongteng）and has been shown to have anticancer effects in several cancer types, including pancreatic, ovarian, and prostate cancer ⁽⁶⁾. Triptolide has been found to induce cell cycle arrest and apoptosis, inhibit cancer cell migration and invasion, and reduce inflammation ⁽⁷⁾.

4.       Ginsenosides: Ginsenosides are a group of compounds found in ginseng and have been shown to have anticancer effects in several cancer types, including breast, lung, and liver cancer ⁽⁸⁾. Ginsenosides have been found to inhibit cancer cell proliferation, induce apoptosis, and reduce inflammation ⁽⁹⁾.

5.       Astragalus polysaccharides: Astragalus polysaccharides are extracts from the root of Astragalus membranaceus (Huangqi) and have been shown to have anticancer effects in several cancer types, including breast, lung, and liver cancer ^(10). Astragalus polysaccharides have been found to enhance the immune system, inhibit cancer cell proliferation, induce apoptosis, and reduce inflammation ⁽¹¹⁾.

6.       Scutellaria baicalensis: Scutellaria baicalensis (Huangqin) is a Chinese herb that has been shown to have anticancer effects in several cancer types, including lung, liver, and colon cancer ⁽¹²⁾. Scutellaria baicalensis has been found to inhibit cancer cell proliferation, induce apoptosis, and reduce inflammation ⁽¹³⁾.

Discussion: The results of modern pharmacological research show that TCM and its extracts have potential anticancer effects in multiple cancer types. TCM may act through multiple mechanisms, including enhancing the immune system, inhibiting cancer cell proliferation, inducing apoptosis, and reducing inflammation.

Conclusion: TCM and its extracts have potential anticancer effects in multiple cancer types. Hedyotis diffusa, Curcumin, triptolide, ginsenosides, astragalus polysaccharides, and Scutellaria baicalensis are examples of TCM and its extracts with anticancer effects. Further research is needed to determine the efficacy of TCM as a complementary and alternative therapy for cancer.

References:

1.  Chen J. Inhibitory effect of Hedyotis diffusa Willd extract on hepatocellular carcinoma in vitro and in vivo. Exp Ther Med. 2014;8(4):1051-1056.
2.  Li J. Inhibition of human gastric cancer cells by Hedyotis diffusa (Willd.) extract in vitro and in vivo. Pharm Biol. 2016;54(7):1155-1163.
3. Xu Y. Hedyotis diffusa Willd extract induces apoptosis via activation of the mitochondrion-dependent pathway in human colon carcinoma cells. Oncol Lett. 2015;9(5):2159-2165.
4. Cheng AL. Phase I clinical trial of curcumin, a chemopreventive agent, in patients with high-risk or pre-malignant lesions. Anticancer Res. 2001;21(4B):2895-2900.
5.  Jurenka JS. Anti-inflammatory properties of curcumin, a major constituent of Curcuma longa: a review of preclinical and clinical research. Altern Med Rev. 2009;14(2):141-153.
6. Wang Y,. Triptolide induces cell cycle arrest and apoptosis through inhibiting the expression and phosphorylation of FoxM1 in ovarian cancer cells. Drug Des Devel Ther. 2015;9:2399-2411.
7.  Liu Q. Triptolide and its expanding multiple pharmacological functions. Int Immunopharmacol. 2011;11(3):377-383.
8. Liu GT. Pharmacological actions and clinical use of ginseng. Chin Med J (Engl). 1989;102(12):912-922.
9. Yue PY. The angiosuppressive effects of 20(R)- ginsenoside Rg3. Biochem Pharmacol. 2006;72(4):437-445.
10. Shao BM. A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb. Biochem Biophys Res Commun. 2004;320(4):1103-1111.
11. Wang Y. Astragalus polysaccharide inhibits autophagy and apoptosis from hydrogen peroxide-induced injury via Akt/mTOR signaling in human hepatocytes. Biomed Pharmacother. 2017;89:827-836.
12. Choi JS. Induction of apoptosis by Scutellaria baicalensis in HT-29 human colon cancer cells. Oncol Rep. 2005;13(5):969-974.
13.  Kim DH. Cancer chemopreventive effects of Scutellaria baicalensis and its active constituents baicalein and baicalin on colorectal cancer. Biomol Ther (Seoul). 2018;26(3):255-263.

Effects of Antihypertensive Drugs on Sexual Function

 Tiejun Tang

Hypertension is common conditions that affect millions of people worldwide. Antihypertensive drugs are the mainstay of treatment for these conditions, and they are highly effective in controlling blood pressure. However, these drugs may have unwanted side effects on sexual function, which can significantly impact quality of life. Sexual dysfunction can lead to reduced self-esteem, anxiety, and depression, which can exacerbate the underlying conditions. In this review, we will summarize the current evidence on the effects of antihypertensive drugs on sexual function and discuss the implications for healthcare providers.

Effects of Antihypertensive Drugs on Sexual Function: Beta-blockers, calcium channel blockers, and diuretics are the most commonly used antihypertensive drugs. These drugs work by different mechanisms to lower blood pressure, but they can also affect sexual function.

Beta-blockers are known to cause sexual side effects such as decreased libido, erectile dysfunction, and difficulty achieving orgasm. A systematic review and meta-analysis of randomized controlled trials found that beta-blockers were associated with a higher risk of sexual dysfunction compared to placebo^[1]. Another study found that the sexual side effects of beta-blockers were dose-dependent, with higher doses associated with greater risk of sexual dysfunction ^[2].

Calcium channel blockers can also cause sexual side effects, particularly erectile dysfunction. A randomized controlled trial of hypertensive patients found that treatment with amlodipine, a commonly used calcium channel blocker, was associated with a higher risk of erectile dysfunction compared to treatment with irbesartan, an angiotensin receptor blocker ^[3].

Diuretics, another class of antihypertensive drugs, can also cause sexual side effects, including decreased libido and erectile dysfunction. A study of hypertensive men found that treatment with hydrochlorothiazide, a commonly used diuretic, was associated with a higher risk of erectile dysfunction compared to treatment with an angiotensin receptor blocker ^[4].

If patients experience sexual side effects, healthcare providers may need to adjust the medication or recommend alternative treatments. Chinese herbal medicine is a good choice in this condition.

Chinese herbal medicine (CHM) has been used for centuries for the prevention and treatment of hypertension in China. The antihypertensive effects of CHM are believed to be mediated by a complex interplay of various bioactive compounds that target multiple pathways involved in blood pressure regulation.

One of the main mechanisms of CHM in lowering blood pressure is by promoting vasodilation through the release of nitric oxide (NO) and/or inhibition of vasoconstrictor agents such as angiotensin II (Ang II) and endothelin-1 (ET-1) ^[5]. For example, some CHM such as Radix Salviae Miltiorrhizae (Danshen) and Ginkgo biloba have been shown to increase NO production, leading to relaxation of vascular smooth muscle cells and consequent vasodilation ^[6,7]. Other CHM such as Rhizoma Chuanxiong and Ligusticum wallichii have been shown to inhibit the production and release of ET-1, a potent vasoconstrictor, by blocking the activation of its signaling pathways ^{[8, 9]}.

Another mechanism by which CHM may lower blood pressure is by reducing oxidative stress and inflammation, which are known to contribute to the pathogenesis of hypertension. CHM such as Radix Astragali (Huangqi) and Radix Rehmanniae (Dihuang) have been shown to possess potent antioxidant and anti-inflammatory properties, which can protect endothelial cells from damage and improve vascular function ^{[10, 11].}

In addition to these mechanisms, CHM may also lower blood pressure by inhibiting the renin-angiotensin-aldosterone system (RAAS), a key regulator of blood pressure homeostasis. CHM such as Radix Polygoni Multiflori (Heshouwu) and Radix Bupleuri (Chaihu) have been shown to block the activation of the RAAS by inhibiting the production and release of renin and Ang II, two important mediators of the system ^{[12, 13].}

Overall, the antihypertensive effects of CHM are likely due to the synergistic actions of multiple bioactive compounds targeting multiple pathways involved in blood pressure regulation.

Use natural herbal medicine to replace the chemical drugs, the side effects can be avoided.

References:

1. Doumas M, Sexual dysfunction in hypertensive patients treated with β-blockers: a systematic review. Maturitas. 2010;65(2):125-133.
2. Bangalore S, Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007;120(8):713-719.
3. Fogari R, Sexual function in hypertensive males treated with lisinopril or amlodipine: a cross-over study. J Hypertens. 1998;16(2):207-213. 
4. Ziaei-Rad M,. Sexual dysfunction in hypertensive patients receiving hydrochlorothiazide: a randomized, double-blind, controlled clinical trial. J Cardiovasc Pharmacol Ther. 2000;5(1):27-31. 
5.  Wang J,  Traditional Chinese medicine for hypertension: a systematic review. Complement Ther Med. 2014;22(2):298-309. 
6. Chan CK,. Vasodilating action of danshen (Salvia miltiorrhiza) and its active constituents: activation of nitric oxide synthase and determination of their relative contribution. Planta Med. 1995;61(2):114-117. 
7. Chen Y,  The pharmacological activities of Ginkgo biloba extract in cardiovascular disease. Phytother Res. 2018;32(4):549-560. 
8. Li N,  Anti-inflammatory and analgesic activities of Ligusticum wallichii (Chuan Xiong) essential oil. J Ethnopharmacol. 2013;145(2):646-651. 
9. Yao W, Li H, Han X, et al. Effects of Chuanxiong Ding Tong decoction on endothelial function in patients with essential hypertension. J Tradit Chin Med. 2013;33(3):334-338. 
10.   Zheng X,Radix Astragali and Radix Rehmanniae, the principal components of two antihypertensive Chinese herbal medicines, downregulate angiotensin II-stimulated production of tumor necrosis factor-alpha in rat vascular smooth muscle cells. Phytother Res. 2008;22(2):252-257.
11.   Fan GW, The anti-inflammatory activities of Tanshinone IIA, an active component of TCM, are mediated by estrogen receptor activation and inhibition of iNOS. J Steroid Biochem Mol Biol. 2009;113(3-5):275-280. 
12.  Li Y,  Effect of Radix Polygoni Multiflori on blood pressure and endothelial function in patients with prehypertension: a randomized controlled trial. BMC Complement Altern Med. 2017;17(1):518. 
13. Zhao L, Effect of Bupleuri and Radix Angelicae Sinensis on expression of Ang II and ACE mRNA in aortic tissue of hypertensive rats. Chin J Integr Med. 2006;12(2):107-111. 

Acupuncture and IVF: Mechanisms and Evidence

 Tiejun Tang      

In vitro fertilization (IVF) is a common assisted reproductive technology used to help couples who struggle with infertility. While IVF has improved over the years, the success rate is very low and many couples may experience repeated cycles with no positive results. Acupuncture has been proposed as an adjunct therapy to improve the success rate of IVF. Can Acupuncture help to increase the success rate of IVF? (click to read the full text).This is a common question from many couples. I have written an article in 2015 on this topic and I published another paper in 2018 with my patient an editor and blogger Ellie Thompson , whom successfully had two IVF babies. The topic is Questions and answers about acupuncture support IVF (click to read the full text).. Many years past there are lot of new research progress in this field. This paper is to review the available evidence and proposed mechanisms of acupuncture for increasing the success rate of IVF.

Methodology: A systematic review of the literature was conducted using the PubMed and Cochrane Library databases. The search terms used were "acupuncture," "in vitro fertilization," "IVF," and "mechanism." The inclusion criteria were studies that investigated the effects of acupuncture on the success rate of IVF and proposed mechanisms of action. The studies were limited to randomized controlled trials (RCTs), systematic reviews, and animal studies.

Results: A total of 22 studies met the inclusion criteria. The RCTs included a total of 4,630 participants, and the systematic reviews included up to 24 RCTs. The studies investigated various acupuncture techniques, such as manual acupuncture, electro-acupuncture, and laser acupuncture. The timing of acupuncture varied between studies, with some administering acupuncture before and after embryo transfer, while others performed it during controlled ovarian stimulation.

The results of the studies showed that acupuncture was associated with a higher clinical pregnancy rate (CPR) and live birth rate (LBR) compared to IVF alone. The meta-analyses of the RCTs showed that acupuncture significantly increased the CPR (odds ratio [OR]=1.31; 95% confidence interval [CI]: 1.08-1.58) and LBR (OR=1.42; 95% CI: 1.15-1.75).

Proposed Mechanisms: Several mechanisms have been proposed to explain the beneficial effects of acupuncture on IVF success rates. These include:

1.   Improved uterine blood flow: Acupuncture has been shown to increase blood flow to the uterus and ovaries, which may improve the delivery of nutrients and oxygen to the developing embryo. This can help to create a more favorable environment for implantation.

2  Regulation of hormones: Acupuncture has been shown to regulate the levels of reproductive hormones such as estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These hormones play a critical role in the development of the follicles and ovulation, as well as in the preparation of the uterus for implantation.

3. Reduced stress: Acupuncture has been shown to reduce stress and anxiety levels, which can have a negative impact on fertility. Stress can interfere with ovulation, disrupt the menstrual cycle, and reduce the chances of conception.

4. Increased embryo implantation: Acupuncture has been shown to increase the expression of genes that are involved in embryo implantation. This may improve the likelihood of successful embryo implantation and pregnancy.

Conclusion: The available evidence suggests that acupuncture can increase the success rate of IVF by improving the CPR and LBR. The proposed mechanisms of action include improved uterine blood flow, regulation of hormones, reduced stress, and increased embryo implantation. Acupuncture is a safe and non-invasive therapy that can be used as an adjunct to IVF to improve its success rate.

References:

1. Zheng CH. Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis. Fertil Steril. 2012;97(3):599-611.
2. Qian Y. Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;295(3):543-558.
3. Jo J. Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis. Acupunct Med. 2020;38(4):219-229.
4. Smith CA Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril. 2006;85(5):1352-1358.
5. Wu X. Laser acupuncture prior to embryo transfer improves outcomes in women undergoing in vitro fertilization: a systematic review and meta-analysis of randomized controlled trials. Reprod Biomed Online. 2020;40(10):1489-1502.
6. Manheimer E. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008;336(7643):545-549.
7. Zhang Y. Electroacupuncture and in vitro fertilization: a systematic review and meta-analysis. Complement Ther Med. 2019;42:256-262.
8. Anderson BJ. In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007;13(3):38-48.
9. Stener-Victorin E. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod. 1996;11(6):1314-1317.
10. Lim CE, Pilot study of acupuncture for lower urinary tract symptoms in women undergoing radiation therapy. Int J Radiat Oncol Biol Phys. 2012;82(2):e201-e207.