Is Eating Chili Peppers Good or Bad for Your Heart?

 Tiejun Tang

For centuries, chili peppers have added heat and flavor to cuisines around the world. But beyond the spice, scientists have been asking a fiery question: is chili good or bad for the human heart? Recent research suggests that moderate chili consumption might actually protect cardiovascular health — though not everyone agrees.

The Evidence for a Healthy Heart

Over the past decade, several large population studies have investigated the link between spicy foods and heart disease. One of the most influential was conducted in China, following nearly half a million adults for seven years. The researchers found that those who ate spicy food almost every day had a 14% lower risk of death compared with those who rarely did ^[1]. The reduction was particularly strong for deaths due to ischemic heart disease and stroke.

Similar results appeared in Italy’s Moli-sani study, which tracked over 22,000 adults for eight years. Regular chili eaters had a significantly lower risk of cardiovascular and all-cause mortality, even after accounting for other lifestyle factors such as smoking, body weight, and Mediterranean-diet adherence^[2].

When these and other studies were pooled together, meta-analyses confirmed the trend: frequent chili consumption was consistently linked to lower overall and heart-related death rates ^[3,4].

What Could Explain the Benefit?

Scientists believe the active compound capsaicin, which gives chili its heat, may help explain these effects. Capsaicin activates a receptor called TRPV1 in blood vessels and nerve endings. This can lead to vasodilation (wider blood vessels), improved blood flow, and lower inflammation ^[5].

Laboratory experiments and small human trials have shown that capsaicin may reduce cholesterol levels, improve blood vessel flexibility, and boost metabolism ^[6]. These effects could, in theory, lower cardiovascular risk over time.

But the Story Isn’t Entirely Sweet (or Spicy)

Not all findings are conclusive. Most of the strongest human studies are observational, meaning they can show an association but not prove that chili itself causes better heart health. People who eat more chili might also have other habits — such as more plant-based diets or higher physical activity — that contribute to their good outcomes.

In addition, excessive spicy food can cause stomach irritation, worsen acid reflux, or lead to discomfort in people with gastritis or ulcers. Very high doses of capsaicin, especially in supplement form, have been linked to rare cases of coronary vasospasm, a temporary narrowing of heart arteries ^[7]. Howeve, such effects are uncommon at normal dietary levels.

How Much Is Too Much?

So far, the evidence suggests that moderate chili consumption — a few times a week, as part of a balanced diet — is safe and may offer modest cardiovascular benefits. Those who enjoy spicy foods can continue to do so, provided it doesn’t cause gastrointestinal distress. On the other hand, taking high-dose capsaicin supplements for heart protection is not recommended until large, long-term clinical trials confirm clear benefits.

The Takeaway

The spice of life may indeed be good for your heart — in moderation. While scientists continue to study the exact effects of capsaicin, the best advice remains simple: eat a balanced diet rich in fruits, vegetables, and whole foods, and if you like your meals with a little kick, that’s probably just fine for your heart.

References

1. Lv J et al. Consumption of spicy foods and total and cause-specific mortality: a population-based cohort study. BMJ. 2015;351:h3942.
2. Bonaccio M et al. Chili pepper consumption and mortality in Italian adults (Moli-sani study). J Am Coll Cardiol. 2019;74(25):3139-3149.
3. Yamani N et al. Meta-analysis evaluating the impact of chili-pepper intake on all-cause and cardiovascular mortality: A systematic review. Ann Med Surg (Lond). 2021; 8;70:102774
4. Ofori-Asenso R et al. Association of Spicy Chilli Food Consumption With Cardiovascular and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. Angiology. 2021;72(7):625-632.
5. Sreepadaarchana Munjuluri .Capsaicin and TRPV1 Channels in the Cardiovascular System: The Role of Inflammation. Cells. 2021 Dec 22;11(1):18.
6. Vijaya Juturu . Capsaicinoids Modulating Cardiometabolic Syndrome Risk Factors: Current Perspectives. J Nutr Metab. 2016 May 23;2016:4986937.
7. Ozgur Sogut . Acute myocardial infarction and coronary vasospasm associated with the ingestion of cayenne pepper pills in a 25-year-old male. Int J Emerg Med. 2012 Jan 20;5:5.

Is the Famous TCM Formula Angong Niuhuang Wan Effective or Ineffective?

 Tiejun Tang   

Recently, I came across a video on YouTube by a highly popular YouTuber celebrity, Mr. Wang, who claimed that the traditional Chinese patent medicine Angong Niuhuang Wan has no therapeutic benefit in treating acute stroke and performs no better than a placebo. Based on this, he concluded that this long-celebrated and expensive remedy is completely ineffective. Could it really be true that a classic formula used by traditional Chinese medicine (TCM) practitioners for hundreds of years is useless? This article aims to analyze and discuss this issue in detail.

 Source of the Controversy

Mr. Wang’s argument was based on a recently published study in the Chinese Medical Journal (English edition) ^[1]. The study included 117 patients from 17 hospitals across China — 57 in the Angong Niuhuang Wan treatment group and 60 in the placebo group. The conclusion stated that there was no significant difference in efficacy between the two groups. The research was conducted by the Peking Union Medical College Hospital, one of the most prestigious Western medical institutions in China, and published in a top-tier Chinese medical journal. Unsurprisingly, the findings quickly drew attention and spread widely across both mainstream and social media.

Angong Niuhuang Wan was formulated by Wu Jutong (1758-1836), a renowned physician of the Qing dynasty and an expert in the study of febrile diseases. The formula has the functions of clearing heat, resolving phlegm, detoxifying, and opening the orifices. It has been used for over 200 years to treat high fever with coma, stroke-induced unconsciousness, and convulsions in children. It is known as one of the “Three Cooling and Orifice-Opening Treasures” for treating stroke of the Close Symdrome in TCM. So, why did a formula with long-standing clinical efficacy fail to show benefit in a randomized, double-blind clinical trial?

 Clinical Research Evidence

A research team from the China Academy of Chinese Medical Sciences published a meta-analysis with a much larger sample size, reporting different conclusions ^[2]. The study included 28 randomized controlled trials (RCTs) with a total of 2,745 acute stroke patients (1,375 in the experimental group and 1,370 in the control group). The results showed that Angong Niuhuang Wan  significantly improved the overall effective rate, Glasgow Coma Scale (GCS) score, Mini-Mental State Examination (MMSE) score, Activities of Daily Living (ADL) score, and Barthel Index score. It also reduced the National Institutes of Health Stroke Scale (NIHSS) score and serum brain natriuretic peptide (BNP) levels. No serious adverse events were reported, indicating good safety.

 Experimental Research Evidence

Experimental studies have also provided insights into the mechanisms of Angong Niuhuang Wan.

One study established a cerebral ischemia–reperfusion injury (CIRI) model via middle cerebral artery occlusion and used acetylomics and proteomics to explore the neuroprotective effects of  Angong Niuhuang Pill (ANP). The results showed that ANP pretreatment significantly reduced neurological deficit scores and infarct volume, increased regional cerebral blood flow (rCBF), and decreased neuronal apoptosis. Further analysis revealed that ANP regulates autophagy at the transcriptional level via H4K16ac modification, promotes sirtuin 1 (SIRT1) accumulation, and modulates the SIRT1–H4K16ac axis to inhibit excessive autophagy, thereby exerting neuroprotective effects^[3].

Another study used network pharmacology to identify key active compounds in ANP and predict its potential pathways. Five bioactive equivalent combinatorial components (BECCs) were identified, which demonstrated comparable effects to ANP in improving motor recovery in zebrafish and reducing neurological deficits and infarct volume in MCAO mice, mainly through the PI3K/AKT signaling pathway^[4].

More recently, researchers applied ultra-high-performance liquid chromatography coupled with quadrupole-Orbitrap high-resolution mass spectrometry (UHPLC-Q-Exactive-Orbitrap-MS) to identify chemical constituents in ANP and its serum-absorbed components. Using network pharmacology and transcriptomic analysis, they found that 169 compounds were identified in total, 13 of which were detected in serum and interacted with 91 key targets. ANP significantly reduced serum TNF-α and IL-6 levels, as well as hypothalamic COX-2 and PGE2 levels. It upregulated NRF2 and KEAP1 expression while downregulating TLR4, IL-17A, p-P65/P65, TNF-α, and NLRP3. In LPS-induced RAW264.7 cells, ANP inhibited excessive secretion of inflammatory mediators (NO, IL-6, TNF-α), suppressed iNOS and CD86 expression, and enhanced NRF2 expression, thereby demonstrating strong anti-inflammatory and antioxidant effects^[5].

Discussion

Experimental studies have clearly demonstrated the multi-target mechanisms and material basis underlying the efficacy of Angong Niuhuang Wan. Why, then, do some clinical trials report conflicting results? What causes these discrepancies? And ultimately — is the medicine effective or not?

In my view, the key to evaluating the efficacy of a Chinese medicine lies in syndrome differentiation. No matter how famous or expensive a medicine is, if it is not prescribed according to the correct diagnosis (zheng), it will not be effective — and vice versa.

In TCM, stroke patients with impaired consciousness are classified under the category of Close Syndrome (闭证), which can be further divided into Heat Close syndrome  and Cold Close syndrome. For heat close syndrome, depending on whether heat or phlegm predominates, and whether convulsions are present, practitioners select different formulas. The “Three Cooling and Orifice-Opening Treasures” — Angong Niuhuang Wan, Zhibao Dan, and Zixue Dan— are used for heat closed syndrome, whereas Suhexiang Wan is used for cold close syndrome.

Western medicine researchers often administer Angong Niuhuang Wan to all stroke patients with coma, without distinguishing between heat and cold syndromes — which contradicts TCM principles. Wu Jutong would never have used a randomized double-blind method to treat patients; instead, he and generations of TCM practitioners after him applied individualized treatments according to syndrome differentiation, saving countless lives in the process. The enduring use of this formula for over 200 years is itself strong evidence of its clinical value.

Therefore, evaluating Chinese medicine efficacy using Western evidence-based criteria alone is inappropriate and misleading. TCM requires its own evaluation system — one that respects syndrome differentiation and the holistic principles of Chinese medicine. Only through research designed on these foundations can we truly assess the therapeutic effects of formulas like Angong Niuhuang Wan.

 References

1. Li S. Safety and efficacy of Angong Niuhuang Pills in patients with moderate-to-severe acute ischemic stroke (ANGONG TRIAL): A randomized double-blind placebo-controlled pilot clinical trial. Chin Med J (Engl). 2025 Mar 5;138(5):579–588.
2. Meng X. Effectiveness and safety of Angong Niuhuang Pill in treatment of acute stroke: A systematic review and meta-analysis.  J Tradit Chin Med. 2023 Aug;43(4):650–660.
3. Wang L.  Angong Niuhuang Pill pretreatment alleviates cerebral ischemia-reperfusion injury by inhibiting excessive autophagy through the SIRT1-H4K16ac axis.  J Ethnopharmacol. 2025 Jan 31;340:119214.
4. Zhang X. A newly discovered bioactive equivalence of combinatorial components of Angong Niuhuang Pill improves ischemic stroke via the PI3K/AKT axis.  J Ethnopharmacol. 2025 Mar 13;343:119453.
5. Gao F.  Explore the chemical components of Angong Niuhuang Pill and its potential mechanisms for fever treatment based on UHPLC-Q-Exactive Orbitrap HRMS, transcriptomics, and experiment verification.  J Ethnopharmacol. 2025 Sep 5;354:120542.

 

Traditional Chinese Medicine and Homocysteine Regulation

 Tiejun Tang

Introduction

Homocysteine (Hcy) is a sulfur-containing amino acid produced during methionine metabolism.  Under physiological conditions, Hcy is remethylated to methionine or trans-sulfurated to cysteine via folate- and vitamin B-dependent pathways ^[1]. When this balance is disrupted, plasma Hcy accumulates, leading to hyperhomocysteinemia (HHcy) ^[2]. Elevated Hcy is associated with endothelial dysfunction, oxidative stress, and inflammation, contributing to atherosclerosis, coronary artery disease, ischemic stroke, and vascular dementia ^[1,3]. Epidemiological data indicate that each 5 μmol/L increase in plasma Hcy raises cardiovascular event risk by approximately 20% ^[2].

Conventional therapy primarily involves folic acid and vitamins B6 and B12 supplementation to enhance Hcy clearance ^[3]. However, some patients respond poorly due to genetic factors such as MTHFR polymorphisms. Therefore, alternative or complementary strategies are under investigation.

 

Traditional Chinese Medicine (TCM), emphasizing holistic balance, circulation improvement, and organ support, has long been used for cardiovascular and cerebrovascular disorders ^[4]. Both classical herbal formulas and modern patent medicines have been shown to improve endothelial function, reduce oxidative stress, and support metabolic homeostasis ^[5]. Recent studies suggest that TCM may directly or indirectly influence Hcy metabolism, potentially complementing conventional therapies ^[6].

This review aims to (1) summarize mechanisms by which TCM influences Hcy metabolism, (2) highlight experimental and clinical evidence on single herbs, active compounds, and compound formulas, and (3) identify limitations and future research directions ^[4–6].

Mechanisms of Action of TCM in Homocysteine Regulation

1 Modulation of One-Carbon Metabolism

TCM interventions may support folate- and vitamin B-dependent one-carbon cycles ^[1,5]. Herbal extracts can upregulate enzymes such as methionine synthase and cystathionine β-synthase, promoting remethylation of Hcy to methionine or trans-sulfuration to cysteine.  Some compounds act as methyl donors, supporting DNA and protein methylation impaired in HHcy ^[5].

2 Antioxidant and Anti-inflammatory Effects

HHcy generates reactive oxygen species (ROS) and impairs nitric oxide (NO) bioavailability, causing endothelial dysfunction ^[2,3]. Herbs such as Salvia miltiorrhiza (Danshen) and Astragalus membranaceus (Huangqi) contain polyphenols and saponins that scavenge ROS, upregulate antioxidant enzymes like superoxide dismutase, and inhibit pro-inflammatory cytokines including TNF-α and IL-6 ^[5,6].

3 Improvement of Endothelial Function

TCM enhances eNOS activity, restores NO levels, and reduces endothelin-1 expression . Fufang Danshen preparations improve flow-mediated dilation in patients with elevated Hcy ^[4,5], reducing vascular injury and thrombotic risk.

4 Hepatorenal Protection and Metabolic Clearance

The liver and kidneys are central to Hcy metabolism. Herbs like Rehmannia glutinosa and Lycium barbarum demonstrate hepatoprotective and nephroprotective effects, indirectly supporting systemic Hcy clearance ^[6].

5 Epigenetic and Gene Expression Modulation

Hcy disrupts DNA methylation and gene expression, leading to endothelial apoptosis. Certain herbal compounds modulate epigenetic mechanisms, restoring methylation balance and protecting vascular endothelium ^[6].

Single Herbs and Active Compounds

1. Danshen (Salvia miltiorrhiza): Tanshinones and salvianolic acid B reduce oxidative stress, preserve NO, and modestly lower Hcy ^[5,6].

2. Huangqi (Astragalus membranaceus): Polysaccharides mitigate oxidative injury and inflammation; vascular protection evident ^[5,6].

3. Gegen (Pueraria lobata): Isoflavones lower Hcy in animal models and improve endothelial vasodilation ^[6].

4. Chuanxiong (Ligusticum chuanxiong) and Danggui (Angelica sinensis): Blood-activating herbs improve circulation ^[5].

5. Other herbs: Rehmannia glutinosa, Lycium barbarum, and polyphenols from tea, resveratrol, and garlic also show potential ^[5,6].

Herbal Formulas and Patent Medicines

1. Fufang Danshen preparations: Improve endothelial function and modestly lower Hcy ^[4,5].

2. Yiqi Huoxue formulas: Combine qi-tonifying and blood-activating herbs; reduce Hcy and improve angina, fatigue, and post-stroke outcomes ^[5].

3. Kidney- and spleen-tonifying formulas: Enhance hepatic and renal metabolism; partial Hcy reductions observed ^[6].

4. Acupuncture and integrative therapies: Electroacupuncture reduces serum Hcy in vascular dementia ^[6].

5. Emerging patent formulas: Combinations such as Huangqi, Danggui, Gardenia, and fermented teas target Hcy ^[6].

Clinical Studies

- Fufang Danshen: improved endothelial function and modest Hcy reduction ^[4,5].

- Yiqi Huoxue: beneficial for post-stroke and angina patients ^[5].

- Kidney/spleen tonifying formulas: improved organ function with partial Hcy reduction ^[6].

- Acupuncture: reduced serum Hcy in vascular dementia ^[6].

Conclusion

TCM provides a multifaceted approach to elevated Hcy, targeting metabolic pathways and vascular consequences. Single herbs like Danshen, Huangqi, and Gegen offer antioxidant and endothelial-protective effects. Compound formulas, including Fufang Danshen and Yiqi Huoxue prescriptions, provide synergistic benefits. Complementary therapies like acupuncture further enhance outcomes. Evidence is encouraging, but high-quality, large-scale trials are needed to validate efficacy and establish standardized protocols ^[4–6].

References

1. Huang, X. Effect of Fufang Danshen preparations on endothelial dysfunction associated with hyperhomocysteinemia. Chinese Journal of Integrative Medicine. 2020; 26(4), 289–296.
2. Zhang, L. Natural plant-derived compounds in the regulation of homocysteine: A review. Molecules. 2021; 26(11), 3081. https://doi.org/10.3390/molecules26113081
3. Wang, J. Huang Qi Decoction improves homocysteine-induced endothelial dysfunction. Evidence-Based Complementary and Alternative Medicine.2016; 7272694. https://doi.org/10.1155/2016/7272694
4. Li, Y. Electroacupuncture lowers serum homocysteine in patients with vascular dementia. International Journal of Clinical and Experimental Medicine.2020; 13(9), 6531–6538.
5. Chen, Q. Traditional Chinese medicine and vascular protection: Effects on homocysteine metabolism. Frontiers in Pharmacology.2022;  13, 874562. https://doi.org/10.3389/fphar.2022.874562
6. Liu, H. Isoflavones from Pueraria lobata reduce homocysteine and improve endothelial function in hyperhomocysteinemic models. Journal of Ethnopharmacology. 2021; 277, 114179. https://doi.org/10.1016/j.jep.2021.114179

Beyond Painkillers: How Acupuncture and Chinese Medicine Are Changing Migraine Care

 Tiejun Tang

This week is migraine awareness week of UK. Migraine is one of the most prevalent and disabling neurological conditions globally. Migraine affects nearly 1 billion people worldwide, or approximately 15% of the global population.WikipediaWorldmetrics. Around 33% of women and 18% of men experience migraine at some point.Wikipedia.  From 1990 to 2021, the number of migraine cases rose from about 733 million to 1.16 billion, while incidence increased by ~42%, and disability-adjusted life years (DALYs) surged by ~58%.SpringerLink. This underscores the immense and growing health and socio-economic burden of migraines worldwide.

Western Medicine: Principles & Challenges

a) Treatment Principles

Western approaches to migraine management include:

• Acute (abortive) treatment:
• Migraine-specific agents such as triptans, CGRP antagonists, and ditans.Wikipedia+1The Times
• Triptans offer rapid relief—70‑80% of patients experience symptom reduction within 30–90 minutes.Wikipedia
• CGRP-targeting therapies (e.g., Aimovig, Ubrelvy) are emerging as first-line preventive options per the American Headache Society, given their strong efficacy and tolerability.Verywell Health
• Preventive treatment:
• Traditional categories: beta-blockers, anticonvulsants, antidepressants.
• Newer agents: anti-CGRP medications—effective with fewer side effects but pose cost/access barriers.Verywell HealthThe Times
• Supportive strategies: Lifestyle modifications—regular sleep, hydration, stress management, trigger avoidance—plus patient education and use of headache diaries.World Health Organization

b) Challenges and Limitations

• Medication overuse headache (MOH): Frequent use of analgesics, triptans, opioids, or combination therapies can exacerbate headaches. MOH is a well-described iatrogenic complication.Wikipedia
• Side effects and accessibility:
• Triptans may cause chest tightness or lethargy (e.g., eletriptan).The Times
• CGRP agents, while effective, are expensive and may be restricted by healthcare systems.The TimesVerywell Health

Traditional Chinese Medicine (TCM) Approaches

 TCM treatments for migraine commonly include: Acupuncture, Chinese herbal medicine and Massage (e.g., Tui Na). These interventions are rooted in TCM theories of qi, blood flow, meridians, and holistic balance.

The Mechanisms (From Modern Medicine Perspective):

According to a comprehensive review (2000–2023), TCM therapies may relieve migraine through:

• Reducing neuropeptides and inflammatory markers
• Modulating neuronal sensitization
• Altering brain function and structure
• Affecting BBB (blood–brain barrier) permeability
• Balancing hormones
• Relieving muscle tensionPubMed

Clinical and Systematic Evidence

• A systematic review of 15 SRs (up to 2019) found high-quality evidence that acupuncture is more effective than Western medicine in reducing headache days, pain intensity, and analgesic use.PubMed
• A later overview (2022) confirms that acupuncture is effective, safe, and worthy of clinical promotion, though study quality needs improvement.PubMed

Additional supportive findings:

• Multiple RCTs and observational studies (Zhu’s scalp acupuncture, electro-acupuncture, etc.) report positive clinical efficacy and improved cerebral blood flow.PMC

Acupuncture Specifically: Evidence & Mechanisms

Clinical Evidence:

• 2017 study: Real acupuncture significantly reduced migraine attacks compared with sham. A meta-analysis of ~5,000 patients found that about two-thirds saw a 50% reduction in attack frequency.GQ
• As per a widely-cited article, acupuncture was found as effective as Imitrex (sumatriptan) in one study, and regular acupuncture prevented ~50% of migraines in another.Allure
• Systematic and meta-analyses: Strong evidence supports its safety and efficacy in both acute and preventative contexts.PMC

Mechanistic Insights

• Neurochemical modulation: Acupuncture may trigger release of neurotransmitters and enhance endogenous opioid receptor availability, as evidenced in brain imaging studies.TIMEGQ
• Neuroimaging data: A 2025 review of neuroimaging trials identified involvement of brain networks—including the default mode network (DMN), salience network (SN), central executive network (CEN), and descending pain modulatory system (DPMS)—in both immediate and preventive acupuncture effects.PubMed

---

Summary Table

Aspect	Western Medicine	TCM & Acupuncture
Acute treatment	Triptans, CGRP antagonists, NSAIDs; effective but risks include side effects and MOH	Acupuncture shows efficacy comparable to medication with fewer systemic risks
Preventive care	Beta-blockers, anticonvulsants, antidepressants; CGRP antibodies promising but costly	Acupuncture may reduce migraine frequency, analgesic use, and improve QoL; needs higher-quality trials
Mechanism	Targets neurovascular triggers, receptor modulation, and central sensitization	Supports neurotransmitter release, opioidergic system, network modulation (DMN, DPMS), inflammation reduction
Safety & access	Effective but may cause adverse effects; MOH and under-prescribing common	Generally safe (with proper technique); minor risks; broader accessibility, patient acceptability
Challenges	Cost, side effects, lack of awareness, gender bias, inadequate training and diagnosis	Variability in study quality, need for standardized protocols and larger, rigorous RCTs and imaging studies

---

Conclusion

Migraine remains a globally prevalent and debilitating condition. Western treatments offer strong efficacy but face limitations such as medication overuse headache, cost, and side effects.

TCM—and acupuncture in particular—offers a compelling complementary or alternative avenue. The current evidence suggests:

• Clinical efficacy: Demonstrated reduction in migraine frequency and intensity, sometimes comparable to pharmacotherapy.
• Mechanistic plausibility: Supported by neuroimaging and neurochemical data highlighting central modulation of pain and regulatory networks.
• Safety and acceptability: Low risk of systemic adverse effects, high patient acceptability.

That said, further high-quality research, including well-designed RCTs and mechanistic trials, is needed to standardize protocols, verify long-term benefits, and integrate acupuncture effectively into comprehensive migraine care.

 

References

• Incidence and burden of migraine: Global rise in prevalence and DALYsSpringerLinkWikipediaWorldmetrics
• Western treatment principles, challenges, MOH, gender biasThe TimesVerywell HealthWorld Health OrganizationWikipedia+1The Times of India
• TCM mechanisms and tools (acupuncture, herbs, massage)PubMed
• Clinical evidence of acupuncture vs Western medicinePubMed+1PMC+1
• Acupuncture RCTs and meta-analysis findingsGQAllureTIME
• Neuroimaging mechanisms in acupuncturePubMed

How to Treat Psoriasis with Chinese Herbal Medicine

 Tiejun Tang

Psoriasis is a chronic inflammatory skin disease characterized by red, scaly patches that can cause severe physical discomfort and psychological distress. The disease is prevalent in the UK, and modern medicine offers limited treatment options with often unsatisfactory efficacy. Can traditional Chinese medicine (TCM) treat psoriasis? How effective is it? What are the underlying mechanisms? This paper aims to answer these questions from the perspective of patients.

Incidence of Psoriasis in the UK and Worldwide

Psoriasis affects approximately 1.7% of the UK population, equating to around 1.1 million individuals^.[1] Globally, prevalence rates vary significantly, with Western countries reporting rates of around 2%, while East Asia has a notably lower prevalence of approximately 0.12%. These variations may be influenced by genetic, environmental, and lifestyle factors.

Western Medicine Treatment Principles

In Western medicine, psoriasis is understood as an immune-mediated disorder involving the overproduction of skin cells. Treatment strategies aim to reduce inflammation and slow skin cell turnover through the following approaches:

·       Topical Treatments: Corticosteroids, vitamin D analogs, and moisturizers are commonly used for mild to moderate psoriasis.

·       Phototherapy: Controlled exposure to ultraviolet (UV) light can help reduce symptoms in moderate to severe cases.

·       Systemic Medications: For severe psoriasis, systemic treatments include methotrexate, cyclosporine, and biologic agents targeting specific immune pathways.

Despite these options, challenges persist, including variable patient responses, potential side effects, frequent relapse after drug withdrawal, the high cost of biologic therapies, and long waiting times for phototherapy in the NHS^.[2]

Traditional Chinese Medicine Perspectives on Psoriasis

TCM conceptualizes psoriasis as a manifestation of internal disharmony, often attributing it to factors such as blood heat, blood dryness, blood stasis, and blood deficiency^.[3] According to TCM theory, these imbalances disrupt the flow of Qi and blood, leading to skin lesions. External factors such as wind, dampness, and heat, along with emotional stress and dietary habits, are also considered contributory. This holistic perspective emphasizes the interconnectedness of bodily systems and the need to address underlying imbalances. TCM employs a personalized approach, tailoring treatments based on individual presentations and underlying patterns.

The Efficacy of TCM in Treating Psoriasis

The efficacy of Chinese medicine in treating psoriasis has been found to be satisfactory. A review of 40 clinical research reports found that:

·       15 studies used Chinese herbal decoctions based on syndrome differentiation,

·       5 studies used Chinese patent medicines,

·       10 studies used Chinese herbal fumigation combined with narrow-band ultraviolet (NB-UVB) phototherapy,

·       10 studies used Chinese herbal baths combined with phototherapy.

              The reported efficacy in these studies ranged between 90% and 100%. ^[3]

Modern Pharmacological Research on TCM Treatments

Research has identified a close association between the AhR/NF-κB axis and the inflammatory response in psoriasis. Indigo Naturalis (IDG) is a commonly used traditional Chinese medicine for psoriasis treatment. Studies suggest that its mechanism may involve the regulation of the AhR/NF-κB signaling pathway. Experimental research has demonstrated that IDG treatment significantly reduces TNF-α, IL-6, and NF-κB mRNA levels while enhancing the expression of AhR and CYP1A1 mRNA. Additionally, IDG promotes the translocation of AhR from the cytoplasm to the nucleus. In psoriasis-like mouse models, IDG significantly improved skin lesion severity, reduced inflammatory cytokines (such as IL-6, IL-17A, MCP-1, and TNF-α), increased CYP1A1 protein expression, and inhibited p65 and p-p65 protein expression. ^[4]

Shengma Jiedu Decoction is a commonly used TCM prescription for psoriasis treatment. The key ingredients, Shengma (Cimicifugae Rhizoma) and Tufuling (Smilax glabra Roxb), have been studied using network pharmacology combined with RNA sequencing. Research suggests that this herbal pair significantly improves psoriasis lesions, reduces inflammatory cell infiltration, and suppresses keratinocyte proliferation. Potential targets include TNF, JNK, IL-6, and IL-1β. ^[5]

Jingfang Granule (JFG) is derived from the ancient prescription Jingfang Baidu San. Research utilizing network pharmacology and molecular biology techniques has shown that JFG improves psoriasis by inhibiting the maturation and activation of BMDCs and reducing keratinocyte proliferation and inflammation. ^[6]

Shibiman (SBM) is a traditional Chinese medicine preparation composed of Renshen (ginseng), Danggui (angelica), Heshouwu (Polygonum multiflorum), and Luhui (aloe vera). Studies indicate that SBM significantly alleviates imiquimod-induced psoriatic skin inflammation in mice by inhibiting the IL-23/Th17 axis and CXCL16-mediated endothelial activation. ^[7]

Conclusion

A large number of clinical randomized controlled trials (RCTs) have demonstrated that Chinese medicine is effective in treating psoriasis, with a favorable safety profile and minimal side effects. The mechanisms of action have been supported by extensive molecular biological research. Whether through single herbs, compound decoctions, or patent remedies, TCM provides multiple viable options for psoriasis treatment.

References

1.     https://cks.nice.org.uk/topics/psoriasis/background-information/prevalence

2.     SP. Smith. "The Landscape of Psoriasis Provision in the UK." Clin Exp Dermatol. 2020 Dec;45(8):1040-1043.

3.     Yang Su. "A Review of Chinese Medicine for the Treatment of Psoriasis: Principles, Methods, and Analysis." Chin Med. 2021 Dec 20;16:138.

4.     Yu Lin. "Indigo Alleviates Psoriasis Through the AhR/NF-κB Signaling Pathway: An In Vitro and In Vivo Study." PeerJ. 2024 Oct 21;12:e18326.

5.     Xueqing Hu. "Combining Network Pharmacology, RNA-seq, and Metabolomics Strategies to Reveal the Mechanism of Cimicifugae Rhizoma - Smilax Glabra Roxb Herb Pair for the Treatment of Psoriasis." Phytomedicine. 2022 Oct;105:154384.

6.     Qingqing Xu. "Jingfang Granules Exert Anti-Psoriasis Effects by Targeting MAPK-Mediated Dendritic Cell Maturation and PPARγ-Mediated Keratinocyte Cell Cycle Progression In Vitro and In Vivo." Phytomedicine. 2023 Aug;117:154925.

7.     Chenyang Zhang. "Traditional Chinese Medicine Shi-Bi-Man Ameliorates Psoriasis via Inhibiting IL-23/Th17 Axis and CXCL16-Mediated Endothelial Activation." Chin Med. 2024 Mar 1;19:38.

How Cupping Works: from Practice to Mechanism

Tiejun Tang

Cupping therapy is a traditional healing practice that has gained significant attention in recent years due to its purported health benefits. Rooted in ancient medical traditions, cupping is used in various cultures to treat a range of ailments. This article explores the history, clinical indications, contraindications, and scientific mechanisms underlying cupping therapy.

History of Cupping Therapy

Cupping therapy dates back thousands of years and has been used in different forms across many civilizations. The earliest recorded use of cupping can be traced to ancient Egyptian, Chinese, and Middle Eastern cultures. Egyptian medical texts, such as the Ebers Papyrus (circa 1550 BC), mention cupping as a method to remove toxins from the body. In Traditional Chinese Medicine (TCM), cupping is associated with promoting the flow of Qi (vital energy) and blood circulation. Islamic medicine, as documented by renowned scholars like Avicenna, also advocated for cupping as a therapeutic intervention for various diseases. The tools for cupping have evolved from animal horns used in ancient times to bamboo, pottery, glass, etc.

Clinical Indications of Cupping Therapy

Cupping is commonly used for a variety of conditions, including:

• Musculoskeletal pain: It is frequently applied to alleviate conditions such as back pain, neck pain, and arthritis.
• Respiratory issues: Cupping has been traditionally employed to relieve symptoms of colds, asthma, and bronchitis.
• Stress and anxiety: The relaxing effect of cupping may help in reducing mental stress and tension.
• Digestive disorders: Some practitioners use cupping to aid digestion and treat gastrointestinal conditions.
• Sports recovery: Many athletes incorporate cupping to reduce muscle soreness and improve recovery time.

Contraindications of Cupping Therapy

While cupping is generally considered safe, it is contraindicated in certain conditions, including:

• Skin infections or open wounds: Cupping over compromised skin can lead to infections.
• Bleeding disorders: Individuals with hemophilia or those on anticoagulant therapy should avoid cupping due to the risk of excessive bruising.
• Pregnancy: Cupping should be avoided over the abdomen and lower back in pregnant women.
• Severe cardiovascular conditions: Those with uncontrolled hypertension or cardiac disease should seek medical advice before undergoing cupping therapy.

Scientific Explanation of the Mechanism of Cupping

Cupping is believed to promote healing by enhancing blood flow, reducing pain, and removing toxins. Modern research suggests that cupping therapy exerts its effects through multiple physiological mechanisms:

1.    Pain Modulation via Diffuse Noxious Inhibitory Controls (DNICs):

Cupping may activate the body's DNIC system, where the introduction of a new noxious stimulus (the suction) can diminish the perception of pre-existing pain. This "pain inhibits pain" phenomenon suggests that the discomfort from cupping can trigger the body's pain-relief mechanisms.^[1] ​

2.    Enhanced Blood Circulation and Nitric Oxide Release:

The suction effect of cupping causes localized vasodilation, increasing blood flow to the treated area.^[2] This process may involve the release of nitric oxide, a molecule that regulates blood pressure and promotes vascular health. Improved circulation can facilitate the removal of toxins and supply oxygen-rich blood to tissues, aiding in healing and reducing muscle tension.^[3] ​

3.    Reflex Zone Stimulation:

According to reflex zone theory, stimulating specific skin areas through cupping can influence corresponding internal organs and tissues. This suggests a neurobiological connection where cupping affects deeper structures via skin receptors, potentially improving organ function and alleviating discomfort.^[1]  ​

4.    Activation of Endogenous Analgesic Systems:

The mechanical action of cupping may stimulate mechanosensitive nerve fibers (Aδ and C fibers), leading to the release of endorphins—natural pain-relieving chemicals. This mechanism is similar to that proposed for acupuncture, where physical stimulation results in analgesia.^[2] ​

5.    Hemorphin Release from Hemoglobin Degradation:

Cupping can cause minor bleeding under the skin, leading to the breakdown of hemoglobin. This process may release hemorphins, peptides with analgesic properties, contributing to pain relief experienced after cupping sessions.^[2] ​

The above studies provide scientific evidence for the mechanism of cupping therapy, and further scientific research is needed to fully reveal the mystery of cupping therapy.

Conclusion

Cupping therapy remains a widely practiced and valued treatment in both traditional and contemporary medicine. While scientific evidence continues to evolve, many individuals report significant relief from various ailments. However, it is crucial to consult a qualified healthcare provider before undergoing cupping therapy, especially for those with underlying health conditions.

As interest in alternative medicine continues to grow, further research will help clarify the full range of benefits and mechanisms behind this ancient therapeutic practice.

  Reference:

1.    Abdullah MN Al-Bedah .The medical perspective of cupping therapy: Effects and mechanisms of action. J Tradit Complement Med. 2018 Apr 30;9(2):90–97

2.    Changzheng Song. Hemorphin-Based Analgesia: A Mechanism of Cupping Technique? J Pain Res. 2023 May 29;16:1751–1754.

3.    Dominador Perido. How does cupping work? Mechanisms of action explained. Massage Magazine 2022; Dec. 12.

How to treat Hair Loss with Chinese Medicine

 Tiejun Tang

Hair loss is a common condition affecting millions of people worldwide. In the UK, approximately 50% of men over the age of 50 and 50% of women over the age of 65 experience hair loss.^[1] Androgenetic alopecia, alopecia areata, and telogen effluvium are the most common types of hair loss. This condition can lead to significant psychological distress and social anxiety. According to the NHS, hair loss is often underreported, and many individuals seek treatment only after the condition has progressed significantly.^[2]

Western Medicine Approaches to Hair Loss

Western medicine offers several treatments for hair loss, but their effectiveness is often limited:

1.     Minoxidil: A topical solution that stimulates hair growth by increasing blood flow to the scalp. It requires continuous use to maintain results; stopping treatment leads to hair loss recurrence. It is only effective for a subset of patients, with studies showing significant regrowth in about 30-40% of users. Side effects include scalp irritation, itching, and unwanted facial hair growth in some cases.

2.     Finasteride: An oral medication that inhibits the hormone dihydrotestosterone (DHT), which is responsible for androgenetic alopecia. It is primarily effective for male pattern baldness and is not suitable for women. Side effects include sexual dysfunction, which can persist even after discontinuation (post-finasteride syndrome).

3.     Hair Transplant Surgery: A surgical option for advanced hair loss. This therapy is costly and invasive, carrying risks such as scarring, infection, and unnatural-looking results if not performed well. Additionally, it does not prevent further hair loss in non-transplanted areas.

The Chinese Medicine Approach to Hair Loss

Traditional Chinese Medicine (TCM) views hair loss as a manifestation of internal imbalances, particularly involving the kidneys, liver, and blood. According to TCM, healthy hair growth depends on the abundance of Qi (vital energy) and blood, as well as the proper functioning of the kidneys, which are believed to govern hair health. Common TCM treatments for hair loss include:

Herbal Remedies

 Heshouwu (Polygonum multiflorum):  A popular herb known for its hair-nourishing properties. Studies suggest it promotes hair growth by improving blood circulation and reducing oxidative stress. Research has shown that Heshouwu extract supports hair growth by prolonging the anagen phase and counteracting the effects of androgens in cultured human dermal papilla cells.^[3]

Ginseng: Enhances Qi and blood circulation, supporting hair follicle health. Treatment with Red Ginseng Oil (RGO) and its main components has been found to upregulate the expression of hair growth-related proteins, inhibit inflammation and apoptosis, and induce cytoprotective mechanisms, thereby preventing or treating hair loss and protecting the skin from UV radiation.^[4]

 Danggui (Angelica sinensis)：A commonly used herb for  nourishing blood, it containing glycoside active ingredients mainly promote hair follicle cells to enter the growth phase earlier or inhibit hair follicle cell apoptosis.^[5]

 BeauTop (BT): A traditional Chinese medicine compound composed of Ginseng, Angelica, and Astragalus. It has been shown to promote hair growth by increasing the expression of vascular endothelial growth factor (VEGF), which is a key mediator in the angiogenesis process involved in hair growth and development.^[6]

 Yangxue Shengfa Capsule (YSC): Clinically used for many years to improve androgenetic alopecia (AGA). Studies have demonstrated that five of its compounds significantly promote cell proliferation in cultured immortalized human dermal papilla cells. Ferulic acid and rhamnolide have shown promising pharmacological properties against AGA.^[7]

Acupuncture

Acupuncture stimulates specific points on the scalp to improve blood flow and balance Qi. Research has shown that acupuncture can be effective in treating alopecia areata.^[8]

Conclusion

Hair loss is a multifaceted condition with significant psychological and social impacts. While Western medicine provides effective treatments, these often come with limitations, including suboptimal results for some patients, side effects, and high costs.

Traditional Chinese Medicine, on the other hand, aims to address the root causes of hair loss by harmonizing Qi and blood, regulating internal organ function, and taking a multi-target approach. This holistic strategy results in a stable and lasting therapeutic effect.

References

1.     https://www.alopecia.org.uk/androgenetic-alopecia-pattern-hair-loss

2.     Hunt, N., & McHale, S.  The psychological impact of alopecia. British Medical Journal. 2005; 331(7522), 951-953.

3.     Shin, J.Y.  Polygonum multiflorum extract supports hair growth by elongating the anagen phase and counteracting the effects of androgens in cultured human dermal papilla cells. BMC Complement Med Ther. 2020; 20(1), 144.

4.     Van-Long Truong.  Red ginseng oil promotes hair growth and protects skin against UVC radiation. J Ginseng Res. 2021; 45(4), 498-509.

5.     Jinjin Dou. Exploring the effects of Chinese herbal ingredients on the signaling pathway of alopecia and the screening of effective Chinese herbal compounds. Journal of Ethnopharmacology. 2022; Volume 294, 115320.

6.     Chien-Ying Lee.  Observation of the expression of vascular endothelial growth factor and the potential effect of promoting hair growth treated with Chinese herbal BeauTop. Evid Based Complement Alternat Med, 2021, 6667011.

7.     Justin J.Y Tan. Bioactives in Chinese Proprietary Medicine modulate 5α-reductase activity and gene expression associated with androgenetic alopecia. Front Pharmacol. 2017; 8, 194.

8.     Andraia R. Li.  Efficacy of acupuncture and moxibustion in alopecia: A narrative review. Front Med (Lausanne, 9), 2022; 868079.