Guan Xin II

Functions

The formula activates the blood flow, removes blood stasis, and regulates qi to help alleviate pain. It is primarily used to treat coronary heart disease, angina pectoris, and other heart and stomach diseases caused by qi stagnancy and blood stasis.

Dosage Info

Tablets (0.5g/tablets, containing 1.63g of crude drug): 6 to 8 tablets 3 times daily. Injection solution (5ml/ampule, containing 10g of crude drug dissolved in 250 ml of 5 to 10% glucose): once a day. 5:1 concentrated extract: 6 to 10g/day.

Ingredients

• Chuan Xiong
• Chi Shao
• Dan Shen

Precautions

Patients with qi-asthenia and blood stasis should refrain from taking this formula. Pregnant and menstruating women should use the formula with great care.

Pharmacology

Effects on blood rheology: This formula can help to improve red blood cell’s rheological properties. This includes lowering the mutual attractive force among red blood cells and increasing the superficial electric charge to lower the cellular aggregation. Hong Hua (Carthamus) and Chi Shao (Peony Red) can improve the elastic parameters of thrombus. Chuan Xiong (Cnidium), Dan Shen (Salvia), and Chi Shao (Peony Red) can significantly lower platelet adhesion while Chuan Xiong (Cnidium), Chi Shao (Peony Red), and Jiang Xiang (Dalbergia Wood) can lower fibrinogen levels. All the ingredients in this formula can aid in suppressing platelet aggregation. (1) In addition, Guanxin-II can lower the total blood viscosity and the plasmic viscosity ratio. It can also increase red blood cell electrophoresis velocity, which is superior to the effects of low molecular dextran. (2)

Protecting myocardium from injury: In ischemic myocardial injury, both the structure and function of the cellular membranes undergo considerable changes. Guanxin-II can stabilize the myocyte membrane, lower the membrane permeability, protect the mitochondria and lysosome from injury, and raise the hypoxia endurance of the myocytes. (3)

Immunization: Guanxin-II has dual actions on the macrophage phagocytic function. At a low dosage, it can inhibit the phagocytic ability. At a high dosage, it can enhance the phagocytic ability. (4)

Lowering blood-lipid: In rabbits with experimental atherosclerosis and hyperlipidemia, Guanxin-II can lower serum total cholesterol, neutral fat, beta-lipoprotein levels, the total cholesterol, and total lipid levels in the aortic wall. This significantly reduces the proportion and the mean thickness of plaques in the total area of the intima in the aortic wall. In addition, it lowers the incidence of plaque in the anterior descending branch of the coronary artery and the small arteries, and lessens the blocking severity of the coronary cavity. When seen under a microscope, the lipid stain of the atherosclerotic plaques is uneven and the lipids move towards the middle layer of the artery, suggesting a tendency to disintegrate plaques. (5)

Anti-thrombus action:In rats, a Guanxin-II injection can inhibit thrombosis in vitro, shorten the length and lighten the weight of the thrombus, and prolong the specific thrombosis duration. (6) In the rat, the formula has antagonistic actions on acute myocardial infarction caused by stress-induced myocardial intravascular platelet aggregation. (7) Except Jiang Xiang (Dalbergia Wood), the other four ingredients in Guanxin-II, particularly Chi Shao (Peony Red), prolonged the duration of the specific thrombus and the fibrinous thrombus formation. Guanxin-II and its ingredients all caused thrombus weight (dry or damp) to decrease, and the effects of Chi Shao (Peony Red) were the strongest, while Jiang Xiang (Dalbergia Wood) was the weakest. (8) When used in small doses, Guanxin-II had no apparent effect on fibrin, while used in large doses however, it could lower the concentration of fibrin stable factor. (9) It could also raise cAMP levels via inhibiting the activity of phosphodiesterase of platelet. (10)

Improving microcirculation: Guanxin-II has certain effects in preventing and treating adrenaline induced disturbances of mesenteric microcirculation in the mouse, and in treating adrenaline induced vasoconstriction by improving micrangium formation, lowering capillary permeability, and reducing vascular exudation. (11)

Clinical Applications

Treatment in coronary heart disease (CHD) and angina pectoris
It was reported that in the treatment of 25 cases of CHD, the Guanxin-II formula used contained Dan Shen (Salvia), Chuan Xiong (Cnidium), Chi Shao (Peony Red), Hong Hua (Carthamus), and Jiang Xiang (Dalbergia Wood). One dose of the formula in a decoction was administered daily, once in the morning and evening. For those with frequent attacks, this formula was processed into capsules to be taken 2 to 6g, 3 times a day. The results indicated that after taking 20 to 200 doses, of the 25 cases, 8 were resolved, 10 had significantly improved, 6 showed some improvement, and 1 did not respond to the treatment. (12)

Wang Hong observed the therapeutic effects of modified Guanxin-II in 105 cases of CHD with angina pectoris (treatment group) and compared them with the effects of Dan Shen Tablets (4 tablets 3 times a day) in 104 cases of CHD (control group). The modified Guanxin-II was composed of Dan Shen (Salvia), Chuan Xiong (Cnidium), Hong Hua (Carthamus), Xie Bai (Bakeri), Gui Zhi (Cinnamon Twig), Chi Shao (Peony Red), Gua Lou (Trichosanthes Fruit), and Jiang Xiang (Dalbergia Wood). One dose of the modified formula was administered daily. 20 days constituted one course of treatment. After 3 courses of treatment, the results for treatment and control groups were, respectively: 51 and 27 cases had significant improvement in angina attacks, 48 and 47 had some improvement, and 6 and 30 did not respond to the treatment. The total effectiveness rates were 94.3% and 71.2%, respectively. With respect to ECG, the results for the treatment and control groups were, respectively: 18 and 9 cases had significant improvement, 33 and 23 cases had some improvement, and 54 and 72 did not respond to the treatment. The total effectiveness rates were 49.6% and 30.8%, respectively. The therapeutic effects in the treatment group were significantly superior to that of control group (P

References

1. Wang Yi, et al. Guanxin-II’s effect of blood rheology. Journal of Applied Integrated Traditional Chinese and Western Medicine. 1997;10(15):1427-1430.
2. Weng Wei Liang, et al. Observations on effects of Guanxin II on blood adhesion and red blood cell electrophoresis duration for patients with coronary heart disease. Journal of Traditional Chinese Medicine. 1980;(12):40-41.
3. Shi Qi Huang, et al. Effects of Guanxin-II on platelets’ release of serotonin and supermicrostrudture in rabbits. Journal of Integrated Traditional Chineses and Western Medicine. 1981;1(2) 90.
4. Ni Zhu Mei, et al. Effects of Guanxin-II, stress, and cortisol on abdominal macrophagocytes’ phagocytosis in mice. Journal of Traditional Chinese Medicine. 1981;(1):73-75.
5. Effects of Guanxin-II on experimental rabbit atherosclerosis and hyperlipemia. Fundamental Medicine Research Group of Chinese Academy of Medical Sciences. Journal of Modern Medicine and Pharmacy. 1972;(1):32-35.
6. Effects on in vitro rat thrombus formation by herbs that function to nourish the blood and remove stasis—Research on effects of Guanxin -II, Chuan Xiong total biological alkaloids and ligustrazine. Journal of Modern Medicine and Pharmacy. 1978;(6):41-43.
7. Xi Yuan Hospital affiliated to Chinese Academy of TCM et. al. Effects of Guanxin-II on stress induced platelet aggregation in capillaries of cardiac muscle. Journal of Modern Medicine and Pharmacy. 1978;(7):62-65.
8. Xi Yuan Hospital affiliated to Chinese Academy of TCM et. Al. Effects on in vitro rat thrombus formation by herbs that function to nourish the blood and remove stasis—Analysis of Guanxin-II and its ingredients’ effects on counteracting thrombus formation. Journal of Modern Medicine and Pharmacy. 1978;(8):64-65,63.
9. Xi Yuan Hospital affiliated to Chinese Academy of TCM et. al. The effects of Guanxin-II on serum level’s fibrin stabilizing factor. Journal of Modern Medicine and Pharmacy. 1976;(8):40-41,24.
10. Sun Ai Xu. Recent pharmacology advances in Chinese herbs counteracting platelet aggregation. Journal of Traditional Chinese Medicinal Materials. 1990;13(6), 41-43.
11. Weng Wei Liang, et al. Effects of Guanxin-II on experimental impedence to microcirculation. Journal of Integrated Traditional Chinese and Western Medicine. 1982;2(3):176-177.
12. Zhu Guang Liang, et al. Treating 25 cases of coronary heart disease with Guanxin-II. Sichuan Journal of TCM. 1987;5(10):30.