Herbal Medicine in Stroke

Is There Room for Paradox in CAM?

Traditional Chinese Medicine (TCM) and integrative medicine are key components of the cultural heritage from Eastern Asia with thousands-of-years history in research and healthcare delivery. Traditional oriental medicine contributes significantly to the prosperity of Chinese and Eastern Asian culture. After the introduction of western biomedicine to Asia, traditional medicine still plays an important role in the healthcare system of many Asian countries and integrated with the mainstream medical treatments as a new track of healthcare named as integrative medicine. With the current trend of globalization, traditional medicine and integrative medicine are receiving gradual acceptance in the Western world. As a result, studies on traditional medicine attract more and more attention from researchers with various knowledge backgrounds and technologies. Medical informatics is a new interdisciplinary branch in medical science when computer science and information technology are combined with research of health science. The application of medical informatics that has extended to the studies of traditional medicine and other therapies of complementary and alternative medicine (CAM). The special issue supported by this journal provides a forum for traditional and integrative medical researchers and practitioners to share and exchange their new ideas on using computer science and information technology to explore and solve problems in healthcare. It is proposed with the Fifth International Workshop on Information Technology for Chinese Medicine (ITCM 2014) in Guangzhou, China, on 12 to 14 December 2014. The workshop is in conjunction with the 2014 IEEE International Conference on Bioinformatics and Biomedicine (BIBM'14), which was held in Belfast, UK, on 2 to 5 November 2014. Professor Xusheng Liu, Professor Honglai Zhang, and Professor Guozheng Li cochaired the workshop. The conference invited top experts from the US, UK, Australia, and Hong Kong to present their inspiring research outcomes and prospect the future of traditional and integrative medicine. However, numerous scientists and researchers were unable to introduce their excellent idea due to time limit of the workshop. The ITCM 2014 received about 100 submissions. All papers were anonymously reviewed by members of the IEEE conference organization committee. The accepted papers were published in the Proceedings of the 2014 IEEE International Conference on Bioinformatics and Biomedicine Workshops (IEEE-BIBMW) (ISBN 978-1-4799-1309-1). Just a few excellent papers were later invited to submit the extension version to the special issue alongside external submissions for consideration of publishing. This special issue has received 37 submissions. All papers have gone through rigorous view, and only 10 of them (27%) are finally accepted for publication. This special issue reflects the up-to-date progress in applications of information technology to traditional and integrative medicine. The papers are categorized to represent the four aspects of medical informatics research of the discipline. In the paper entitled “Standardization of Syndrome Differentiation Defined by Traditional Chinese Medicine in Operative Breast Cancer: A Modified Delphi Study,” Q. Guo and Q. Chen present their research on TCM syndromes. Five papers are selected to demonstrate the research progress in disease diagnosis and treatment. G.-X. Shi et al. report a clinical study on vascular dementia. Z. Chen presents a new mathematics method to explore the classical theory of five elements in TCM in his work “Researches on Mathematical Relationship of Five Elements of Containing Notes and Fibonacci Sequence Modulo 5.” In “Syndrome Differentiation Analysis on MARS500 Data of Traditional Chinese Medicine,” Y.-Z. Li et al. succeed to use MARS500 to process the data of traditional medicine. The paper entitled “Detecting Disease in Radiographs with Intuitive Confidence” by S. Jaeger introduces the new idea to use informatics method to detect disease. Three papers are about information processing of traditional medicine. The paper entitled “Patterns Exploration on Patterns of Empirical Herbal Formula of Chinese Medicine by Association Rules” by L. Huang et al. used association rules to retrieve patterns from classical traditional medical formula. B. Zhang et al. proposed a bioinformatics approach to explore the latent patterns from conventional formula Shuang-Huang-Lian in their work “Using Bioinformatics Approach to Explore the Pharmacological Mechanisms of Multiple Ingredients in Shuang-Huang-Lian.” The paper entitled “Pulse-Diagnosis Signals Analysis of Fatty Liver Disease and Cirrhosis Patients by Using Machine Learning” by N. Wang et al. introduces new data mining method to process diagnostic data of liver disease. Finally, the paper entitled “An Ensemble Learning Based Framework for Traditional Chinese Medicine Data Analysis with ICD-10 Labels” by G. Zhang et al. and the paper entitled “ISMAC: An Intelligent System for Customized Clinical Case Management and Analysis” introduce the applications of machine learning to electronic data analysis of traditional medicine.

WHO International Standard Terminologies on Traditional Chinese Medicine: Use in Context, Creatively

In 2021, Acupuncture and Herbal Medicine (AHM) in English is officially published by Tianjin University of Traditional Chinese Medicine and China Association of Chinese Medicine. AHM is a peer-reviewed, diamond open-access international journal dedicated to publishing high quality research in the field of acupuncture and herbal medicine. The types of publication considered are editorial, review article, original article, guidelines and standards, commentary, short communications, case report, methodology, and letter to the editor. Featured by evidence-based medicine researches, AHM publishes innovative studies on acupuncture and herbal medicine, promotes academic exchanges, and drives the transformation of research achievements to serve the international development of traditional Chinese medicine (TCM) and establish the frontrunner journal for international communication of traditional medicine. Since the late 2000s, changes in the disease spectrum have led to significant transformation in medical models and the goals of medicine worldwide. World Health Organization has advocated for universal access to essential medical services for global health benefits and starts the great journey of building a healthy world. Mainly based on acupuncture and herbal medicine, TCM has a long history and has played an important role in ensuring the prosperity of the nation and safeguarding the health of the Chinese people. Although it is ancient, its concepts are not outdated, such as the concepts of harmony between human beings and the nature, the dynamic balance between yin and yang, the individualized treatment through syndrome differentiation, and the active preventive medical thought of health maintenance. All of these theories converge with the frontier directions of modern life science, and exhibit the value of TCM in modern society. The extensive practice has proven that solutions to life sciences and medical problems are entrenched in TCM, emphasizing the worth of its vigorous inheritance and development. The modernization of TCM has been more than 20 years and has made great progress. A meaningful experience is to maintain the inheritance and promote the innovation, through following the theoretical basis of TCM, introducing and learning from advanced scientific and technological methods which is making the past serve the present. “Stones from other mountains can serve to polish our jade.” The synergistic effect can be realized through complementary advantages. Since 2020, a sudden COVID-19 epidemic has wreaked havoc around the world, with China bearing the brunt. Chinese people have united in struggling against COVID-19 with the fearless heroism, and forged the great anti-epidemic spirit of “the supremacy of life, the unity of the whole country, the sacrifice of life and death, respect for science, and the sharing of destiny.” In less than three months, we have won a phased victory in the fight against the epidemic. TCM has participated in the prevention and control of COVID-19 epidemic and played a critical role in all of the stages[1]. Strict isolation and widespread use of TCM effectively blocked the spread of COVID-19 epidemic, reduced the development from mild to severe, increased the cure rate and reduced the mortality rate. In response to the different outcomes in clinical evaluation studies, the world's first Core Outcome Set (COS) was developed by Tianjin University of Traditional Chinese Medicine for clinical trials on COVID-19 (COS-COVID), which determined the “rate of mild to severe” as a critical clinical evaluation outcome[2]. This outcome was recognized and widely used in evaluating the results of clinical trials for TCM, clinical drugs and vaccines. In addition, China has also actively shared its anti-epidemic experience of integrated traditional Chinese and Western medicine with the world, which has been widely concerned and positively commented by the international community. The combination of the TCM and Western medicine is not only one of the characteristics of China's COVID-19 response[3], but also a vivid practice of inheriting the essence of TCM, maintaining the integrity and promoting the innovation. The pandemic has not only changed the world, but also change the world's attitude towards TCM. Mainly based on acupuncture and herbal medicine, TCM has been popularized and applied in more than 100 countries around the world and legalized in health insurance by dozens of countries and regions. A number of high-level papers have been published and high-level education and personnel training have been sustainably performing. AHM will hold to evidence-based medicine research and adhere to the directions of “inheriting the essence, maintaining the integrity, and promoting the innovation”, report innovative theories and excellent academic achievements in the field of acupuncture and herbal medicine, and move forward to the international leading journal. We will strive to build a bridge between traditional medicine and modern medicine, promote global communication and cooperation, and contribute to the health and well-being of all mankind! Conflict of interest statement Boli Zhang is the Editor-in-Chief of this journal. Funding This article was supported by the Action Plan for Excellence of Chinese Science and Technology Journals(Excellence Plan-D-028).

Section Editor: Graeme J. Hankey MD, FRCP Ginkgo biloba extract, a Chinese traditional medicine, is used widely in the treatment of acute ischemic stroke in China and is also used occasionally in Europe, but its efficacy is uncertain. The primary objective was to determine whether Ginkgo biloba extract improves functional outcome without causing undue harm in patients with acute ischemic stroke. Secondary objectives were to assess the effect of Ginkgo biloba extract on neurological impairment and quality of life. We searched the Cochrane Stroke Group Trials Register (last searched October 2004), the Trials Register of the Cochrane Complementary Medicine Field (last searched October 2004) and the Chinese Stroke Trials Register (last searched June 2004). In …

: In China, allergic rhinitis patients are looking not only for western therapy in Chinese traditional medicine but also for treatment in Western and Chinese mixed medicine. Several studies have compared traditional Chinese medicine, Western and Western combined. Such three forms of treatment were not analyzed simultaneously. Aim: The research examines the differences between populations and medical applications of allergic rhinitis patients who received all three treatments to determine the use of different drugs. Methods: The inventory for patients diagnosed with allergic rhinitis (International Disease Classification). The Chi-square test and Tukey test were performed for the region of interest to check the disparity between these three treatments (a significant difference still exists). Results: The interview rate for women with allergic rhinitis is higher than for men regardless of whether it is treatment with traditional Chinese medicine, Western or combined traditional Chinese and Western medicine. Persons 0-19 years of age was first in the proportion of allergic rhinitis diagnosis and care. Traditional Chinese medicine includes medical measures with maximum hours per person, the daily cost per hour of medicines and minimum overall hourly expenditure. Western medicine, by comparison, costs the lowest daily drug per hour, and the highest total drug costs per hour per person. Between traditional Chinese and western medicine, the total cost per capita of integrated traditional Chinese and Western Medicine as well as drug costs per capita and the total cost per capita. Conclusion: Although only 6.82% of allergic rhinitis patients opt for combined traditional Chinese medicines and western medicine, their rate of receipt is higher each year. Moreover, mixed medications are used more frequently compared to single-component medicines

Traditional Chinese Medicine (TCM) consists of acupuncture, moxibustion, qigong, and herbal medicine. In modern times, TCM has often been used as complementary treatment for diseases that do not respond satisfactorily to conventional medicine. Autonomic disorders, which are caused by chronic imbalance of vegetative organs as well as autonomic-related areas in the central nervous system, fall into this category of difficult-to-treat conditions. Therefore, a significant role for TCM has been increasingly accepted in both Asian and Western countries for the treatment of autonomic disorders. The purpose of this special issue was to gather the most up-to-date evidence concerning the effective use of TCM for the treatment of autonomic disorders. Particular focus in this issue was placed on the effective use of herbal medicine. Three papers are related to digestive function. Inflammatory bowel disease (IBD) is a chronic intestinal disorder which is characterized by bouts of severe intestinal inflammation and colonic mucosal ulcer. D. Liu et al. showed that Si Shen Wan significantly inhibited apoptosis of IECs (intestinal epithelial cells) through activation of PLC-γ1 and suppression of P13K/Akt signal pathway. Their results indicate that Si Shen Wan (which consist of four components) can effectively treat colitis by inhibiting excessive apoptosis of IECs. A basic study on the effects of Huqi San (Qi-protecting powder) for cholestasis was conducted by X. Xue et al. They investigated the positive effects of Huqi San in the rat, indicating that it can stimulate Cl ion secretion in the distal colon by means of increasing the mRNA transcript and protein content of the cystic fibrosis transmembrane regulator in the liver, distal colon, and pancreas. They suggest that transporter modulation at a transcriptional level may serve as a potential target for a new therapeutic strategy for cholestasis. Swertianlarin, isolated from Swertia mussotii Franch. and Enicostemma axillare, has hepatoprotective effects against cholestasis. In China, it is often used for treatment of jaundice. A pilot study was conducted by L. Zhang et al. using a rat bile duct-ligation (BDL) model. Serum bile acid levels were reduced in BDL rats treated for 14 days with Swertianlarin. This observation suggests that Swertia mussotii Franch. attenuates liver injury, inflammation, and cholestasis. Further studies are critically needed on whether Swertianlarin exerts the protective role in other cholestatic models and what the molecular mechanism underlying Swertianlarin-induced protective effects on liver injury, inflammation, and cholestasis is. Hyperglycemia and diabetes-related depression can be improved by Chinese herbal medicine, Zuogui jiangtang jieyu (ZGJTJY) in rats. Y. Wang et al. conducted an interesting study using a 28-day mild stress model together with consistent high-fat diet and injection of streptozotocin. They investigated whether ZGJTJY prescription has hypoglycemic and antidepressant effects and found that ZGJTJY inhibits the expression of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) and increases glucocorticoid (GR) levels in the hippocampus and subsequently modulates blood glucose levels. They concluded that this potential property of ZGJTJY could be of benefit for the treatment of behavior and cognitive function in diabetes-related depression. Shenfu Decoction (SFD) is one of the most popular herbal medicine formulas with a long history of use in China. This herbal medicine consists of a mixture of Panax ginseng and Radix Aconiti Lateralis Preparata. Decoction is a typical traditional method of extraction by boiling of dissolved chemicals from herbal material and widely conducted in China, Japan, Korea, and other Asian countries. A study by J. He et al. had the main purpose of developing a rapid and sensitive Ultra Performance Liquid Chromatography/Quadrupole Time-of-flight Mass Spectrometry method. This technique is thought to be important to analyze pharmacokinetics of multiple components in various herbal medicines. We believe that this special issue will provide many readers with relevant up-to-date information in the fields of autonomic nervous system and traditional medicines. Kazuo Toda Jorge L. Zeredo Sae Uchida Vitaly Napadow

Recently, herbal medicine including traditional Chinese medicine (TCM) has gained huge attention in the world. In 2015, the global trades of herbal medicine reached 93.15 billion US dollars. And, the latest statistics from the Ministry of Industry and Information Technology of People's Republic of China showed that total sales of Chinese patent medicine and raw herbs reached 120 billion US dollars in 2014. Therefore, the aim of this study was to analyze the situation of international marketing on herbal medicine and how much TCM shared in it. The PubMed database, search engines and government websites and research reports were searched for analyses. The results showed that total trades of TCM products in both domestic and foreign markets, were about 135 billion US dollars, including Chinese patent medicine, raw herbs, herbal extracts, herbal health care products, whose proportion of the global marketing was 80%. Key words: Traditional Chinese medicine; Herbal medicine; Traditional medicine; Chinese materia medica exports; Global marketing

<p indent=0mm>The combined use of herbal and traditional medicine with synthetic drugs is a common clinical issue in China, as well as in other countries around the world. The improper combination of Traditional Chinese Medicine (TCM) with synthetic drugs may increase the risk of severe adverse drug reactions (ADRs). In China, the combination of Shuanghuanglian (SHL) and Ribavirin injections (RB) is one such example that has led to a higher risk of pseudo-allergic ADRs, observed during post-marketing safety monitoring. Such combination-related ADRs may be associated with concurrent drug exposure concentrations <italic>in vivo</italic>. Thus, it is important to administer both formulations at acceptable intervals to prevent ADRs. In this study, we propose an appropriate time interval of administration to reduce ADR risk in combination drug use. SHL and RB combination was then tested in rats. This combination was tested at different administration intervals. Ear weight was chosen as the quantitative index to indicate tissue edema and intensity of pseudo-allergic reactions. Compared to the control group, rats that were simultaneously administered with SHL and RB intravenously, showed different behaviors and symptoms such as ear edema and increase in weight, swelling of limbs and huddling, which were similar to those seen in pseudo-allergic reactions. By contrast, rats administered solely with either RB or SHL did not exhibit obvious pseudo-allergic reactions. With respect to the combination groups at different administration intervals, there were two different types of responses. One of them was similar to the concurrent administration of drug pairs, which occurred in groups at intervals of 0, 1.5, 2, 3.5 and <sc>4 h.</sc> The other type was similar to the sole use of RB or SHL, which occurred in groups with intervals of 6, 8, 12 and <sc>24 h.</sc> We also determined serum concentrations of complement <sc>C5 (C5)</sc> and thrombomodulin (THBD), proteins that mediate the complement system and coagulation cascade-depended pseudo-allergic reactions. Results showed that there was significant increase in these two indices in combination groups, with intervals below or equal to 4 h and non-significant increase in combination groups with intervals above or equal to 6 h. These results indicate that a “safe window” of administration interval exists when using the drug pair: SHL and RB, thus reducing the risk of pseudo-allergic reactions. Moreover, we tested serum metabolomic profiles of each group. The principal component analysis revealed that there was an obvious distinction between the rat groups, of both clusters: One cluster included the normal control group where either SHL or RB group was administered and the combination groups that were administered both SHL and RB at intervals of over or equal to 6 h. The other cluster involved combination groups that were administered both drugs at intervals below or equal to 4 h. Thus, the metabolomic results also elucidated a “safe window” administration interval, when using such drug pairs. We then screened out metabolites that might be used to distinguish these two clusters of rat groups. The results of ROC curves showed that compounds of <italic>m</italic>/<italic>z</italic> 154.0592, <italic>m</italic>/<italic>z</italic> 433.2357, and <italic>m</italic>/<italic>z</italic> 331.0528 could distinguish rats where SHL was used after and before 6 h. These metabolites were identified as L-2-Amino-3-(1-pyrazolyl) propanoic acid, [2-hydroxy-1-(6-hydroxy-1-oxo-1H-isochromen-3-yl) butoxy] sulfonic acid and LysoPA (0:0/18:2 (9Z, 12Z)) according to their MS/MS spectrum, respectively. This study verified the hypothesis of the “safe window” of administration interval in combination drug use, including TCM and synthetic drugs. Administered at appropriate intervals, it can reduce ADR risk and prevent safety-related issues from occurring. This study thus provides a new perspective for improving safety, when using Chinese herbal medicines in combination with synthetic medicine.

Objective To investigate the effects of electroacupuncture combined with Traditional Chinese Medicine on daily living activity, neurological function and inflammatory factors in patients with ischemic stroke. Methods 83 patients with ischemic stroke admitted to our hospital were divided into two groups according to the admission. Among them, 41 patients in the control group were treated with self-made Tongluo Decoction and 42 patients in the observation group were treated with electroacupuncture. When the treatment was over, the neurological and activities of daily living activities were compared between the two groups, and the levels of inflammatory factors in the body were measured. Results After treatment, the levels of inflammatory factors interleukelin-6, interleukelin-8, tumor necrosi factor-α and nafional institate of health stroke scale in the observation group were lower than those in the control group, and the barthel index score was higher than that in the control group (P<0.05). There were no serious adverse reactions in the two groups. Conclusions Electroacupuncture combined with self-made Tongluo Decoction had a good effect on the neurological function and daily activity of patients with ischemic stroke, and effectively reduced the secretion of inflammatory factors with high safety. Key words: Ischemic stroke; Traditional Chinese Medicine; Electroacupuncture; Nerve function

Application of signs of dying identified in traditional Chinese, Tibetan, and modern Western medicine in terminal care

근대 동아시아 전통의학의 지위 부침과 변화는 메이지시대 한방의학을 제도적으로 폐지하였던 일본의 역사적 경험이 끼친 영향이 컸다. 이는 식민지 조선, 대만뿐만 아니라 주권국가로서 면모를 유지하였던 중국 역시 예외가 아니었다. 중국은 근대로 접어들면서 전통문화를 부정하고 서양문명을 급급하게 추구하는 근대주의 사조가 팽배하였다. 그 가운데 중의부정론과 중의폐지론이 제기되었다. 그리고 일본에 갔다 온 의학유학생과 정계인사에 의해 법적, 제도적으로 중의학을 배제하려는 중의폐지안도 등장하였다. 이로써 근대 중의학은 식민지 조선의 한의학과 마찬가지로 불안정한 지위에 처하게 되었다. 하지만 식민지 조선과 달리 끝까지 주권국가였던 중국에서는 중의폐지론자도 있었지만, 국수주의, 민족주의, 민생주의 등 이념으로 무장한 중의옹호론자 역시 엄연히 존재하였다. 중의폐지론자와 중의옹호론자는 치열한 각 축전을 전개하였다. 양쪽의 대립은 비록 중·서의계 각각의 집단 이익과 무관하지 않았지만, 한편으로는 동서의학의 관계 설정 및 중국 의료근대화 방식 등의 문제에 대한 논의와 고민을 심화시키는 데 기여하였다. 한편, 조선인 한의계와 마찬가지로 근대 중의계는 서양의학을 배척할 대상으로 보지 않고, 일찍부터 동서의학의 대화를 모색하기 시작하였다. 중서의회통, 중의과학화, 이후 중서의결합까지 근대 중의학은 서양의학을 수용하여 중의학 스스로 개량과 혁신을 시도하며 새로운 형태로 변화하였다. 하지만 서양의학을 수용하는 것과 동서의학의 근본적 차이를 무시한 채 동아시아의학의 서양의학화를 지향하는 것은 별개의 문제였다. 일원적인 근대 과학 인식을 거부하고 서양의학을 상대한 동아시아 전통의학의 독특한 가치를 주장하는 인식은 근대 한중양국에서 공유되고 있었다. 그리고 그 시대에 공통적으로 미해결된 문제로 남겨진 동아시아 전통의학의 과학화와 동서의학 절충의 과제는 오늘날 중국의 중서의결합, 한국의 동서의학 통합(혹은 협진) 같은 형식으로 계속 추진되고 있다.In the Meiji Period, Japan abolished Kampo Medicine systematically; the historical experience impacted the status’ changing of traditional medicine in modern East Asia. The situation was not only in Korea and Taiwan that are colonies, while China, who could maintain the form of a sovereign country, was not exceptional. In modern times, the trend of thought that blindly denied traditional culture and pursued westernizing was very active, and the theory of denying or abolishing traditional Chinese medicine came on stage under the background. Some oversea medical students who had come back from Japan and some politicians launched the campaign of“abolishing traditional Chinese medicine”, which wanted to abolish Chinese traditional medicine systematically and legitimately. Since then the traditional Chinese medicine’s status, which is the same as traditional Korean medicine, was greatly shaken. Nonetheless, it is different from colonial Korea that China has maintained the status of a sovereign state all along. Although there was a group who tried to abolish traditional Chinese medicine, meanwhile there was a group who embraced nationalism and people’s livelihood, and the group was headed by traditional Chinese medical circles. The two groups competed fiercely. Although the antagonism between the two groups was closely related with the respective advantages of Chinese and western medical circles, their argument made contribution to the deep thinking and discussion about the relationship between eastern and western medicine and the modernization of Chinese medicine. On the other hand, traditional Chinese medical circles in modern times, who were the same as traditional Korean medical circles, didn’t regard western medicine as something that should be repelled, on the contrary, they tried to communicate with western medicine in very early times. From confluence of Chinese and western medicine, scientization of traditional Chinese Medicine, to combination of traditional Chinese and western medicine in later times, modern traditional Chinese medicine absorbed western medicine constantly, tried to promote the reformation and improvement by itself, and accomplished new development. Absorbing western medicine, however, is different from pursuing westernization of east medicine blindly without the awareness of the difference between them. Some of the men of insight in the two countries had the consensus that they would refuse unitary learning of modern science, and emphasize the unique value of traditional East Asia in comparison with western medicine. The tasks of scientific systemizing traditional East Asia medicine and harmonizing eastern and western medicine were not solved at that time by the two countries; nowadays the combination of Chinese traditional and Western medicine in China and medical integration of eastern traditional and Western medicine in Korea are trying to figure out the solutions.

The possibility of the preventive and therapeutic effects of Chinese traditional patent medicine for myocardial infarction has been reported in the literature, but there have been few studies. This paper presents three tendencies for the secondary prevention of myocardial infarction and presents a systematic evaluation of current research evidence related to the use of Chinese traditional patent medicine in secondary prevention of myocardial infarction, with a goal of making objective recommendations for patient rehabilitation. Literature was retrieved from traditional Chinese medicine websites, MEDLINE, CNKI, VIP, CINAHL, The Cochrane Library, EMBASE, HealthSTAR, and Academic ASAP to locate research-based scientific evidence related to the use of Chinese traditional patent medicine for myocardial infarction. Some Chinese traditional patent medicine therapies alone or in combination with routine rehabilitation therapies might be useful in patients with myocardial infarction, but we found insufficient evidence to support the use of most Chinese traditional patent medicine therapies in the secondary prevention of myocardial infarction. Difficulty in accessing information regarding traditional Chinese medicine has implications for health education in both myocardial infarction and patient safety. Some Chinese traditional patent medicine therapies hold promise for patients in the secondary prevention of myocardial infarction but further research is essential in all areas of traditional Chinese medicine to confirm its efficacy.

The global burden of disease has driven a broad shift from communicable, maternal, neonatal, and nutritional causes to noncommunicable diseases. Cardiovascular diseases (CVDs) remain the most prevalent cause of human morbidity and mortality all over the world [1]. According to the survey by Global Burden of Disease Study, 29.6% of all deaths worldwide were caused by CVDs in 2010 [2]. It is estimated that the number of people that die from CVDs, mainly from heart disease and stroke, will increase to more than 24 million by 2030 [3]. Despite progress in molecular medicine and biology and translational scientific efforts on improvement of diagnostic and therapeutic strategies over the past 20 years, CVDs continue to be a major global health problem. The use of herbal medicines, one of the main therapeutic approaches of complementary and alternative medicine (CAM), can be tracked back thousands of years ago in the East [4]. Currently, there is a recent resurgence of the use of herbal medicines in popularity among patients in the West and they were consumed by more than 15 million people in the US [5]. With increasing enhancement of people's awareness of self-care and concerning on the inevitable adverse effects of conventional medicine, herbal medicines are favored by people with CVDs all over the world for their unique advantages in preventing and curing diseases, rehabilitation, and health care [6]. There is growing evidence showing that many herbal medicines and their active ingredients contribute to the standard therapy for CVDs, for example, aspirin, digitalis, and reserpine [7]. Despite enormous interests in the medicinal uses by consumers, there is still a great deal of confusion and misunderstanding about their identification, effectiveness, pharmacology, toxicology, and herb-drug interaction to science world [8]. Therefore, the role of herbal medicines in CVDs still needs more scientific and clinical data proving their efficacy and safety. The special issue aims to summarize the current progress of promising herbal medicines and their extractions for various CVDs. Altogether, we gathered 31 papers for publication, out of which 14 papers were accepted. The original research articles and reviews in this issue cover a wide range of topics, including coronary heart disease, hypertension, heart failure, dyslipidemia, and arrhythmia. Five papers addressed the clinical application and the mechanism of herbal medicines in the treatment of coronary heart disease. “A multicentre randomized clinical trial on efficacy and safety of huxin formula in patients undergoing percutaneous coronary intervention” provided evidence on huxin formula, an experienced Chinese medicine formula, for the treatment of patients undergoing percutaneous coronary intervention. “Traditional formula, modern application: Chinese medicine formula sini tang improves early ventricular remodeling and cardiac function after myocardial infarction in rats” evaluated the improvement of early ventricular remodeling and cardiac function in myocardial infarction in rats by sini tang, which is a traditional Chinese classical herbal formula first described by Zhongjing Zhang (150–219 A.D.). “The comparative study on expression of SIRT1 signal transduction by xuefuzhuyu capsule” tested the protective effect of xuefuzhuyu formula, another classical herbal formula in traditional Chinese medicine (TCM), on ischemic myocardial cells induced by ischemia through SIRT1-mediated signal transduction pathway. “Protective effects of shen-yuan-dan, a traditional Chinese medicine, against myocardial ischemia/reperfusion injury in vivo and in vitro” investigated the effectiveness and mechanisms of shen-yuan-dan's pharmacological postconditioning on myocardial ischemia/reperfusion injury by targeting the phosphatidylinositol 3-kinase/Akt (PI3K/Akt) pathway. “Ligusticum wallichii extract inhibited the expression of IL-1β after AMI in rats” addressed the effects of Ligusticum wallichii (chuanxiong) extract on IL-1βexpression in myocardium and central nervous system after acute myocardial infarction. Hypertension is an important public-health challenge worldwide and a major risk factor for stroke, myocardial infarction, vascular disease, and chronic kidney disease. Prevention, detection, treatment, and control of this condition should receive high priority. How about the role of TCM for managing hypertension? One review article “Traditional Chinese medicine syndromes for essential hypertension: a literature analysis of 13,272 patients” analyzed the diagnosis rules and common TCM syndromes of hypertension and recommended the corresponding Chinese herbal medicines and formulas. “Chinese herbal medicine bushen qinggan formula for blood pressure variability and endothelial injury in hypertensive patients: a randomized controlled pilot clinical trial” examined the therapeutic effects of bushen qinggan formula as adjunctive therapy for antihypertensive drugs on mean blood pressure, blood pressure variability, and endothelial function for hypertension. One paper “Yiqi huoxue recipe improves heart function through inhibiting apoptosis related to endoplasmic reticulum stress in myocardial infarction model of rats” explored the mechanism of cardioprotective effects of yiqi huoxue formula in rats with myocardial infarction-induced heart failure by inhibiting endoplasmic reticulum stress response pathway. Two papers discussed the cardiovascular protective effects of Hawthorn (Crataegus oxyacantha). “Effect of Crataegus usage in cardiovascular disease prevention: an evidence-based approach” reviewed the cardiovascular pharmacological properties of Crataegus in vivo and in vitro. “Evaluation of a Crataegus-based multiherb formula for dyslipidemia: a randomized, double-blind, placebo-controlled clinical trial” examined the effects of a multiherb formula containing Crataegus pinnatifida on plasma lipid and glucose levels in Chinese patients with dyslipidemia. Finally, “Yiqihuoxuejiedu formula inhibits vascular remodeling by reducing proliferation and secretion of adventitial fibroblast after balloon injury” analyzed effects and mechanisms of the yiqihuoxuejiedu formula on inhibiting vascular remodeling, especially adventitial remodeling. “Ganoderma lucidum polysaccharides reduce lipopolysaccharide-induced interleukin-1β expression in cultured smooth muscle cells and in thoracic aortas in mice” examined the effects of an extract of Ganoderma lucidum (Reishi) polysaccharides on interleukin-1β expression by human aortic smooth muscle cells (HASMCs) and the underlying mechanism. A review article “Aspirin resistance and promoting blood circulation and removing blood stasis: current situation and prospectives” provided insight into the relationship between aspirin resistance and blood stasis syndrome and explored the therapeutic role of Chinese herbal medicines with promoting blood circulation and removing blood stasis for this condition. Recently, a great progress has been made focusing on the effectiveness and safety of herbal medicines in patients with CVDs. Some RCTs and systematic reviews provided strong evidence for clinical usage. The special issue presented the updated knowledge of partial herbal medicines for CVDs, which unraveled a complex posttranscriptional gene-regulating machinery and paved the evidence-based way. Xingjiang Xiong Francesca Borrelli Arthur de Sa Ferreira Tabinda Ashfaq Bo Feng

Traditional medicine has become an increasingly common treatment option for many patients. Traditional Chinese medicine is one of the more popular modalities. The aim of this study was to investigate the clinical characteristics of the needs of male subjects who visited a traditional Chinese medicine expert in a men's health polyclinic. A total of 231 male patients visited a men's health polyclinic comprised of psychiatry, andrology and traditional Chinese medicine. Participants completed a set of general data and screening assessments, including the Androgen Deficiency in Aging Males Questionnaire, the Aging Males' Symptoms Rating Scale, Insomnia Severity Index, Chinese version of the Beck Depression Inventory-II, Chinese version of the Beck Anxiety Inventory, Gotland Male Depression Scale, the abridged 5-item version of the International Index of Erectile Function, and the Situational Fatigue Scale. Blood testing, including a profile of sex hormone levels, was selectively performed according to clinical needs. Eighty-six males (37.2%) sought traditional Chinese medicine. The subjects who had been to traditional Chinese medicine before had a higher rate of erectile dysfunction and infertility complaints, and lower scores on the Gotland Male Depression Scale as compared to those who had never been to traditional Chinese medicine. Infertile male patients seek help from traditional Chinese medicine due to oligo-astheno-tetratozoo-spermia syndrome or failure to achieve pregnancy after treatment for correctable causes such as varicocele. Specific symptoms of male depression might be related to overall sexual complaints rather than to erectile dysfunction specifically. Herbal medicine may be an alternative and complementary treatment for male infertility, erectile dysfunction and mood disturbances, but further research is necessary to determine its efficacy in the male population.