Abstract
Background
Stable angina pectoris is a common condition, worldwide. Traditional Chinese herbal products (TCHP) are developed for treating stable angina pectoris in China.
Objectives
To assess the effectiveness and safety of TCHP in patients with stable angina.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1995 to June 2008), EMBASE (1995 to June 2008), the Chinese Biomedical Database (CBM) (1995 to June 2008), Chinese Science and Technique Journals Database (VIP) (1994 to June 2008) and Chinese National Knowledge Infrastructure (CNKI) (1995 to June 2008). We handsearched the relevant Chinese journals. We also contacted researchers in the field and authors of studies evaluated in this review for more information. No language restrictions were applied.
Selection criteria
Randomised controlled trials comparing TCHP with placebo, various other TCHP preparations, or with other regimes commonly used currently in the treatment of stable angina.
Data collection and analysis
Quality of studies was assessed independently by two authors. Data were extracted by one author and checked by the other one.
Main results
Three studies each with the number of participants ranging from 60 to 80, and a total of 216 participants, were included in this review. The interventions used in the included studies were different from one another. One study compared TCHP with nitrates and was of good methodological quality whereas the remaining two trials compared one preparation with another preparation and one was of poor methodological quality. As such, we were unable to perform a summary meta‐analysis. Only one trial with small patient numbers showed positive results favouring TCHP treatment compared with nitrates, in improved angina symptoms. Two of the trials stated that adverse reactions occurred but detailed data could not be obtained.
Authors' conclusions
There is currently insufficient evidence for effectively treating stable angina pectoris with any of the examined TCHP in this review, due to the small number of included studies and participants. Therefore, TCHP should be used with caution. High quality randomised trials with similar interventions are required to strengthen the evidence for the effectiveness and safety of Chinese medicinal herbs in angina pectoris.
Plain language summary
This review did not find strong evidence to demonstrate the effect of traditional Chinese herbal products in the treatment of stable angina
Traditional Chinese herbal products (TCHP) are often used to treat patients with stable angina but there is not sufficient evidence to show that TCHP are effective. The authors of this review undertook a systematic review of the potential benefits and safety of TCHP in patients with stable angina. Three randomised controlled studies with a total of 216 patients were identified. Only one small trial was able to detect benefits of using TCHP compared with nitrates in improving angina symptoms. The remaining two trials were inconclusive. Due to the very small number of included studies and participants in the studies, TCHP should be used with caution. We recommend that larger‐scale high quality randomised controlled trials of TCHP are required to strengthen the evidence for the efficacy and safety of certain TCHP in treating angina.
Background
Angina pectoris is the most common clinical manifestation of myocardial ischaemia, caused by an imbalance between myocardial blood supply and oxygen demand. Angina is a common presenting symptom, typically chest pain, among patients with coronary artery disease (Bernard 1979; Kau 1996). Myocardial ischaemia develops when the coronary blood flow becomes inadequate to meet myocardial oxygen demand. This causes myocardial cells to switch from aerobic to anaerobic metabolism with progressive impairment of metabolic as well as mechanical and electrical function (Bernard 1979). Angina is a sign of increased risk of heart attack, cardiac arrest and sudden cardiac death (Bernard 1979; Kau 1996).
Stable angina is chest pain or discomfort that typically occurs with activity or stress. It persists for more than four months and occurs more than five times a week. The pain usually begins slowly and gets worse over the next few minutes. It disappears rapidly with rest or with sublingual nitroglycerin (Bernard 1979). The stable angina attack (or chronic stable angina) is usually predictable, if the patient feels chest discomfort, pressure, or a squeezing sensation. Less commonly sensations of burning, sticking, or sharp pain may occur (Pope 2000).
As a symptom of cardiac ischaemia stable angina occurs because the flow of blood is being restricted, by any of (1) clogged arteries, which are often a sign of coronary artery disease; (2) problems in the aortic valve (one of the four heart valves), such as regurgitation (leaking) or stenosis (narrowing); (3) problems in the heart muscle (e.g. hypertrophic subaortic stenosis) (Hamby 2001). Ischaemic heart disease is the most common cause of death in Western countries, where it amounts to almost 33% of overall mortality (Braunwald 1992). The 'first clinical sign' in over half of patients is angina pectoris. In recent years, there has been an increasing tendency for ischaemic heart disease incidence to rise in developing countries, in conjunction with their economic development. For example in Beijing, China, mortality from this disease has increased from 21.7/100,000 in 1970 to 62.0/100,000 in 1980 (Chen 2000).
Although angina attacks usually pass with little long‐term damage to the heart the episodes of cardiac ischaemia that trigger the angina attacks can lead to dangerous problems if left untreated. They can cause abnormal heart rhythms (arrhythmias), which can lead to either syncope (fainting) or sudden cardiac death; heart disease patients whose episodes are triggered by stress (for example frustration) are more likely to die from their heart condition; severe or lengthy episodes can trigger a heart attack; and the small effects of minor episodes can eventually add up and lead to permanent weakening of the heart muscle (cardiomyopathy). So people with new, worsening, or persistent chest discomfort should be monitored carefully (Hamby 2001).
Antiplatelet agents consist of aspirin, ticlopidine, clopidogrel, and dipyridamole (ACC/AHA 1999). These medications prevent thrombus formation by inhibition of platelet aggregation (Alaeddini 2002). The Swedish Angina Pectoris Trial (SAPAT 1992) randomised 2935 patients with a history of at least one month of exertional angina to receive 75 mg aspirin daily in addition to beta‐blockers. The intervention resulted in a 34% reduction in primary outcomes (non‐fatal myocardial infarction (MI), fatal MI, or sudden death) and a 32% decrease in secondary vascular events after 72 months. Absolute risk reduction was 4% (95% confidence interval 1% to 7%) (SAPAT 1992).
Beta blockers inhibit the activation of beta‐receptors, which is associated with a reduction in cardiac inotropic state and sinus rate and slowing of atrioventricular (AV) conduction. The decreases in resting and exercise heart rate, cardiac contractility and arterial blood pressure with beta blockers are associated with decreased myocardial oxygen demand. A reduction in heart rate also increases diastolic perfusion time, which may enhance left ventricular (LV) perfusion (Frishman 1991; Narahara 1990). Patients who require regular, symptomatic treatment should be treated initially with a beta blocker (unless specifically contraindicated) (SIGN 2001). The Beta‐Blocker Pooling Project reported a highly significant reduction in mortality in this subgroup and it seems reasonable to assume that beta blockers have the potential to prevent death, especially sudden death, and also the development of myocardial infarction (MI) even when there has been no prior infarction (ESC 1997).
Calcium antagonists reduce the transmembrane flux of calcium via the calcium channels. They can reduce smooth muscle tension in the peripheral vascular bed. This is associated with vasodilation, and can decrease coronary vascular resistance and increase coronary blood flow. All of these agents cause dilation of the epicardial conduit vessels and the arteriolar resistance vessels. Calcium antagonists improve exercise time to onset of angina or ischaemia (ACC/AHA 1999). Long‐acting and slow‐release calcium antagonists are effective in relieving symptoms in patients with chronic stable angina (ACC/AHA 1999) and are specifically indicated for vasospastic angina (ESC 1997).
For nitroglycerin and nitrates, nitrates can reduce the myocardial oxygen requirement by reducing LV volume and preload, and also by improved nitroglycerin‐induced central arterial compliance. Nitrates can improve myocardial perfusion by dilating large epicardial coronary arteries and collateral vessels. Nitroglycerin also exerts antithrombotic and antiplatelet effects in patients with stable angina (ACC/AHA 1999). Sublingual (under the tongue) nitroglycerin tablets or nitroglycerin spray are used for the immediate relief of angina. However, these have not been shown to decrease death or the incidence of heart attacks (Caremark 2003). Both isosorbide dinitrate and mononitrate have been shown in controlled trials to be superior to placebo in controlling symptomatic angina (Chrysant 1993; Thadani 1992).
Angiotensin converting enzyme (ACE) inhibitors, which lower blood pressure and have other effects on blood vessels, could save lives and prevent heart attacks and strokes among certain patients with chronic stable angina (ACC 2002). The Heart Outcomes Prevention Evaluation (HOPE) trial, which compared the ACE inhibitor ramipril against placebo in more than 9000 patients with vascular disease including more than 3500 patients with diabetes, suggests that the use of an ACE inhibitor reduces the rates of death, MI or heart attack, stroke and revascularization procedures (ACC 2002).
Lipid lowering agents, including statins, help lower lipid levels in blood. Recent clinical trials have documented that low density lipoprotein (LDL) lowering agents can decrease the risk of adverse ischaemic events in patients with established coronary artery disease (CAD) (ACC/AHA 1999). The Scandinavian Simvastatin Survival Study showed that a statin given to patients with angina pectoris, and a total cholesterol level between 5.5 and 8.0 mmol/L (212 and 308 mg/dL), substantially reduce the risk of myocardial infarction, death, and the need for coronary bypass surgery by 30% to 35% (4S 1994). In patients with established CAD, including chronic stable angina, lipid‐lowering therapy should be recommended even in the presence of mild to moderate elevations of LDL cholesterol (ACC/AHA 1999).
Chinese herbal medicine in the treatment of stable angina
Traditional Chinese Medicine (TCM) is a 3000‐year old holistic system combining the use of medicinal herbs, acupuncture, food therapy, massage and therapeutic exercise for both treatment and prevention of disease (Fulder 1996). TCM has its unique theories for concepts of etiology, systems of diagnosis and treatment which are vital to its practice. TCM treatment consists typically of complex prescriptions of a combination of different components. The combination is based on the Chinese diagnostic patterns (that is inspection, listening, smelling, inquiry, and palpation) and follows a completely different rationale than many Western drug treatments (Liu 2000).
Some researchers have provided evidence on the rationale for use of traditional Chinese herbal medicines for angina. Rationales include (1) relieving myocardial ischaemia as some herbal medicines can dilate coronary arteries and increase coronary blood flow, for example Flos carthami, Radix puerariae, Rhizoma ligustici chuanxiong, Radix astragali seu hedysari, Radix notoginseng and Radix salviae miltiorrhizae (Ou 1992); (2) reducing myocardial oxygen consumption as some herbal medicines can reduce myocardial oxygen consumption, for example Radix augelicae sinensis and Radix notoginseng (Ou 1992); (3) antiplatelet and anticoagulant activity as some herbal medicines act on various blood‐clotting factors, increase the level of cAMP in thrombocytes, inhibit the rheological state of blood to impede the formation of thrombi, for example Radix salviae miltiorrhizae and Hirudo; some can lower the level of blood lipids and counter the development of atheroma, for example Radix augelicae sinensis (Ou 1992); (4) relieving pain as some herbal medicines can reduce the symptoms of chest pain and radiation pain, for example Radix augelicae sinensis, Radix notoginseng and Radix astragali seu hedysari (Ou 1992).
In addition, when using TCM two or more herbs are always used in the one prescription. In this way, the herbs used correctly interact. They may support each other to increase their effects or counteract each other to reduce or remove toxicity or side effects (Ou 1992).
The term 'Traditional Chinese herbal product' (TCHP) refers to an industrially manufactured drug which contains effective extracts of some herbal medicines according to the TCM prescription. The TCHP can be in various forms, for example as a capsule, injection, granule or tablet. Thus the TCHP can be used very conveniently for clinical purposes.
The effectiveness and safety of such treatments need to be reviewed systematically and appraised critically to inform current practice and direct the continued search for new treatment regimens.
Objectives
To assess the effects (benefits and harms) of traditional Chinese herbal products (TCHP) for stable angina.
Methods
Criteria for considering studies for this review
Types of studies
We included randomised controlled trials (RCTs) where the randomisation procedure could be authenticated.
Types of participants
Participants were male or female of any age or ethnic origin with stable angina. Participants were excluded if they had acute myocardial infarction, heart failure, hepatic failure or renal failure.
Types of interventions
TCHP compared with a current standard treatment regime or another anti‐anginal drug, placebo or no intervention, as well as comparisons between different doses or routes of administration of TCHP.
We decided to exclude studies that used the author's self‐prepared decoctions of herbs because these decoctions are limited and have not undergone quality control. We intend to include and analyse those drugs if in the future they become industrial products and enter the market.
Current standard regimes include the following preparations: antiplatelet agents, beta blockers, calcium antagonists, nitroglycerin and nitrates, ACE inhibitors and lipid lowering agents.
Types of outcome measures
We considered the following outcome measures.
Primary outcome measures
Death or acute myocardial infarction
Secondary outcome measures
Resolution of anginal symptoms
Frequency of anginal symptoms
Consumption of short‐acting nitroglycerine
Quality of life
Readmission to hospital
Revascularisation
Adverse event outcome measures
As a result of treatment:
mortality;
life threatening events;
toxic responses, for example gastrointestinal reaction;
anaphylaxis;
discontinuation of treatment.
Search methods for identification of studies
Comprehensive and exhaustive search strategies were formulated in an attempt to identify all relevant studies regardless of language or publication status (published, unpublished, in press and in progress).
Electronic searches
The following electronic databases were searched:
The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006);
MEDLINE (1995 to June 2008);
EMBASE (1995 to June 2008);
CBM (Chinese biomedical database, 1995 to June 2008);
VIP Chinese Science and Technique Journals Database (1994 to June 2008);
Chinese National Knowledge Infrastructure (CNKI) (1995 to June 2008).
See Appendix 1 for a general search strategy which was changed for different databases.
The Chinese databases were searched by Chinese characters. See Figure 1 for the Chinese search strategies. We checked the references of published studies to identify additional trials. We contacted ongoing trial authors to identify unpublished papers, but could not contact pharmaceutical companies who produced relevant products. Authors of identified studies were contacted for additional information.
1.
Search strategy in the Chinese databases
Searches for ongoing studies
We searched five World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) primary registers for ongoing trials (up to 30 June 2008), which include trials registered in:
Australia and New Zealand Clinical Trial Registry (www.anzctr.org.au/),
Chinese Clinical Trial Register (www.chictr.org),
ISRCTN (www.controlled‐trials.com/isrctn/),
National Institute of Health Clinical Trials Database (www.clinicaltrials.gov/),
Clinical Trials Registry‐India (www.ctri.in:8080/Clinicaltrials/index.jsp).
Data collection and analysis
Study selection
Three authors (ZQ, YZY, CHX) searched the databases. To determine which studies were to be assessed further, the authors independently scanned the titles, abstracts and keywords of every record retrieved. Full articles were retrieved for further assessment. We contacted the original authors of these studies to clarify the methods used in the process of randomisation. If the author could not be reached, the article was added to those 'awaiting assessment'. Differences in opinion were mostly resolved by discussion. There was no disagreement in the selection of studies.
Assessment of risk of bias of included studies
Risks of bias were assessed independently by at least two authors using the criteria that are described in the Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 (Higgins 2008) and (Wu 2007).
Randomisation process: assessment for selection bias
Adequate sequence generation was reported using one of the following approaches: random number tables or computer‐generated random numbers, coin tossing, or shuffling for generating the allocation sequence before recruiting the participants; trial was eligible and had a low risk of selection bias.
A study that did not specify one of the adequate methods outlined above but only mentioned 'random' was considered to have a moderate risk of selection bias.
Studies that used other methods of allocation, for example quasi‐randomisation, and appeared to have a high risk of bias and were excluded.
Allocation concealment process: assessment of selection bias
Adequate measures to conceal allocation meant that the person who generated the allocation sequence did not attend recruitment of the participants. The allocation sequence was kept secure, for example by using central randomisation, sealed opaque envelopes or a locked computer, or another description that contained convincing elements of concealment. These were considered to have a low risk of selection bias.
Trials in which the report mentioned 'concealed allocation' but did not report on the approach were considered as 'unclear', with moderate risk of selection bias.
Trials in which the report described an inadequate method to conceal allocation or did not conceal allocation were considered as having high risk of selection bias.
Level of blinding: assessment for performance bias and detection bias
Double blinding, by masking participants and results assessors, was considered to have a low risk of both performance and detection bias. In particular, the use of a placebo or simulant was considered as being the most effective approach for blinding.
Single blinding of the results assessor was considered to have a moderate risk of both performance and detection bias. If single blinding of the participants was carried out, and not the results assessor, the study was considered to have a high risk of detection bias.
No blinding was considered to have a high risk of both performance and detection bias.
We did not consider that blinding was needed for reporting mortality.
Incomplete data bias
< 5% of participants dropped out or lost to follow up: low risk of bias
5% to 15% of participants dropped out or lost to follow up: moderate risk of bias even if intention‐to‐treat analysis was used
≥ 15% of participants dropped out or lost to follow up, or wide differences in exclusions between groups: high risk of bias
Selective reporting bias
If all outcomes were reported in detail, a trial was recognised as having low risk of reporting bias.
If at least one of the outcomes was reported on, but not in detail, the trial was recognised as having moderate risk of reporting bias.
If one or more outcomes were not reported on, the trial was considered as having high risk of reporting bias.
Data extraction
Each trial was assessed independently by two authors (ZQ, YY). Information on trial design, study population, interventions and outcomes were extracted independently by two authors (ZQ, YY) using a data extraction form specifically designed for this review. The data extraction form included the following items.
General information: published or unpublished, title, authors, reference or source, contact address, country, urban or rural etc., language of publication, year of publication, duplicate publications, sponsor and setting.
Trial characteristics: design, duration of follow up, method of randomisation, allocation concealment, blinding (patients, people administering treatment, outcome assessors).
Intervention(s): intervention(s) (dose, route and timing), comparison intervention(s) (dose, route and timing), and co‐medication (dose, route and timing).
Patients: exclusion criteria, total number and number in each comparison group, age (adults), baseline characteristics, diagnostic criteria, similarity of groups at baseline (including any co‐morbidities), assessment of compliance, withdrawals and losses to follow up (reasons, description) and subgroups.
Outcomes: as specified above, any other outcomes assessed, other events, length of follow up, quality of reporting of outcomes.
Results: for outcomes and times of assessment (including a measure of variation) if necessary converted to the measures of effect specified below, intention‐to‐treat analysis.
Differences in data extraction were resolved by referring back to the original article and consensus. When necessary, information was sought from the authors of the primary studies.
All data in the included studies were binary outcomes, so the number of events and total number in each group were extracted or imputed.
We extracted herb names in three languages and the formulation contents for the included studies, given in Additional Table 4 and Table 5.
1. Latin‐Chinese‐English Names for Chinese Herbs.
| Latin Name | Pin Yin Name | Common Name |
| Borneolum | Bingpian | Borneol |
| Cortex et Radix Polygalae | Yuanzhi | Thinleaf Milkwort Root‐bark |
| Flos Carthami | Honghua | Safflower |
| Fructus Aurantii | Zhiqiao | Bitter Orange |
| Fructus Lycii | Gouqizi | Barbary Wolfberry Fruit |
| Rhizoma Chuanxiong | Chuanxiong | Szechuan Lovage Rhizome |
| Cortex et Radix Polygalae | Yuanzhi | Thinleaf Milkwort Root‐bark |
| Fructus Trichosanthis | Gualou | Snakegourd Fruit |
| Herba Epimedii | Yinyanghuo | Epimedium Herb |
| Hirudo | Shuizhi | Leech |
| Lumbricus | Dilong | Earthworm |
| Poria | Fuling | Indian Buead |
| Radix Achyranthis Bidentatae | Niuxi | Twotooth Achyranthes Root |
| Radix Angelicae Sinensis | Danggui | Chinese Angelica |
| Radix Astragali | Huangqi | Membranous Milkvetch Root / Mongolian Milkcetch Root |
| Radix Bupleuri | Chaihu | Chinese Thorowax Root /Red Thorowax Root |
| Radix Codonopsis | Dangshen | Pilose Asiabell Root /Moderate Asiabell Root/Szechwon Tangshen Root |
| Radix Curcumae | Yujin | Turmeric Root‐tuber |
| Radix Ginseng | Renshen | Ginseng |
| Radix Glycyrrhizae | Gancao | Liquoric Root |
| Radix Notoginseng | Sanqi | Sanchi |
| Radix Paeoniae Alba | Baishao | White Paeony Root |
| Radix Paeoniae Rubra | Chishao | Red Paeony Root |
| Radix Polygoni Multiflori | Radix Polygoni Multiflori | Tuber Fleeceflower Root |
| Radix Puerariae | Gegen | Kudzuvine Root |
| Radix Salviae Miltiorrhizae | Danshen | Danshen Root |
| Ramulus Cinnamomi | Guizhi | Cassia Twig |
| Rhizoma Acori Calami | Changpu | Drug Sweetflag Rhizome |
| Rhizoma Alismatis | Zexie | Oriental Waterplantain Rhizome |
| Rhizoma Corydalis | Yanhusuo | Yanhusuo |
| Rhizoma Cyperi | Xiangfu | Nutgrass Galingale Rhizome |
| Rhizoma Polygonati Odorati | Yuzhu | Fragrant Solomonseal Rhizome |
| Semen Platycladi | Baiziren | Platycladi Seed |
| Semen Ziziphi Spinosae | Suanzaoren | Spina Date Seed |
2. Contents of the formulations used in included studies.
| Study ID | Contents | Treatment |
| Wang 2004 | Linaoxin capsule: Danshen Root, Szechuan Lovage Rhizome, Kudzuvine Root, Earthworm, Red Paeony Root, Safflower,Turmeric Root‐tuber,Oriental Waterplantain Rhizome,Tuber Fleeceflower Root,Spina Date Seed,Barbary Wolfberry Fruit,Drug Sweetflag Rhizome,Thinleaf Milkwort Root‐bark,Twotooth Achyranthes Root,Liquoric Root | 4 capsule orally t.i.d |
| Fang 2004 | Yixinmai granule: Ginseng 5g, Cassia Twig 10g, Snakegourd Fruit 10g, Leech 6g, Indian Buead 15g | 10g particles a time orally t.i.d for 4 weeks |
| Wang 1999 | Baoxinbao film: not mentioned | Film (containing dried medicinal herb 16.2g/piece) precordially 2 pieces for the 1st time, then 1 piece each time for 4 days at a time (altogether 6 pieces for 20 days) |
Data analysis
Because of obvious clinical heterogeneity between included studies, we decided against doing a meta‐analysis to calculate pooled effect size. Data for each study were analysed and expressed as relative risks. The numbers of dropouts and participants that were lost to follow up for each study, if available, were summarized using an intention‐to‐treat analysis. When different herbal preparations were used (the TCHP) as the intervention, we considered treatment groups as a whole and compared them to certain chemical drugs in the control groups using qualitative analysis. In summary, data were summarized in a narrative format and different comparisons were analysed separately.
If data are available for meta‐analysis in the future, we will proceed as follows. The data will be included in a meta‐analysis if similar and of sufficient quality. We expect both event (dichotomous) and continuous data. Dichotomous data will be expressed as odd ratios (OR). The relative risk (RR) may be used as an alternative to the OR as interpretation is easier, especially if the outcome is a negative event. Continuous data will be expressed as weighted mean differences (WMD). Overall results will be calculated based on the random‐effects model. Heterogeneity will be tested for using the Chi2 statistic with significance set at P < 0.1. The I2 statistic will be used to estimate total variation across studies that is due to heterogeneity rather than chance where: 0% to 40% might not be important, 30% to 60%: may represent moderate heterogeneity, 50% to 75% may represent substantial heterogeneity and 75% to 100% considerable heterogeneity (Higgins 2003). Possible sources of heterogeneity will be assessed by sensitivity and subgroup analysis, as described below. Publication bias will be tested for using the funnel plot or another corrective analytical method, depending on the number of clinical trials included in the systematic review.
We have listed non‐randomised controlled studies and the reasons for exclusion of studies in the 'Characteristics of excluded studies' table, but have not discussed them further.
Results
Description of studies
We contacted the original authors by telephone or e‐mail to assess the authenticity of the RCT and to retrieve, where applicable. missed information such as about quality issues including allocation concealment.
Studies identified
Initially, we found 242 potentially relevant publications; we eliminated those that did not appear to meet our inclusion criteria. We subsequently retrieved 127 studies classified as RCTs of traditional Chinese medicine in the treatment of stable angina. However, only three of these that were published in Chinese (Fang 2002; Wang 1999; Wang 2004) could be included. Detailed descriptions of these trials are provided in the table 'Characteristics of included studies'. Table 5 shows the main components of the herbal formulations in the included studies. The remaining RCTs were excluded because:
the methodology used did not fulfil those required for an RCT,
patients had complicated unstable angina,
they were multiple versions of the publication itself,
self‐prepared formulations were used.
Specific reasons for exclusion of studies are given in Characteristics of excluded studies. The detailed searches and selection of trials for the review are graphically represented in Figure 2, as recommended by the QUOROM consensus guidelines (Moher 1999).
2.
QUOROM flow chart
Design of included studies
Details of the included studies are shown in the table 'Characteristics of included studies'. All included studies had a randomised controlled parallel study design. All the trials were conducted in China.
Participants of included studies
In one study (Wang 2004) patients with stable angina pectoris were included according to the diagnostic criteria in 'The Guidence of Conducting A Clinical Trial for New Drug of Traditional Chinese Medicine', issued by the Health Ministry of People's Republic of China. The diagnostic criteria in the other two studies were in accordance with the Report of the Joint International Society and Federation of Cardiology and WHO Task Force on Standardization of Clinical Nomenclature.
No included study mentioned exclusion criteria. Patients were adults aged from 40 to 76 years. In one trial the duration of illness on entry was not mentioned (Wang 2004); in the other two trials the mean duration of illness on entry was more than three years.
Interventions used in the included studies
Fang 2002: Yixinmai granule versus compound Danshen tablet Wang 1999: Baoxinbao tablet versus isosorbide dinitrite Wang 2004: Linaoxin capsule versus Xinnaokang capsule
In the study using isosorbide dinitrate as control, the dosage was 10 mg three times daily (Wang 1999). The details about drug components, types, routes and dosages are described in the table 'Characteristics of included studies' and 'Additional Table 5'.
Outcome measures of included studies
No study assessed death or acute myocardial infarction. The included three studies reported outcome measures according to the Standard on the Assessment of Curative Effect of Angina and ECG of Coronary Heart Disease, constituted by a Symposium on Integrated Western and Chinese Medicine for the Angina of Coronary Heart Disease in 1979, in China. It specified the following criteria for the measurement of stable angina.
1. Criteria for improvement of angina symptoms in the included studies
Marked improvement: symptoms disappeared or are reduced by > 80%
General improvement: severity, frequency and duration of angina attacks reduced by 50% to 80%
Inefficacy: the severity, frequency and duration of angina attacks similar to before intervention, or reduced by < 50%
2. Criteria for ECG improvement in the included studies Marked improvement: ECG became normal General improvement: ST‐segment depression improved by > 0.05 mV; the depth of the inverse T wave decreased by > 25% or horizontal T wave turned positive on the main lead of the 12‐lead surface ECG Inefficacy: no improvement of ECG
Two studies (Wang 1999; Wang 2004) reported the number of people with 50% or more decrease in nitroglycerin use per week. One study (Wang 1999) reported heart rate (HR), systolic blood pressure (SBP) and the rate pressure product (HR* SBP) (RPP). Two studies (Wang 1999; Wang 2004) reported on adverse side effects.
None of the studies reported on our other secondary outcomes of quality of life, readmission to hospital or revascularisation.
Risk of bias in included studies
Randomisation
All of the included studies mentioned randomisation but none of the studies described allocation concealment. After confirmation by telephone, we corroborated that the three included studies were authentic RCTs; in two of the studies allocation concealment was 'adequate' (Wang 1999; Wang 2004).
Blinding
By telephone, we verified that two studies (Wang 1999; Wang 2004) used double blinding in which the patients and people administering the treatment were blind to the intervention. One study employed single blinding (Fang 2002), where only the patients were blind to the intervention.
Incomplete data
Only one of the three included studies mentioned withdrawals and reported the reasons (Wang 2004).
Compliance assessment
None of the studies reported on the methods to ensure compliance.
Similarity of comparison groups at baseline
Similarity of comparison groups at baseline was ensured in all studies by stratified randomisations; based on age, sex and disease duration at entry.
Effects of interventions
The data were heterogeneous and of poor quality. Furthermore, no more than two studies used the same intervention. We decided against undertaking a meta‐analysis and instead concentrated on a descriptive summary of results. Unfortunately there were no reported data on our selected primary outcomes of death or acute myocardial infarction. We therefore focused on the following outcome measures.
1. Improvement of angina symptoms
This outcome measure synthesized the severity, duration and frequency of angina attacks, and was reported by all three studies.
Data on marked improvement of angina symptoms are shown in Analysis 1.1.
1.1. Analysis.
Comparison 1 Improvement of angina symptoms, Outcome 1 Marked improvement (symptoms disappeared or reduced by > 80%).
1. TCHP versus nitrate
One study in this subcategory showed positive results favouring the TCHP: Baoxinbao patch compared with isosorbide dinitrite (RR 4.28; 95% CI 1.60 to 11.39) (Wang 1999).
2. One type of TCM versus another (chief active ingredient of the control group: Danshen root)
Two studies (Fang 2002; Wang 2004) compared one type of TCM with another. The main active ingredient was Danshen root, which is regarded by many Chinese physicians as effective (a so‐called 'positive effect drug') in treating ischaemic heart diseases.
Of the two studies, Yixinmai granule was more effective than Danshen tablets (RR 2.71; 95% CI 1.34 to 5.48) (Fang 2002). The more recent and better quality trial (Wang 1999) was not able to demonstrate the effectiveness of Linaoxin capsule over Xinnaokang capsule (Wang 2004).
Data on general improvement of angina symptoms are shown in Analysis 1.2.
1.2. Analysis.
Comparison 1 Improvement of angina symptoms, Outcome 2 General improvement (severity, frequency and duration of angina attacks markedly decreased by 50‐80%).
1. TCHP versus nitrate The one study in this subcategory showed no statistical significance favouring the TCHP: Baoxinbao patch compared to isosorbide dinitrite (RR 0.96; 95% CI 0.54 to 1.71) (Wang 1999).
2. The other two studies in this category also showed no statistically significant differences (Fang 2002, Wang 2004) between Yixinmai granule and Danshen tablet (Fang 2002) or Linaoxin and Xinnaokang capsule (Wang 2004).
Data on Inefficacy of interventions in improving angina symptoms are shown in Analysis 1.3
1.3. Analysis.
Comparison 1 Improvement of angina symptoms, Outcome 3 Inefficacy (severity, frequency and duration of angina attacks remain similar as before intervention, or reduced by < 50%).
1. TCHP versus nitrate The one study in this subcategory showed a significant statistical difference suggesting the inefficacy of TCHP: Baoxinbao patch compared to isosorbide dinitrite (RR 0.30; 95% CI 0.13 to 0.67) (Wang 1999).
2. One type of TCM versus another (chief active ingredient of the control group: Danshen root) No significant differences were observed for the two studies in this subcategory, which compared Yixinmai granule with Danshen tablet (Fang 2002) and Linaoxin with Xinnaokang capsule (Wang 2004).
2. ECG Improvement
See Analysis 2.1 for 'Marked improvement of ECG', Analysis 2.2 for 'General improvement' and Analysis 2.3 for 'Inefficacy of interventions in improving ECG readings'.
2.1. Analysis.
Comparison 2 ECG improvement, Outcome 1 Marked improvement (ECG resumed to normal ranges).
2.2. Analysis.
Comparison 2 ECG improvement, Outcome 2 General improvement (depth of ST‐segment depression recovered by >0.05mv; on the main lead out of surface 12‐lead ECG, the depth of inversed T wave decreases by >25%, or horizontal T wave turns positive).
2.3. Analysis.
Comparison 2 ECG improvement, Outcome 3 Inefficacy (no improvement of ECG readings).
The ECG is a valuable diagnostic tool for evaluating myocardial ischaemia and infarction and the effects of cardiac drugs (Surawicz B 2001). The detailed information about this criterion can be found in the 'Description of studies' segment. All three studies reported on ECG improvement but none could demonstrate a marked improvement. Only Wang 1999 could find a general improvement using nitrates, which was of borderline significance (RR 1.80; 95% CI 1.02 to 3.17).
3. Number of people with decreased use of nitroglycerin per week, by 50% or more
See Analysis 3.1 for 'TCHP versus nitrates' and Analysis 3.2 for 'One type of TCHP versus another'. Two studies reported on the number of people who decreased their use of nitroglycerin by 50% or more per week (Wang 1999; Wang 2004). One demonstrated statistical significance favouring the TCHP Baoxinbao patch compared with isosorbide dinitrite (RR 2.00; 95% CI 1.32 to 3.02) (Wang 1999).
3.1. Analysis.
Comparison 3 Number of people with decrease of nitroglycerin use by 50% and above per week, Outcome 1 TCHPs versus Nitrates.
3.2. Analysis.
Comparison 3 Number of people with decrease of nitroglycerin use by 50% and above per week, Outcome 2 One type of TCHPs versus another (chief ingredient: Danshen Root).
4. Adverse effects
The included studies mentioned adverse effects of TCHP but only in terms of "none obvious" or "low adverse effect". As such, these data were not used.
Discussion
Summary of main results
This systematic review examined and compared the effectiveness of TCHP for patients with stable angina alone or in combination, with nitrates or another TCHP whose main active ingredient was Danshen root. Overall, studies of TCHP for stable angina lack sufficient power to provide reliable estimates of the effects. No study provided data for us to compare the effect of TCHP on our primary outcome measures of death or acute myocardial infarction. The reason for this might be that most patients with chronic stable angina have a relatively low risk of death or major adverse cardiovascular events.
One study in particular was able to provide positive results for our secondary outcome measures, the frequency of angina symptoms and use of nitroglycerin. This is believed to consistently predict mortality and cardiovascular events among outpatients with coronary artery disease. No study measured patient quality of life. One study was able to demonstrate limited benefit of TCHP compared with nitrates in terms of improved angina symptoms. We were unable to determine if TCHP was more effective than the nitrate regimen, mainly because the trial was small with wide confidence intervals and insufficient statistical power. The improvement in ECG was of borderline significance, inferring that the observed effects were of limited clinical importance. No other positive results were identified, particularly in the two studies comparing one type of TCHP versus another, with Danshen root as the main ingredient. The effectiveness of TCHP in treating stable angina is yet to be established.
Quality of the evidence
The evidence from the included studies was of low quality.
(1) Publication bias may exist because only Chinese language publications were found and included.
(2) Among the 127 papers that we retrieved for further details, the great majority were small clinical trials (around 100 people) which for various reasons could not be included in the systematic review. A large number of the trials claimed to be RCTs but most of them failed to give adequate and convincing information about the methodological quality. When we telephoned the trial authors about the method of randomisation they had used, we found that the majority of the authors described the concept of randomisation incorrectly. In addition, some of the studies were conducted several years ago and the trial authors may have forgotten the details of the methodology they employed, which could lead to bias and end up influencing the veracity of the information provided.
By careful clarification with the authors, we identified only three of the retrieved studies as true RCTs. These had funding sources and only two studies used allocation concealment. The same two studies used double blinding and the third study employed single blinding, which may introduce performance bias. None of the studies mentioned blinding of the outcome assessors, promoting suspicion of detection bias. No analysis was reported based on intention to treat.
(3) None of the three studies used a placebo as control, but 'positive‐effect drugs' were selected in two studies (Fang 2002; Wang 2004). Both studies used Danshen preparations as controls, the reason possibly being that the trialists thought that the effect of Danshen was generally accepted in the treatment of ischaemic heart disease. Large sample multicentre RCTs are required.
This may result in false positive findings as a number of interventions are considered effective for stable angina, particularly if trialists know that a 'positive' drug was used in the trial and the purpose of the study was to demonstrate the same effect as the control (so called 'equal effect test' or comparative effectiveness).
(4) We found that the interventions in two of the three studies (Fang 2002; Wang 2004) were prepared by the trial authors themselves or their colleagues in the trial author's hospital. We included these two study because they were funded either by government or a pharmaceutical company and, therefore, had a guarantee of quality. However, the fact that in these two studies the trialists acted as the main players, including formulation designer, trial designer and trialist, may lead to a high possibility of favouring the intervention and introduce conflict of interest.
Although TCHP as a treatment for stable angina and its method of manufacture are widely accepted in China, most of the constituents of the pharmacologically prepared drugs used in the trials cannot be clearly specified. This is in marked contrast to pharmacological agents used in Western medicine, in which the chemical constituents, their quantities and the percentages of any impurities or contaminants are precisely known; and the variation between different production batches is kept within specified limits. Variations between decoctions and batches of treatments are inevitable consequences of TCHP, though the Chinese Government also specifies the acceptable limits of variation. This variation is a factor that may contribute to heterogeneity between different study results. Furthermore, one must accept that the overall treatment concept for TCHP is different to that used in Western medicine. When a study uses a self‐prepared herbal decoction, the quality of herbs and methods of preparation should be stated in detail in order to achieve consistent effects.
(5) One study (Wang 2004) used unequal numbers of participants in each arm of the trial. Wang 2004 used a proportion of 3:1 and only 20 patients were included in the control group (60:20). Considerations for the sample sizes were not reported and so the trial cannot detect differences between the two groups.
(6) None of the studies abided by the criteria laid down in the CONSORT statement (CONSORT 2001). The results for the interventions did not come close to reaching a confirmable conclusion as to the effectiveness of a certain Chinese patent medicine or a herbal preparation compared to another. If more high quality studies on the same interventions had been found, the effectiveness of certain TCMs could have been evaluated more reliably using meta‐analysis.
(7) The outcome definitions adopted by this review, and employed by all the studies, were based on a subjective judgement of the extent of improvement of angina symptoms by individual clinicians, making the results somewhat unreliable. Another main outcome measure used was improvement in ECG, which may be a valuable diagnostic tool to evaluate the effects of cardiac drugs (Surawicz B 2001) but it is a surrogate measure. Furthermore, the current ACC/AHA 2002 guideline states that the treatment of chronic stable angina has two complementary objectives. These are to reduce the risk of mortality and morbid events and to reduce symptoms. From the patient's perspective, it is often the latter that is of greater concern. The definition of successful treatment of chronic stable angina, for most patients, should be complete or nearly complete elimination of anginal chest pain and return to normal activities and a functional capacity of CCS class I angina. This goal should be accomplished with minimal side effects of therapy. Unfortunately, neither mortality nor a more precise and objective symptom improvement outcome measure were used. Specific adverse effects were not adequately reported by any of the studies. We intend to adopt changes and improve the next updated version of this review.
(8) It is difficult to compare the outcomes of TCM with standard 'Western' clinical outcomes. TCHP outcomes rely on the subjective interpretation of experienced TCHP physicians in their observations. For example, in the examination of the pulse and tongue (mai xiang and she xiang respectively) outcomes are dependent on the expertise of the physicians and are usually classified in the three main domains of mild, medium and severe. TCM researchers and physicians need to establish a gold standard method for evaluating TCHP outcomes.
Potential biases in the review process
There were 28 studies for which we were unable to contact the authors to authenticate the RCT methodology. Some of these trials may have used adequate RCT methodology and may be included in this review in the future, perhaps leading to different results.
Agreements and disagreements with other studies or reviews
A research team published a meta‐analysis (Wang 2006) and a subsequent quality assessment (Fan 2007) on Dan Shen Di Wan (Compound salvia pellet, CSP) versus nitrates for treating stable angina. In that review, 27 articles were included and the quality was assessed using the Jadad scale. They found the following.
1. CSP significantly improved angina, compared with nitrates, in terms of angina symptoms (RR 1.13; 95% CI 1.07 to 1.20), electrocardiogram results (RR 1.39; 95% CI 1.28 to 1.50) and fewer adverse events (2.4% versus 29.7%) (Wang 2006).
2. The methodological quality of clinical trials needs to be improved (Wang 2006) as none of the studies conducted an ethics review or obtained informed consent and thus were not considered to be good enough to provide reliable evidence for clinical practice (Fan 2007).
The review used different criteria for inclusion of studies and as such may have found more favourable results than our systematic review.
Authors' conclusions
Implications for practice.
There is currently insufficient evidence on the examined Chinese medicinal herbs for treating stable angina pectoris effectively, due to the small number of randomised controlled trials conducted and the paucity of patients enrolled in these trials. In addition, the safety of TCHP is unknown due to the lack of adequate date on adverse reactions. Therefore, TCM should be used with caution. We recommend that stronger evidence is obtained.
Implications for research.
It is largely believed in China that TCM is beneficial in the treatment of stable angina pectoris, compared with routine western medicine. However, current clinical studies generally focus on the descriptive analysis of well‐known and patented medicines and lack an analysis of TCHP compounds. Most TCHP physicians will choose the component medicinal herb from their own perspective, which makes summary analysis difficult. Finding new and effective agents and sufficient corresponding evidence is therefore difficult. It is necessary to have a clearer description of the medicinal herbal preparations being tested, including information on plant species, geographical origin, harvest season, preparation procedures and quality control measures.
It is of note that most trials are of low methodological quality and with small numbers of participants (mostly 60 to 80). There is a requirement for more studies with high methodological quality, large numbers of participants and good reporting to provide stronger evidence. Hopefully well‐designed, randomised and multicentre, instead of sporadic, small‐sampled and poorly‐designed, clinical trials will be carried out in future. For most clinicians in China, allocation concealment should be emphasized and the approaches should be reported clearly. Another problem exists in the specific appearance and smell of TCHP, which may make blinding difficult. Drug types and routes should be consistent in both of the comparison groups and capsules may be a good answer to this problem.
Despite the outcome measures laid down according to TCM theory, clinical trials should include endpoints of death and major cardiovascular events and, from the patients' perspective, quality of life. Both require long‐term follow up.
Future trials should use a standard risk‐stratified population. Standardized monitoring or an effective reporting system should be adopted to critically estimate adverse events and the safety of specific preparations.
What's new
| Date | Event | Description |
|---|---|---|
| 4 March 2013 | Review declared as stable | No longer being updated |
| 25 April 2012 | Amended | Lead author's details updated. |
Notes
No longer being updated.
Acknowledgements
We thank all of the authors of the original studies for their cooperation in responding to our telephone interviews. We also thank all members of the Cochrane Heart Group Editorial Board for all the advice and help in writing the review.
Jiafu Wei, Juan Ni, Jie Zhen, Xin Duan, Likun Zhou are acknowledged for their previous work on the development of the protocol. Dr Joey Kwong is acknowledged for providing language support.
Appendices
Appendix 1. Search strategy
The general search strategy was used and was changed for different databases: #1 ANGINA‐PECTORIS*:ME #2 ANGINA #3 CORONARY‐DISEASE*:ME #4 (CORONARY near DISEASE*) #5 (((#1 or #2) or #3) or #4) #6 MEDICINE‐ORIENTAL‐TRADITIONAL*:ME #7 DRUGS‐CHINESE‐HERBAL*:ME #8 (CHINESE near MEDICINE*) #9 (TRADITIONAL near CHINESE) #10 (TRADITIONAL near MEDICINE*) #11 (CHINESE next DRUG*) #12 KAMPO #13 ((((((#6 or #7) or #8) or #9) or #10) or #11) or #12) #14 Composite Danshen droplet pills #15 Fu Fang Dan Shen Di Wan #16 Fu Fang Dan Shen Pian #17 Tong xin tang #18 Yi Qi Tong Bi Tang #19 Svate #20 Ci Wu Jia injection #21 Yi Qi Huo Xue Hua Yu Fa #22 Puerarin #23 Ligustrazine #24 Mai Luo Ning #25 Sheng Mai #26 Huang Dan Xin Le pills #27 Xin ta hua capsule #28 Yi Qi Huo Xue Tang #29 Bao Xin Yao Zhen #30 (#14˜#29)/or #31 (#5 and #13 and #30)
Data and analyses
Comparison 1. Improvement of angina symptoms.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Marked improvement (symptoms disappeared or reduced by > 80%) | 3 | 213 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.27 [1.42, 3.62] |
| 1.1 TCMs versus Nitrates | 1 | 76 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.28 [1.60, 11.39] |
| 1.2 One type of TCMs versus another (chief ingredient: Danshen Root) | 2 | 137 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.68 [0.98, 2.87] |
| 2 General improvement (severity, frequency and duration of angina attacks markedly decreased by 50‐80%) | 3 | 213 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.63, 1.29] |
| 2.1 TCMs versus Nitrates | 1 | 76 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.96 [0.54, 1.71] |
| 2.2 One type of TCMs versus another (chief ingredient: Danshen Root) | 2 | 137 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.55, 1.37] |
| 3 Inefficacy (severity, frequency and duration of angina attacks remain similar as before intervention, or reduced by < 50%) | 3 | 213 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.49 [0.31, 0.78] |
| 3.1 TCMs versus Nitrates | 1 | 76 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.3 [0.13, 0.67] |
| 3.2 One type of TCMs versus another (chief ingredient: Danshen Root) | 2 | 137 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.68 [0.38, 1.20] |
Comparison 2. ECG improvement.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Marked improvement (ECG resumed to normal ranges) | 3 | 213 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.43 [0.72, 2.87] |
| 1.1 TCMs versus Nitrates | 1 | 76 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.35 [0.24, 7.63] |
| 1.2 One type of TCMs versus another (chief ingredient: Danshen Root) | 2 | 137 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.45 [0.68, 3.10] |
| 2 General improvement (depth of ST‐segment depression recovered by >0.05mv; on the main lead out of surface 12‐lead ECG, the depth of inversed T wave decreases by >25%, or horizontal T wave turns positive) | 3 | 213 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.43 [0.94, 2.16] |
| 2.1 TCMs versus Nitrates | 1 | 76 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.8 [1.02, 3.17] |
| 2.2 One type of TCMs versus another (chief ingredient: Danshen Root) | 2 | 137 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [0.61, 2.08] |
| 3 Inefficacy (no improvement of ECG readings) | 3 | 213 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.71 [0.53, 0.97] |
| 3.1 TCMs versus Nitrates | 1 | 76 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.37, 0.94] |
| 3.2 One type of TCMs versus another (chief ingredient: Danshen Root) | 2 | 137 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.82 [0.55, 1.21] |
Comparison 3. Number of people with decrease of nitroglycerin use by 50% and above per week.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 TCHPs versus Nitrates | 1 | 76 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.80 [1.18, 2.76] |
| 2 One type of TCHPs versus another (chief ingredient: Danshen Root) | 1 | 30 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.52 [0.79, 2.95] |
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Fang 2002.
| Methods | Parallel design. The randomisation procedure was not mentioned in the original article, we telephoned the author and confirmed that a random number table was used to generate the allocation sequence. Single blinding was used, for the participants. | |
| Participants | Ethnicity: Chinese Setting: outpatients 60 patients with at least 3 months history of classic angina of effort and at least 3 episodes of attack per week, being relieved by rest or sublingual nitroglycerin, and all in line with Report of the Joint International Society and Federation of Cardiology/World Health Organization Task Force on Standardization of Clinical Nomenclature: 30 in treatment group, M/F 23/7, mean age 56.8 years (46‐76), mean disease duration 3.6 years (3 months‐ 6 years); 30 in control group, M/F 24/6, mean age 57.2 years (5 months‐ 8 years). Withdrawals and drop‐outs: not stated Exclusion criteria: not stated Characteristics of patients at baseline: similar. | |
| Interventions | Treatment group: 10g 'Yi Xin Mai' Granules a time orally t.i.d for 4 weeks (components: Ginseng 5g, Cassia Twig 10g, Snakegourd Fruit 10g, Leech 6g, Indian Buead 15g); Control group: 3 Compound 'Dan Shen' tablets a time orally t.i.d for 4 weeks. | |
| Outcomes | 1. Improvement of clinical symptoms: chest pain, palpitation, dyspnea, fatigue etc): using semi‐quantitative scale (1‐4 points) graded with marked effect (disappearance of clinical symptoms and total score reduced by >= 80%), general effect(marked improvement of clinical symptoms and total score reduced by 40%‐79%), ineffective (no improvement of clinical symptoms and total score reduced by < 40%), aggravation (worsening of clinical symptoms and total score increased by ≥10%). 2. Therapeutic effect of angina: 1) marked effect:symptoms disappeared or almost disappeared; 2) general effect: marked improvement of the frequency and severity and duration of the disease; 3) ineffective: almost no improvement as before treatment. 3. Improvement of ECG: 1) marked effect: rest ECG returning to normal,and/or exercise test from positive to negative; 2) general effect: improvement of rest ECG and exercise test, but still not normal; 3) ineffective:ECG remaining almost the same as before treatment. 4. Adverse effect. | |
| Notes | 1 It was a local government supported project 2 This was a clinical study for new drug development 3 The formulation of the drug was provided by author's department 4 The drug was made by the author's hospital. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Allocation concealment (selection bias) | Unclear risk | Not used |
| Blinding (performance bias and detection bias) All outcomes | Low risk | Single blinding was used for the participants |
| Incomplete outcome data (attrition bias) All outcomes | High risk | |
| Other bias | High risk | The formulation of the drug was provided by author's department, and the drug was made by the author's hospital. |
Wang 1999.
| Methods | Parallel design. The randomisation procedure was not mentioned in the original article, we telephoned the author and confirmed that a random number table was used to generate the allocation sequence. Double blinding was used for the participants and drug provider. | |
| Participants | Ethnicity: Chinese Setting: inpatients and outpatients 76 patients with stable angina pectoris, all in line with the Report of the Joint International Society and Federation of Cardiology/World Health Organization Task Force on Standardization of Clinical Nomenclature: 40 in treatment group, M/F 23/17, mean age 61 years(45‐70), mean disease duration 35.7 months(2 weeks‐10 years); 36 in control group, M/F 21/15, mean age 59.6 years(47‐70),mean disease duration 36.8 months(2 weeks‐10 years). Exclusion criteria: not stated Withdrawals and drop‐outs: not stated Characteristics of patients at baseline: similar. | |
| Interventions | Treatment group: 'Bao Xin Bao' patch (containing dried medicinal herb 16.2g/piece) precordially 2 pieces for the 1st time, then 1 piece each time for 4 days at a time(altogether 6 pieces for 20 days) with or without isosorbide dinitrate therapy in the meantime. Control group: isosorbide dinitrate orally 10mg t.i.d for 20 days. | |
| Outcomes | 1. Therapeutic effect of angina: intensity, duration, frequency of attack per week, dosage of isosorbide dinitrate and precipitating factors 2. Clinical symptoms and signs of CHD: chest pain, palpitation, dyspnea, tongue picture and pulse tracings; 3. Resting ECG 4. Heart Rate (HR), Systolic Blood Pressure (SBP), HR*SBP (RPP) 5. Routine test of blood and urine, liver and kidney function test and adverse effects 6. Level of blood ET and NO. | |
| Notes | In the telephone interview, we completed the following information missed in the article: 1 this was a pharmaceutical company funded topic; the name of company is Hefei Delin Keji Ltd; 2. this was a clinical study for pre‐market drug development. The number of the certificate issued by the State Food and Drug Administration was "CZS0006". | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | Low risk | Adequate |
| Blinding (performance bias and detection bias) All outcomes | Low risk | Double blinding |
| Other bias | Low risk | |
Wang 2004.
| Methods | Parallel design. Due to that the randomisation procedure was not mentioned in the original article, we telephoned the author and confirmed that a random number table was used to generate the allocation sequence. Double blinding was used for the participants and drug provider. | |
| Participants | Ethnicity: Chinese Setting: inpatients and outpatients 80 patients with at least 2 episodes of attack per week, all in line with The Golden Rule for Clinical Research of New Traditional Chinese Drug (Zhongyao Xinyao Linchuanyanjiu Zhidaoyuanze), mean age 58‐65 years; 60 in treatment group and 20 in control group Exclusion criteria: not stated Withdrawals and drop‐outs: 3 drop‐outs in treatment group Characteristics of patients at baseline: similar. | |
| Interventions | Treatment group: 4 'Li Nao Xin' capsules orally, t.i.d (components: Danshen Root Szechuan Lovage Rhizome, Kudzuvine Root, Earthworm, Red Paeony Root, Safflower, Turmeric Root‐tuber, Oriental Waterplantain Rhizome, Tuber Fleeceflower Root, Spina Date Seed, Barbary Wolfberry Fruit, Drug Sweetflag Rhizome, Thinleaf Milkwort Root‐bark, Twotooth Achyranthes Root, Liquoric Root). Control group: 4 'Xin Nao Kang' capsules orally t.i.d. (components unidentified). | |
| Outcomes | 1.Therapeutic effect of angina: 1) marked effect:symptoms disappeared or almost disappeared; 2) general effect: marked improvement of the frequency and severity and duration of the disease; 3) ineffective: almost no improvement as before treatment. 2. Improvement of ECG: 1) marked effect: rest ECG returning to normal,and/or exercise test from positive to negative; 2) general effect: improvement of rest ECG and exercise test, but still not normal; 3) ineffective: ECG remaining almost the same as before treatment. 3. Dosage changes of nitroglycerin: 1) cease use: complete stopping use of nitroglycerin after treatment; 2) reduced dosage: dosage reduced by at least 50% after treatment; 3) unchanged: dosage reduced by less than 50% after treatment. 4. Adverse effects. | |
| Notes | 1 This was a pharmaceutical company funded topic. 2 The formulation of the drug was provided by author's department. 3 The drug was made by the author's hospital. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | |
| Allocation concealment (selection bias) | High risk | Adequate |
| Blinding (performance bias and detection bias) All outcomes | Low risk | Double blinding was used for healthcare provider and the participants. |
| Incomplete outcome data (attrition bias) All outcomes | High risk | |
| Other bias | High risk | The study was funded by a pharmaceutical company. The formulation of the drug was provided by the author's department, and the drug was made by the author's hospital. |
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
|---|---|
| Bian 2005 | unable to contact authors on methodology used |
| Cao 2005 | unable to contact authors on methodology used |
| Chang 2005 | We consider acupuncture as having no standard method in the therapeutic process and did not intend to discuss it in details. |
| Chen 2003 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Chen 2004 | We telephoned the original author only to identify and find that the trial was actually not a real RCT. |
| Chen 2005 | We telephoned the original author only to identify and find that the trial was actually not a real RCT. |
| Chen 2006a | We telephoned the original author only to identify and find that the trial was actually not a real RCT. |
| Chen 2006b | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Chen 2006c | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Cheng 2006 | unable to contact authors on methodology used |
| Deng 2002 | unable to contact authors on methodology used |
| Ding 1999 | unable to contact authors on methodology used |
| Feng 1999 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Feng 2002 | unable to contact authors on methodology used |
| Feng 2003 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Fu 2006 | We telephoned the original author only to identify and find that the trial was actually not a real RCT. |
| Gao 2000 | Upon contacting the authors, it was identified that the study was not a RCT |
| Guo 2006 | unable to contact authors on methodology used |
| Hai 2004 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Han 1999 | unable to contact authors on methodology used |
| He 2003 | The author used another unproved TCHP as control which we consider as inappropriate. |
| Hou 2003 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Hu 1997 | The author used another unproved TCHP as control which we consider as inappropriate. |
| Huang 2002 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Jia 1999 | The authors refused to provide any information about their trial. |
| Jiang 2005 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Jiang 2005a | Upon contacting the authors, it was identified that the study was not a RCT. |
| Jiang 2005b | Upon contacting the authors, it was identified that the study was not a RCT. |
| Jiang 2006 | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Jin 2003 | Upon contacting the authors, it was identified that the study was not a randomised trial. |
| Jing 2006 | unable to contact authors on methodology used |
| Kong 1998 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Li 1998 | The authors refused to provide any information about their trial. |
| Li 1999 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Li 2001 | We tried hard to contact and interview the authors but they refused to provide any information about their trials. |
| Li 2003 | Upon contacting the authors, it was identified that the study was not a randomised trial. |
| Li 2005a | Upon contacting the authors, it was identified that the study was not a RCT. |
| Li 2005b | Upon contacting the authors, it was identified that the study was not a RCT. |
| Li 2005c | unable to contact authors on methodology used |
| Li 2005d | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Li 2005e | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Li 2005f | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Li 2005g | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Li 2006a | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Li 2006b | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Liang 2005 | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Liao 2005 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Lin 2004 | The authors refused to provide any information about their trial. |
| Liu 1999 | The participants included patients with unstable angina, which did not meet our inclusion criteria. |
| Liu 2004 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Liu 2006a | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Liu 2006b | unable to contact authors on methodology used |
| Lu 2002 | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Lu 2003 | unable to contact authors on methodology used |
| Lu 2004 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Luo 2003 | The authors refused to provide any information about their trial. |
| Ma 2004 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Mo 2005 | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Ni 2005 | Upon contacting the authors, it was identified that the study was not a RCT |
| Ou 2002 | unable to contact authors on methodology used |
| Peng 2005 | The authors refused to provide any information about their trial. |
| Qi 2001 | The authors refused to provide any information about their trial. |
| Qian 2002 | unable to contact authors on methodology used |
| Qiao 2004 | unable to contact authors on methodology used |
| Qiao 2006 | unable to contact authors on methodology used |
| Sang 2004 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Shen 2003 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Shen 2004 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Shi 1997 | unable to contact authors on methodology used |
| Shi 2001 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Sun 2002 | Upon contacting the authors, it was identified that the study was not a RCT |
| Tan 2005 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Teng 2005 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Tursun 2006 | unable to contact authors on methodology used |
| Wang 2001a | Upon contacting the authors, it was identified that the study was not a RCT. |
| Wang 2001b | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Wang 2003 | Upon contacting the authors, it was identified that the study was not a RCT |
| Wang 2004a | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Wang 2005a | Upon contacting the authors, it was identified that the study was not a RCT. |
| Wang 2005b | Upon contacting the authors, it was identified that the study was not a RCT. |
| Wang 2005c | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Wang 2005d | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Wang 2005e | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Wang 2006a | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Wang 2006b | unable to contact authors on methodology used |
| Wang 2006c | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Wei 2002 | unable to contact authors on methodology used |
| Wu 2005a | We tried hard to contact and interview the authors but they refused to provide any information about their trials. |
| Wu 2005b | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Xin 2005 | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Xing 2005 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Xing 2006 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Xu 2001 | The authors refused to provide any information about their trial. |
| Xu 2003 | The authors refused to provide any information about their trial. |
| Xu 2005 | We contacted and interviewed the original author only to identify and find that the trial was actually a retrospective study. |
| Xue 2001 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Yan 2004 | unable to contact authors on methodology used |
| Yan 2006 | unable to contact authors on methodology used |
| Yang 2000 | The authors refused to provide any information about their trial. |
| Yang 2001 | Upon contacting the authors, it was identified that the study was not a RCT |
| Yao 2002a | The authors refused to provide any information about their trial. |
| Yao 2002b | unable to contact authors on methodology used |
| Yi 2006 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Yin 2005 | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Yu 2004 | The trial administered different interventions at different phases which did not meet our inclusion criteria. |
| Zeng 2000 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Zhang 1999 | unable to contact authors on methodology used |
| Zhang 2001 | Upon contacting the authors, it was identified that the study was not a RCT |
| Zhang 2003a | The authors refused to provide any information about their trial. |
| Zhang 2003b | unable to contact authors on methodology used |
| Zhang 2003c | unable to contact authors on methodology used |
| Zhang 2004 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Zhang 2005 | Upon contacting the authors, it was identified that the study was not a RCT |
| Zhang 2005a | The authors refused to provide any information about their trial. |
| Zhang 2005b | unable to contact authors on methodology used |
| Zhang 2005c | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Zhang 2005d | unable to contact authors on methodology used |
| Zhang 2005e | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Zhang 2006 | We contacted and interviewed the original author only to identify and find that the trial was actually not a real RCT. |
| Zhong 2004 | The authors refused to provide any information about their trial. |
| Zhou 2001 | Upon contacting the authors, it was identified that the study was not a RCT. |
| Zhou 2005 | The authors used self‐prepared drug, which was manufactured by the authors themselves and did not have standardised formulations. |
| Zuo 2007 | unable to contact authors on methodology used |
Contributions of authors
Yong Yuan and Qi Zhuo worked on searches and selection of trials, telephone interviewed the original authors of trials, undertook data extraction, quality assessment and review development. Henxi Chen contributed to retrieval of articles and data extraction. WU Taixiang was responsible for organising the team, methodological advice, development of review.
The authors are responsible for the creation and running of all search strategies.
Sources of support
Internal sources
-
West China Hospital, Sichuan University, China.
Providing salary for the authors.
External sources
-
Cochrane Heart Group, UK.
Providing technique support for the author team.
Declarations of interest
None
Stable (no update expected for reasons given in 'What's new')
References
References to studies included in this review
Fang 2002 {published data only}
- Fang XM, Xiao LH, Yang JS. 'Yi Xin Mai' Granules for 30 Cases of CHD Stable Angina. Shanxi Zhong Yi (Shanxi Journal of Traditional Chinese Medicine) 2002;23(12):1092‐3. [Google Scholar]
Wang 1999 {published data only}
- Wang AC, Chang BH, Yang SY. The Influence of 'Bao Xin Bao' Patch on Plasma Endothelin and NO Level in CHD Stable Angina Patients. Zhong Guo Lin Chuang Yao Li Xue Yu Zhi Liao Xue (Chinese Journal of Clinical Pharmacology and Therapeutics) 2000;5(2):145‐6. [Google Scholar]
- Wang AC, Ke YS, Yang SY. Clinical Observation of 'Bao Xin Bao' Patch for 40 Cases of CHD Stable Angina. Xian Dai Zhong Xi Yi Jie He Za Zhi (Modern Journal of Integrated Chinese Traditional and Western Medicine) 1999;8(9):1412‐3. [Google Scholar]
- Wang AC, Ma DL, Ke YS. Clinical Observation of 'Bao Xin Bao' Patch for 40 Cases of CHD Stable Angina Pectoris. Zhong Guo Yi Yao Xue Bao (Chinese Journal of Traditional Chinese Medcine and Pharmacy) 1999;14(4):32‐4. [Google Scholar]
Wang 2004 {published data only}
- Wang SS, Zhang CL, Han D. Clinical Observation of 'Li Nao Xin' Capsule for 80 Cases of CHD Angina. Zhong Guo Nao Nian Xue Za Zhi (Chinese Journal of Gerontology) 2004;24:1196. [Google Scholar]
References to studies excluded from this review
Bian 2005 {published data only}
- Bian JF, Wang QH, Huang L. Clinical Observation on Guan Xin Kang' Granules in Treating 49 Cases of Coronary Stable Angina Cordis. Henan Zhong Yi (Henan Traditional Chinese Medicine) 2005;25(7):30‐2. [Google Scholar]
Cao 2005 {published data only}
- Cao XY, Fu HX, Wang YP. Observation and Investigate the Antianginal Effect and Resistance with Polypharmacy of Composite Danshen droplet Pill and Milkvetch Root Oral Liquids. Hebei Yi Xue (Hebei Medicine) 2005;11(11):1062‐4. [Google Scholar]
Chang 2005 {published data only}
- Chang PF. My Experience about Acupuncture Treatment of 30 Cases of Stable Angina Pectoris. Zhen Ci Yan Jiu (Acupuncture Research) 2005;30(1):50‐2. [Google Scholar]
Chen 2003 {published data only}
- Chen WY. Observation of Therapeutic Effect of 'Xing Ding' Injection for Stable Angina. Shi Yong Lin Chuang Yi Xue (Practical Clinical Medicine) 2003;4(6):55‐7. [Google Scholar]
Chen 2004 {published data only}
- Chen HQ, Guo WC, Ou LJ. A Comparative Study of Combination of 'Xue Sai Tong' Injection and Isosorbide Mononitrate Injection for Stable Angina. Fujian Zhong Yi Yao (Fujian Journal of Traditional Chinese Medicine) 2004;35(5):9‐10. [Google Scholar]
Chen 2005 {published data only}
- Chen JW. Therapeutic Observation on the Treatment of 62 Cases of Stable Type Angina Pectoris With Compound 'Dan Shen' Droplet Pills. Zhong Yi Yao Dao Bao (Guiding Journal of TCM) 2005;11(7):13‐4. [Google Scholar]
Chen 2006a {published data only}
- Chen WS. A Comparative Study of the Effect of 'Mai Luo Ning' Combined with Isosorbide Mononitrate Injection. Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi (Chinese Journal of Integrative Medicine on Cardio‐/Cerebrovascular Disease) 2006;4(3):264‐5. [Google Scholar]
Chen 2006b {published data only}
- Chen AP, Guo SH. Fifty‐three Cases of Anti‐myocardial Infartion Mixture for CHD Angina. Zhong Yi Yan Jiu (Traditional Chinese Medicinal Research) 2006;19(6):32‐4. [Google Scholar]
Chen 2006c {published data only}
- Chen LL. Effect of 'Yi Qi Huo Xue Tong Yang' Method in Treating Coronary Heart Disease. Shenzhen Zhong Xi Yi Jie He Za Zhi (Shenzhen Journal of Integrated Traditional Chineseand Western Medicine) 2006;16(4):239‐40. [PubMed] [Google Scholar]
Cheng 2006 {published data only}
- Cheng JT, Zhu MJ, Du TH. Clinical Study of 'Kang Xin' Capsule for CHD Stable Angina. Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi (Chinese Journal of Integrative Medicine on Cardio‐/Cerebrovascular Disease) 2006;4(4):283‐4. [Google Scholar]
Deng 2002 {published data only}
- Deng GH. Compound 'Danshen' Droplet Pills for Stable Angina. Tian Jin Yao Xue (Tianjin Pharmacy) 2002;1(4):48. [Google Scholar]
Ding 1999 {published data only}
- Ding XM, Jia LZ, Wang CH. A Comparative Study of Compound 'Danshen' Droplet Pills for Stable Angina. Suzhou Da Xue Xue Bao (Medicine version) (Acta Academiae Medicinae Suzhou) 1999;19(5):512‐3. [Google Scholar]
Feng 1999 {published data only}
- Feng PF, Qing NP, Tan YG. The Influence of Compound 'Dan Shen' Drop Pills on the Expression of Endothelin Gene of Circulatory Endothelium. Zhong Guo Zhong Xi Yi Jie He Za Zhi (Chinese Journal Of Integrated Traditional And Western Medicine) 1999;19(5):2868. [PubMed] [Google Scholar]
Feng 2002 {published data only}
- Feng Z, Gao X. Observation of Therapeutic Effect of Compound 'Danshen' Droplet Pills for Angina Pectoris. Kou An Wei Sheng Kong Zhi (Port Health Control) 2002;7(3):19‐20. [Google Scholar]
Feng 2003 {published data only}
- Feng DQ. 'Fu Guan' Decoction for 55 Cases of Angina Pectoris. Liaoning Zhong Yi Za Zhi (Liaoning Journal of Traditional Chinese Medicine) 2003;30(10):821‐2. [Google Scholar]
Fu 2006 {published data only}
- Fu WB, Ding SF, Jiang JQ. Comparison of Curative Effects of 'Fu Xin' Tablets and Compound 'Dan Shen' Droplet Pills on Stable Angina Pectoris. Huanan Guo Fang Yi Xue Za Zhi (Military Medical Journal of South China) 2006;20(5):5‐6, 12. [Google Scholar]
Gao 2000 {published data only}
- Gao FM, Quan JS, Wang CW. Observation of Therapeutic Effect of 'Shen Mai' Injection for Unstable Angina. Zhong Hua Shi Yong Zhong Yi Yao Za Zhi (Journal of Practical Traditional Chinese Medicine) 2000;13(5):943. [Google Scholar]
Guo 2006 {published data only}
- Guo CL. Therapeutic Observation of Milkvetch Root for CHD Angina. Shanxi Zhong Yi Xue Yuan Xue Bao (Journal of Shanxi College of Traditional Chinese Medicine) 2006;7(2):22. [Google Scholar]
Hai 2004 {published data only}
- Hai R, Liu HQ, Wu JH. Observation of Therapeutic Effect of 'Xing Ding' Injection for Stable Angina. Neimenggu Yi Xue Yuan Xue Bao (Acta Academiae Medicinae Neimongo) 2004;26(2):128‐9. [Google Scholar]
Han 1999 {published data only}
- Han XX, Yang JC, Li CX. Observation of Therapeutic Effect of 'Huang Qi' and 'Compound Danshen' for CHD. Lin Chuang Hui Cui (Clinical Focus) 1999;14(2):75‐6. [Google Scholar]
He 2003 {published data only}
- He FY, Chen HC. Observation of Therapeutic Effect of 'Chi Wu Jia' Injection for Stable Angina. Lin Chuang Hui Cui (Clinical Focus) 2003;18(13):745‐6. [Google Scholar]
Hou 2003 {published data only}
- Hou YJ, Zhang X, Ning YJ. Clinical Observation of 'Shu Xin Yang Yao' Inhalation for Stable Angina. Zhong Guo Yi Yao Xue Bao (China Journal of Traditional Chinese Medicine and Pharmacy) 2003;18(6):378‐9. [Google Scholar]
Hu 1997 {published data only}
- Hu XL, Xie ZY. Clinical Observation of Therapeutic Effect of 'Xin Ta Hua' Capsule for Stable Angina. Zhong Guo Zhong Xi Yi Jie He Ji Jiu Za Zhi (Integrated Traditional Chinese and Western Medicine In Practice Of Critical Care Medicine) 1997;4(11):490‐2. [Google Scholar]
Huang 2002 {published data only}
- Huang JC, Hou XX. Report of 36 Cases of 'Huang Qi' Injection with 'Xue Sai Tong' Injection for Exertional Stable Angina. Anhui Zhong Yi Lin Chuang Za Zhi (Clinical Journal of Anhui Traditional Chinese Medicne) 2002;14(4):145‐6. [Google Scholar]
Jia 1999 {published data only}
- Jia LZ, Ding XM, Wang CH. Compound 'Danshen' Droplet Pills for CHD Stable Angina. Zhong Guo Lin Chuang Yi Xue (Clinical Medical Journal of China) 1999;6(1):21‐2. [Google Scholar]
Jiang 2005 {published data only}
- Jiang MY, Shi HG. Clinical Observation of Self‐prepared 'Xin An Ning' Decoction for Stable Angina Pectoris of Effort. Zhong Guo Mei Tan Gong Ye Yi Xue Za Zhi (Chinese Journal of Coal Industry Medicine) 2005;8(1):92‐3. [Google Scholar]
Jiang 2005a {published data only}
- Jiang XZ, Lin XS, Lin QX. A Comparative Study between ''Puerarin' and Nitroglycerin Injection for Stable Angina. Xian Dai Zhen Duan Yu Zhi Liao (Modern Diagnosis & Treatment) 2005;16(2):98‐9. [Google Scholar]
Jiang 2005b {published data only}
- Jiang H, Deng XL. Clinical Observation of 'Xin Ke Shu' Capsule for CHD Angina. Zhong Guo Zhong Yi Ji Zheng (Journal of Emergency in Traditional Chinese Medicine) 2005;14(14):400‐1. [Google Scholar]
Jiang 2006 {published data only}
- Jiang MH. Clinical Observation of 'Guan Xin Yao Mo' Patch for CHD Stable Angina. Zhong Yi Yao Xue Kan (Chinese Archives of Traditional Chinese Medicine) 2006;24(10):1959‐60. [Google Scholar]
Jin 2003 {published data only}
- Jin JJ, He B. Clinical Observation of Therapeutic Effect of 'Tong Xin Luo' Capsule for Senile CHD Angina. Zhong Guo Ming Kang Yi Xue (Medical Journal of Chinese People Heacth) 2003;15(9):526‐8. [Google Scholar]
Jing 2006 {published data only}
- Jing J, Yuan C. Clinical Observation of 'She Xiang Bao Xin Wan' Pills for Stable Exertional Angina. Zhong Guo She Qu Yi Shi (Chinese Community Doctors) 2006;22(313):28‐9. [Google Scholar]
Kong 1998 {published data only}
- Kong YL. Clinical Observation of 'Yi Qi Huo Xue Hua Yu' Method for Stable Angina. Jilin Zhong Yi Yao (Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin) 1998;18(3):8‐9. [Google Scholar]
Li 1998 {published data only}
- Li Y, Chen CD. Observation of Therapeutic Effect of Compound' Danshen' Droplet Pills for Angina Pectoris. She Zhi (Journal of Snake) 1998;10(3):15‐7. [Google Scholar]
Li 1999 {published data only}
- Li ZQ, Qu YH, Li ZY. Clinical Study of Compound 'Dan Shen' Droplet Pills for Stable Angina. Zhong Yi Yao Xue Bao (Acta Chinese Medicine and Pharmacology) 1999;27(6):16. [Google Scholar]
Li 2001 {published data only}
- Li WH, Du XH, Zhang WZ. Clinical Observation of 'Wei Ao Xin' Tablet for 100 Cases of Stable Angina Patients. Xin Xue Guan Kang Fu Yi Xue Za Zhi (Chinese Journal of Cardiovascular Rehabilitation Medicine) 2001;10(3):247‐9. [Google Scholar]
Li 2003 {published data only}
- Li SG, Li ZM, Zheng QL. A Comparison of Therapeutic Efect between 'She Xiang Bao Xin' Pills and Single‐dose Isosorbide Dinitrate for Stable Angina. Zhong Chen Yao (Chinese Traditional Patent Medicine) 2003;25(10):814‐6. [Google Scholar]
Li 2005a {published data only}
- Li XG, Zhu B, Liu SH. Clinical Observation of 49 Cases of 'Huang Qi Xiang Dan' Injection with Western Medicine for CHD Stable Angina. Zhong Hua Shi Yong Zhong Xi Yi Za Zhi (Journal of Practical Traditional Chinese Medicine) 2005;18(4):337‐8. [Google Scholar]
Li 2005b {published data only}
- Li Y, Chen L, Liu L. Observation of Therapeutic Effect of 'Xing Ding' Injection for Stable Angina. Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi (Chinese Journal of Integrative Medicine on Cardio‐/Cerebrovascular Disease) 2005;3(5):379‐81. [Google Scholar]
Li 2005c {published data only}
- Li R, Zhang X. Clinical Observation of 'Tong Xin Luo' Capsule for Stable Angina. Jilin Zhong Yi Yao (Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin0 2005;25(1):20. [Google Scholar]
Li 2005d {published data only}
- Li PC, Liu JH, Cheng CF. Thirty Cases of 'Guan Xin Xiao Ban' Decoction for Silence Angina. Zhong Guo Zhong Yi Yao Xin Xi Za Zhi (Chinese Journal of Information on Troditional Chinese Medicine) 2005;12(5):63‐4. [Google Scholar]
Li 2005e {published data only}
- Li CP, Zhang YL, Liu PZ. Seventy Cases of 'Zhen Ci Bu Shen Therapy' for CHD Angina. Zhong Guo Zhong Yi Yao Xin Xi Za Zhi (Chinese Journal of Information on Troditional Chinese Medicine) 2005;12(1):76,79. [Google Scholar]
Li 2005f {published data only}
- Li Y, Chen L, Liu L. Efficacy of Therapy with Ginkgo Leaf Extract and Diphyridamole Injection for Stable Angina Pectoris. Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi (Chinese Journal of Integrative Medicine on Cardio‐/Cerebrovascular Disease) 2005;3(5):379‐815. [Google Scholar]
Li 2005g {published data only}
- Li Y, Chen L, Liu L. Curative Effect Of Ligustrazine Combined Medication On Stable Angina Pectoris Of Coronary Disease. Xian Dai Yi Yuan (Modern Hospital) 2005;5(6):60‐2. [Google Scholar]
Li 2006a {published data only}
- Li YP, Xi YX, Zhou CL. Observation on Efficacy of Compound 'Dan Shen' Droplet Pills in Treatment of Stable Angina Pectoris. Lin Chuang Jun Yi Za Zhi (Clinical Journal of Medical Officer) 2006;34(6):673‐4. [Google Scholar]
Li 2006b {published data only}
- Li SW. Therapeutic Observation Of Integrated Traditional and Western Wedicine for 'Qi Xu Xue Yu' Type of Stable Angina. Jilin Zhong Yi Yao (Jilin Journal of Traditional Chinese Medicine) 2006;26(5):45‐6. [Google Scholar]
Liang 2005 {published data only}
- Liang HY, Li DH, Li GM. Clinical Observation of 'Tong Xin Luo' Capsule for Stable Exertional Angina. Handan Yi Xue Gao Deng Zhuan Ke Xue Xiao Xue Bao (Journal of Handan Medical College) 2005;18(6):518‐9. [Google Scholar]
Liao 2005 {published data only}
- Liao ZM, Li YZ. 'Ziyinhuoxue method' for 30 cases of coronary heart disease patients. Jilin Zhong Yi Yao (Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin) 2005;25(6):37. [Google Scholar]
Lin 2004 {published data only}
- Lin LQ, Zheng HZ. Observation of Therapeutic Effect of 'Ge Gen Su' Injection for CHD Stable Angina. Hei Longjiang Yi Xue (Heilongjiang Medical Journal) 2004;28(10):785‐6. [Google Scholar]
Liu 1999 {published data only}
- Liu CJ. Clinical Observation of Puerarin‐Yantai for CHD Angina. Xian Dai Yi Yao Wei Sheng (Modern Medicine Health) 1999;15(5):267. [Google Scholar]
Liu 2004 {published data only}
- Liu JX, Zhang JY, Feng LJ. Clinical Observation of Integrated TCM and Western Medicine for Stable Angina. Zhong Guo Xin Yi Yao Za Zhi (China New Medicine) 2004;3(2):57‐8. [Google Scholar]
Liu 2006a {published data only}
- Liu HM, Sun L, Li YC. Therapeutic analysis of 'Tongxinluo capsule' adjunctive for CHD stable angina. Tianjin Yao Xue (Tianjin Pharmacy) 2006;18(4):39‐40. [Google Scholar]
Liu 2006b {published data only}
- Liu X, Liao YH, Zhu YG. Clinical Study on Stable Angina Pectoris by 'Tong Xin Luo' Capsules and 'Xin Ao Le' Injection. Yi Xue Lun Tan (Medicine World) 2006, (11):11‐2. [Google Scholar]
Lu 2002 {published data only}
- Lu Z. Exploration of 'Tong Xin Luo' Capsule for 41 Cases of Stable Angina. Shi Yong Zhong Yi Yao Za Zhi (Journal of Practical Traditional Chinese Medicine) 2002;18(12):3‐4. [Google Scholar]
Lu 2003 {published data only}
- Lu FY, Tian L, Wang LY. Clinical Observation of Therapeutic Effect of 'Ge Gen Su' for Stable Angina. Zhong Hua Shi Yong Zhong Xi Yi Za Zhi (Chinese Journal of the Practical Chinese With Modern Medicine) 2003;16(1):17‐8. [Google Scholar]
Lu 2004 {published data only}
- Lu JQ. 'Xin Tong Ning' Decoction for 42 Cases of CHD Stable Angina of Effort. Liaoning Zhong Yi Za Zhi (Liaoning Journal of Traditional Chinese Medicine) 2004;31(2):122‐3. [Google Scholar]
Luo 2003 {published data only}
- Luo ZX. Clinical Observation of 'Huan Wei Huang Yang Xin D' for Chronic Stable Angina. Zhong Hua Yi Yao Hui Cui (Chinese Medicine Focus) 2003;2(5):15‐16. [Google Scholar]
Ma 2004 {published data only}
- Ma H, Li MY, Yang XF. Clinical Observation of 'Lv Xin' Decoction for Stable Angina Complicated with Premature Beat. Zhong Hua Shi Yong Zhong Xi Yi Za Zhi (Journal of Practical Traditional Chinese Medicine) 2004;17(5):643‐4. [Google Scholar]
Mo 2005 {published data only}
- Mo ZM, Zhang ZG, Liao SY. Clinical Study of 'Gualoupi injection' for CHD stable angina. Guo Wai Yi Xue Nei Ke Xue Fen Ce ( Section of Internal Medicine.foreign Medical Science) 2005;32(8):357‐9. [Google Scholar]
Ni 2005 {published data only}
- Ni MH. The Clinical Summary of 30 Cases of 'Can Si Tong Mai' Decoction for CHD Angina. Hunan Zhong Yi Za Zhi (Hunan Journal of Traditional Chinese Medicine) 2005;21(2):12‐13. [Google Scholar]
Ou 2002 {published data only}
- Ou YL. Clinical Observation of 'Tong Xin Luo' Capsule for 60 Cases of Stable Angina Patients. Henan Yi Yao Xin Xi (Henan Medical Information) 2002;10(14):70‐1. [Google Scholar]
Peng 2005 {published data only}
- Peng ZG, Xu BP. Treatment of Stable Angina Pectoris by Ruanmai Xiaoban Fang:A Clinical Observation of 30 Cases. Xin Zhong Yi (New Journal of Traditional Chinese Medicine) 2005;37(11):36‐7. [Google Scholar]
Qi 2001 {published data only}
- Qi LP, Wang TP, Shi XG\. Study of The 'Dan Shen' Injection on The Antioxidation in Stable Angina Patients. Anhui Yi Ke Da Xue Xue Bao (Acta Universitis Medicinalis Anhu) 2001;36(4):287‐9. [Google Scholar]
Qian 2002 {published data only}
- Qian ZM. Observation of Therapeutic Effect of 'Mai Luo Ning' Injection and Compound 'Danshen' Droplet Pills for Stable Angina. Zhong Guo Xiao Yi (Chinese Journal of School Doctor) 2002;16(3):230‐1. [Google Scholar]
Qiao 2004 {published data only}
- Qiao WL, Wu ZR. Clinical Observation of 'Guan Xin Ning' Injection for CHD Stable Angina. Henan Zhong Yi Xue Yuan Xue Bao (Journal of Henan College of Traditional Chinese Medicine) 2004;19(6):51. [Google Scholar]
Qiao 2006 {published data only}
- Qiao CD, Sun YY, Jiang SX. Clinical investigation of composite Danshen pill for treatment of angina pectoris. Lanzhou Da Xue Xue Bao (Yi Xue Ban) [Journal of Lanzhou University Medical Sciences (Quarterly)] 2006;32(1):42‐4. [Google Scholar]
Sang 2004 {published data only}
- Sang L, Zhang HX. Clinical Study of 'Xue Fu Zu Yu' Capsule for Stable Angina. Zhong Guo Lao Nian Xue Za Zhi (Chinese Journal of Gerontology) 2004;24(11):1068‐9. [Google Scholar]
Shen 2003 {published data only}
- Shen JP, Yan Q, Hu ZL. Mid‐ and Long‐term Influence of Compound Danshen Droplet Pills on Prognosis of CHD Angina. Hei Longjiang Zhong Yi Yao (Heilongjiang Journal of Traditional Chinese Medicine) 2003, (6):11‐2. [Google Scholar]
Shen 2004 {published data only}
- Shen JP, Hu ZL, Jia XB, Si YF. A Comparative Study of 'Long Zhi Ping Nian' Capsule with Compound Danshen Droplet Pills in Treatment of Stable Angina. Zhonghua Shi Yong Zhong Xi Yi Za Zhi (Chinese Journal of the Practical Chinese with Modern Medicine) 2004;4(4):544‐6. [Google Scholar]
Shi 1997 {published data only}
- Shi YH. A Control Study of Compound 'Danshen' Droplet Pills and Isosorbide Dinitrate for Stable Angina. Zhong Guo Zhong Xi Yi Jie He Za Zhi (Chinese Journal of Integrated Traditional and Western Medicine) 1997;17(1):23‐5. [PubMed] [Google Scholar]
Shi 2001 {published data only}
- Shi YG, Zhang ZX, Li RH, Guan YZ. Therapeutic Effect Analysis of Compound Danshen Droplet Pills for Stable Angina. Nei Menggu Zhong Yi Yao (Nei Mongol Journal of Traditional Chinese Medicine) 2001, (5):6. [Google Scholar]
Sun 2002 {published data only}
- Sun YZ. Observation of Therapeutic Effect of Compound Danshen Droplet Pills for Stable Angina. Zhong Guo Yi Xue Li Lun Yu Shi Jian (Theory and Practice of Chinese Medicine ) 2002, (8):995‐996. [Google Scholar]
Tan 2005 {published data only}
- Tan JP, Cai GX, Mao HQ. Clinical research of stable angina patients treated with Huxinkang. Zhong Guo Xian Dai Yi Xue Za Zhi (China Journal of Modern Medicine) 2005;15(23):3652‐4. [Google Scholar]
Teng 2005 {published data only}
- Teng YX, Ma W. Effect Of 'Tongxinluo Capsule' On Function Of Vascular Endothelium In Patients With Stable Angina Pectoris. Zhong Guo Zhong Yi Yao Xin Xi Za Zhi (Chinese Journal of Information on TCM) 2005;12(9):9‐10. [Google Scholar]
Tursun 2006 {published data only}
- Jialiken Tursun, An DQ. Effect of 'Tian Xiang Dan' Pills on Improving the Quality of Life in Patients with Angina Pectoris. Xinjiang Yi Ke Da Xue Xue Bao (Journal Of Xinjiang Medical University) 2006;29(11):1053‐55. [Google Scholar]
Wang 2001a {published data only}
- Wang W, Jiang JL, Qu MR. Clinical Observation of Compound Danshen Droplet Pills for Stable Angina. Qingdao Yi Yao Wei Sheng (Qingdao Medical Journal) 2001;33(5):383‐4. [Google Scholar]
Wang 2001b {published data only}
- Wang X. 'Yi Qi Zu Zu' Decoction for 60 Cases of Stable Angina. Nanjing Zhong Yi Yao Da Xue Xue Bao (Natural science version) (Journal of Nanjing University of Traditional Chinese Medicine) 2001;17(1):61‐2. [Google Scholar]
Wang 2003 {published data only}
- Wang JB, Duan XF. A Comparison Between The Therapeutic Effect of The Danshen Granules and Isosorbide Dinitrate for Stable Angina. Zhong Hua Jin Ri Yi Xue Za Zhi (Chinese Journal of Today's Medicine) 2003;3(20):24‐25. [Google Scholar]
Wang 2004a {published data only}
- Wang XZ. Clinical Observation of 'Su Yu Zao Gan' for CHD Angina. Zhong Guo Xin Xue Guan Bing Yan Jiu Za Zhi (Chinese Journal of Information on TCM) 2004;2(4):256. [Google Scholar]
Wang 2005a {published data only}
- Wang Jin. Clinical Observation of 'Su Gan Tong Yu' Decoction for CHD Stable Angina. Zhong Cheng Yao (Chinese Traditional Patent Medicine) 2005;27(1):120‐1. [Google Scholar]
Wang 2005b {published data only}
- Wang TP, Wang XM, Li ZL. Clinical Observation of Integrated TCM and Western Medicine for Stable Angina. Zhongguo Zhong Yi Ji Zhen (Journal of Emergency in Traditional Chinese Medicine) 2005;14(1):10‐11. [Google Scholar]
Wang 2005c {published data only}
- Wang H. Clinical Observation of 'Tong Xin Luo' Capsule for 36 Cases of Stable Angina. Xian Dai Zhen Duan Yu Zhi Liao (Modern Diagnosis & Treatment) 2005;16(3). [Google Scholar]
Wang 2005d {published data only}
- Wang H. Clinical Observation on 36 Cases of Stable Angina Treated with 'Tong Xin Luo' Capsule. Xian Dai Zheng Duan Yu Zhi Liao (Modern Diagnosis & Treatment) 2005;16(3):157‐8. [Google Scholar]
Wang 2005e {published data only}
- Wang TP, Wang XM, Li ZL. Clinical Observation of Integrated Traditional and Western Medicine for Stable Exertional Angina. Zhong Guo Zhong Yi Ji Zheng (Journal of Emergency in Traditional Chinese Medicine) 2005;14(1):10‐1. [Google Scholar]
Wang 2006a {published data only}
- Wang JS, Hao AH, Zuo AH. Observation of the Therapeutic Efficacy of 'Xing Ding' Injection in Treeting Angina Pectoris. Zhong Guo Minkang Yi Xue Za Zhi (Medical Journal of Chinese People Heacth) 2006;18(2):116‐7. [Google Scholar]
Wang 2006b {published data only}
- Wang J, Cui ZY. Therapeutic Observation on the Treatment of 57 Cases of Stable Type Angina Pectoris with Compound 'Dan Shen' Droplet Pills. Shanxi Zhi Gong Yi Xue Yuan Xue Bao (Journal of Shanxi Medical College for Continuing Education) 2006;16(2):34‐5. [Google Scholar]
Wang 2006c {published data only}
- Wang Q, Hao LF, Li H. Effect Of 'Jiang Zhi Tong Mai Fang' On Extertional Tolerance in Patients With Coronary Heart Disease. Zhong Guo Zhong Yi Ji Zheng (Journl of Emergency in Traditional Chinese Medicine) 2006;15(9):944‐5. [Google Scholar]
Wei 2002 {published data only}
- Wei Q, Zong M. Observation of Therapeutic Effect of 'Die Mai Ling' Injection for Stable Angina. Zhong Guo She Qu Yi Shi ( Journal of Chinese Rural Physician) 2002;18(7):29‐30. [Google Scholar]
Wu 2005a {published data only}
- Wu WY. Therapeutic Effect Analysis of 'Deng Zhan Xi Xin' Injection for 41 Cases of CHD Angina. Journal of Nanhua University (Medical Edition) 2005;33(1):126‐7. [Google Scholar]
Wu 2005b {published data only}
- Wu XS, Chang XF. Clinical Observation of Compound 'Xue Shuan Tong' with Persantin in Angina. Zhong Xi Yi Jie He Xin Nao Xue Guan Bing Za Zhi (Chinese Journal of Integrative Medicine on Cardio‐/Cerebrovascular Disease) 2005;3(7):637‐8. [Google Scholar]
Xin 2005 {published data only}
- Xin S, Lin ZS, He SC. Therapeutic Observation Of 'Jinnaduo injection' For Senile Stable Exertional Angina. Xin Xue Guan Kang Fu Yi Xue Za Zhi (Chinese Journal of Cardiovascular Rehabilitation Medicine) 2005;14(1):60‐1. [Google Scholar]
Xing 2005 {published data only}
- Xing ZH, Yi L, Liu WP. Clinical Effectiveness of Baoxin Decoction on Coronary Heart Disease with Stable Angina Pectoris and Effect of that on plasma Basic Fibroblast Growth Factor. Hunan Zhong Yi Xue Yuan Xue Bao (Journal of TCM University of Hunan) 2005;25(6):43‐4, 47. [Google Scholar]
Xing 2006 {published data only}
- Xing ZH, Yi L, Liu WP. Effect of Baoxin Decoction on Plasma Vascular Endothelial Growth Factor and Basic Fibroblast Growth Factor in Patients with Stable Angina Pectoris. Zhong Guo Kang Fu (Chinese Journal of Rehabilitation) 2006;21(1):21‐2. [Google Scholar]
Xu 2001 {published data only}
- Xu WP, Jin Y, Rong YZ. 'Ruo Di Kang' Capsule for Stable Angina. Zhong Guo Xin Yao Yu Lin Chuang Za Zhi (Chinese Journal of New Drugs and Clinical Remedies) 2001;20(5):343‐5. [Google Scholar]
Xu 2003 {published data only}
- Xu DM, Jin Y, Xu WP. 'Hong Hua' Injection for Stable Angina. Zhong Guo Xin Yao Yu Lin Chuang Za Zhi (Chinese Journal of New Drugs and Clinical Remedies) 2003;22(1):13‐5. [Google Scholar]
Xu 2005 {published data only}
- Xu HZ, Li JY, Su ZD. Clinical Observation of 'Si Miao Yong An' Decoction for CHD Angina. Handan Yi Xue Gao Deng Zhuan Ke Xue Xiao Xue Bao (Journal of Handan Medical College) 2005;18(1):45‐46. [Google Scholar]
Xue 2001 {published data only}
- Xue FF, Liu SL. Clinical Observation of Compound Danshen Droplet Pills for Stable Angina Pectoris. Hunan Zhong Yi Xue Yuan Xue Bao (Journal of Hunan College of TCM) 2001;21(2):36‐8. [Google Scholar]
Yan 2004 {published data only}
- Yan P, Luo XP, Shi HM. The Clinical Effect and Influence on The Platelet Function of 'Dan Shen' Polyphenol Acid for Patients With Angina Pectoris. Jie Ru Fang She Xue Za Zhi (Journal of Interventional Radiology) 2004;/(Supplement 2):55‐9. [Google Scholar]
Yan 2006 {published data only}
- Yan K. Therapeutical observation of Milkvetch Root injection for 26 cases of stable angina patients. Zhong Xi Yi Jie He Xin Nao Xue Guan Za Zhi (Chinese Journal of Integrative Medicine on Cardio‐/Cerebrovascular Disease) 2006;4(6):541‐2. [Google Scholar]
Yang 2000 {published data only}
- Yang YC, Wu YG. Compound 'Danshen' Droplet Pills for 47 Cases of Stable Angina Patients. Anhui Zhong Yi Xue Yuan Xue Bao (Journal of Anhui Traditional Chinese Medical College) 2000;19(5):15‐6. [Google Scholar]
Yang 2001 {published data only}
- Yang HH, Guo MZ. Clinical Observation of Integrated TCM and Western Medicine for Stable Angina. Liaoning Zhong Yi Za Zhi (Liaoning Journal of Traditional Chinese Medicine) 2001;28(5):297‐8. [Google Scholar]
Yao 2002a {published data only}
- Yao XY. Compound 'Dan Shen' Droplet Pills for 50 Cases of CHD Angina. Zhong Guo Zhong Yi Ji Zhen (Journal of Emergency in Traditional Chinese Medicine) 2002;11(1):26‐7. [Google Scholar]
Yao 2002b {published data only}
- Yao FH, Zhang YS, Huang MH. Compound 'Dan Shen' Droplet Pills for 50 Cases of Stable Angina. Shan Dong Zhong Yi Za Zhi (Shandong Journal of Traditional Chinese Medicine) 2002;21(3):147‐9. [Google Scholar]
Yi 2006 {published data only}
- Yi L, Xing ZH, Liu WP. Clinical Effectiveness of Baoxin Decoction on Coronary Heart Disease with Stable Angina Pectoris and Effect of that on plasma VEGF. Zhong Guo Zhong Yi Ji Zheng ( Journl of Emergency in Traditional Chinese Medicine) 2006;15(6):584‐5. [Google Scholar]
Yin 2005 {published data only}
- Yin XQ, Shen HP. Clinical observation of 'Xinyuan capsule' and Isosorbide Mononitrate for stable exertional angina. Zhong Guo Zhong Yi Ji Zheng (Journal of Emergency in Traditional Chinese Medicine) 2005;14(12):1144, 1161. [Google Scholar]
Yu 2004 {published data only}
- Yu HB. Report of 45 Cases of '' Wei Ao Xin' Tablet for Stable Angina. Shi Zhen Guo Yi Guo Yao (Lishizhen Medicine and Materia Medica Research) 2004;15(6):349. [Google Scholar]
Zeng 2000 {published data only}
- Zeng JS. Clinical observation of 'Bu Xue Tong Mai' Decoction for Stable Angina. Zhong Hua Shi Yong Zhong Xi Yi Za Zhi (Journal of Practical Traditional Chinese Medicine) 2000;13(6):1067‐8. [Google Scholar]
Zhang 1999 {published data only}
- Zhang GH, Cao Y, Lu XM. Compound 'Danshen' Droplet Pills for 69 Cases of CHD Stable Angina. Jilin Zhong Yi Yao (Journal of Traditional Chinese Medicine and Chinese Materia Medica of Jilin) 1999;19(3):10. [Google Scholar]
Zhang 2001 {published data only}
- Zhang Y, Fan P. Clinical Observation of 36 Cases of 'Guan Xin Tong' Mixture for CHD Angina '. Zhong Yi Za Zhi (Journal of Traditional Chinese Medicine) 2001;42(10):602‐4. [Google Scholar]
Zhang 2003a {published data only}
- Zhang ZH, Chen SQ, Sun XF. Clinical Observation of Self‐prepared 'Xiong Bi Drink' for 38 Cases of Stable Angina. Shi Yong Zhong Yi Nei Ke Za Zhi (Journal of Practical Traditional Chinese Internal Medicine) 2003;17(6):464. [Google Scholar]
Zhang 2003b {published data only}
- Zhang HY. Observation of Therapeutic Effect of 'Xin Ke Ning' Capsule for Stable Angina. Zhong Hua Shi Yong Zhong Xi Yi Za Zhi (Journal of Practical Traditional Chinese Medicine) 2003;16(10):1351‐2. [Google Scholar]
Zhang 2003c {published data only}
- Zhang FL, Wu HZ, Chen JH. A Comparative Study of Combination of 'Su Xue Tong' and Isosorbide Mononitrate Injection for Stable Angina. Zhong Guo Xin Xue Guan Bing Yan Jiu Za Zhi (Chinese Journal of Cardiouascular Review) 2003;1(2):104‐5. [Google Scholar]
Zhang 2004 {published data only}
- Zhang ZZ. Observation of Therapeutic Effect of 'Di Tan Tong Mai' Decoction for CHD Angina. Liaoning Zhong Yi Za Zhi (Liaoning Journal of Traditional Chinese Medicine ) 2004;31(12):1018. [Google Scholar]
Zhang 2005 {published data only}
- Zhang HX. Therapeutic Effect Observation of Combination of 'Ge Gen Su' and 'Huang Qi' for CHD Angina. Liao Ning Zhong Yi Xue Yuan Xue Bao (Journal of Liaoning College of Traditional Chinese Medicine) 2005;7(1):38. [Google Scholar]
Zhang 2005a {published data only}
- Zhang JH, Sang RX, Li ZH. Clinical Study of 'Yi Qi Huo Xue Tong Luo Fang Qi Dan Jian' for CHD Stable Angina. Lin Chuang Hui Cui (Clinical Focus) 2005;20(3):166‐7. [Google Scholar]
Zhang 2005b {published data only}
- Zhang H, Sun B, Zhang B. Therapeutic Observation of 'Tong Xin Luo' Capsule for 43 cases of Angina Patients. Bethune Jun Yi Xue Yuan Xue Bao (Journal of Bethune Military Medical College) 2005;3(4):220. [Google Scholar]
Zhang 2005c {published data only}
- Zhang JW, Huang MY. Comparative Study of 'Xue Sai Tong' Injection and Isosorbide Mononitrate Injection on Patients with Stable Angina. Zhong Guo Ji Ceng Yi Yao (Chinese Journal of Primary Medicine and Pharmacy) 2005;12(11):1500‐1. [Google Scholar]
Zhang 2005d {published data only}
- Zhang Q, Chen ZY, Wu LB. Clinical Nonferiority Evaluation on the Efficacy and Safety of Safflower Yellow Pigment Lyophilized Power & Dripping Solution in the Treatment of Patients with Angina. Zhong Guo Xun Zheng Yi Xue Za Zhi (Chinese Journal of Evidence‐Based Medicine) 2005;5(4):276‐85. [Google Scholar]
Zhang 2005e {published data only}
- Zhang J. Therapeutic Observation of 'Huo Xue Hua Yu Bu Shen' Method for CHD Stable Angina in Climacteric Women. XIn Zhong Yi (New Journal of Traditional Chinese Medicine) 2005;37(8):40‐1. [Google Scholar]
Zhang 2006 {published data only}
- Zhang MH, Chen SZ. Clinical observation of 'Xinkeshu capsule' for stable angina. Zhong Yi Yao Xue Kan (Chinese Archives of Traditional Chese Medicine) 2006;24(2):369‐70. [Google Scholar]
Zhong 2004 {published data only}
- Zhong DM, Feng CL, Lu JH. Clinical Observation of Integrated TCM and Western Medicine for CHD Stable Angina. Hunan Zhong Yi Yao Dao Bao (Hunan Guiding Journal of Traditional Chinese Medicine and Pharmacology) 2004;10(6):20‐1. [Google Scholar]
Zhou 2001 {published data only}
- Zhou CP. A Comparative Study between the Drug Resistance of Anti‐anginal Effect of 'Di Ao Xin Xue Kang' and 'Isosorbide Dinitrate'. Tian Zhong Xue Kan (Journal of Tian Zhong) 2001, (5):116. [Google Scholar]
Zhou 2005 {published data only}
- Zhou ZX. Clinical observation of additional 'Shuxin Zhitong Tang' for 37 cases of stable CHD angina. Guangxi Zhong Yi Xue Yuan Xue Bao (Journal of Guangxi Traditional Chinese Medical University) 2005;8(3):82‐3. [Google Scholar]
Zuo 2007 {published data only}
- Zuo YQ, Ru DF. A clinical study of Traditional Chinese Medicine in the treatment of stable angina. Journal of Liaoning Traditional Chinese Medicine 2007;34(3):319‐20. [Google Scholar]
Additional references
4S 1994
- The Scandinavian Simvastatin Survival Study (4S). Randomised trial of cholesterol lowering in 4,444 patients with coronary heart disease. Lancet 1994, (344):1383‐9. [PubMed] [Google Scholar]
ACC 2002
- American College of Cardiology. New guidelines for management of certain patients with chest pain highlight expanded role for ACE Inhibitors. http://www.acc.org/media/releases/highlights/2002/nov02/stable.htm.
ACC/AHA 1999
- Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al. ACC/AHA/ACP‐ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Journal of the American College of Cardiology 1999;33(7):2092‐197. [DOI] [PubMed] [Google Scholar]
ACC/AHA 2002
- Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients with Chronic Stable Angina); 2002. www.acc.org/clinical/guidelines/stable/stable.pdf. (Accessed 1/7/2005).
Alaeddini 2002
- Jamshid Alaeddini. Angina Pectoris. http://www.emedicine.com/med/topic133.htm#section˜bibliography 2002.
Bernard 1979
- R. Bernard, E. Corday, H. Eliasch, A. Gonin, R. Hiait, L.F. Nikolaeva, C.M. Oakley, M.F. Oliver, Z. Pias, V. Puddu, E. Rapaport, T. Strasser, H. Wellens. Nomenclature and Criteria for Diagnosis of Ischemic Heart Disease, The Joint International Society and Federation of Cardiology/World Health Organization Task Force on Standardization of Clinical Nomenclature. Circulation 1979;59(3):607‐9. [DOI] [PubMed] [Google Scholar]
Braunwald 1992
- Brauwald E (editor). Heart Disease: A Textbook of Cardiovascular Medicine. 4th edition. Philadelphia. London: Saunders, 1992. [Google Scholar]
Caremark 2003
- Patel H, Raval K. ACC/AHA 2002 Guideline Update for Chronic Stable Angina. The Caremark Clinical Update: http://www.caremark.com/clininfo/?/clininfo/html/library/clinical_update/January2003/ 2003.
Chen 2000
- Chen HZ. Atherosclerosis and coronary atherosclerotic heart disease. In: Yei RG editor(s). Internal Medicine. second. Beijing: People's Medical Publishing House, 2000:271‐312. [Google Scholar]
Chrysant 1993
- Chrysant SG, Glasser SP, Bittar N, Shahidi FE, Danisa K, Ibrahim R, et al. Efficacy and safety of extended‐release isosorbide mononitrate for stable effort angina pectoris. American Journal of Cardiology 1993, (72):1249‐56. [DOI] [PubMed] [Google Scholar]
CONSORT 2001
- Moher D, Schulz KF, Altman DG, for the CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomised trials. Lancet 2001;357:1191‐4. [PubMed] [Google Scholar]
ESC 1997
- Task Force of the European Society of Cardiology. Management of stable angina pectoris. European Heart Journal 1997;/(18):394‐413. [DOI] [PubMed] [Google Scholar]
Fan 2007
- Fan T, Wang G, Wang L, Xiong ZY, Mao B. Quality Assessment of Clinical Studies on Compound Salvia Pellet (CSP) for Angina Pectoris. Chinese Journal of Evidence‐Based Medicine 2007;7(6):461‐71. [Google Scholar]
Frishman 1991
- Frishman WH, Heiman M, Soberman J, Greenberg S, Eff J. Comparison of celiprolol and propranolol in stable angina pectoris. American Journal of Cardiology 1991, (67):665‐70. [DOI] [PubMed] [Google Scholar]
Fulder 1996
- Fulder S. The Handbook of Alternative and Complementary Medicine. Oxford: Oxford University Press, 1996. [Google Scholar]
Hamby 2001
- Robert I. Hamby. Angina. http://www.heartcenteronline.com/Angina.html.
Higgins 2003
- Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. [DOI] [PMC free article] [PubMed] [Google Scholar]
Higgins 2008
- Higgins JPT, Green S (editors). Application of quality assessment criteria. Cochrane Handbook for Systematic Reviews of Interventions 2008.
Kau 1996
- KAU, (AHCPR guidelines revised by KAU 1/96). Unstable Angina: Diagnosis and Management. http://www.medana.unibas.ch/eng/internt/angina.htm.
Liu 2000
- Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for chronic hepatitis B. Cochrane Database of Systematic Reviews 2000, Issue 4. [DOI: 10.1002/14651858.CD001940] [DOI] [PMC free article] [PubMed] [Google Scholar]
Moher 1999
- Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta‐analyses of randomised controlled trials: the QUOROM statement. Lancet 1999;354:1896‐1900. [DOI] [PubMed] [Google Scholar]
Narahara 1990
- Narahara KA. Double‐blind comparison of once daily betaxolol versus propranolol four times daily in stable angina pectoris. American Journal of Cardiology 1990, (65):577‐82. [DOI] [PubMed] [Google Scholar]
Ou 1992
- Ou Ming. Chinnese‐English Manual of Common‐used in Traditional Chinese Medicine. Guangzhou: Guangdong Science and Technology Pess, 1992. [Google Scholar]
Pope 2000
- Pope B. Angina pectoris. http://www.sh.lsuhsc.edu/fammed/OutpatientManual/Angina.htm.
SAPAT 1992
- Juul‐Moller S, Edvardsson N, Jahnmatz B, Rosen A, Sorensen S, Omblus R. Double‐blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. Lancet 1992, (340):1421‐5. [DOI] [PubMed] [Google Scholar]
SIGN 2001
- The SIGN Guideline Development Group. Management of Stable Angina. Scottish Intercollegiate Guidelines Network (SIGN) Publication No. 51: http://www.sign.ac.uk/guidelines/fulltext/51/ 2001.
Surawicz B 2001
- Surawicz B, Knilanas TK. Chou's Electrocardiography in Clinical Practice. Saunders, 2001. [Google Scholar]
Thadani 1992
- Thadani U, Bittar N. Effects of 8:00 a.m. and 2:00 p.m. doses of isosorbide‐5‐mononitrate during twice‐daily therapy in stable angina pectoris. American Journal of Cardiology 1992;70:286‐92. [DOI] [PubMed] [Google Scholar]
Wang 2006
- Wang G, Wang L, Xiong ZY, Mao B, Li TQ. Compound salvia pellet, a traditional Chinese medicine, for the treatment of chronic stable angina pectoris compared with nitrates : a meta‐analysis. Medical Science Monitor 2006;12(1):SR1‐SR7. [PubMed] [Google Scholar]
Wu 2007
- Taixiang Wu, Guanjian Liu. What about the concepts, design, practice and report of allocation concealment and blinding exactly?. Chinese Journal of Evidence‐Based Medicine 2007;7(3):203‐7. [Google Scholar]