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Traditional Medicine Research  2018, Vol. 3 Issue (2): 70-81    DOI: 10.12032/TMR201810066
Review     
Clinical evidence and potential mechanisms of Chinese medicines for the treatment of diabetic retinopathy
Jian Huo1, Ke-Yu Zhu1, Qian Yang1, Wen Liu2, Jun-Guo Duan1,*()
1Academy of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
2Chengdu University of Traditional Chinese Medicine Affiliated Ineye Hospital, Chengdu, Sichuan, China.
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Highlights

This article summarizes the application of Chinese medicines and their mechanisms of action in the treatment of diabetic retinopathy.

Editor’s Summary

More and more Chinese formulaes have been used by China FDA for the prevention and treatment of diabetic retinopathy. And their mechanisms of action have gained increasing attention around the world.

Abstract

Diabetic retinopathy is one of the main causes of visual impairment and blindness on a global scale. At present, the limitations of anti-vascular endothelial growth factor agents, steroids, laser photocoagulation, and vitreous surgery have led to a growing awareness of the role of Chinese medicines in the treatment of diabetic retinopathy. This review first describes the ingredients and characteristics of the formulae including Chinese herbal formulaes, Chinese patent drugs and ancient processed drugs and summarizes the application of Chinese medicines and their mechanisms of action in the treatment of diabetic retinopathy. Due to the complexity of Chinese medicines, in-depth mechanisms, side effects of herb, and drug interactions need to be elaborated in future research. Chinese medicines have the potencial to protect the residual eyesight and delay the progression of disease, thereby offering a beneficial, exploitable option in the treatment/prevention of diabetic retinopathy.



Key wordsDiabetic retinopathy      Chinese medicines      Formula      Chinese patent drugs     
Published: 05 March 2018
Corresponding Authors: Duan Jun-Guo     E-mail: duanjg@vip.sina.com.
Cite this article:

Jian Huo, Ke-Yu Zhu, Qian Yang, Wen Liu, Jun-Guo Duan. Clinical evidence and potential mechanisms of Chinese medicines for the treatment of diabetic retinopathy. Traditional Medicine Research, 2018, 3(2): 70-81. doi: 10.12032/TMR201810066

URL:

https://www.tmrjournals.com/tmr/EN/10.12032/TMR201810066     OR     https://www.tmrjournals.com/tmr/EN/Y2018/V3/I2/70

Symptom analysis Therapeutic principle Formulaes Ingredients
Qi and Yin deficiency, and meridian stagnation Tonify Qi and nourish Yin, regulate blood circulation and open colleteral Shengmai Powder and Qijudihuang Pill Danshen (Radix Salviae Miltiorrhizae), Maidong (Radix ophiopogonis), Wuweizi (Fructus Schisandrae Chinensis), Gouqizi (Fructus Lycii), Juhua (Chrysanthemum), Shudihuang (Rehmanniae Radix Praeparata), Shanzhuyu (Fructus Corni), Shanyao (Rhizoma Dioscoreae), Fuling (Poria), Zexie (Rhizoma Alismatis), Mudanpi (Cortex Moutan)
Liver and kidney deficiency, and colletoral of eyes cannot be nourished Tonify liver and kidney, nourish the dryness and generate fluid Liuweidihuang Pill Shudihuang (Rehmanniae Radix Praeparata), Shanzhuyu (Fructus Corni), Mudanpi (Cortex Moutan), Shanyao (Rhizoma Dioscoreae), Fuling (Poria), Zexie (Rhizoma Alismatis)

Yin and Yang deficiency, with blood stasis and phlegm stagnation

Tonify Yin and Yang, get rid of phlegm and stasis

Zuogui Pill and
Yougui Pill
Zuogui Pill: Shudihuang (Rehmanniae Radix Praeparata), Shanyao (Rhizoma Dioscoreae), Shanzhuyu (Fructus Corni), Tusizi (Semen cuscutae), Gouqizi (Fructus Lycii), Chuanniuxi (Radix cyathulae), Lujiaojiao (Colla Corni Cervi), Guijiajiao (Tortoise shell and plastron glue)
Yougui Pill: Shudihuang (Rehmanniae Radix Praeparata), Shanyao (Rhizoma Dioscoreae), Shanzhuyu (Fructus Corni), Gouqizi (Fructus Lycii), Tusizi (Semen cuscutae), Lujiaojiao (Colla Corni Cervi), Duzhong (Cortex Eucommiae), Rougui (Cortex Cinnamomi), Danggui (Radix Angelicae Sinensis), Zhifuzi (Processed Radix aconiti lateralis)
Table 1 Formulaes for diabetic retinopathy based on syndrome differentiation
Formula/herb Ingredients Experimental evidence
Heyingqingre Formula Jinyinhua (Flos Lonicerae), Danggui (Radix Angelicae Sinensis), Xuanshen (Radix Scrophulariae), Gancao (Radix Glycyrrhizae), Shengdi (Rehmannia glutinosa), Gouqi (Fructus Lycii) and Huangjing (Rhizoma Polygonati) Inhibit AGEs; recover on endothelial dysfunction via modulation of tight junction and AGEs downstream signaling.
Jiawei Buyanghuanwu Decoction Huangqi (Radix Astragali seu Hedysari), Guiwei (Angelica tail), Chishao (Radix Paeoniae Rubra), Honghua (Flos Carthami), Taoren (Semen persicae), Chuanxiong (Rhizoma Ligustici Chuanxiong), Shengdi (Rehmannia glutinosa), Xuanshen (Radix Scrophulariae), Shanyao (Rhizoma Dioscoreae), Fuling (Poria) and Cangzhu (Atractylodes Rhizome) Decrease blood viscosity; descend plasma ET-1; inhibit the apoptosis of retinal microvessel pericytes of DR.
Zhenwu Decoction Fuzi (Radix Aconiti Lateralis Praeparata), Shengjiang (Rhizoma Zingiberis Recens), Fuling (Poria), Baizhu (Atractylodis Macrocephalae) and Baishao (Radix Paeoniae Alba) Reduce the level of plasma endothelin.
Qiming Granule Huangqi (Radix Astragali seu Hedysari), Gegen (Radix Puerariae), Dihuang (Radix Rehmanniae), Gouqizi (Fructus Lycii), Juemingzi (Cassia Seed), Chongweizi (Motherwort Fruit), Puhuang (Cattail Pollen) and Shuizhi (Hirudo) Inhibit the polyol pathway; affect oxidative stress; regulate the level of VEGF and IGF-1; accelerate retinal microvascular blood circulation.
Fufang Xueshuantong Capsule Sanqi (Radix Notoginseng), Huanqi (Radix Astragali seu Hedysari), Danshen (Radix Salviae Miltiorrhizae) and Xuanshen (Radix Scrophulariae) Improve hemodynamic indexes; affect anti-oxidative stress; inhibit of hyper-level of VEGF, ICAM-1, ET-1, and AR hyper-activity, up-regulate of the hypo-expression of PEDF and occludin.
Fufang Danshen Dripping Pill Danshen (Radix Salviae Miltiorrhizae), Sanqi (Radix Notoginseng) and Bingpian (Borneol) Inhibit ET-1 and ICAM-1 production; reduce inflammatory response; improve the role of vascular endothelial function.
Ginkgo biloba Yinxingye (Folium Ginkgo) Reduce the malondialdehyde; increase erythrocyte deformability, blood flow velocity and the oxygen transport efficiency value of the blood; affect retinal VEGF protein levels and retinal cell apoptosis.
Qishenyiqi Dropping Pill Huangqi (Radix Astragali seu Hedysari), Danshen (Radix Salviae Miltiorrhizae), Sanqi (Radix Notoginseng) and Jiangxiang (Dalbergia odorifera) Decrease the expression of retinal AGEs, ICAM-1, VEGF and RAGE mRNA, ICAM-1-mRNA, VEGF mRNA; increase the expression of retinal PEDF and PEDF mRNA; promote the level of retinal GLAST and GS; reduce the high concentrations of the role of glutamate excitotoxicity.
Liuweidihuang Pill (Decoction) Shudihuang (Rehmanniae Radix Praeparata), Shanzhuyu (Fructus Corni), Mudanpi (Cortex Moutan), Shanyao (Rhizoma Dioscoreae), Fuling (Poria) and Zexie (Rhizoma Alismatis) Improve insulin resistance, anti-apoptosis and anti-oxidation.
Naoxintong Capsule Huangqi (Radix Astragali seu Hedysari), Chishao (Radix Paeoniae Rubra), Danshen (Radix Salviae Miltiorrhizae), Danggui (Radix Angelicae Sinensis), Honghua (Flos Carthami), Chuanxiong (Rhizoma Ligustici Chuanxiong), Taoren (Semen persicae), Niuxi (Radix et Rhizome Achyranthes), Jixueteng (Caulis Spatholobi), Sangzhi (Mulberry Twig), Guizhi (Ramulus Cinnamomi), Ruxiang (Olibanum), Moyao (Myrrha), Shuizhi (Hirudo), Quanxie (Scorpion) and Dilong (Lumbricus) Decrease fasting blood glucose levels; inhibit the diabetes-induced retinal vascular abnormalities; inhibite the diabetes-induced expression of CAS-3, MMP-2, MMP-9, and TNFα in the retina.
Table 2 Experimental evidence of formulaes/herbs for diabetic retinopathy
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