Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

Effect of Geopungdan and Chunghyuldan Combination Therapy on Cardio-Ankle Vascular Index: Retrospective Chart Review

Article information

J Korean Med. 2025;46(1):57-69
Publication date (electronic) : 2025 March 01
doi : https://doi.org/10.13048/jkm.25005
Dabin Lee1,§orcid_icon, Sang-Kwan Moon1,2,§orcid_icon, Seungwon Kwon1,2orcid_icon, Seung-Yeon Cho1,2orcid_icon, Woo-Sang Jung1,2orcid_icon, Seong-Uk Park1,2orcid_icon, Jung-Mi Park1,2orcid_icon, Chang-Nam Ko1,2orcid_icon, Han-Gyul Lee1,2,orcid_icon
1Dept. of Clinical Korean Medicine, Graduate school, Kyung-Hee University
2Dept. of Cardiology and Neurology, College of Korean medicine, Kyung-Hee University
Correspondence to: Han-Gyul Lee, KyungHeeDae-ro 23, KyungHee University Medical Center, Dongdaemun-Gu, Seoul, Republic of Korea, Tel: +82-2-958-9190, Fax: +82-2-958-9132, E-mail: gyulee0614@hanmail.net
§

These authors contributed equally to this work.

Received 2025 January 8; Revised 2025 February 5; Accepted 2025 February 11.

Abstract

Backgrounds and objectives

Cardio-Ankle Vascular Index (CAVI) is one of the indicators used for cardiovascular indexes, which are not affected by blood pressure so that it can independently measure the cardiovascular risk. Herbal medicines including Geopungdan and Chunghyuldan are already known as preventive effect of vascular diseases including stroke and arteriosclerosis. In this study, the cases in which patients were measured by CAVI before and after taking these herbal medicines were retrospectively collected.

Methods

This is a 13-patient case series from a retrospective chart review of patients with high CAVI (>8.0) who were treated with a combination of Geopungdan 300mg and Chunghyuldan 600mg per day for a month from 1st, January 2019 to 30th, June 2023. Changes of both CAVI before and after the treatment were collected. Also, medical records were reviewed such as general characteristics, disease-related characteristics, social history, treatment-related characteristics and chief complaints of each patient.

Results

After taking a combination of Geopungdan and Chunghyuldan for a month, both CAVI was significantly decreased (Left, 9.72±0.28 to 8.90±0.29, p<0.001; Right, 9.87±0.31 to 9.14±0.31, p=0.003). CAVI for the combined left and right also decreased significantly after treatment (9.79±1.04 to 9.02±1.06, p<0.001). The estimated ages of each CAVI after the treatment was also decreased compared to those before the treatment (p=0.004). No adverse effects or sequelae were found.

Conclusions

CAVI was significantly decreased in patients who took combination of Geopungdan and Chunghyuldan for a month. This result may infer that combination of Geopungdan and Chunghyuldan may have preventive effects to the patients who have vascular risks.

Keywords: Cardio-Ankle Vascular Index; Arteriosclerosis; Geopungdan; Chunghyuldan
Fig. 1

Decrease of Left(A) and Right CAVI(B) After the Treatment. Both CAVI after treatment were significantly decreased compared with those before treatment.

CAVI, Cardio-Ankle Vascular Index.

Fig. 2

Changes of Both CAVI before and after the treatment

*, by Fisher’s exact test.

Composition of Chunghyuldan and Geopungdan

General Characteristics of Subjects

The difference of CAVI between before and after treatment

Summary of the Clinical Information of Patients

References

1. Bergheanu S., Bodde M., Jukema J.. 2017;Pathophysiology and treatment of atherosclerosis: Current view and future perspective on lipoprotein modification treatment. Netherlands Heart Journal 25:231–242. 10.1007/s12471-017-0959-2.
2. Moon S-K., Jung M., Kwon S., Cho S-Y., Park S-U., Jung W-S., et al. 2018;The effect of geopungchunghyul-dan on circumferential strain of carotid artery: A case series. Journal of Korean Medicine 39(1):86–94. 10.13048/jkm.18009.
3. Niiranen TJ., Lyass A., Larson MG., et al. Prevalence, Correlates, and Prognosis of Healthy Vascular Aging in a Western Community-Dwelling Cohort. Hypertension 2017;70(2):267–274. 10.1161/hypertensionaha.117.09026.
4. Vasan RS., Pan S., Larson MG., Mitchell GF., Xanthakis V.. 2021;Arteriosclerosis, atherosclerosis, and cardiovascular health: Joint relations to the incidence of cardiovascular disease. Hypertension 78(5):1232–1240. 10.1161/HYPERTENSIONAHA.121.18075.
5. Nickinson AT., Coles B., Zaccardi F., Gray LJ., Payne T., Bown MJ., et al. 2020;Missed opportunities for timely recognition of chronic limb threatening ischaemia in patients undergoing a major amputation: A population based cohort study using the uk’s clinical practice research datalink. European Journal of Vascular and Endovascular Surgery 60(5):703–710. 10.1016/j.ejvs.2020.05.010.
6. Tölle M., Reshetnik A., Schuchardt M., Höhne M., van der Giet M.. 2015;Arteriosclerosis and vascular calcification: Causes, clinical assessment and therapy. European journal of clinical investigation 45(9):976–985. 10.1111/eci.12493.
7. Kirigaya J., Iwahashi N., Abe T., Gohbara M., Hanajima Y., Horii M., et al. 2022;Influence of the cardio-ankle vascular index on chronic-phase left ventricular dysfunction after st-segment elevation myocardial infarction. Journal of Hypertension 40(8):1478–1486.
8. Sun C-K.. 2013;Cardio-ankle vascular index (cavi) as an indicator of arterial stiffness. Integrated blood pressure control :27–38. 10.2147/IBPC.S34423.
9. Zhao G-R., Xiang Z-J., Ye T-X., Yuan Y-J., Guo Z-X.. 2006;Antioxidant activities of salvia miltiorrhiza and panax notoginseng. Food chemistry 99(4):767–774. 10.1016/j.foodchem.2005.09.002.
10. Lei X-L., Chiou GC.. 1986;Cardiovascular pharmacology of panax notoginseng (burk) fh chen and salvia miltiorrhiza. American Journal of Chinese Medicine :14.
11. Moon S-K., Kim SB., Kwon S., Cho S-Y., Park S-U., Jung W-s., et al. 2018;Anti-hypertensive effect by single adminstration of chunghyul-dan: A case series. Journal of Korean Medicine 39(1):95–103. 10.13048/jkm.18010.
12. Jung W-S., Kwon S., Cho S-Y., Park S-U., Moon S-K., Park J-M., et al. 2016;The effects of chunghyul-dan (a korean medicine herbal complex) on cardiovascular and cerebrovascular diseases: A narrative review. Evidence-Based Complementary and Alternative Medicine 2016(1):2601740. 10.1155/2016/2601740.
13. HAYAKAWA J., NODA N., YAMADA S., MIKAMI E., UNO K.. Studies on Physical and Chemical Quality Evaluation of Crude Drugs Preparations. III. Analysis of Gardenia Fruits and Its Preparations. YAKUGAKU ZASSHI 1985;105(10):996–1000. 10.1248/yakushi1947.105.10_996.
14. 김정범 최승훈., 안규석 . 1997;도인승기탕 및 그 구성약물이 어혈병태모형에 미치는 영향. 동의병리학회지 11(1):65–76.
15. 신원준 박영민., 홍진우 정동원., 이준우 김석민., et al. 2005;Cavi 를 이용한 arteriosclerosis 평가와 한방 변증과의 관련성 연구. The Journal of Internal Korean Medicine :241–254.
16. 김석민 선종주., 최창민 정재한., 황재웅 민인규., et al. 2007;뇌졸중환자의 어혈병태모형과 cavi, 심혈관질환 위험도간의상호관계에 관한 임상적 연구. 대한한방내과학회지 제 28(3):421–433.
17. Yun SP., Jung WS., Park SU., Moon SK., Ko CN., Cho KH., et al. 2005;Anti-hypertensive effect of chunghyul-dan (qingxue-dan) on stroke patients with essential hypertension. The American Journal of chinese Medicine 33(03):357–364. 10.1142/S0192415X05002977.
18. Cho KH., Kang HS., Jung WS., Park SU., Moon SK.. 2005;Efficacy and safety of chunghyul-dan (qingwie-dan) in patients with hypercholesterolemia. The American Journal of Chinese Medicine 33(02):241–248. 10.1142/S0192415X05002898.
19. Lee H-G., Kwon S., Cho S-Y., Park S-U., Jung W-S., Moon S-K., et al. 2023;Effect of an herbal medicine, chunghyul-dan, on prevention of recurrence in patients with ischemic stroke: A retrospective cohort study. Medicine 102(45):e35840. 10.1097/MD.0000000000035840.
20. Horie Y., Han JY., Mori S., Konishi M., Kajihara M., Kaneko T., et al. 2005;Herbal cardiotonic pills prevent gut ischemia/reperfusion-induced hepatic microvascular dysfunction in rats fed ethanol chronically. World J Gastroenterol 11(4):511–515. 10.3748/wjg.v11.i4.511.
21. Park TH., Lee HG., Cho SY., Park SU., Jung WS., Park JM., et al. 2023;A comparative study on the neuroprotective effect of geopung-chunghyuldan on in vitro oxygen-glucose deprivation and in vivo permanent middle cerebral artery occlusion models. Pharmaceuticals (Basel) 16(4)10.3390/ph16040596.
22. 김남재 진성민., 최혁재 주수만., 송보완 김종우.. 2002;한약과 양약의 약물상호작용에 관한 연구-nicardipine 과 청혈단의 상호작용. 병원약사회지 19(4):383–394.
23. Cho K., Jung W., Park S., Moon S., Kim Y., Hae H.. 2003;Clinical assessment on the safety of chunghyul-dan (qingwie-dan). The Journal of Korean Oriental Medicine 24(3):45–50.
24. Lee YW., Kim DH., Jeon SJ., Park SJ., Kim JM., Jung JM., et al. 2013;Neuroprotective effects of salvianolic acid b on an aβ25–35 peptide-induced mouse model of alzheimer’s disease. European journal of pharmacology 704(1–3):70–77. 10.1016/j.ejphar.2013.02.015.
25. Lee H-G., Kwon S., Moon S-K., Cho S-Y., Park S-U., Jung W-S., et al. 2023;Neuroprotective effects of geopung-chunghyuldan based on its salvianolic acid b content using an in vivo stroke model. Current Issues in Molecular Biology 45(2):1613–1626. 10.3390/cimb45020104.
26. Ng T.. 2006;Pharmacological activity of sanchi ginseng (panax notoginseng). Journal of Pharmacy and Pharmacology 58(8):1007–1019. 10.1211/jpp.58.8.0001.

Article information Continued

Fig. 1

Fig. 1

Decrease of Left(A) and Right CAVI(B) After the Treatment. Both CAVI after treatment were significantly decreased compared with those before treatment.

CAVI, Cardio-Ankle Vascular Index.

Fig. 2

Fig. 2

Changes of Both CAVI before and after the treatment

*, by Fisher’s exact test.

Table 1

Composition of Chunghyuldan and Geopungdan

Components Scientific Name Weight(mg)
Chunghyul-dan Scutellariae Radix Scultellaria Bailcalensis GEORGI 70.59
Coptidis Rhizoma Coptis japonica MAKINO 70.59
Phellodendri Cortex Phellodendron Amurense RUPPECHT 70.59
Gardeniae Fructus Gardenia jasminoides ELLIS 70.59
Rhei Rhizoma Rheum palmatum L. 17.65
Total 300.00
Geopung-dan Scutellariae Radix Salvia miltiorrhiza BUNGE 125.00
Coptidis Rhizoma Panax notoginseng F.H.CHEN 25.00
Total 150

Table 2

General Characteristics of Subjects

General characteristics Number of patients (%)
Sex Male 11(84.6)
Female 2(15.4)
Age 40s 1(7.7)
50s 1(7.7)
60s 3(23.1)
70s 6(46.2)
80s 2(15.4)
Main Impression Angina 2(15.4)
Arrhythmia 1(7.7)
Dizziness with unknown causes 1(7.7)
Essential tremor 1(7.7)
HTN 2(15.4)
Migraine 1(7.7)
Stroke (including Cerebral infarction, Cerebral hemorrhage) 5(38.5)
Chief Complaint Chest discomfort 1(7.7)
Dizziness 1(7.7)
Dysarthria 2(15.4)
Facial palsy 1(7.7)
Headache 4(30.8)
Tremor 1(7.7)
Weakness 3(23.1)
Risk factors Heart disease 3(23.1)
Diabetes Mellitus 3(23.1)
Dyslipidemia 6(46.2)
Hypertension 8(61.5)
Social history Alcohol 5(38.5)
Smoking 2(15.4)

Table 3

The difference of CAVI between before and after treatment

Before the treatment A month after the treatment p-value*
CAVI (Lt.) 9.72±0.28 8.90±0.29 p<0.001
CAVI (Rt.) 9.87±0.31 9.14±0.31 p=0.003
CAVI (Both) 9.79±1.04 9.02±0.06 p<0.001

CAVI, Cardio-Ankle Vascular Index;

*

, by paired t test.

Table 4

Summary of the Clinical Information of Patients

Case Age/Sex Main Impression Chief Complaints Past history Initial LFT Initial RFT Adverse event
P1 67/M Arrhythmia Chest discomfort HTN
Dyslipidemia		 None None None
P2 76/M Angina s/p stent insertion Dysarthria HTN
Dyslipidemia
BPH
Spinal stenosis s/p op		 None None None
P3 82/M Stable Angina s/p CAG #2, PCI #1 Headache
Dizziness		 HTN
Dyslipidemia		 AST 28
ALT 34
ALP 54
rGTP 46		 BUN 22
Cr 1.19
eGFR 56.9		 None
P4 76/M Cerebral infarction (Lt. parietal lobe, temporal lobe) Dysarthria Cerebrovascular disease
Gastric cancer		 None None None
P5 79/M Cerebral infarction of Rt. Periventricular White Matter Facial palsy HTN None None None
P6 74/F Headache Headache
Cervicalgia		 HTN
Dyslipidemia		 AST 30
ALT 30
ALP 74
rGTP 46		 BUN 21
Cr 0.50
eGFR 96.01		 None
P7 74/M Dizziness Dizziness DM None None None
P8 47/M Headache Headache HTN
Dyslipidemia		 None None None
P9 80/M Headache Headache Dyslipidemia None None None
P10 60/M Cerebral infarction (Rt. Basal Ganglia and Corona Radiata) Discomfort of movement HTN
DM		 None None None
P11 57/M Cerebral infarction (Rt. Middle Cerebral Artery territory) Left side weakness (IV+/IV+)
Dysarthria		 - None None None
P12 66/M ICH (Rt. Basal Ganglia and Corona Radiata) Left side weakness (IV/IV) HTN None None None
P13 74/M Essential tremor Hand tremor c
Anxiety		 DM None None None

LFT, Liver Function Test. RFT, Renal Function Test. HTN, hypertension. BPH, Benign Prostatic Hypertrophy. CAG, Coronary Angiography. PCI, Percutaneous Coronary Intervention. AST, Aspartate Transaminase. ALT, Alanine Transaminase. ALP, Alkaline Phosphatase. rGTP, Gamma-glutamyl transpeptidase. BUN, Blood Urea Nitrogen. Cr, Creatinine. eGFR, Estimated Glomerular Filtration Rate, DM, Diabetes Mellitus. ICH, Intracerebral Hemorrhage.