Qiliqiangxin
{{Short description|Traditional Chinese medicine formulation}}
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Qiliqiangxin (QLQX, {{Zh|c=气力强心|l=strengthening the heart through energy and power|p=qī lǐ qiáng xīn}}) is a traditional Chinese medicine formulation used for the treatment of chronic heart failure.{{Cite journal |last=Hao |first=Panpan |last2=Jiang |first2=Fan |last3=Cheng |first3=Jing |last4=Ma |first4=Lianyue |last5=Zhang |first5=Yun |last6=Zhao |first6=Yuxia |date=2017-06-20 |title=Traditional Chinese Medicine for Cardiovascular Disease: Evidence and Potential Mechanisms |url=https://pubmed.ncbi.nlm.nih.gov/28619197 |journal=Journal of the American College of Cardiology |volume=69 |issue=24 |pages=2952–2966 |doi=10.1016/j.jacc.2017.04.041 |issn=1558-3597 |pmid=28619197}}{{Cite journal |last=Jia |first=Qiujin |last2=Wang |first2=Lirong |last3=Zhang |first3=Xiaonan |last4=Ding |first4=Yuejia |last5=Li |first5=Hao |last6=Yang |first6=Yingxi |last7=Zhang |first7=Ao |last8=Li |first8=Yanyang |last9=Lv |first9=Shichao |last10=Zhang |first10=Junping |date=2020 |title=Prevention and treatment of chronic heart failure through traditional Chinese medicine: Role of the gut microbiota |url=https://pubmed.ncbi.nlm.nih.gov/31747557 |journal=Pharmacological Research |volume=151 |pages=104552 |doi=10.1016/j.phrs.2019.104552 |issn=1096-1186 |pmid=31747557}} It was approved by the Chinese Food and Drug Administration in 2004 and included in the Chinese guidelines for the management of heart failure in 2014.{{Cite journal |last=Li |first=Xinli |last2=Zhang |first2=Jian |last3=Huang |first3=Jun |last4=Ma |first4=Aiqun |last5=Yang |first5=Jiefu |last6=Li |first6=Weimin |last7=Wu |first7=Zonggui |last8=Yao |first8=Chen |last9=Zhang |first9=Yuhui |last10=Yao |first10=Wenming |last11=Zhang |first11=Boli |last12=Gao |first12=Runlin |last13=Efficacy and Safety of Qili Qiangxin Capsules for Chronic Heart Failure Study Group |date=2013-09-17 |title=A multicenter, randomized, double-blind, parallel-group, placebo-controlled study of the effects of qili qiangxin capsules in patients with chronic heart failure |url=https://pubmed.ncbi.nlm.nih.gov/23747768 |journal=Journal of the American College of Cardiology |volume=62 |issue=12 |pages=1065–1072 |doi=10.1016/j.jacc.2013.05.035 |issn=1558-3597 |pmid=23747768}}{{Cite journal |last=Chinese Society of Cardiology of Chinese Medical Association |last2=Editorial Board of Chinese Journal of Cardiology |date=2014 |title=[Chinese guidelines for the diagnosis and treatment of heart failure 2014] |url=https://pubmed.ncbi.nlm.nih.gov/24735621 |journal=Zhonghua Xin Xue Guan Bing Za Zhi |volume=42 |issue=2 |pages=98–122 |issn=0253-3758 |pmid=24735621}}
Composition
Qiliqiangxin consists of a standardized extract derived from eleven medicinal herbs commonly used in traditional Chinese medicine (TCM), including:{{Cite journal |last=Han |first=Anbang |last2=Lu |first2=Yingdong |last3=Zheng |first3=Qi |last4=Zhang |first4=Jian |last5=Zhao |first5=YiZhou |last6=Zhao |first6=Mingjing |last7=Cui |first7=Xiangning |date=2018 |title=Qiliqiangxin Attenuates Cardiac Remodeling via Inhibition of TGF-β1/Smad3 and NF-κB Signaling Pathways in a Rat Model of Myocardial Infarction |url=https://karger.com/article/doi/10.1159/000487871 |journal=Cellular Physiology and Biochemistry |language=en |volume=45 |issue=5 |pages=1797–1806 |doi=10.1159/000487871 |issn=1015-8987}}
- Panax ginseng (ginseng)
- Astragalus mongholicus (Mongolian milkvetch)
- Aconitum carmichaeli (Chinese aconite root)
- Salvia miltiorrhiza (red sage)
- Descurainia sophia (flixweed)
- Periploca sepium (Chinese silkvine root bark)
- Alisma plantago-aquatica subsp. orientale (Oriental waterplantain)
- Carthamus tinctorius (safflower)
- Polygonatum odoratum (Angular Solomon's seal)
- Citrus reticulata (dried mandarin peel)
- Cinnamomum cassia (cinnamon twig)
Identified bioactive compounds include astragaloside IV, tanshinone IIA, ginsenosides (Rb1, Rg1, Re), periplocymarin, and nobiletin.{{Cite journal |last=Packer |first=Milton |date=2023 |title=Qiliqiangxin: A multifaceted holistic treatment for heart failure or a pharmacological probe for the identification of cardioprotective mechanisms? |url=https://pubmed.ncbi.nlm.nih.gov/37877337 |journal=European Journal of Heart Failure |volume=25 |issue=12 |pages=2130–2143 |doi=10.1002/ejhf.3068 |issn=1879-0844 |pmid=37877337}} These components are associated with various pharmacological properties, including positive inotropic effects, vasodilation, and anti-inflammatory and antifibrotic activity.
= Traditional medicine perspective =
In traditional Chinese medicine, chronic heart failure is associated with a deficiency of heart qi and yang, often resulting in symptoms attributed to blood stasis, phlegm accumulation, and impaired fluid transport. Qiliqiangxin is formulated to replenish heart qi, yang, activate blood circulation, and resolve phlegm according to TCM theory.
Administration
Qiliqiangxin is administered orally in the form of capsules or placebo. In clinical use, including the QUEST trial, the standard dosage consisted of 0.3 g capsules taken as four capsules three times daily (a total daily dose of 3.6 g). The capsules were administered alongside standard guideline-directed therapy for chronic heart failure. Dose adjustments, such as reducing to two or three capsules three times daily, or temporary discontinuation, were permitted in response to adverse events.{{Cite journal |last=Cheang |first=Iokfai |last2=Yao |first2=Wenming |last3=Zhou |first3=Yanli |last4=Zhu |first4=Xu |last5=Ni |first5=Gehui |last6=Lu |first6=Xinyi |last7=Liao |first7=Shengen |last8=Gao |first8=Rongrong |last9=Zhou |first9=Fang |last10=Shen |first10=Jiangang |last11=Leung |first11=Alice Yeuk Lan |last12=Jiang |first12=Meng |last13=Kong |first13=Hong |last14=Bai |first14=Ling |last15=Mahemuti |first15=Ailiman |date=2024 |title=The traditional Chinese medicine Qiliqiangxin in heart failure with reduced ejection fraction: a randomized, double-blind, placebo-controlled trial |url=https://www.nature.com/articles/s41591-024-03169-2 |journal=Nature Medicine |language=en |volume=30 |issue=8 |pages=2295–2302 |doi=10.1038/s41591-024-03169-2 |issn=1546-170X |pmc=11333273 |pmid=39095596}}
In preclinical studies, the administration methods varied according to the model organism. In rat models of myocardial infarction, qiliqiangxin was administered at a dose of 1.0 g/kg/day, dissolved in sterile water and given by oral gavage for four weeks. In mouse studies, intragastric administration was employed, with doses ranging from 0.25 to 0.75 g/kg/day. A dose of 0.5 g/kg/day was used in most subsequent mouse experiments, as it was considered pharmacologically equivalent to clinical dosing in humans.{{Cite journal |last=Tao |first=Lichan |last2=Shen |first2=Sutong |last3=Fu |first3=Siyi |last4=Fang |first4=Hongyi |last5=Wang |first5=Xiuzhi |last6=Das |first6=Saumya |last7=Sluijter |first7=Joost P. G. |last8=Rosenzweig |first8=Anthony |last9=Zhou |first9=Yonglan |last10=Kong |first10=Xiangqing |last11=Xiao |first11=Junjie |last12=Li |first12=Xinli |date=2015-02-11 |title=Traditional Chinese Medication Qiliqiangxin attenuates cardiac remodeling after acute myocardial infarction in mice |url=https://pubmed.ncbi.nlm.nih.gov/25669146 |journal=Scientific Reports |volume=5 |pages=8374 |doi=10.1038/srep08374 |issn=2045-2322 |pmc=4648480 |pmid=25669146}}