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Review
. 2019 Aug 18;7(3):60.
doi: 10.3390/biomedicines7030060.

A Classic Herbal Formula Guizhi Fuling Wan for Menopausal Hot Flushes: From Experimental Findings to Clinical Applications

Mingdi Li  1 , Andrew Hung  2 , Hong Li  1 , Angela Wei Hong Yang  3
Affiliations
Review

A Classic Herbal Formula Guizhi Fuling Wan for Menopausal Hot Flushes: From Experimental Findings to Clinical Applications

Mingdi Li et al. Biomedicines. .

Abstract

A classic herbal formula Guizhi Fuling Wan (GFW) has been used for managing menopausal hot flushes (MHFs), but the evidence across different study types has not been systematically summarized. This project investigated the clinical effects, phytochemistry, pharmacodynamics, and potential mechanisms of actions of GFW on the causative target proteins potentially driving MHFs. Twenty English and Chinese databases were searched for relevant clinical and experimental studies. A total of 12,988 studies were identified, of which 46 were included. Seven clinical studies demonstrated GFW had no statistically significant changes in the frequency and severity of MHFs; however, it could improve peripheral blood flow in the fingertips, jaw, and toes. Thirty-five studies on phytochemistry identified 169 chemical compounds of GFW. Four experimental studies revealed GFW's therapeutic effects (e.g., normalize calcitonin gene-related peptide [CGRP] level) and potential target protein/cytokine (estrogen receptor beta [ESR2] with genetic variation, CGRP receptor, and interleukin-8) on MHFs. Therapeutic effects across different study types were inconsistent, possibly due to the dose difference and genotype variety of ESR2 in the human population. Further clinical and experimental studies, as well as biochemical investigation on the mechanisms of actions of GFW, are recommended.

Keywords: Cinnamon twig and Poria cocos pill; herbal medicine; integrative medicine; literature review; menopause; natural products; women’s health.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study selection procedures of Guizhi Fuling Wan on menopausal hot flushes.
Figure 2
Figure 2
Molecular structures of the 24 chemical constituents of Guizhi Fuling Wan. Note: C3: Benzol-β-gentiobioside, C6: Mandelic acid gentiobioside/isomer, D1: 4′-O-galloypaeoniflorin, D6: Benzoylpaeoniflorin sulfate, D10: Galloyglucose/isomer, D12: Galloylpaeoniflorin sulfonate, D13: Hexagalloyl glucose, D14: Isoxypaeoniflora, D19: Tetragalloy glucose, D20: Trigalloy glucose, E1: 3-hydroxypaeonol, E10: Mudanpioside E sulfonate, F1: 1-O-β-d-glucopyranosyl-paeonisuffrone, F2: 6-O-β-d-glucopyranosyl lactinolide, F7: Isomaltopaeoniflorin sulfonate, G4: 25-Hydroxypachymic acid, G5: 31-Hydroxyl-16-O-acetylpachymic acid, G10: 3-oxo-6,16α-dihydroxy-lanosta-7,9(11),24(31)-trien-21-oic acid, G12: 3β,16α-Dihydroxy-lanosta-7,9(11),24-trien-21-oic acid, G14: 6α-Hydroxydehydropachymic acid, G21: Pachymic acid methyl ester, H1: (2R)-[(6-O-β-d-glucopyranosyl-β-d-glucopyranosyl) oxy] (phenyl) ethanoic acid, H2: 2,5-dihydroxy-4-methylacetophenone, H15: Benzyl-β-d-glucopyranosyl-(1→6)-β-d-glucopyranoside.
Figure 3
Figure 3
Quality assessment of included in vivo studies according to ARRIVE (Animal Research: Reporting of In Vivo Experiments) guideline.
Figure 4
Figure 4
Therapeutic effects of Guizhi Fuling Wan on menopausal hot flushes across different types of studies. Notes: CGRP: calcitonin gene-related peptide; E2: estradiol; ESR: estrogen receptor; FSH: follicle-stimulating hormone; 1IL: interleukin; LH: luteinizing hormone; LL: two long alleles; MIP: macrophage inflammatory protein; MCP: serum monocyte chemotactic protein; RCT: randomized controlled trial.
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