Aspirin vs. Dan Shen in pain treatment

Aspirin vs. Dan Shen in pain treatment
                                              Online researched by Feng Mei ,  07/09/11

Aspirin is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication.
Salicylic acid, the main metabolite of aspirin, is an integral part of human and animal metabolism. While much of it is attributable to diet, a substantial part is synthesized endogenously.
Aspirin also has an antiplatelet effect by inhibiting the production of thromboxane, which under normal circumstances binds platelet molecules together to create a patch over damaged walls of blood vessels. Because the platelet patch can become too large and also block blood flow, locally and downstream, aspirin is also used long-term, at low doses, to help prevent heart attacks, strokes, and blood clot formation in people at high risk for developing blood clots. It has also been established that low doses of aspirin may be given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue.
The main undesirable side effects of aspirin are gastrointestinal ulcers, stomach bleeding, and tinnitus, especially in higher doses. In children and adolescents, aspirin is no longer used to control flu-like symptoms or the symptoms of chickenpox or other viral illnesses, because of the risk of Reye's syndrome.Aspirin is part of a group of medication called nonsteroidal anti-inflammatory drugs (NSAIDs). Though it, and other in its group called the salicylates, have similar effects (antipyretic, anti-inflammatory, analgesic) and inhibit the same enzyme cyclooxygenase as their mechanism of action, they do so in a irreversible manner (see NSAID mechanism of action). For example, NSAIDs antiplatelet effects last in the order of hours, whereas aspirin's effect lasts for days (until the body replaces the suppressed platelets). Hence, when physicians tell patients to stop taking NSAIDs, they usually imply aspirin as well.
 
Pain
In general, aspirin works well for dull, throbbing pain; it is ineffective for pain caused by most muscle cramps, bloating, gastric distension and acute skin irritation. The most studied example is pain after surgery, such as tooth extraction, for which the highest allowed dose of aspirin (1 g) is equivalent to 1 g of paracetamol, 60 mg of codeine or 5 mg of oxycodone. A combination of aspirin and caffeine, generally, affords greater pain relief than aspirin alone. Effervescent aspirin alleviates pain much faster than aspirin in tablets (15–30 min vs. 45–60 min).
Nevertheless, as a postsurgery painkiller, aspirin is inferior to ibuprofen and has higher gastrointestinal toxicity. The maximum dose of aspirin (1 g) provides weaker pain relief than an intermediate dose of ibuprofen (400 mg), and this relief does not last as long. A combination of aspirin and codeine may have a slightly higher analgesic effect than aspirin alone; however, this difference is not clinically meaningful. It appears ibuprofen is at least equally, and possibly more, effective than this combination.
According to a meta-analysis of clinical trials for menstrual pain, aspirin demonstrated higher efficacy than placebo, but lower than ibuprofen or naproxen, although maximum doses of aspirin were never used in these trials. The authors concluded ibuprofen has the best risk-benefit ratio.
Aspirin did not ease pain during cycling exercise, while caffeine, surprisingly, was very effective. Similarly, aspirin, codeine or paracetamol were not better than placebo for muscle soreness after exercise.
Headache
Aspirin is a first-line drug in the treatment of migraine, bringing relief in 50–60% of the cases. When used at a high dose of 1000 mg (as compared to 275–325 mg when used as a pain killer or 81 mg as a antiplatelet therapy), no significant differences were seen as compared to triptan medication, sumatriptan (Imitrex) and other painkillers such as paracetamol(acetaminophen) or ibuprofen. The combination of aspirin, paracetamol (acetaminophen) and caffeine (Excedrin) is even more potent. For the treatment of migraine headache, this formulation works better than any of its three components taken separately, better than ibuprofen and better than sumatriptan. Similarly to all other medications for migraine, it is recommended to take aspirin at the first signs of the headache, and it is the way these medications were used in the comparative clinical trials.
Aspirin alleviates pain in 60–75% of patients with episodic tension headaches. It is equivalent to paracetamol (acetaminophen) in that respect, except for the higher frequency of gastrointestinal side effects. Comparative clinical trials indicated metamizole and ibuprofen may relieve pain faster than aspirin, although the difference becomes insignificant after about two hours. The addition of caffeine in a dose of 60–130 mg to aspirin increases the analgesic effect in headache. The combination of aspirin, paracetamol (acetaminophen) and caffeine (Excedrin) is still more effective, but at the cost of more stomach discomfort, nervousness and dizziness.
There is some evidence low-dose asprin has benefit for reducing the occurrence of migraines in susceptible individuals.
Prevention of heart attacks and strokes
There are two distinct uses of aspirin for prophylaxis of cardiovascular events: primary prevention and secondary prevention. Primary prevention is about decreasing strokes and heart attacks in the general population of those who have no diagnosed heart or vascular problems. Secondary prevention concerns patients with known cardiovascular disease.
Low doses of aspirin are recommended for the secondary prevention of strokes and heart attacks. For both males and females diagnosed with cardiovascular disease, aspirin reduces the chance of a heart attack and ischaemic stroke by about a fifth. This translates to an absolute rate reduction from 8.2% to 6.7% of such events per year for people already with cardiovascular disease. Although aspirin also raises the risk of hemorrhagic stroke and other major bleeds by about twofold, these events are rare, and the balance of aspirin's effects is positive. Thus, in secondary prevention trials, aspirin reduced the overall mortality by about a tenth.
For persons without cardiovascular problems, the benefits of aspirin are unclear. In the primary prevention trials, aspirin decreased the overall incidence of heart attacks and ischaemic strokes by about a tenth. However, since these events were rare, the absolute reduction of their rate was low: from 0.57% to 0.51% per year. In addition, the risks of hemorrhagic strokes and gastrointestinal bleeding almost completely offset the benefits of aspirin. Thus, in the primary prevention trials, aspirin did not change the overall mortality rate. Further trials are in progress.
The expert bodies diverge in their opinions regarding the use of aspirin for primary prevention, such as can be accomplished by including aspirin in a polypill for the general population. The US Government Preventive Services Task Force recommended making individual, case by case choices based on the estimated future risk and patients' preferences. On the other hand, Antithrombotic Trialists’ Collaboration argued such recommendations are unjustified, since the relative reduction of risk in the primary prevention trials of aspirin was same for persons in high- and low-risk groups and did not depend on the blood pressure. The Collaboration suggested statins as the alternative and more effective preventive medication.
Coronary and carotid arteries, bypasses and stents
The coronary arteries supply blood to the heart. Aspirin is recommended for one to six months after placement of stents in the coronary arteries and for years after a coronary artery bypass graft.
The carotid arteries supply blood to the brain. Patients with mild carotid artery stenosis benefit from aspirin; it is recommended after a carotid endarterectomy or carotid artery stent.
Interactions
Aspirin is known to interact with other drugs. For example, acetazolamide and ammonium chloride have been known to enhance the intoxicating effect of salicyclates, and alcohol also increases the gastrointestinal bleeding associated with these types of drugs. Aspirin is known to displace a number of drugs from protein binding sites in the blood, including the antidiabetic drugs tolbutamide and chlorpropamide, the immunosuppressant methotrexate, phenytoin, probenecid, valproic acid (as well as interfering with beta oxidation, an important part of valproate metabolism) and any nonsteroidal anti-inflammatory drug. Corticosteroids may also reduce the concentration of aspirin. Ibuprofen can negate the antiplatelet effect of aspirin used for cardioprotection and stroke prevention. The pharmacological activity of spironolactone may be reduced by taking aspirin, and aspirin is known to compete with Penicillin G for renal tubular secretion. Aspirin may also inhibit the absorption of vitamin C.

Dan Shen (Savia militorrhiza)
Salvia miltiorrhiza (simplified Chinese: 丹参; traditional Chinese: 丹參; pinyin: dānshēn).
Dan Shen: taste is bitter, nature is slightly cold, energy go into heart, pericardium and liver meridians. TCM functions: active blood cycle, cool blood clear heat swell, tonify blood and calm down spirit.
This herb is commonly known as a heart tonic. It has been used to strengthen and tone the heart by helping it to beat in a steady, regular rhythm. It is also used to strengthen the liver and stimulate the production of bile.
It is used in traditional herbal medicine to prevent pain.
This herb protects nerve cells from free-radical damage, and may have applications in preventing alcohol and drug abuse.
Dan shen extracts relax the smooth muscles that support the coronary arteries and increase circulation to the heart, making it useful in treating angina, atherosclerosis, and stroke.
The herb contains a substance called tanshinone IIA1, which slows the transmission of nerve impulses within the heart, slowing the pulse while increasing the heart's ejection fraction, or the percentage of available blood that the heart's main pumping chamber pumps into the blood vessels.

This herb prevents the formation of clots in the bloodstream and reduces blood cholesterol and triglyceride levels. It is used to enhance the heart-healthy effect of unsaturated fatty acids and protect heart and nerve cells from free-radical damage.
Research in China reports improvements in people taking this herb for angina, stroke, and phlebitis.
Dan shen changes the rate at which the body absorbs and uses copper. The binding of copper by compounds in dan shen retards the production of fibrin, a protein "rope" on which new blood clots are suspended. This may be useful in treating people with chronic fatigue syndrome.
Dan shen is useful in treating menopause problems and uterine fibroids. It has been noted by authorities on traditional Chinese medicine (TCM) that this herb "releases" congealed blood, as shown by dark-red clots during menses, and eases pelvic congestion.
This herb may also be a valuable ally for treating hepatitis and liver damage. It has been shown clinically to be effective in treating chronic hepatitis. It's also been reported to be effective in suppressing fibrosis in the liver.
Chemical Identification
Take this product 0.1g, plus dissolved in ethanol, as the test solution.  Take protocatechuic aldehyde reference substance, add ethanol made from 1mg per 1ml of solution, as the reference solution.  According to TLC (Appendix Ⅵ B) experiment, to learn the two solutions of 2 ~ 5μl, respectively, points on the same silica gel G TLC plate with benzene - ethyl acetate - formic acid (8:5:0.8) as the agent , started out, dried, sprayed with 2% ferric chloride 1% potassium ferricyanide solution (1:1).  Test products for chromatography, chromatography with reference substance corresponding position, was the same color spots.
Pharmacological efficacy
Expansion of the coronary artery, increase coronary blood flow effects 
Protocatechuic aldehyde holly leaves in the anti-angina is the main active component of the cardiovascular system can increase coronary blood flow and reduce cardiac excitability and conductivity of acute myocardial ischemia and hypoxia-induced myocardial injury has a significant protective effect.  Early years of herbal medicine in the treatment of burns holly extract the active ingredients of anti-angina protocatechuic aldehyde, and the use of synthetic method for producing the drug treatment of coronary heart disease - An ECG (protocatechuic aldehyde film) has been used in clinical.  Salvia protocatechuic aldehyde and then confirmed from the blood circulation is one of the active ingredients.
On the role of the heart and peripheral vascular
Recent studies show that water-soluble components of Salvia protocatechuic aldehyde, Danshensu expansion cardiovascular effects than diterpene quinone tanshinone stronger, is the main component of myocardial ischemia.
Inhibition of platelet aggregation
Protocatechuic aldehyde can improve microcirculation and inhibit adenosine diphosphate-induced platelet aggregation and thrombosis, and can decrease blood viscosity.  Salvia miltiorrhiza water-soluble extract of protocatechuic aldehyde, protocatechuic acid, Sal A, Sal B, Sal C, rosmarinic acid and fat-soluble extract of collagen-induced platelet aggregation inhibition in varying degrees role.
With broad-spectrum anti-bacterial anti-inflammatory effect
Protocatechuic aldehyde old man grass is the main active ingredient in the treatment of nephritis.
Antioxidant: soluble part of Salvia isolated from the seven phenolic compounds: Sal A, Sal B, protocatechuic aldehyde, protocatechuic acid, Salvia, caffeic acid and rosmarinic acid, peroxidative damage to the biofilm has a strong protective effect in vitro to inhibit TNF-a induced leukocyte adhesion and vascular endothelial cells, inhibit the vascular endothelial cell adhesion molecule ICAM-1, VCAM-1 expression role.
Calcium antagonism
Danshensu and protocatechuic aldehyde adult red blood cells are reduced the role of cytosolic Ca2 + concentration, and showed dose-dependent, both combination therapy, efficacy sum, the role and Danshen injection similar to the calcium antagonist Danshen injection role of the main active ingredient.
Repair damaged venous valves, treatment of varicose veins
Protocatechuic aldehyde can effectively reduce the fibrosis of tissues and organs, dissolves fibrin, promote fibrosis, cell regeneration and repair of damaged venous valves, thus effectively prevent backflow of blood, healing varicose veins;
Drug Interactions
Danshen has been shown to potentiate the effects of the common anticoagulation drug warfarin, leading to gross anticoagulation and bleeding complications. Dan shen should be avoided by those using warfarin.