Research Progress on Zhenwu Decoction in the Treatment of Type 2 Cardiorenal Syndrome

Q: What is the clinical evidence from this study?

Study design: Review. Population: Type 2 cardiorenal syndrome (progressive renal impairment secondary to chronic heart failure). Intervention: Zhenwu Decoction (comprising Aconiti Lateralis Radix Praeparata, Atractylodis Macrocephalae Rhizoma, Poria, ginger, and Paeoniae Radix Alba) or its modified forms combined with Western medicine vs. Standard Western medicine therapy alone (e.g., diuretics, RAS inhibitors, beta-blockers). Primary outcome: Cardiorenal surrogate indicators (LVEF, NT-proBNP, BNP, Scr, BUN, CysC, eGFR), inflammatory cytokines (IL-1, IL-6, TNF-α, hs-CRP), and overall clinical response rate.

Q: What does this research mean for the field?

Zhenwu Decoction, particularly as an adjunct to Western medicine, improves cardiorenal surrogate markers and reduces inflammatory cytokines in type 2 cardiorenal syndrome, although high-quality evidence on hard clinical endpoints remains lacking. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

阳 陈

doi:10.12677/acm.2026.16113616

January 1, 2026Advances in Clinical MedicineOpen Access

Research Progress on Zhenwu Decoction in the Treatment of Type 2 Cardiorenal Syndrome

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Key result

Zhenwu Decoction added to conventional therapy improves cardiorenal biomarkers in type 2 cardiorenal syndrome.

Why the study?

Does Zhenwu Decoction combined with standard Western medicine improve cardiorenal function and reduce inflammation in patients with type 2 cardiorenal syndrome?

Key Points

To review the disease background, herbal formulation, pharmacological mechanisms, clinical evidence, and safety profile of Zhenwu Decoction in treating type 2 cardiorenal syndrome.
Narrative synthesis evaluating basic pharmacological studies, animal experimental models, and predictive network pharmacology analyses of Zhenwu Decoction.
Review of clinical trials assessing Zhenwu Decoction, its modified forms, or combinations with standard Western medical therapies in chronic heart failure and cardiorenal syndrome.
Basic research shows Zhenwu Decoction enhances hemodynamics, downregulates renal aquaporin 2 and aquaporin 3 expression, inhibits NF-κB and TGF-β1/Smad pathways, and reduces renal fibrosis.
Clinical studies demonstrate improvements in surrogate markers—such as left ventricular ejection fraction, serum creatinine, and inflammatory cytokines—with reported total effective rates including 90.63% versus 76.56% and 97.37% versus 78.95% over controls.
Current clinical evidence is constrained by small sample sizes, single-center designs, and an absence of hard endpoints like all-cause mortality, alongside toxicity concerns due to aconite's narrow therapeutic window.

Structured PICO

Does Zhenwu Decoction combined with standard Western medicine improve cardiorenal function and reduce inflammation in patients with type 2 cardiorenal syndrome?

P

Population

Patients with type 2 cardiorenal syndrome (progressive renal impairment secondary to chronic heart failure) and preclinical animal models evaluated across reviewed studies.

I

Intervention

Zhenwu Decoction (composed of Aconiti Lateralis Radix Praeparata [processed aconite], Atractylodis Macrocephalae Rhizoma, Poria, ginger, and Paeoniae Radix Alba) or its modified/combined formulas (e.g., with Baoyuan Decoction or Juedu Decoction) added to conventional Western medicine for 14 days to 3 months.

C

Comparator

Conventional Western medical therapy alone (including diuretics, renin-angiotensin system inhibitors such as irbesartan or valsartan, and beta-blockers such as metoprolol).

O

Outcome

Cardiorenal function surrogate indicators (LVEF, LVEDD, LVESD, NT-proBNP, BNP, Scr, BUN, CysC, eGFR), inflammatory and endothelial markers (IL-1, IL-6, TNF-α, hs-CRP, ET-1, NO), TCM syndrome scores, and overall clinical effective rate.surrogate

Limitations

Existing clinical trials have small sample sizes (typically 20 to 67 patients per group) and are mostly single-center
Short treatment durations (14 days to 3 months) that cannot reflect long-term cardiorenal function evolution
Reliance on surrogate indicators and subjective TCM syndrome scores rather than hard endpoints (all-cause mortality, HF rehospitalization, renal function progression)
Inadequate reporting of randomization methods, allocation concealment, and blinding, leading to high risk of bias and lack of placebo controls
A considerable portion of mechanistic evidence relies on database-driven network pharmacology predictions without in vivo/in vitro experimental confirmation
Existing clinical trials are predominantly single-center with small sample sizes (20 to 67 patients per arm) and short durations (14 days to 3 months)
Lack of high-quality RCTs evaluating hard clinical endpoints such as all-cause mortality, heart failure rehospitalization, or progression of renal dysfunction
Poor methodological quality in primary trials, with frequent omission of randomization details, allocation concealment, blinding, and placebo controls
Preclinical mechanistic studies largely rely on acute/subacute single-cause animal models and unvalidated network pharmacology database predictions
Lack of standardized safety monitoring, blood concentration tracking, and long-term follow-up despite the narrow therapeutic window of aconite

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Implication

This narrative review synthesizes preclinical and preliminary clinical evidence suggesting that Zhenwu Decoction may improve surrogate cardiorenal and inflammatory markers in type 2 cardiorenal syndrome, while highlighting the lack of hard clinical endpoint data and the critical need for aconite toxicity monitoring in renally impaired patients.

Abstract

Type 2 cardiorenal syndrome (CRS) is a clinical syndrome of progressive renal impairment secondary to chronic heart failure, with high prevalence and poor prognosis.Although Western medicine can partially improve cardiorenal function, its benefit is limited by diuretic resistance, drug nephrotoxicity and insufficient neuroendocrine suppression.Zhenwu Decoction, first recorded in Zhang Zhongjing's Treatise on Cold Damage Diseases, is a representative formula for warming Yang and promoting diuresis; with Aconiti Lateralis Radix Praeparata as the sovereign drug to warm heart-kidney Yang, Atractylodis Macrocephalae Rhizoma and Poria to strengthen the spleen and drain dampness, ginger to disperse retained water and Paeoniae Radix Alba to nourish Yin and harmonize the nutrient, it matches the core pathogenesis of heart-kidney Yang deficiency with exuberant water-dampness.Basic studies suggest that the formula protects the heart and kidney by improving haemodynamics, suppressing inflammation and oxidative stress, regulating water-sodium metabolic pathways, delaying renal fibrosis and modulating multiple targets.Available clinical studies indicate that its modified forms or its combination with Western medicine may improve cardiorenal surrogate indicators and reduce inflammatory cytokines, yet most are single-centre, small-sample and short-duration trials, and high-quality evidence based on hard endpoints such as all-cause mortality, heart failure rehospitalisation and progression of renal function is still lacking.In addition, the sovereign drug aconite has well-defined toxic constituents and a narrow therapeutic window, so its safety requires close monitoring.This article reviews the disease background, formula characteristics, mechanisms, clinical evidence and safety of Zhenwu Decoction in type 2 CRS, and objectively evaluates the strength and limitations of the current evidence.

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Cite This Study

阳陈 (2026) conducted a review in Type 2 cardiorenal syndrome (progressive renal impairment secondary to chronic heart failure). Zhenwu Decoction (comprising Aconiti Lateralis Radix Praeparata, Atractylodis Macrocephalae Rhizoma, Poria, ginger, and Paeoniae Radix Alba) or its modified forms combined with Western medicine vs. Standard Western medicine therapy alone (e.g., diuretics, RAS inhibitors, beta-blockers) was evaluated on Cardiorenal surrogate indicators (LVEF, NT-proBNP, BNP, Scr, BUN, CysC, eGFR), inflammatory cytokines (IL-1, IL-6, TNF-α, hs-CRP), and overall clinical response rate. Zhenwu Decoction combined with Western medicine improves cardiorenal surrogate markers and reduces inflammatory cytokines in type 2 cardiorenal syndrome, though hard endpoint evidence is lacking.

synapsesocial.com/papers/6af0e999de503f3774140a0c https://doi.org/10.12677/acm.2026.16113616

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Research Progress on Zhenwu Decoction in the Treatment of Type 2 Cardiorenal Syndrome

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Research Progress on Zhenwu Decoction in the Treatment of Type 2 Cardiorenal Syndrome

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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