Vascular Response of Raynaud’s Phenomenon to Nifedipine or Herbal Medication (Duhuo-Tisheng Tang with Danggui-Sini Tang): A Preliminary Study

Background: Raynaud’s phenomenon (RP) is a common manifestation in connective tissuediseases. Calcium channel antagonists are most effective and frequently usedfor treating RP. This study compared the efficacy, digital vascular response,and tolerability between nifedipine and a combination of 2 Chinese herbalmedications (Duhuo-Tisheng Tang and Danggui- Sini Tang) for treating RP.Methods: This open-label non-randomized clinical trial included 47 connective tissuedisease patients with RP. The herbal group and the nifedipine group included26 and 21 patients, respectively. The duration of therapy was 4 weeks.Baseline and posttreatment laser Doppler blood flow imaging of both handswere performed at room temperature and after cold challenge. Nailfold capillarymicroscopy was performed at the baseline and after 4 weeks of therapy.Serum levels of soluble intercellular adhesion molecule-1 (sICAM-1),prostaglandin E2 (PGE2), nitrite (NO2), and nitrate (NO3), and plasma levelsof endothelin-1 (ET-1) were also measured. Self-reported symptoms, using avisual analog scale (VAS) and a physician global assessment (PGA), wererecorded at the baseline and after treatment.Results: After 4 weeks of treatment, VAS scores improved (p = 0.0035) and thephysician’s global assessment of RP severity decreased in the nifedipinegroup (p = 0.0078) but not in the herbal group. Episodes of RP attacksdecreased in the nifedipine group after treatment (p = 0.008). The nifedipinegroup had increased laser Doppler flow (116.3 ± 70.7 AU) compared to thebaseline (72.4 ± 49.0 AU, p = 0.0008). Laser Doppler images improved atvarious time points after cold challenge in the nifedipine group after therapy.Laser Doppler flow in the herbal group did not significantly change withtherapy. Capillary microscopy demonstrated no significant difference inenlargements, avascularity, or hemorrhagic spots between groups. SerumNO2 concentrations were higher in the nifedipine group than in the herbalgroup. Levels of sICAM-1, PGE2, NO3, and ET-1 after therapy were similarto those at the baseline in both groups.Conclusions: The digital vascular response in RP improved with nifedipine but wasunchanged with a combination of the Chinese medicines Duhuo-TishengTang and Danggui-Sini Tang.