Syndrome differentiation and treatment is an important aspect of traditional Chinese medicine. In a multicentre randomized controlled clinical trial of 220 patients with CHF, researchers reported that patients taking the herbal medicine had better improvements in LVEF after 28 days compared to a placebo group. The patients in the Chinese herbal medicine group took different kinds of prescriptions according to the syndrome differentiation. The TCM syndrome score in the TCM group also improved significantly compared with the placebo group. The only side effect was atrial fibrillation in one patient in the Chinese herbal medicine group [40]. The study showed that TCM treatment based on syndrome differentiation can effectively improve the heart function of CHF patients and is safe. Two other studies using Nuanxin Capsule and Shencao Tongmai granules showed that after two weeks of treatment, TCM syndrome scores of CHF patients in the TCM group dropped to levels lower than those in the placebo group. Chinese medicine treatment can also significantly relieve the symptoms and signs of CHF patients.

One problem with clinical evaluation is that the concentration of the active ingredient is often unknown and the amount of the bioactive ingredient may vary from capsule to capsule. Inconsistencies in compounds in formula or capsules guarantee that results from clinical trials should be cautiously optimistic. Despite the challenges, clinical trials will provide an opportunity to explore how the multiple compounds in traditional Chinese medicine may play a combined role in heart failure syndrome.

The pharmacological mechanism of traditional Chinese medicine in treating heart failure has been explored in many studies. The most commonly used animal models in these studies are acute myocardial ischemia (AMI) models or doxorubicin-induced cardiotoxicity models. The H9C2 cardiac cell line has also been extensively studied in vitro. The forms of Chinese medicine studied include single Chinese medicine, Chinese herbal extracts and recipes. Experimental studies have shown that traditional Chinese medicine has the properties of anti-fibrosis, anti-inflammation, anti-oxidation, anti-apoptosis, promoting angiogenesis and metabolic regulation. These biological pathways are interconnected, and Chinese medicine may function in a multi-component, multi-target mode.