Latest Issue
      Vol. 29 ， Issue 4 ， 2023

        Original Article

      • LI Xiu-fang,WANG Zhong-qing,XU Hai-yan,LIU Hong,SHENG Yan,XU Jin,LI Yuan-mei,LIAN Fang
        Vol. 29, Issue 4, Pages: 291-298(2023) DOI: 10.1007/s11655-023-3546-y
        Abstract：Objective:To explore the effects of Zishen Yutai Pills (ZYPs) on the quality of oocytes and embryos, as well as pregnancy outcomes in patients with diminished ovarian reserve (DOR) receiving in vitro fertilization-embryo transfer (IVF-ET). The possible mechanisms, involving the regulation of bone morphogenetic protein 15(BMP15) and growth differentiation factor 9 (GDF9), were also investigated.Methods:A total of 120 patients with DOR who underwent their IVF-ET cycle were randomly allocated to 2 groups in a 1: 1 ratio. The patients in the treatment group (60 cases) received ZYPs from the mid-luteal phase of the former menstrual cycle by using gonadotropin-releasing hormone (GnRH) antagonist protocol. The patients in the control group (60 cases) received the same protocol but without ZYPs. The primary outcomes were the number of oocytes retrieved and high-quality embryos. Secondary outcomes included other oocyte or embryo indices as well as pregnancy outcomes. Adverse events were assessed by comparison of the incidence of ectopic pregnancy, pregnancy complications, pregnancy loss, and preterm birth. Contents of BMP15 and GDF9 in the follicle fluids (FF) were also quantified with enzyme-linked immunosorbent assay.Results:Compared with the control group, the numbers of oocytes retrieved and high-quality embryos were significantly increased in the ZYPs group (both P <0.05). After treatment with ZYPs, a significant regulation of serum sex hormones was observed, including progesterone and estradiol. Both hormones were up-regulated compared with the control group (P=0.014 and 0.008), respectively. No significant differences were observed with regard to pregnancy outcomes including implantation rates, biochemical pregnancy rates, clinical pregnancy rates, live birth rates, and pregnancy loss rates (all P >0.05). The administration of ZYPs did not increase the incidence of adverse events. The expressions of BMP15 and GDF9 in the ZYPs group were significantly up-regulated compared with the control group (both P <0.05).Conclusions:ZYPs exhibited beneficial effects in DOR patients undergoing IVF-ET, resulting in increments of oocytes and embryos, and up-regulation of BMP15 and GDF9 expressions in the FF. However, the effects of ZYPs on pregnancy outcomes should be assessed in clinical trials with larger sample sizes (Trial reqistration No. ChiCTR2100048441).  
        Keywords：Zishen Yutai Pills;diminished ovarian reserve;in vitro fertilization-embryo transfer;oocytes;embryos   
        29
        |
        4
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941141 false
        Published：2023-04-05
      • CHEN Xu,CHEN Jiu-xi,HAN Xue-yan,ZHAO Yang,CAO Jing,JIAO Xiu-zhen,LIU Hong-mei,GUO Chun-li,MENG Shuo,LIANG Shuai,QI Jiang-xia,CHEN Dong,LI Ming-xia,JIAO Yun-xia,WANG Ting-ting,HONG Xia
        Vol. 29, Issue 4, Pages: 299-307(2023) DOI: 10.1007/s11655-022-3685-6
        Abstract：Objective:To evaluate the efficacy and safety of Jianpi Jieyu Decoction (JJD) for treating patients with mild-to-moderate depression of Xin (Heart)-Pi (Spleen) deficiency (XPD) syndrome.Methods:In this multi-center, randomized, controlled study, 140 patients with mild-to-moderate depression of XPD syndrome were included from Xiyuan Hospital of China Academy of Chinese Medical Sciences and Botou Hospital of Traditional Chinese Medicine from December 2017 to December 2019. They were randomly divided into JJD group and paroxetine group by using a random number table, with 70 cases in each group. The patients in the JJD group were given JJD one dose per day (twice daily at morning and evening, 100 mL each time), and the patients in the paroxetine group were given paroxetine (10 mg/d in week 1; 20 mg/d in weeks 2–6), both orally administration for a total of 6 weeks. The primary outcome was the change of 17-item Hamilton Depression Rating Scale (HAMD-17) score at week 6 from baseline. The secondary outcomes included the Hamilton Anxiety Scale (HAMA) score, Traditional Chinese Medicine Symptom Scale (TCMSS), and Clinlcal Global Impression (CGI) scores at the 2nd, 4th, and 6th weekends of treatment, HAMD-17 response (defined as a reduction in score of >50%) and HAMD-17 remission (defined as a score of ≤7) at the end of the 6th week of treatment. Adverse events (AEs) were also recorded.Results:From baseline to week 6, the HAMD-17 scores decreased 10.2±4.0 and 9.1±4.9 points in the JJD and paroxetine groups, respectively (P=0.689). The HAMD-17 response occurred in 60% of patients in the JJD group and in 50% of those in the paroxetine group (P=0.292); HAMD-17 remission occurred in 45.7% and 30% of patients, respectively (P=0.128). The differences of CGI scores at the 6th week were not statistically significant (P >0.05). There were significant differences in HAMD-17 scores between the two groups at 2nd and 4th week (P=0.001 andP=0.014). The HAMA scores declined 8.1±3.0 and 6.9±4.3 points from baseline to week 6 in the JJD and paroxetine groups, respectively (P=0.905 between groups). At 4th week of treatment, there was a significant difference in HAMA between the two groups (P=0.037). TCMSS decreased 11.4±5.1, and 10.1±6.8 points in the JJD and paroxetine groups, respectively (P=0.080 between groups). At the 6th week, the incidence of AEs in the JJD group was significantly lower than that in the paroxetine group (7.14% vs. 22.86%, P<0.05).Conclusion:Compared with paroxetine, JJD was associated with a significantly lower incidence of AEs in patients with mild-to-moderate depression of XPD syndrome, with no difference in efficacy at 6 weeks. (Trial registration No. ChiCTR2000040922)  
        Keywords：depression;Xin (Heart)-Pi (Spleen) deficiency syndrome;Chinese medicine;Jianpi Jieyu Decoction;efficacy;safety   
        19
        |
        2
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941169 false
        Published：2023-04-05
      • QU Yi-lun,DONG Zhe-yi,CHENG Hai-mei,LIU Qian,WANG Qian,YANG Hong-tao,MAO Yong-hui,LI Ji-jun,LIU Hong-fang,GENG Yan-qiu,HUANG Wen,LIU Wen-hu,XIE Hui-di,PENG Fei,LI Shuang,JIANG Shuang-shuang,LI Wei-zhen,DUAN Shu-wei,FENG Zhe,ZHANG Wei-guang,LIU Yu-ning,TIAN Jin-zhou,CHEN Xiang-mei
        Vol. 29, Issue 4, Pages: 308-315(2023) DOI: 10.1007/s11655-022-3520-0
        Abstract：Objective:To investigate the factors related to renal impairment in patients with diabetic kidney disease (DKD) from the perspective of integrated Chinese and Western medicine.Methods:Totally 492 patients with DKD in 8 Chinese hospitals from October 2017 to July 2019 were included. According to Kidney Disease Improving Global Outcomes (KDIGO) staging guidelines, patients were divided into a chronic kidney disease (CKD) 1–3 group and a CKD 4–5 group. Clinical data were collected, and logistic regression was used to analyze the factors related to different CKD stages in DKD patients.Results:Demographically, male was a factor related to increased CKD staging in patients with DKD (OR=3.100, P=0.002). In clinical characteristics, course of diabetes >60 months (OR=3.562, P=0.010), anemia (OR=4.176, P <0.001), hyperuricemia (OR=3.352, P<0.001), massive albuminuria (OR=4.058, P=0.002), atherosclerosis (OR=2.153, P=0.007) and blood deficiency syndrome (OR=1.945, P=0.020) were factors related to increased CKD staging in patients with DKD.Conclusion:Male, course of diabetes >60 months, anemia, hyperuricemia, massive proteinuria, atherosclerosis, and blood deficiency syndrome might indicate more severe degree of renal function damage in patients with DKD. (Registration No. NCT03865914)  
        Keywords：diabetic kidney disease;integrated Chinese and Western medicine;Chinese medicine syndrome   
        6
        |
        0
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941167 false
        Published：2023-04-05
      • XIAO Zhun,JI Qiang,FU Ya-dong,GAO Si-qi,HU Yong-hong,LIU Wei,CHEN Gao-feng,MU Yong-ping,CHEN Jia-mei,LIU Ping
        Vol. 29, Issue 4, Pages: 316-324(2023) DOI: 10.1007/s11655-021-3304-y
        Abstract：Objective:To observe the effect of amygdalin on liver fibrosis in a liver fibrosis mouse model, and the underlying mechanisms were partly dissected in vivo and in vitro.Methods:Thirty-two male mice were randomly divided into 4 groups, including control, model, low- and high-dose amygdalin-treated groups, 8 mice in each group. Except the control group, mice in the other groups were injected intraperitoneally with 10% carbon tetrachloride (CCl4)–olive oil solution 3 times a week for 6 weeks to induce liver fibrosis. At the first 3 weeks, amygdalin (1.35 and 2.7 mg/kg body weight) were administered by gavage once a day. Mice in the control group received equal quantities of subcutaneous olive oil and intragastric water from the fourth week. At the end of 6 weeks, liver tissue samples were harvested to detect the content of hydroxyproline (Hyp). Hematoxylin and eosin and Sirius red staining were used to observe the inflammation and fibrosis of liver tissue. The expressions of collagen Ⅰ (Col-Ⅰ), alpha-smooth muscle actin (α-SMA), CD31 and transforming growth factor β (TGF-β)/Smad signaling pathway were detected by immunohistochemistry, quantitative real-time polymerase chain reaction and Western blot, respectively. The activation models of hepatic stellate cells, JS-1 and LX-2 cells induced by TGF-β1 were used in vitro with or without different concentrations of amygdalin (0.1, 1, 10 μmol/L). The effect of different concentrations of amygdalin on the expressions of liver sinusoidal endothelial cells (LSECs) dedifferentiation markers CD31 and CD44 were observed.Results:High-dose of amygdalin significantly reduced the Hyp content and percentage of collagen positive area, and decreased the mRNA and protein expressions of Col-Ι, α-SMA, CD31 and p-Smad2/3 in liver tissues of mice compared to the model group (P<0.01). Amygdalin down-regulated the expressions of Col-Ⅰ and α-SMA in JS-1 and LX-2 cells, and TGFβR1, TGFβR2 and p-Smad2/3 in LX-2 cells compared to the model group (P<0.05 or P<0.01). Moreover, 1 and 10 μmol/L amygdalin inhibited the mRNA and protein expressions of CD31 in LSECs and increased CD44 expression compared to the model group (P<0.05 or P<0.01).Conclusions:Amygdalin can dramatically alleviate liver fibrosis induced by CCl4 in mice and inhibit TGF-β/Smad signaling pathway, consequently suppressing HSCs activation and LSECs dedifferentiation to improve angiogenesis.  
        Keywords：amygdalin;liver fibrosis;hepatic stellate cells;liver sinusoidal endothelial cells;TGF-β/Smad signaling pathway   
        28
        |
        2
        |
        1
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941148 false
        Published：2023-04-05
      • WEN Jing,ZHANG Jian-wu,LYU Yuan-xia,ZHANG Hui,DENG Kai-xi,CHEN Hong-xue,WEI Ying
        Vol. 29, Issue 4, Pages: 325-332(2023) DOI: 10.1007/s11655-022-3536-5
        Abstract：Objective:To evaluate the antidiarrheal effect of ethanol extract of Glycyrrhiza uralensis Fisch root (GFR) in vivo and jejunal contraction in vitro.Methods:In vivo, 50 mice were divided into negative control, positive control (verapamil), low-, medium- and high-dose GFR (250, 500, 1,000 mg/kg) groups by a random number table, 10 mice in each group. The antidiarrheal activity was evaluated in castor oil-induced diarrhea mice model by evacuation index (EI). In vitro, the effects of GFR (0.01, 0.03, 0.1, 0.3, 1, 3, and 10 g/L) on the spontaneous contraction of isolated smooth muscle of rabbit jejunum and contraction of pretreated by Acetylcholine (ACh, 10 μmol/L) and KCl (60 mmol/L) were observed for 200 s. In addition, CaCl2 was accumulated to further study its mechanism after pretreating jejunal smooth muscle with GFR (1 and 3 g/L) or verapamil (0.03 and 0.1 μmol/L) in a Ca2+-free-high-K+ solution containing ethylene diamine tetraacetic acid (EDTA).Results:GFR (500 and 1,000 mg/kg) significantly reduced EI in castor oil-induced diarrhea model mice (P<0.01). Meanwhile, GFR (0.01, 0.03, 0.1, 0.3, 1, 3, and 10 g/L) inhibited the spontaneous contraction of rabbit jejunum (P<0.05 or P<0.01). Contraction of jejunums samples pretreated by ACh and KCl with 50% effective concentration (EC50) values was 1.05 (0.71–1.24), 0.34 (0.29–0.41) and 0.15 (0.11–0.20) g/L, respectively. In addition, GFR moved the concentration-effect curve of CaCl2 down to the right, showing a similar effect to verapamil.Conclusions:GFR can effectively reduce diarrhea and inhibit intestinal contraction, and these antidiarrheal effects may be based on blocking L-type Ca2+ channels and muscarinic receptors.  
        Keywords：Glycyrrhiza uralensis Fisch;antidiarrheal;spasmolysis;Chinese medicine   
        11
        |
        0
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941129 false
        Published：2023-04-05
      • WANG Rong-rong,LI Ting,ZHANG Lei,HU Zheng-yan,ZHOU Li,SHAN Le-tian,HUANG Jia-wei,LI Lan
        Vol. 29, Issue 4, Pages: 333-340(2023) DOI: 10.1007/s11655-022-3302-8
        Abstract：Objective:To evaluate toxicity of raw extract of Panax notoginseng (rPN) and decocted extract of PN (dPN) by a toxicological assay using zebrafish larvae, and explore the mechanism by RNA sequencing assay.Methods:Zebrafish larvae was used to evaluate acute toxicity of PN in two forms: rPN and dPN. Three doses (0.5, 1.5, and 5.0 μg/mL) of dPN were used to treat zebrafishes for evaluating the developmental toxicity. Behavior abnormalities, body weight, body length and number of vertebral roots were used as specific phenotypic endpoints. RNA sequencing (RNA-seq) assay was applied to clarify the mechanism of acute toxicity, followed by real time PCR (qPCR) for verification. High performance liquid chromatography analysis was performed to determine the chemoprofile of this herb.Results:The acute toxicity result showed that rPN exerted higher acute toxicity than dPN in inducing death of larval zebrafishes (P<0.01). After daily oral intake for 21 days, dPN at doses of 0.5, 1.5 and 5.0 μg/mL decreased the body weight, body length, and vertebral number of larval zebrafishes, indicating developmental toxicity of dPN. No other adverse outcome was observed during the experimental period. RNA-seq data revealed 38 genes differentially expressed in dPN-treated zebrafishes, of which carboxypeptidase A1 (cpa1) and opioid growth factor receptor-like 2 (ogfrl2) were identified as functional genes in regulating body development of zebrafishes. qPCR data showed that dPN significantly down-regulated the mRNA expressions of cpa1 and ogfrl2 (both P<0.01), verifying cpa1 and ogfrl2 as target genes for dPN.Conclusion:This report uncovers the developmental toxicity of dPN, suggesting potential risk of its clinical application in children.  
        Keywords：Panax notoginseng;zebrafish larvae;developmental toxicity;RNA sequencing   
        6
        |
        0
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941280 false
        Published：2023-04-05

        Evidence-Based Integrative Medicine

      • YAN Li-jiao,FANG Min,ZHU Si-jia,WANG Zhi-jie,HU Xiao-yang,LIANG Shi-bing,WANG Dou,YANG Dan,SHEN Chen,Nicola Robinson,LIU Jian-ping
        Vol. 29, Issue 4, Pages: 341-352(2023) DOI: 10.1007/s11655-022-3319-z
        Abstract：Background:Primary dysmenorrhea (PD) is the most common complaint associated with menstruation and affects up to three-quarters of women at some stage of their reproductive life. In Chinese medicine, navel therapy, treatment provided at Shenque (CV 8), is used as a treatment option for PD.Objective:To evaluate the effect of navel therapy on pain relief and quality of life in women with PD, compared with Western medicine (WM).Methods:China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), SinoMed and Wanfang Database, MEDLINE, the Cochrane Library, Embase, Web of Science, and the International Clinical Trial Registry of the U.S. National Institutes of Health were searched from their inceptions to April 1, 2021. Randomized controlled trials (RCTs) assessing therapeutic effects of navel therapy on PD were eligible for inclusion. RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool.Results:Totally 24 RCTs involving 2, 614 participants were identified. Interventions applied to acupuncture point CV 8 included: herbal patching, moxibustion or combined navel therapy (using at least 2 types of stimulation). Compared to placebo, there was a significant effect in favor of navel therapy on reducing overall menstrual symptom scores at the end of treatment [mean difference: –0.82, 95% confidence interval (CI): –1.00 to –0.64, n=90; 1 RCT]. As compared with Western medicine, navel therapy had a superior effect on pain intensity as assessed by Visual Analogue Scale at the end of treatment [standardized mean difference (SMD): –0.64, 95% CI: –1.22 to –0.06, I2=80%, n=262; 3 RCTs]; on symptom resolution rate at 3-month follow-up (risk ratio: 1.94, 95% CI: 1.47 to 2.56, n=1527, I2=38%; 13 RCTs); and on global menstrual symptoms score at the end of treatment (SMD: –0.67, 95% CI: –0.90 to –0.45, I2=63%, n=990; 12 RCTs). Subgroup analyses showed either a better or an equivalent effect comparing navel therapy with Western medicine. No major adverse events were reported. The methodological quality of included trials was poor overall.Conclusions:Navel therapy appears to be more effective than Western medicine in decreasing menstrual pain and improving overall symptoms of PD. However, these findings need to be confirmed by well-designed clinical trials with adequate sample size (Systematic review registration at PROSPERO, No. CRD42021240350)  
        Keywords：navel therapy;Shenque;primary dysmenorrhea;quality of life;systematic review;meta-analysis   
        12
        |
        2
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941297 false
        Published：2023-04-05

        Thinking and Methodology

      • WU Xiao-dong,ZHAO Nan-qi,DING Nan,YUAN Jing-yun,DONG Guo-feng,WANG Xin,LIU Bao-yan
        Vol. 29, Issue 4, Pages: 353-360(2023) DOI: 10.1007/s11655-022-3680-y
        Abstract：The clinical questions of acupuncture-moxibustion (Acup-Mox) guidelines are complicated, including not only the curative effect of Acup-Mox intervention measures, but also the operational elements of Acup-Mox. This paper aimed to put forward the idea and process of collecting clinical questions in developing international acupuncture clinical practice guidelines. The experience was collected and the idea of collecting clinical questions of Acup-Mox was formed through expert consultation and discussion in combination with expert opinions. Based on the characteristics of Acup-Mox discipline. This paper put forward the thinking of  
        Keywords：acupuncture-moxibustion intervention;Chinese medicine;I-P-O-C inquiry process;suitable population;outcome evaluation   
        5
        |
        0
        |
        2
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941242 false
        Published：2023-04-05

        Review

      • ZHANG Qiao-li,LEI Ya-ling,DENG Yan,MA Rui-lin,DING Xue-song,XUE Wei,SUN Ai-jun
        Vol. 29, Issue 4, Pages: 361-367(2023) DOI: 10.1007/s11655-021-3353-2
        Abstract：Diminished ovarian reserve (DOR), generally defined as a decreased number or quality of oocytes, has a significant impact on quality of life and fertility in women. In recent years, the incidence of DOR has been increasing and the ages of patients are younger. The search for an effective DOR treatment has emerged as one of the preeminent research topics in reproductive health. An effective DOR therapy would improve ovarian function, fertility, and quality of life in patients. In this review we evaluated DOR treatment progress both in Western medicine and Chinese medicine, and elucidated the characteristics of each treatment.  
        Keywords：diminished ovarian reserve;treatment;Chinese medicine;Western medicine   
        8
        |
        0
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941282 false
        Published：2023-04-05
      • ZHUANG Shu-zhao,CHEN Pei-jie,HAN Jia,XIAO Wei-hua
        Vol. 29, Issue 4, Pages: 368-376(2023) DOI: 10.1007/s11655-021-3529-9
        Abstract：Lower limb osteoarthritis (OA) is a chronic, multifactorial disease characterized by impaired physical function, chronic pain, compromised psychological health and decreased social functioning. Chronic inflammation plays a critical role in the pathophysiology of OA. Tai Chi is a type of classical mind-body exercise derived from ancient Chinese martial arts. Evidence supports that Tai Chi has significant benefits for relieving lower limb OA symptoms. Using a biopsychosocial framework, this review aims to elucidate the beneficial effects of Tai Chi in lower limb OA and disentangle its potential mechanisms from the perspective of biology, psychology, and social factors. Complex biomechanical, biochemical, neurological, psychological, and social mechanisms, including strengthening of muscles, proprioception improvement, joint mechanical stress reduction, change of brain activation and sensitization, attenuation of inflammation, emotion modulation and social support, are discussed.  
        Keywords：Tai Chi;osteoarthritis;mechanism;biopsychosocial model   
        4
        |
        0
        |
        0
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941241 false
        Published：2023-04-05
      • CHEN Guan-ru,XIE Xiao-fang,PENG Cheng
        Vol. 29, Issue 4, Pages: 377-384(2023) DOI: 10.1007/s11655-021-3521-4
        Abstract：Irritable bowel syndrome (IBS) is a common refractory disease. Chinese medicine (CM) has remarkable efficacy and advantages on the treatment of IBS. This review summarized the articles focusing on the treatment of IBS with CM to sum up the latest treatment methods for IBS and the underlying mechanisms. Literature analysis showed that prescriptions, acupuncture, and moxibustion are the primary methods of CM treatment for IBS. The potential mechanisms center on the regulation of the enteric nervous system, the alleviation of visceral hypersensitivity, the stability of intestinal flora, and the regulation of the immune system.  
        Keywords：irritable bowel syndrome;Chinese medicine;literature review   
        5
        |
        0
        |
        1
        <HTML>
        <Meta-XML>
        <CITATION> <Bulk Citation> 35941285 false
        Published：2023-04-05
      0