Latest Issue
      2019 Year 25 Vol. 7 Issue

        Feature Article

      • Wen-bin LIU,Sai LI,Xiao-ling YU,Tie-ying DAI,Rui-lan GAO
        2019, 25(7): 483-489. DOI: 10.1007/s11655-019-3031-9
        Abstract：Chronic primary immune thrombocytopenia (CITP) is the most common acquired autoimmune disease that seriously threaten the physical and mental health of patients. Compared with Western medicine treatment, the intervention and treatment of Chinese medicine (CM) has shown certain therapeutic advantages. This paper reviewed the new pathogenesis progress on T cell immune abnormality in CITP, and CM studies on interferes effects of cellular immune regulation of CITP in recent years. Qi deficiency failing to control blood and internal obstruction of blood stasis are the two common types of CM syndromes in CITP patients, the corresponding treatments include invigorating Pi (Spleen), supplementing qi, activating blood, as well as tonifying qi and activating yang, regulating Gan (Liver) to invigorate Pi. The authors also mentioned the problems in the research field of CM for CTIP treatment, and put forward new ideas for the research in the future.  
        Keywords：chronic immune thrombocytopenia;cellular immunity;Chinese medicine   
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        Published：2021-08-27

        Original Article

      • Yan-ling CHENG,Xin-hua ZHANG,Yu-wen SUN,Wen-juan WANG,Jie HUANG,Na-li CHU,Su-ping FANG,Zhi-kui WU
        2019, 25(7): 490-496. DOI: 10.1007/s11655-018-2777-9
        Abstract：Objective:To examine the clinical effects of Yisui Shengxue Granules (益髓生血颗粒) in the treatment of β-thalassemia and explore its mechanism on DNA methylation levels.Methods:A randomized placebo-controlled double-blinded trial was conducted. Forty patients with β-thalassemia were recruited and distributed randomly by envelope method into an experimental group and a control group, 20 patients in each group. The patients were given Yisui Shengxue Granules in the experimental group and placebo in the control group (12 g/bag, 3 times a day) during a 3-month intervention. Before and after 1, 2, and 3 months of treatment, peripheral intravenous blood was sampled, and blood parameters such as hemoglobin (Hb), red blood cells (RBCs), reticulocytes (Ret), and fetal hemoglobin (HbF) were analyzed. Mononuclear cells from 5 patients, who showed an obvious treatment effect, were isolated by density gradient centrifugation. DNA methylation was analyzed using an Affymetrix USA GeneChip Human Promoter 1.0 Array and Input-promoter 1.0.Results:Compared with pre-treatment, there was an obvious increase in Hb and RBCs counts after 1, 2, and 3 months in the experiment group (P<0.01 or P<0.05). Meanwhile, HbF increased from the 2nd to the 3rd month (P<0.05). In the control group, Hb and RBCs showed no obvioas change. After 3-month treatment, DNA methylation results from 5 patients revealed that there were 24 hypomethylated genes and 3,685 hypermethylated genes compared with pre-treatment. Genes of insulin-like growth factor 1 receptor (IGF1R) and Janus kinase 3 (JAK3) revealed the most relations with other genes (degree: 21) and genes of 1-phosphatidylinositol-4, 5-bisphosphate phosphodiesterase gamma 2 (PLCG2) and mitogen-activated protein kinase 10 (MAPK10) showed a stronger intermediary role (betweenness centrality=0.04).Conclusions:JAK3 and MAPK10 are two key genes in bone marrow and the lymphatic system, and JAK3 is likely to be related to hematopoietic cytokines in the process of early hematopoiesis. (Registration No. NCT01549080)  
        Keywords：β-thalassemia;Yisui Shengxue Granule;Chinese medicine;DNA-methylation   
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        Published：2021-08-27
      • Zhong-yang DENG,Shi-rong ZHU,Ming-jing WANG,Su FANG,Pan ZHAO,Qian-zhe ZHU,Hong-zhi WANG,Xiao-qing GUO,Yong-gang XU,Bo-wen YI,Xiao-hong SHANG,Rou MA,Xiao-mei HU
        2019, 25(7): 497-501. DOI: 10.1007/s11655-019-3070-2
        Abstract：Objective:To investigate the relation of blood arsenic concentration (BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder (青黄散, QHP) in patients with myelodysplastic syndrome (MDS).Methods:Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluorescence spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed.Results:After 2 courses of treatment, the total effective rate was 89.6% (146/163), with 31.3% (51/163) of hematological improvement and 58.3% (95/163) of stable disease. The hemoglobin increased from 73.48±19.30 g/L to 80.39±26.56 g/L (P<0.05), the absolute neutrophil count increased from 0.81±0.48×109/L to 1.08±0.62×109/L (P<0.05), and no significant changes were observed in platelet counts (P>0.05). Among 46 patients previously depended on blood transfusion, 28.3% (13/46) completely got rid of blood transfusion and 21.7% (10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17±18.04 μg/L (P<0.05), 3 months with 33.56±15.28 μg/L (P<0.05), and 6 months with 36.78±11.92 μg/L (P<0.05), respectively, as compared with those before treatment (4.08±2.11 μg/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months (P>0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases (8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions (22.39±10.38 vs. 37.89±11.84, μg/L, P<0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment (40.41±11.69 vs. 23.84±12.03, μg/L, P<0.05).Conclusion:QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.  
        Keywords：myelodysplastic syndrome;realgar;arsenic;Qinghuang Powder;Chinese medicine   
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        Published：2021-08-27
      • Mohsen Mardani-Kivi,Reza Montazar,Mohammad Azizkhani,Keyvan Hashemi-Motlagh
        2019, 25(7): 502-506. DOI: 10.1007/s11655-018-2996-0
        Abstract：Objective:To compare the possible effects of wet-cupping therapy with conventional therapy on persistent nonspecific low back pain (PNSLBP).Methods:In this randomized clinical trial, 180 participants with the mean age of 45±10 years old, who had been suffering from PNSLBP were randomly assigned to wet-cupping and conventional groups using random blook. The wet-cupping group was treated with two separate sessions (4 weeks in total) on the inter-scapular and sacrum area. In the conventional group, patients were conservatively treated using rest (6 weeks) and oral medications (3 weeks). The primary and the secondary outcome were the quantity of disability using Oswestry Disability Index (ODI), and pain intensity using Visual Analogue Scale (VAS), respectively.Results:There was no significant difference in demographic characteristics (age, gender, and body mass index) between the two groups (P>0.05). Therapeutic effect of wet-cupping therapy was comparable to conventional treatment in the 1st month follow-up visits (P<0.05). The functional outcomes of wet-cupping at the 3rd and 6th month visits were significantly increased compared to the conventional group. Final ODI scores in the wet-cupping and conventional groups were 16.7±5.7 and 22.3±4.5, respectively (P<0.01).Conclusion:Wet-cupping may be a proper method to decrease PNSLBP without any conventional treatment. The therapeutic effects of wet-cupping can be longer lasting than conventional therapy. (Registration No. IRCT2013021672741)  
        Keywords：low back pain;chronic;wet-cupping therapy;traditional medicine;Chinese medicine;alternative medicine;conservative treatment;randomized clinical trial   
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        Published：2021-08-27
      • Yang CHENG,Ping LIU,Tian-lu HOU,Maerbiya Maimaitisidike,Reyangguli Ababaikeli,Aini Abudureyimu
        2019, 25(7): 507-514. DOI: 10.1007/s11655-018-3013-3
        Abstract：Objective:To explore the action mechanisms of Huangqi Decoction Granules (黄芪汤颗粒剂, HQDG) on hepatitis B cirrhosis.Methods:A total of 85 patients with hepatitis B cirrhosis were randomly divided into HQDG group (42 cases) and control group (43 cases) by a random number table and were treated with HQDG or placebo for 48 weeks (6 g per times and orally for 3 times a day), respectively. After RNA-sequencing of serum samples extracted from the patients, the differentially expressed genes (DEGs) in HQDG and control groups before and after treatment were separately screened. The DEGs were then performed pathway enrichment analysis and proteinprotein interaction (PPI) network analysis. The expression levels of key genes were detected by quantitative realtime polymerase chain reaction (qRT-PCR).Results:After the investigation, 4 and 3 cases were respectively excluded from HQD and control groups because of the incomplete data. Additionally, 3 and 5 cases were lost to follow up in HQD and control groups, respectively. Finally, a total of 70 cases with good compliance were included for further DEGs analysis. A total of 1,070 DEGs (including 455 up-regulated genes and 615 down-regulated genes) in HQDG group and 227 DEGs (including 164 up-regulated genes and 63 down-regulated genes) in the control group were identified after treatment. Compared with the control group, 1,043 DEGs were specific in HQDG group. Besides, 1 up-regulated transcription factor (TF, such as GLI family zinc finger 1, GLI1) and 25 down-regulated TFs (such as drosophila mothers against decapentaplegic proteinfamily member 2, SMAD2) were identified. Pathway enrichment analysis showed that down-regulated Ras homolog gene family member A (RHOA) was enriched in pathogenic Escherichia coli infection. In the PPI network, up-regulated epidermal growth factor receptor (EGFR), and down-regulated cell division cycle 42 (CDC42) as well as v-akt murine thymoma viral oncogene homolog 1 (AKT1) had higher degrees. Moreover, long non-coding RNAs (lncRNA) growth arrest-specific 5 (GAS5) was involved in the lncRNA-target regulatory network. Furthermore, qRT-PCR revealed that expression levels of CDC42 and GLI1 had significant differences in HQDG group before and after treatment (P<0.05).Conclusions:CDC42 and GLI1 may be the targets of HQDG in patients with hepatitis B cirrhosis. Additionally, SMAD2, EGFR, AKT1, RHOA and GAS5 might be associated with the curative effect of HQDG on hepatitis B cirrhosis patients.  
        Keywords：hepatitis B cirrhosis;Huangqi Decoction Granules;differentially expressed gene;transcription factor;long non-coding RNAs;Chinese medicine   
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        Published：2021-08-27
      • Xiao-qi LIU,Dan-hong PENG,Yan-ping WANG,Rong XIE,Xin-lin CHEN,Chun-quan YU,Xian-tao LI
        2019, 25(7): 515-520. DOI: 10.1007/s11655-018-2793-9
        Abstract：BackgroundPhlegm and blood stasis syndrome (PBSS) is one of the main syndromes in coronary heart disease (CHD). Syndromes of Chinese medicine (CM) are lack of quantitative and easyimplementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied.Objective:To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD.Methods:Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic (ROC) curve.Discussion:This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study. (No. ChiCTR-OOC-15006599).  
        Keywords：diagnostic accuracy;phlegm and blood stasis;diagnosis scale;syndrome differentiation;coronary heart disease;study protocol   
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        Published：2021-08-27
      • Sheng-nan DAI,Ai-jie HOU,Shu-mei ZHAO,Xiao-ming CHEN,Hua-ting HUANG,Bo-han CHEN,Hong-liang KONG
        2019, 25(7): 521-528. DOI: 10.1007/s11655-018-3018-y
        Abstract：Objective:To investigate whether ginsenoside-Rb1 (Gs-Rb1) improves the CoCl2-induced autophagy of cardiomyocytes via upregulation of adenosine 5'-monophosphate-activated protein kinase (AMPK) pathway.Methods:Ventricles from 1- to 3-day-old Wistar rats were sequentially digested, separated and incubated in Dulbecco's modified Eagle's medium supplemented with 10% fetal bovine serum for 3 days followed by synchronization. Neonatal rat cardiomyocytes were randomly divided into 7 groups: control group (normal level oxygen), hypoxia group (500 μmol/L CoCl2), Gs-Rb1 group (200 μmol/L Gs-Rb1 + 500 μmol/L CoCl2), Ara A group (500 μmol/L Ara A + 500 μmol/L CoCl2), Ara A+ Gs-Rb1 group (500 μmol/L Ara A + 200 μmol/L Gs-Rb1 + 500 μmol/L CoCl2), AICAR group [1 mmol/L 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) + 500 μmol/L CoCl2], and AICAR+Gs-Rb1 group (1 mmol/L AICAR + 200 μmol/L Gs-Rb1 + 500 μmol/L CoCl2). Cells were treated for 12 h and cell viability was determined by methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay and cardiac troponin I (cTnI) levels were detected by enzyme-linked immunosorbent assay (ELISA). AMPK activity was assessed by 2',7'-dichlorofluorescein diacetate (DCFH-DA) ELISA assay. The protein expressions of Atg4B, Atg5, Atg6, Atg7, microtubule-associated protein 1A/1B-light chain 3 (LC3), P62, and active-cathepsin B were measured by Western blot.Results:Gs-Rb1 significantly improved the cell viability of hypoxia cardiomyocytes (P<0.01). However, the viability of hypoxia-treated cardiomyocytes was significantly inhibited by Ara A (P<0.01). Gs-Rb1 increased the AMPK activity of hypoxia-treated cardiomyocytes. The AMPK activity of hypoxia-treated cadiomyocytes was inhibited by Ara A (P<0.01) and was not affected by AICAR (P=0.983). Gs-Rb1 up-regulated Atg4B, Atg5, Beclin-1, Atg7, LC3B Ⅱ, the LC3BⅡ/Ⅰ ratio and cathepsin B activity of hypoxia cardiomyocytes (P<0.05), each of these protein levels was significantly enhanced by Ara A (all P<0.01), but was not affected by AICAR (all P>0.05). Gs-Rb1 significantly down-regulated P62 levels of hypoxic cardiomyocytes (P<0.05). The P62 levels of hypoxic cardiomyocytes were inhibited by Ara A (P<0.05) and were not affected by AICAR (P=0.871).Conclusion:Gs-Rb1 may improve the viability of hypoxia cardiomyocytes by ameliorating cell autophagy via the upregulation of AMPK pathway.  
        Keywords：cardiomyocytes;ginsenosides-Rb1;hypoxia;adenosine 5'-monophosphate-activated protein kinase;autophagic flux   
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        Published：2021-08-27
      • Narges Karbalaei,Najmeh Sadeghi,Aliakbar Nekoeian,Ahad Malekzadeh
        2019, 25(7): 529-535. DOI: 10.1007/s11655-019-3025-7
        Abstract：Objective:To investigate the impact of Humulus Lupulus L. hydroalcoholic extract on the body weights, reproductive organs, sperm quality and hormone levels in male rats.Methods:By simple random sampling method, seventy male Sprague-Dawley rats were randomly assigned to 7 groups including control group [distilled water, 1 mL/(kg•d)], Tween 80 group [25% Tween 80 solution, 1 mL/(kg•d)], olive oil group [olive oil, 1 mL/(kg•d)], diethyl stilbestrol (DES) group [DES, 100 μg/(kg•body weight)], H50, H150 and H450 [50, 150 and 400 mg/(kg•d) of Humulus Lupulus L extract, respectively]. The administration was performed via gavage once daily for 7 weeks. Body and reproductive organs weights including testes, seminal vesicles, epididymis and prostate were weighted and epididymal sperm quality were determined by digital balance. Blood samples were collected and serum free testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estrogen (E2) levels were measured by rat specific enzyme-linked immunosorbent assay.Results:The percentage increase in mean body weights of rats in the DES and H50, H150 and H450 groups decreased significantly compared to olive oil and Tween 80 groups (all P<0.05). The weights of seminal vesicle, epididymis and testes in rats receiving H50 were significantly higher than the control group (P<0.05 or P<0.01). The sperm count in the rats receiving H50 was significantly lower than the control group (P<0.05). The sperm motile characteristics of the rats receiving hydroalcoholic extract and DES were significantly lower than those of the control or rats receiving vehicles (all P<0.05). In H50, H150, H450 and DES groups, T and LH levels were decreased, and E2 was significantly increased compared to the control (P<0.05 or P<0.01). The FSH level did not change in all groups (P>0.05).Conclusion:Humulus Lupulus L. extract significantly increased the seminal vesicle and testes weights and reduced the sperm motility.  
        Keywords：sex organ;phytoestrogen;Humulus lupulus L.;sperm quality;male rat   
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        Published：2021-08-27
      • Xin PAN,Kang XU,Rui XIONG,Zhi-min CHEN,Chang-jiang HU,Jian FENG,Wen-bin LI
        2019, 25(7): 536-542. DOI: 10.1007/s11655-017-2766-4
        Abstract：Objective:To investigate whether Ershen Pill (ESP, 二神丸) could alleviate the symptom of Pi (Spleen)-Shen (Kidney) yang deficiency (PSYD)-induced diarrhea in rat model and explore its anti-diarrhea mechanism.Methods:Seventy-five Sprague-Dawley rats were divided into 5 groups by a random number table, including control, positive, model, low-dose (LD) and high-dose (HD) ESP groups, 15 rats in each group. All the rats, except those in the control group, were developed PSYD induced-diarrhea based on its pathology and etiology. The rats in positive, LD and HD ESP groups were treated with Shenling Baizhu Pill (参苓白术丸), LD (1.05 g/kg) or HD (3.50 g/kg) ESP petroleum ether extract once a day for 2 weeks, respectively. Body weight change and diarrhea index were measured. The histology scores of the kidney were evaluated via hematoxylin and eosin (HE) staining. Aquaporin-3 (AQP3) expression in the colon was analyzed by immunofluorescence, quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blot, respectively.Results:Compared with the model group, oral administration of LD and HD ESP prevented body weight loss and inhibited diarrhea after 2-week treatment (P<0.05). Kidney deterioration was impeded, and the histology score in LD and HD ESP groups were 8.2 and 10.5, respectively, which were both higher than those in the model group (P<0.05). In addition, ESP treatment alleviated rat colitis, and HD ESP significantly improved the AQP3 positive staining intensity in the colon tissue compared with the model group. The result from Western blot revealed that AQP3 protein synthesis in colon tissue of LD and HD ESP groups increased by 2.1- and 5.9-fold compared with the model group (P<0.05). qRT-PCR result showed that AQP3 gene expression in the HD ESP group was also up-regulated by 2.5-fold normalized to the model group (P<0.05).Conclusion:ESP extract effectively alleviates the symptoms of PSYD and relieves PSYD-induced diarrhea by improving AQP3 synthesis in the colon.  
        Keywords：Ershen Pill;Chinese medicine;petroleum ether extract;anti-diarrhea;AQP3;colon   
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        Published：2021-08-27

        Acupuncture Research

      • Fu XU,Li-hua XUAN,Hai-jiang ZHOU,Fei-yu CHEN,Zhao-jian ZHENG,Ying BI,Xiang WU
        2019, 25(7): 543-549. DOI: 10.1007/s11655-018-2770-3
        Abstract：Objective:To investigate the effects and safety of catgut embedding on alleviating insomnia.Methods:Totally 510 patients with insomnia were divided into 5 Chinese medicine (CM) syndrome types: Xin (Heart) and Pi (Spleen) deficiency, yin deficiency with excess fire, Xin and gut qi deficiency, Wei (Stomach) disorder, and qi and blood deficiency, respectively. These 5 types of patients were randomly assigned to a catgut embedding group, an acupuncture group or a medication group (30 cases in Xin and Pi deficiency type, Wei disorder type, Xin and gut qi deficiency type, respectively; 40 cases in yin deficiency with excess fire type and qi and blood deficiency type, respectively). In the catgut embedding group, patients were treated by implanting catgut into acupoints once every 10 days for a total of 30 days. In the acupuncture group, patients were treated with acupuncture once per day over 30 days (excluding weekends); and patients in the medication group took 1 mg Eurodin Tablet orally every night for 30 days. Pittsburgh Sleep Quality Index (PSQI) was evaluated before treatment, on 30 and 60 days after the first treatment, respectively. The International Unified Sleep Efficiency Value (IUSEV) was measured at 30 and 60 days. The safety was evaluated after treatment and adverse events were analyzed.Results:The objective PSQI scores including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, daytime dysfunction, and total scores at 30 days were significantly improved compared with pre-treatment in the catgut embedding and acupuncture groups (P<0.01 or P<0.05). At 30 days, the PSQI scores in catgut embedding group were superior to the medication group in the patients with each type of insomnia, with the exception of sleep duration (P<0.01 or P<0.05). At 60 days, significant differences were found between the catgut embedding group and the medication group (P<0.01 for all indices). The IUSEV scores in the catgut embedding group were significantly higher than the acupuncture group at 60 days, and the scores in acupuncture group were higher than the medication group at 30 days (P<0.05 for all types). No severe adverse events were found in this study.Conclusions:Acupoint catgut embedding and acupuncture were more effective than medication in alleviating insomnia syndrome in different Chinese medicine syndrome type. However, the sustained effects of acupoint catgut embedding were superior to acupuncture.  
        Keywords：insomnia;acupoint catgut embedding;acupuncture therapy;medication;randomized controlled trial   
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        Published：2021-08-27

        Thinking and Methodology

      • Ji WANG,Ying-shua LI,Qi WANG
        2019, 25(7): 550-553. DOI: 10.1007/s11655-016-2740-6
        Abstract：Public health is the science and art of preventing disease, prolonging life and prompting physical and mental health through evaluation, policy development and sanitary measures. The development of public health has become an important part of health care reform in China, and it requires the participation of Chinese medicine (CM) in the practice of public health. This study analyzed the problems of CM services in public health, suggested that the identification of CM constitution could propose an application paradigm of CM services in public health, and described from aspects of theory, technology and application. The identification of CM constitution gained national approval and support of government and industry. With the application and popularization of this technology, it will promote the establishment of characteristic CM preventive care system and the development of public health.  
        Keywords：constitutionology of Chinese medicine;identification of constitution;public health   
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        Published：2021-08-27

        Review

      • Shuai YAN,Yin-zi YUE,Yang ZONG,Li ZENG
        2019, 25(7): 554-560. DOI: 10.1007/s11655-018-3021-3
        Abstract：Plants are known to possess plenty of pharmacological activities as a result of various phytoconstituents. Tetramethylpyrazine (TMP), one of the most widely used medicinal compound isolated from traditional Chinese herb, is usually employed for anti-oxidation, anti-inflammation, anti-platelet aggregation, antilipid, anti-fibrosis, as well as activating blood, removing stasis, dilating small arteries, improving microcirculation and antagonizing calcium. In the present paper, the anti-adhesion effect of TMP were reviewed. TMP was found to play a multi-target and muti-link role in anti-adhesion by inhibiting hyperplasia of collagen and overexpression of adhesion-related factors and reducing the concentration of white blood cells and fibrin in plasma. Because previous studies mostly focused on in vitro experiments and animal experiments, there is an urgent need for clinical research with abundant indicators to further prove its anti-adhesion potency. Future basic research should concentrate on the development of TMP as a biological material.  
        Keywords：tetramethylpyrazine;tissue adhesion;pharmacological activity;review   
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        Published：2021-08-27
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