Latest Issue
      2020 Year 26 Vol. 10 Issue

        Feature Article

      • Hong-shan LI,Yi-yang HU
        2020, 26(10): 723-728. DOI: 10.1007/s11655-020-3268-3
        Abstract：Non-alcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver diseases worldwide, causing serious economic and medical burdens. Currently, Chinese medicine (CM) has become an important means in treating NAFLD in China. Intestinal microecology (IM) is an important part of the internal environment in the human body and is involved in the occurrence and development of NAFLD. In this paper, the authors systematically discuss the significance of IM in the pathogenesis of NAFLD and the current status of research on the CM treatment of NAFLD via IM regulation. In combination with our own research practice, we propose that IM is an important target for the treatment of NAFLD with CM and formulate plans for future research to target limitations existing in current studies.  
        Keywords：intestinal microecology;non-alcoholic fatty liver disease;Chinese medicine   
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        Original Article

      • Hamide Khorram Pazhouh,Seyyd Musa al-Reza Hosseini,Ali Taghipour,Shokouhsadat Hamedi,Mohammadreza Noras
        2020, 26(10): 729-735. DOI: 10.1007/s11655-020-3267-4
        Abstract：Objective:To evaluate the efficacy and safety of administration of the formulated Persian herbal syrup on improving the symptoms of patients with constipation-predominant irritable bowel syndrome (IBS-C).Methods:This study was conducted in 70 patients with IBS-C, who were recruited from 3 medical centers in Mashhad, Iran, from November 2017 to August 2018. Seventy patients were randomly assigned to 2 groups including treatment and placebo groups by block randomization, 35 cases in each group. Patients in the treatment group received 15 mL of anti-IBS syrup, thrice daily for 6 weeks and followed up for 4 weeks. Placebo syrup was also prepared through similar instruction, BP syrup without plant extract was used. Primary outcome induding IBS Symptom Severity Scale (IBS-SSS) questionnaire and secondary outcomes in terms of Hospital Anxiety and Depression (HADS) questionnaires, the Bristol Stool Form Scale (BSFS) were completed and evaluated at weeks 6 and 10, respectively. Safety indices were collected at the end of the treatment and Common Terminology Criteria for Adverse Events v4.0 (CTCAE) was used to evaluate the adverse events.Results:The response to treatment was 84.4% (27/32) in the treatment group and 46.4% (13/28) in the placebo group, respectively (P=0.002). Compared with pre-treatment, a significant decrease was found on the IBS-SSS and BSFS scores after 6-week intervention in both groups (P<0.001). Moreover, IBS-SSS and BSFS scores in the treatment group were lower than the placebo group after the intervention (P=0.041). There was no significant difference in the anxiety and depression scores after treatment in both groups (P>0.05). Side effects reported in the treatment group included 2 cases of headache during the first week of the onset of the treatment, 1 case of drowsiness, 1 case of increase in menstrual bleeding, which did not result in discontinuation of the treatment. In the placebo group, 1 case of exacerbation of the disease was reported.Conclusions:Anti-IBS syrup significantly reduced the severity of IBS symptoms compared to placebo. However, there was a need for further investigation regarding the anxiety and depression scores. (Registration No. IRCT2017061034446N1).  
        Keywords：irritable bowel syndrome;herbal medicine;Persian medicine;complementary medicine;functional digestive disorders;randomized controlled trial   
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        Published：2021-08-23
      • Jian-xin DIAO,Jin-ying OU,Huan DAI,Hai-ye LI,Wei HUANG,He-yu HUA,Ting XIE,Ming WANG,Yun-gao YANG
        2020, 26(10): 736-744. DOI: 10.1007/s11655-019-3043-5
        Abstract：Objective:To investigate the phenolic composition, antioxidant properties, and hepatoprotective mechanisms of polyphenols from green tea extract (GTP) in carbon tetrachloride (CCl4)-induced acute liver injury mouse model.Methods:High-performance liquid chromatography was used to analyze the chemical composition of the extract. Antioxidant activity of GTP was assessed by O2•-, OH•, DPPH•, and ferric-reducing antioxidant power (FRAP) assay in vitro. Sixty Kunming mice were divided into 6 groups including control, model, low-, medium-, and high-doses GTP (200, 400, 800 mg/kg) and vitamin E (250 mg/kg) groups, 10 in each group. GTP and vitamin E were administered at a level of abovementioned doses twice per day for 7 days prior to exposure to a single injection of CCl4. Hepatoprotective effects of GTP were evaluated in a CCl4-induced mouse model of acute liver injury, using commercial enzyme linked immunosorbent assay kits, histopathological observation, terminal deoxynucleotidyl transferase-mediated dUTPNick-end labeling (TUNEL) assay and Western blot.Results:GTP contained 98.56 μg gallic acid equivalents per milligram extract total polyphenols, including epicatechingallate, epigallocatechin gallate, epicatechin, and epigallocatechin. Compared with the model group, low-, medium-, or high doses GTP significantly decreased serum levels of alanine aminotransferase and aspartate transaminase (P<0.01). Histopathological observation confirmed that pretreatment of GTP prevented swelling and necrosis in CCl4-exposed hepatocytes. Hepatoprotective effects of low-, medium-, and highdose GTP were associated with eliminating free radicals and improving superoxide dismutase, catalase, and glutathione peroxidase activity in the liver. Additionally, low-, medium-, and high-dose GTP decreased cell apoptosis in the CCl4-exposed liver (P<0.01). Phosphorylated nuclear factor kappa-B (NF-κB), p53, Bcl-2 associated x protein/B-cell lymphoma/leukemia-2 gene, cytochrome C, and cleaved caspase-3 levels were downregulated compared with the model group (P<0.01).Conclusion:GTP achieves hepatoprotective effects by improving hepatic antioxidant status and preventing cell apoptosis through caspase-3-dependent signaling pathways.  
        Keywords：polyphenol;carbon tetrachloride;acute liver injury;anti-oxidant;anti-apoptosis;green tea   
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        Published：2021-08-23
      • Ting CHEN,Xiao-lan YIN,Nan KANG,Xiao-ge WANG,Bao-shuang LI,Hai-jie JI,Yin-qiang ZHANG,Li-qun BIAN,Bei-hua ZHANG,Feng-yun WANG,Xu-dong TANG
        2020, 26(10): 745-753. DOI: 10.1007/s11655-019-3034-6
        Abstract：Objective:To investigate the effect of Chang'an Ⅱ Decoction (肠安Ⅱ号方)-containing serum on intestinal epithelial barrier dysfunction in rats.Methods:Tumor necrosis factor (TNF)-α-induced injury of Caco-2 monolayers were established as an inflammatory model of human intestinal epithelium. Caco-2 monolayers were treated with blank serum and Chang'an Ⅱ Decoction-containing serum that obtained from the rats which were treated with distilled water and Chang'an Ⅱ Decoction intragastrically at doses of 0.49, 0.98, 1.96 g/(kg•d) for 1 week, respectively. After preparation of containing serum, cells were divided into the normal group, the model group, the Chang'an Ⅱ-H, M, and L groups (treated with 30 ng/mL TNF-α and medium plus 10% high, middle-, and low-doses Chang'an Ⅱ serum, respectively). Epithelial barrier function was assessed by transepithelial electrical resistance (TER) and permeability of fluorescein isothiocyanate (FITC)-labeled dextran. Transmission electron microscopy was used to observe the ultrastructure of tight junctions (TJs). Immunofluorescence of zonula occludens-1 (ZO-1), claudin-1 and nuclear transcription factor-kappa p65 (NF-κBp65) were measured to determine the protein distribution. The mRNA expression of myosin light chain kinase (MLCK) was measured by real-time polymerase chain reaction. The expression levels of MLCK, myosin light chain (MLC) and p-MLC were determined by Western blot.Results:Chang'an Ⅱ Decoction-containing serum significantly attenuated the TER and paracellular permeability induced by TNF-α. It alleviated TNF-α-induced morphological alterations in TJ proteins. The increases in MLCK mRNA and MLCK, MLC and p-MLC protein expressions induced by TNF-α were significantly inhibited in the Chang'an Ⅱ-H group. Additionally, Chang'an Ⅱ Decoction significantly attenuated translocation of NF-κBp65 into the nucleus.Conclusion:High-dose Chang'an Ⅱ-containing serum attenuates TNF-α-induced intestinal barrier dysfunction. The underlying mechanism may be involved in inhibiting the MLCK-MLC phosphorylation signaling pathway mediated by NF-κBp65.  
        Keywords：myosin light chain kinase-myosin light chain;signaling pathway;intestinal epithelial cells;tight junction;tumor necrosis factor-α;Chang'an Ⅱ Decoction;drug-containing serum   
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        Published：2021-08-23
      • Emran Habibi,Mohammad Shokrzadeh,Amirhossein Ahmadi,Aroona Chabra,Farshad Naghshvar,Hamed Haghi-Aminjan,Fatemeh Salehi
        2020, 26(10): 754-761. DOI: 10.1007/s11655-018-2984-4
        Abstract：Objective:To evaluate the protective effect of Zataria multiflora extract, an antioxidative medicinal plant, against cyclophosphamide (CP)-induced oxidative lung damage in mice.Methods:Mice were intraperitoneally pre-treated with various doses of Zataria multiflora extract (50, 100, 200, and 400 mg/kg) once daily for 7 consecutive days. Animals were then injected with a single 200 mg/kg intraperitoneal dose of CP 1 h after the last administration of O. vulgare. Twenty-four hours later, mice were euthanized, the lungs were immediately removed, and biochemical and histological studies were conducted.Results:A single dose of CP markedly altered the levels of several biomarkers associated with oxidative stress in lung homogenates. Pretreatment with Zataria multiflora significantly inhibited the elevation of lipid peroxidation level and the depletion in glutathione content, and superoxide dismutase and catalase activities induced by CP in lung. In addition, Zataria multiflora effectively alleviated CP-induced histopathological abnormality and pulmonary damages in mice lung tissues.Conclusions:The results reveal that Zataria multiflora protects lung tissues from CP-induced toxicity and suggest a role for oxidative stress in the pathogenesis of lung toxicity produced by CP in mice. Because Zataria multiflora has been extensively used as an additive agent and is regarded as safe, it may be used concomitantly as a good supplement for reducing organ toxicity in patients undergoing chemotherapy, besides their consolidated ethnopharmacological uses.  
        Keywords：pulmonoprotective;Zataria multiflora;cyclophosphamide;lung toxicity;oxidative stress;antioxidant activity   
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        Published：2021-08-23
      • Shao-li FU,Li-na ZHU,Hua-hua YIN,Yan JIANG,Jing-ci ZHU
        2020, 26(10): 762-768. DOI: 10.1007/s11655-019-3036-4
        Abstract：Objective:To investigate the effects of Da-Cheng-Qi Decoction (DCQD, 大承气汤) combined with Lactobacillus acidophilus (LA) on the recovery of gastrointestinal (GI) function in traumatic brain-injured (TBI) mice.Methods:A total of 150 male C57BL/6 mice were randomly divided into sham-injury, normal saline (NS), DCQD (0.4 mL/day), LA (≥1×1010 cfu/day LA), DCQD+LA (LA administration at the same dosage after 4 h of feeding DCQD), and ½ DCQD+LA groups (LA administration at the same dosage after 4 h of feeding ½ DCQD dose) by a random number table, 5–8 mice in each group. The sever TBI model was constructed according to Feeney's enhanced gravitational forces of free falling. On days 1, 3, and 7 post-TBI, plasma diamine oxidase (DAO) and D-lactic acid levels were assessed by enzyme-linked immunosorbent assay (ELISA). Occludin expression in the intestinal epithelium was assessed by Western blot analysis. Transmission electron microscopy (TEM) was used to observe the morphological changes in the network structure of interstitial cells of Cajal (ICC) and change of enteric nervous system-ICC-smooth muscle cell (ENS-ICC-SMC). Immunofluorescence staining was used to detect changes in the network structure of the ICC.Results:Compared with the NS group, occludin expression in the DCQD+LA group significantly increased on Day 1, 3, and 7 post-TBI (P<0.05 or P<0.01). The concentration of DAO significantly decreased in the LA, DCQD, and DCQD+LA groups on Day 3 and 7, whilst the D-lactate concentrations in the LA and ½ DCQD+LA groups decreased on Day 1 and 3 post-injury (P<0.05 or P<0.01). The NS group experienced a great damage on the ENS-ICC-SMC network morphology and ICC network structure, and all treatment groups had some improvements, among which the DCQD+LA group presented relatively intact network morphology.Conclusions:DCQD combined with LA treatment could effectively repair the intestinal mucosal barrier and improve GI motility in mice after TBI. The combination of DCQD and LA was more effective than their respective monotherapies.  
        Keywords：traumatic brain-injury;Da-Cheng-Qi Decoction;Lactobacillus acidophilus;intestinal mucosal barrier;gastrointestinal motility   
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        Published：2021-08-23

        Acupuncture Research

      • Hai-cheng YUAN,Qi XIANG,Nan ZHANG,Wei-jing QIN,Wang CAI
        2020, 26(10): 769-775. DOI: 10.1007/s11655-019-3048-0
        Abstract：Objective:To assess the efficiency of acupuncture combined with early enteral nutrition (EEN) in patients with postoperative laparoscopic common bile duct exploration.Methods:A total of 200 patients with postoperative laparoscopic bile duct exploration was randomized using sealed envelopes and assigned to the convenitional, EEN, acupuncture plus convenitional and acupuncture plus EEN groups, 50 cases in each group. Twelve hours after operation, the patients in EEN groups began to receive oral enteral nutrition, and the acupuncture approach was performed by acupuncturist in acupuncture plus conventional and acupuncture plus EEN groups. Acupuncture was given at Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) with a depth of 15–20 mm, using the lifting-thrusting and twisting method to obtain Deqi sensation.The needles were maintained for 30 min. Treatment was given once daily, 3 times per section. After the intervention, the patients' characteristics, operation time, bleeding volume, postoperative time to first anal exhaust, postoperative complications including abdominal distension, diarrhea, gastric dilatation, intestinal obstruction, pharyngodynia, incision, abdominal and pulmonary infection and postoperative hospitalization days were assessed and compared in patients among 4 groups.Results:Postoperative time to first anal exhaust in the convenitional group was longer compared with the other 3 groups (P<0.05), and was shorter in the acupuncture plus EEN group than those of the convenitional, acupuncture plus convenitional and EEN groups (P<0.01). The acupuncture plus EEN group showed significant decrease in the incidence of complications and less postoperative hospitalization days compared with the other groups (P<0.05 or P<0.01). There was no readmission.Conclusion:After laparoscopic bile duct exploration, acupuncture combined with EEN treatment significantly improves the patients' gastrointestinal function, reduces complications, and shortens postoperative hospitalization days.  
        Keywords：laparoscopic bile duct exploration;acupuncture;enteral nutrition;gastrointestinal function;enhanced recovery after surgery   
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        Published：2021-08-23

        Clinical Experience

      • Min XU,Hai CHEN,Zai-xiang SHI,Yu-wei DA,Yu-min LUO,Li GAO,Yan LU,Min WANG,Li DI
        2020, 26(10): 776-782. DOI: 10.1007/s11655-019-3045-3
        Abstract：Objective:To investigate the pathological features of blood stasis syndrome (BSS) in non-diabetic peripheral neuropathy.Methods:Clinical data of 31 patients with non-diabetic peripheral neuropathy who had undergone nerve biopsy during December 2004 and December 2010 in Xuanwu Hospital Capital Medical University were retrospectively analyzed. According to Chinese medicine (CM) syndrome differentiation and signs, 26 patients were blood stasis type and 5 patients were non-blood stasis type. Clinical and pathological data were compared in detail.Results:Clinically, although both groups shared similar symptoms of limb numbness, weakness and sensory disturbances, the prevalence of neuralgia was much grievous in BSS group (73.1%, 26/31) compared with the non-BSS group (0%, 0/5). As for signs, dermal nutrients disturbance (84.6%, 22/26), dark or purple tongue (100.0%, 26/26), and sublingual varices (80.7%, 21/26) were more common in the BSS group than the non-BSS group (0%, 60%, 20%, respectively). The prevalence of qi deficiency cases (19/26) in the BSS group was significantly higher compared with the non-BSS group (1/5). The unique histological manifestations of BSS were axonal degeneration (16/26 vs 2/5 in non-BSS group), which was the hallmark of ischemia. Cases with BSS had prominent microangiopathy (61.5%, 16/26), manifested as epineurium vasculitis (inflammatory cell infiltrated to the vessel wall, obliteration and recanalization, vascular proliferation, extravascular hemosiderin deposition), angiotelectasis, proliferation and hyaline degeneration of endoneurium capillary. In the BSS group, impaired blood-nerve barrier was indicated by sub-perineurial edema (46.2%, 11/26) and endoneurial edema (15.4%, 4/26). The Renaut body (15.4%, 4/26) and amyloid deposition (3.8%, 1/26) found in the BSS group were absent in the non-BSS group.Conclusions:BBS was common in non-diabetic peripheral neuropathies. The nerves exhibited ischemic alteration of primary axon degeneration and secondary demyelination. The interstitial tissue revealed microcirculation impairment, blood-nerve barrier disturbance, amyloid deposition and proliferation changes. The high prevalence of qi deficiency also highlights the therapy of promotion of blood circulation and removal of blood stasis.  
        Keywords：Chinese medicine;blood stasis syndrome;non-diabetic peripheral neuropathy;biopsy;pathologic alteration   
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        Published：2021-08-23

        Evidence-Based Integrative Medicine

      • Yu-xi LI,Juan LI,Yue ZHANG,Yan-ping TIAN,Yong-gang ZHANG,Rong-jiang JIN,Yan GUO,Mike Clarke
        2020, 26(10): 786-793. DOI: 10.1007/s11655-020-3431-x
        Abstract：Objective:To systematically review the clinical practice guidelines for the treatment of coronavirus disease 2019 (COVID-19) patients with Chinese herbal medicine (CHM), summarize their recommendations and evaluate their qualities.Methods:Electronic databases, websites of governments, academic associations or organizations for eligible guidelines were searched up to April 2020. Information were extracted to summarize recommendations for the use of Chinese herbal formulae and Chinese patent medicine (CPM) for COVID-19 patients. The methodological quality and reporting quality of the included guidelines were independently evaluated, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) Ⅱ tool and Reporting Items for Practice Guidelines in healthcare (RIGHT) statement, respectively.Results:Totally 45 guidelines were identified: 42 (93%) suggested specific CM formulae for treating COVID-19 patients; and 35 (78%) assigned patients diagnosed with COVID-19 to 4 stages (early, development, critical and recovery). The recommended formulae and CPMs for each stage with diverse syndrome types have been summarized. Most of the included guidelines were of low methodological quality, with only one achieving moderate quality of AGREE Ⅱ. The frequency with which the 35 items in the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist were reported averaged 36.5% across the 45 guidelines.Conclusions:This systematic review has summarized current recommendations for treating COVID-19 patients with CHM and shows that the general quality of present guidelines is quite low. The development of future guidelines should include increased awareness of the features of good quality guidelines.  
        Keywords：coronavirus disease 2019;Covid-19;Chinese medicine;herbal medicine;clinical practice guideline;systematic review   
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        Published：2021-08-23

        Review

      • Yu-tong LIU,Wen-liang LV
        2020, 26(10): 794-800. DOI: 10.1007/s11655-019-3039-1
        Abstract：The interaction between immune cells and hepatic stellate cells (HSCs) can modulate the development of hepatic fibrosis. It can also regulate hepatic fibrosis and liver cirrhosis caused by excessive deposition of extracellular matrix (ECM). This article reviews the action mechanism of immune cells on liver fibrosis and the effect of Astragalus membranaeus and its active components on immune cells. In-depth study of interaction between immune cells and HSCs on the pathogenesis of liver fibrosis, and the regulatory effect of Astragalus membranaeus and its active components on immune mechanism will provide new insights in the treatment of liver fibrosis.  
        Keywords：liver fibrosis;immune cell;Astragalus membranaceus;review   
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