Traditional Chinese medicine for epilepsy

BACKGROUND

Seizures are poorly controlled in many people with epilepsy, despite current antiepileptic treatments. Some turn to alternative or complementary therapy to treat their condition and the use of traditional Chinese medicinal herbs (TCMH) is increasingly popular. However, it remains unclear whether the existing evidence is rigorous enough to support its use.

OBJECTIVES

To determine the effectiveness and safety of traditional Chinese medicine in people with epilepsy.

SEARCH STRATEGY

Our search included the Cochrane Epilepsy Group's Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1), MEDLINE (1950 to 2007) and EMBASE (1974 to 2007).

SELECTION CRITERIA

Randomised controlled trials evaluating traditional Chinese medicine in people of any age with any type of epilepsy, and comparing one formula of TCM with no intervention, placebo or single Western medicine (monotherapy).

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted trial data and assessed quality. We assessed the following outcomes: (a) seizure freedom for at least one year; (b) 50% or greater reduction in seizure frequency; (c) percentage reduction in seizure frequency and duration; and (d) adverse events.

MAIN RESULTS

Five short-term studies involving 1125 participants met the inclusion criteria. All the studies were of poor methodological quality and had a high probability of selection, detection and performance bias.Two studies assessed seizure freedom for one year. One found no difference between Xiaxingci granule and phenytoin for primary generalized tonic-clonic seizures (RR 1.00; 95% CI 0.07 to 14.90).The other study found no difference between Dianxianning pill and valproate (RR 13.00; 95% CI 0.74 to 227.72) for different types of epilepsy.Three studies assessed a 50% or greater reduction in seizure frequency. One found an advantage for Tianmadingxian capsule when compared to phenytoin (RR 1.37; 95% CI 1.23 to 1.53) in different types of epilepsy, the second an advantage for Zhixian I pill when compared to phenytoin (RR 1.31; 95% CI 1.16 to 1.48) in primary generalized tonic-clonic seizure, and the third an advantage for an 'Antiepilepsy capsule' when compared to phenobarbital (RR 1.21; 95% CI 1.02 to 1.43) for primary and secondary generalized tonic-clonic seizure. One study reported the incidence of adverse effects and the Peto odds ratio was 0.04 (99% CI 0.01 to 0.12, P < 0.00001) favouring TCMH compared to phenobarbital.

AUTHORS' CONCLUSIONS

The current evidence is insufficient to support the use of traditional Chinese medicine as a treatment for epilepsy. Much larger, high quality randomised clinical trials are needed to evaluate the effectiveness and safety of traditional Chinese medicinal herbs for treating epilepsy.

Therapeutic efficacy of Traditional Chinese Medicine 319 recipe on hepatic fibrosis induced by carbon tetrachloride in rats

BACKGROUND/AIMS

Hepatic fibrosis is a consequence of severe liver damage that occurs in many patients with chronic liver diseases. TCM 319 recipe is a Chinese Medicine formula which consists of six Chinese herbs. In this study, we investigated the anti-fibrotic efficacy and mechanisms of TCM 319 recipe.

METHODS

Hepatic fibrosis in rats was induced by carbon tetrachloride (CCl4). 34 male adult SD rats were allocated into five groups (group 1-concomitant CCl4 and TCM 319 recipe for 8 weeks; group 2-CCl4 for 4 weeks and then CCl4 and TCM 319 recipe for 4 weeks; group 3-CCl4 alone for 8 weeks; group 4-TCM 319 recipe only for 8 weeks; group 5-untreated controls). After 8 weeks of treatment, serum ALT assay, liver tissue histological examination and immunostaining were carried out to examine the liver function and fibrosis degree. The expression levels of platelet derived growth factor (PDGF-B), PDGF-Rbeta, and transforming growth factor-beta 1 (TGF-beta1) were measured by quantitative RT-PCR and western blot.

RESULTS

TCM 319 recipe reduced liver injury and attenuated hepatic fibrosis in group 1 compared with that in group 3. TCM 319 recipe suppressed the mRNA expression of tissue inhibitor of metalloproteinase 1 (TIMP-1). In addition, treatment with TCM 319 recipe significantly down-regulated mRNA expression of PDGF-B and PDGF-Rbeta, and it also suppressed protein expression of PDGF-Rbeta and TGF-beta1.

CONCLUSIONS

TCM 319 recipe extracts could attenuate hepatic fibrosis induced by CCl4 in rats. The anti-fibrotic effect of TCM 319 recipe is associated with the down-regulation of mRNA expression of TIMP-1, PDGF-B and PDGF-Rbeta, and with the suppression of protein expression of PDGF-Rbeta and TGF-beta1.

An herbal decoction of Radix astragali and Radix angelicae sinensis promotes hematopoiesis and thrombopoiesis

ETHNOPHARMACOLOGICAL RELEVANCE

A decoction containing Radix angelicae sinensis and Radix astragali (Danggui Buxue Tang, DBT) has been used to raise the "Qi" and nourish the "Blood". However, its effects on haematopoiesis and particularly thrombopoiesis have not been studied.

AIMS

This study aims to examine the effects of DBT on hematopoiesis and thrombopoiesis.

MATERIALS AND METHODS

A myelosuppression mouse model was treated with DBT (10mg/kg/day). Peripheral blood cells from DBT and thrombopoietin-treated samples were counted on days 0, 7, 14 and 21. Then CFU assays were used to determine the effects of DBT on the megakaryocytic progenitor cells and other lineages. Last, analyses of annexin V, caspase-3, and mitochondrial membrane potential were conducted in megakaryocytic cell line M-07e.

RESULTS

Morphological examination showed that DBT treatment significantly increased the recovery of the megakaryocytic series. DBT significantly enhanced the platelet recovery and CFU-MK formation in vivo. DBT significantly promoted CFU-MK and CFU-F formation. Last, we observed the antiapoptotic effects of DBT on M-07e cells.

CONCLUSION

DBT might promote haematopoiesis and thrombopoiesis in the mouse model through (i) directly promoting the growth of megakaryocytes; (ii) indirectly promoting the growth of bone marrow stromal cells; (iii) inhibiting apoptosis of megakaryocytes.

A strategy for evaluating antipyretic efficacy of Chinese herbal medicines based on UV spectra fingerprints

ETHNOPHARMACOLOGICAL RELEVANCE

Quality analysis and control of Chinese herbal medicines (CHM) or herbal medicines (HM) are being more and more investigated based on fingerprint analysis, and there are also some researches on correlating fingerprints of CHM to their efficacy. Multi-component analysis methods together with fingerprints are considered potential useful tools to select candidate herbal drugs from extracts of herbs in pharmacological/bio-prospecting investigations.

AIM OF THE STUDY

To explore a strategy for evaluating efficacy strength of CHM samples based on their spectra fingerprints and validate it.

METHODOLOGY

Radix bupleuri (RB), a typical Chinese medicinal herb for relieving exterior syndrome, and Flos lonicerae (FL), Fructus forsythiae (FF), and Radix isatidis (RI) that are widely applied Chinese herbs for heat clearing and detoxifying, were selected as herbal sources. The aqueous extracts, volatile oils and mixtures of the extracts and oils of the four herbs, plus Ibuprofen suspension (IS), Shuanghuanglian oral liquid (SHL), mixture of SHL and the volatile oils of FL and FF, were used for subject samples to do antipyretic experiments on rats. Ultraviolet spectra were used as the spectra fingerprints to represent chemical characteristics of the samples. Principal component analysis (PCA) and canonical correlation analysis (CCA) were adopted as evaluation tools to establish the correlation between pharmacological and spectra data, from which a spectral index for evaluating antipyretic effects of CHM samples was constructed. Furthermore, four compound samples were designed by mixing 50% volatile oils and 50% aqueous extracts of the four herbs with different ratios to validate the strategy.

RESULTS

Efficacy sequence of the 15 calibrating and 4 validating CHM samples, defined by the first canonical correlative variable U(1) of their UV spectra, was consistent with that given by pharmacological experiments.

CONCLUSIONS

The strategy proposed in this study could be applied to evaluate efficacy strength of CHM and helpful for screening candidate herbal drugs from different herbs or prepared by different technologies.

Hepatoprotective effects of Coptidis rhizoma aqueous extract on carbon tetrachloride-induced acute liver hepatotoxicity in rats

AIM OF THE STUDY

Coptidis rhizoma (CR, Chinese name is Huanglian) has been used in treating infectious and inflammatory diseases for two thousand years in Traditional Chinese Medicine (TCM). Its related pharmacological basis for the therapeutics has been studied intensively, but CR can also be used for vomiting of "dampness-heat type or acid regurgitation" due to "liver-fire attacking stomach" in TCM, whose symptoms seem to link the hepatic and biliary disorders, yet details in the therapies of liver diseases and underlying mechanism(s) remain unclear. To clarify this ethnopharmacological relevance, hepatoprotective effect of Coptidis rhizoma aqueous extract (CRAE) and its possible mechanism were studied in rats intoxicated with carbon tetrachloride (CCl4) in the present study.

MATERIALS AND METHODS

SPRAGUE-Dawley (SD) rats aged 7 weeks old were intraperitoneally injected with CCl4 at a dose of 1.0 ml/kg as a 50% olive oil solution. The rats were orally given the CRAE at doses of 400, 600, 800 mg/kg and 120 mg/kg berberine body weight (BW) after 6 h of CCl4 treatment. At 24 h after CCl4 injection, samples of blood and liver were collected and then biochemical parameters and histological studies were carried out.

RESULTS

The results showed that CRAE and berberine inhibited significantly the activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and increased the activity of superoxide dismutase (SOD). Observation on the hepatoprotective effect of berberine was consistent to that of CRAE.

CONCLUSION

The study is the first time to demonstrate that CRAE has hepatoprotective effect on acute liver injuries induced by CCl4, and the results suggest that the effect of CRAE against CCl4-induced liver damage is related to antioxidant property.

Pretreatment with Tongxinluo protects porcine myocardium from ischaemia/reperfusion injury through a nitric oxide related mechanism

BACKGROUND

The traditional Chinese medicine Tongxinluo can protect myocardium against ischaemia/reperfusion injury, but the mechanism of its action is not well documented. We examined the involvement of nitric oxide in the protective role of Tongxinluo.

METHODS

Miniswine were randomized to four groups of seven: sham, control, Tongxinluo and Tongxinluo coadministration with a nitric oxide synthase inhibitor N(omega)-nitro-L-arginine (L-NNA, 10 mg/kg i.v.). Three hours after administration of Tongxinluo, the animals were anaesthetised and the left anterior descending coronary artery ligated and maintained in situ for 90 minutes followed by 3 hours of reperfusion before death. Area of no reflow and necrosis and risk region were determined pathologically by planimetry. The degree of neutrophil accumulation in myocardium was obtained by measuring myeloperoxidase activity and histological analysis. Myocardial endothelial nitric oxide synthase activity and vascular endothelial cadherin content were measured by colorimetric method and immunoblotting analysis respectively.

RESULTS

Tongxinluo significantly increased the local blood flow and limited the infarct and size of no reflow. Tongxinluo also attenuated myeloperoxidase activity and neutrophil accumulation in histological sections and maintained the level of vascular endothelial cadherin and endothelial nitric oxide synthase activity in the reflow region when compared with control group. The protection of Tongxinluo was counteracted by coadministration with L-NNA.

CONCLUSIONS

Tongxinluo may limit myocardial ischaemia and protect the heart against reperfusion injury. Tongxinluo regulates synthesis of nitric oxide by altering activity of endothelial nitric oxide synthase.

Application of traditional Chinese medicine in the treatment of infertility

The philosophy and practice of traditional Chinese medicine (TCM) have been evolving for thousands of years in China, Japan and other Asian countries. TCM is now generating popular interest worldwide for reproductive health care and disease prevention, including applications for treating infertility and improving sexual function. This review focuses on the application of TCM for infertility patients, and provides a critical reflection on the efficacy and safety of selected Chinese herbal formulas. It has been claimed that some formulas produce high clinical pregnancy rates with few or no side effects, as well as improving the general well-being of patients. The need for randomized control trials and research into possible mechanisms of action, effective doses, contra-indications and toxicity is self-evident. However, the task is enormous in view of the number of herbal products currently available on the market; yet among these products are undoubtedly some that will prove to be safe and beneficial.

Evaluation of hypoglycemic activity of the polysaccharides extracted from Lycium barbarum

A study was undertaken to evaluate the hypoglycemic activity of polysaccharide extracted from Lycium barbarum (LBP). The various parameters studied included body weight (bw), fasting blood glucose levels (FBG), total cholesterol (TC) and triglyceride (TG) in diabetic and normal mice. LBP treatment (20, 40 mg/ kg body weight) for 28 days resulted in a significant decrease in the concentration of FBG, TC and TG in diabetes mellitus mice. Furthermore, LBP significantly increased body weight. The data demonstrated LBP at the dose of 40 mg/kg bw exhibited the better effect.

Treating gynaecological disorders with traditional Chinese medicine: a review

Traditional Chinese Medicine (TCM) has significant advantages in treating gynaecological disorders. The paper has provided a brief introduction on the current progress of treating some gynaecological disorders including endometriosis, infertility, dysmenorrhea, abnormal uterine bleeding, premenstrual syndrome, menopausal syndrome, uterine fibroids, chronic pelvic inflammation, polycystic ovarian syndrome (PCOS), cervicitis and vaginitis with Chinese Herbal Medicine (CHM) and acupuncture. The use of TCM in the field of assisted reproductive techniques (ART) has also been included in the review. In addition, thirty-two commonly used Chinese medicinal formulas in treating gynaecological disorders have been introduced.

[Observation on therapeutic effects of different treatments for sudden deafness]

OBJECTIVE

To search for the best acupuncture treatment for sudden sensorineural deafness.

METHODS

One hundred and eighty-seven patients were randomly divided into an acupuncture group (group A), an electroacupuncture group (group B), an acupuncture pius acupoint injection group (group C), an electroacupuncture plus acupoint injection group (group D). Ermen (TE 21), Tinggong (SI 19), Tinghui (GB 2), Yifeng (TE 17), Fengchi (GB 20) on the affected side, and Shangxing (GV 23), Baihui (GV 20), Sishencong (EX-HN 1), Hegu (LI 4), Waiguan (TE 5), etc. were selected. The treatment was given once each day. Hearing was tested after treatment for 40 sessions and the therapeutic effects were compared.

RESULTS

The total effective rate was 47.6% in the group A, 79.2% in the group B, 76.0% in the group C and 94.0% in the group D, the group D being the best and the group A being the worst, and with significant differences between the group D and the other groups (all P < 0.05). In the group D, the therapeutic effect for patients who received the treatment within 2 weeks after attack were superior to those who received the treatment over 2 weeks after attack (P < 0.05); the acupuncture therapeutic effect for the mild and moderate patients was superior to that of severe patients (P < 0.05); the acupuncture therapeutic effect for the patients less than 50 years old was superior to those more than 50 years old (P < 0.05).

CONCLUSION

Electroacupuncture plus acupoint injection is the heat therapy for sudden sensorineural deafness, and the timely intervention of acupuncture, the severity degree of the illness and the patient's age are all related to the prognosis of this disease.

[A multi-centered randomized double-blinded controlled clinical study on efficacy of gulling pa'an capsule in treating Parkinson's disease]

OBJECTIVE

To objectively evaluate the clinical efficacy of Gulling Pa'an Capsule (GPC), a Chinese medicine, in treating Parkinson's disease (PD).

METHODS

According to the good clinical practice (GCP) principle, a multi-centered, double-blinded, layered, randomized and grouping-controlled clinical trial was carried out from May 2002 to January 2005 on 242 PD patients. Among them, 53 patients who had never received levodopa were randomized into two groups, 28 in group A treated with GPC, and 25 in group B treated with placebo; patients who had received levodopa were assigned depending on the Hoehn & Yahr (H-Y) grade, to 4 groups, 75 and 19 of grade 1.5 -3 in group C and E, respectively, 79 and 16 of grade 4 in group D and F, respectively, patients in group C and E were treated with GPC and Levodopa, and those in group D and F treated with placebo and Levodopa for control. The treatment course was 12 weeks for all. Changes of unified Parkinson's disease rating scale (UPDRS) II/III scores in comparing with the baseline were assessed. For the groups C, D, E and F, the dosage of levodopa administered was also recorded. Meanwhile, the blood pressure, pulse rate, blood and urine routine, liver and renal functions, electrocardiogram (ECG) and adverse reactions were monitored as the indices for safety supervise.

RESULTS

(1) After treatment, symptoms were markedly improved in 1 out of the 28 patients in group A and improved in 11, the markedly improving rate was 3.6% and the improving rate 39.3%; while in group B, the corresponding outcomes were 0 (0/25) and 28.0% (7/25) respectively, showing insignificant difference between the two groups. UPDRS scores, including the total, II and III scores were all significantly lowered in group A after treatment (P < 0.01, P < 0.05); while in group B, significant lowering only showed in terms of UPDRS III (P < 0.05); but the inter-group comparison of the changes in all the three items showed no significant difference. (2) The significant improving rate was 12.0% (9/75) and improving rate 48.0% (36/75) in group C, while those in group D, 12.7% (10/79) and 24.1% (19/79) respectively, the efficacy in group C was better (P < 0.05). The items of 3 UPDRS scores in groups C and D were all significantly lowered after treatment (P < 0.01), and the lowering in group C was more significant in terms of the total and II scores (P < 0.05). (3) The significant improving rate was 5.3% (1/19) and improving rate 36.8% (7/19) in group E, while in group F 0% (0/19) and 25.0% (4/16), respectively, showing insignificant difference between them; UPDRS scores lowered significantly in the two groups after treatment (P < 0.01), also showed no statistical significance in comparison (P > 0.05). (4) The dosage of Levodopa required in groups C and E was significantly reduced after treatment (P < 0.05), while in groups D and F, it was unchanged (P > 0.05); yet, the further analysis displayed that significant reduction only presented in group C (P < 0.05), not in the other three groups.

CONCLUSIONS

The overall efficacy of levodopa in combined with GPC for treating PD patients of H-Y grade 1.5 -3 is significantly higher than that of levodopa alone. GPC shows obvious effects in improving patients' motor syndrome and the quality of life; as used in combining with levodopa, the dosage of levodopa required could be reduced.

[Retrospective study of adverse events of Polygonum multiflorum and risk control]

To provide a reference for rational clinical medication and review the irrational use and factors relating the adverse events of Polygonum multiflorum. The literatures on P. multiflorum published between 1978 and 2008 were reviewed and the reports on clinical use were analyzed. A total of 26 literatures were retrieved. 38 cases of adverse drug event were reported, 10 cases of allergy, 24 cases of liver damage, and 4 cases presented with other adverse events. Irrational use is common in both self-medication and doctor prescription. It is one of the main factors of adverse events. Improving clinical rational use is the most important way to control its risk.

[Clinical evaluation of the antioxidant activity of astragalus in women with gestational diabetes]

OBJECTIVE

To evaluate the antioxidant activity of astragalus and its therapeutic effect on gestational diabetes.

METHODS

Eighty-four pregnant women with gestational diabetes were divided into insulin and insulin plus astragalus groups after regular dietary control and insulin treatment to maintain stable blood glucose level. The 43 patients in insulin group received insulin injection, whereas the 41 patients in the other group received treatment with both insulin and astragalus. The SOD activity, MDA level, blood lipids and renal function were determined in both groups after the treatments.

RESULTS

The patients with both insulin and astragalus treatments showed significantly increased serum SOD activity and decreased MDA level, renal function and blood lipids in comparison with those with exclusive insulin treatment.

CONCLUSION

Astragalus can effectively control blood glucose, reduce the free radicals, and promote the antioxidative activity, and may play a role in the prevention and treatment of gestational diabetes.

[Qianlie Beixi capsule for unliquefiable semen: a clinical study of 180 cases]

OBJECTIVE

To investigate the efficacy and possible action mechanism of Qianlie Beixi Capsule in the treatment of unliquefiable semen.

METHODS

A total of 240 patients with unliquefiable semen were randomly divided into a treatment group (n = 180), treated with Qianlie Beixi Capsule, and a control group (n = 60), given compound tablets of zinc and protein. The treatment lasted two courses of 45 days each, and the seminal changes were observed and recorded.

RESULTS

Of the patients in the treatment group, 144 were cured, 12 responded and 24 failed to respond to the medication after the first course; and 158 were cured, 7 responded and 15 failed to after the second course, with the effectiveness rate of 91.67%. Meanwhile, sperm motility was obviously improved, with statistically significant difference from that of the controls (P < 0.01).

CONCLUSION

Qianlie Beixi Capsule is effective for unliquefiable semen by improving the function of the prostate and shortening the time of seminal liquefaction.

[Effect of qingyi decoction in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis and hyperamylasemia]

OBJECTIVE

To explore the preventive effect of Qingyi Decoction (QYD) on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasemia.

METHODS

One hundred and twenty-five patients scheduled to receive ERCP were randomized by the digital table into three groups, two were medicated respectively with QYD (39 cases) and octreotide (42 cases), the other one was untreated for control (44 cases). Changes of blood levels of amylase, C-reactive protein (CRP), and interleukin-10 (IL-10), as well as the incidence of pancreatitis and hyperamylasemia was observed and compared.

RESULTS

The 4 h and 24 h post-operational blood amylase (U/L) was 132.03 +/- 75.29 and 153.15 +/- 78.69 in the QYD group, and 134.74 +/- 22.24 and 148.50 +/- 79.37 in the octreotide group, all were significantly lower than those in the control group (241.27 +/- 137.04 and 286.89 +/- 133.77), respectively. The 24 h CRP (mg/L) in both QYD and octreotide group (11.05 +/- 3.57 and 12.48 +/- 3.80) was also lower than that in the control group (17.70 +/- 4.93, P < 0.05), while the 24 h IL-10 (ng/L) in the QYD group (105.00 +/- 31.85) was higher than that in the octreotide group (77.98 +/- 33.13) and the control group (75.98 +/- 30.99) respectively. The incidence of pancreatitis in the QYD, octreotide, and the control group was 2.6%, 0 and 11.4%, that of hyperamylasemia in them 28.2%, 21.4%, and 56.8%, respectively. The occurrence rate of hyperamylasemia was lower in the QYD group and the octreotide group than in the control group (P < 0.05).

CONCLUSION

QYD could lower CRP and up-regulate IL-10 level, restrain the inflammation reaction and reduce the blood amylase level in the post-ERCP period, thus reducing the incidence of hyperamylasemia.

[Effects of Yi Fu Ning soft gelatin capsules on reproductive endocrine-immune function of ovariectomized rats]

OBJECTIVE

To investigate the effect of Yi Fu Ning Soft Gelatin Capsules (YFN) on reproductive endocrine-immune function of ovariectomized rats.

METHODS

60 3-month old female Sprague-Dawley rats were used, 50 of them were ovariectomized and randomly divided into 5 groups: ovariectomizy (OVX) group, OVX with diethylstilbestrol tablets (DT) group, OVX with YFN (high dose, middle dose and low dose) group. The others were sham-operated group. The rats were administrated initially in the 4th week after the operation. After drugs had been given for 12 weeks the rats were sacrificed, blood serum hormone, IL-2 content and T lymphocyte subpopulation were detected with methods radioimmunoassay and flow cytometry (FCM).

RESULTS

(1) Compared with sham group, the level of serum E2, Te and P significantly decreased (P < 0.01), FSH, LH content significantly increased; Blood T lymphocyte subpopulation CD3+ cells, CD4+ cells and CD4+/CD8+ ratio significantly decreased, serum IL-2 content also significantly decreased (P < 0.01). (2) Compared with model group, after treated by YFN, the level of serum E2 and P significantly increased (P < 0.01), serum FSH and LH content significantly decreased; T lymphocyte subpopulation CD3+ cells, CD4+ cells and CD4+/CD8+ ratio were improved significantly and serum interleukin-2 (IL-2) content increased significantly.

CONCLUSION

YFN can increase serum sexual hormone content,reduce the level of FSH and LH, and improve imbalanced T lymphocyte subpopulation, stimulate IL-2 excretion, which means YFN can regulate inordinate reproductive endocrine-immune network in ovariectomized rats.

[A prospective randomized control clinical study of the effect of Xuebijing injection on prognosis of acute respiratory distress syndrome patients]

OBJECTIVE

To study the effect of Xuebijing injection on prognosis, immune function, adrenal function and inflammatory reaction during the treatment of acute respiratory distress syndrome (ARDS).

METHODS

From January 2008 through December 2008, a clinical study was conducted on consecutive adult patients with ARDS in intensive care unit (ICU). The patients were divided into Xuebijing group (31 patients) and control group (30 patients). Both groups were treated with the routine therapy of ARDS, and in addition, Xuebijing injection was used in a dose of 100 ml twice a day for 7 days in Xuebijing group. Duration of mechanical ventilation (MV) and ICU length of stay, 28-day mortality, acute physiology and chronic health evaluation II (APACHE II), Murray and Marshall scores were recorded in both groups. Every patient was given one injection of corticotrophin 250 microg intravenously before and after treatment, and plasma cortisol level was detected by radio-immunoassay before the injection (T0) and 30 minutes (T30) and 60 minutes (T60) after the injection. The ratio of adrenal insufficiency was evaluated according to diagnostic criteria of relative adrenal insufficiency, which was defined as the difference between T0 and the highest value of T30 or T60 (Delta Tmax)< or =248.4 nmol/L. Human leukocyte antigen-DR (HLA-DR), subpopulations of T lymphocyte (CD4(+)/CD8(+)), interleukin-6 (IL-6), IL-10 in peripheral blood was also determined.

RESULTS

Murray (1.5+/-1.5) and Marshall score (2.9+/-2.7) and the level of IL-6 [(3.4+/-1.9) micromol/L], IL-10 [(1.5+/-0.8) micromol/L] in the Xuebijing group were decreased significantly after the use of Xuebijing compared with control group [4.3+/-3.1, 6.3+/-4.1, (8.9+/-10.2) micromol/L, (4.2+/-4.8) micromol/L, respectively, all P<0.01], while the values of HLA-DR (41.1+/-10.1), CD4(+) (58.0+/-10.7), CD4(+)/CD8(+) (1.9+/-0.3) were increased compared with control group [30.6+/-15.0, 50.5+/-16.2, 1.4+/-0.7, respectively, P<0.05 or P<0.01]. The ratio of adrenal insufficiency in Xuebijing group (45.2%) was lower than that of control group (83.3%), while that of Delta Tmax [(328.4+/-278.3) micromol/L] was higher than that of control group [(172.8+/-110.8) micromol/L, both P<0.01]. MV duration [(4.0+/-3.3) days] and ICU length of stay [(8.4+/-4.2) days] were less than those of control group [(5.9+/-3.8) days, (12.0+/-7.6) days, both P<0.05], and 28-day mortality in Xuebijing group was 35.5%, which was 11.2% less than that of control group (46.7%), but there was no statistically significant difference between two groups (P>0.05).

CONCLUSION

Xuebijing injection improves organ function, decreases MV duration and ICU length of stay in ARDS patients. The underlying mechanism may involve modulation of the immune function, decrease in the degree of adrenal insufficiency, and modulation of regulating inflammatory reaction.

[Clinical and experimental study on effect of qinbal ointment in treating psoriasis in the active stage of blood-heat syndrome type]

OBJECTIVE

To investigate and compare the efficacy and safety of two kinds of Qinbai ointment prepared conventionally and finely (C-QBO and F-QBO) in treating psoriasis in the active stage of blood-heat syndrome type, and to observe their influences on vaginal epithelial cell mitosis, also on keratinization of caudal flakes in mice.

CLINICAL OBSERVATION

Adopting randomized, single-blinded, controlled design, 93 patients administered orally with Liangxue Huoxue Decoction were randomized into three groups treated externally with C-QBO, F-QBO and white vaseline respectively, applied twice a day for 8 weeks. The safety was checked and the changes of modified psoriasis area severity index (PASI), as well as the conditions of skin lesions (size, erythema, infiltration, squama, and itching) and symptom improving time were compared. Experimental study 1: Mice were randomized into the model group, the C-QBO group, the F-QBO group and the blank group, 7 in each group. Their vaginal epithelial cell mitosis indices were compared after 3 days of treatment with corresponding remedies. Experimental study 2: Mice were randomized into the C-QBO group, the F-QBO group and the blank group, 7 in each group. After the mice had been treated with corresponding remedies for 28 days, the granular layer formation in their caudal scales was compared.

CLINICAL OBSERVATION

The markedly effective rate was 63.3% (25/30) in the C-QBO group, 66.7% (20/30) in the F-QBO group, and 36.7% (11/30) in the control group. No statistical difference was showen between the two QBO treated groups (P > 0.05), but that in both of them was significantly different from that in the control group (P < 0.05). PASI scores lowered after treatment in all the three groups (P < 0.01), but the improvement in the two QBO groups was better than that in the control group (P < 0.05); the conditions of skin lesion were improved in all groups, but the improvements were more significant in the two QBO groups in terms of squama, infiltration and itching (P < 0.05), in aspects of improving time on erythema, infiltration and itching, especially the itching, F-QBO was superior to the C-QBO. Experimental study 1: The mitosis index in both QBO groups was lower than that in the blank group and the model group (P < 0.01). Experimental study 2: Number of scales with granular layer formation was higher in the two QBO groups than in the blank group (P < 0.01).

CONCLUSION

C-QBO and F-QBO can effectively relieve the skin lesion of psoriasis patients in the active stage of blood-heat type, and they could also promote the formation of epithelial granular layer in the caudal scales of mice.

[Clinical observation on treatment of 10 patients with chronic inflammatory demyelinating polyneuropathy by gullong tongluo capsule combined with prednisone]

OBJECTIVE

To observe and evaluate objectively the clinical effect of Guilong Tongluo Capsule (GTC) in treating chronic inflammatory demyelinating polyneuropathy (CIDP).

METHODS

Sixty CIDP patients were equally randomized into two groups. The treated group was administered with GTC and prednisone, while the control group with prednisone alone. Changes before and after 3-month treatment in terms of muscle force, functional and sensory disturbance of extremities, as well as scoring by Activity of Daily Living Scale (ADL) and electromyogram (EMG) for nerve conduction velocity were observed and compared.

RESULTS

The total effective rate gained in the treated group and the control group was 90.0% (27/30) and 70.0% (21/30) respectively, showing significant difference between them (chi2 = 14.82, P < 0.01). The improvement in the treated group was superior to the control group in muscle force of lower limb, motive and sensory function of extremities, ADL scores and motive function of ulnar nerve (P < 0.05, P < 0.01).

CONCLUSION

The curative effect of GTC combined with prednisone in treating CIDP was better than that of prednisone alone.

[Exploration into the preparation of placebos used in Chinese medicinal clinical trial]

Placebo-controlled clinical trials have been more and more emphasized in traditional Chinese medicine (TCM) researches, while the preparation of TCM placebos is still to be improved. For this work, some elements should be taken into consideration comprehensively, including the design of clinical trial, the characteristics of researched disease, the nature of testing drugs, and the way of medication, etc. And the technological process for placebo manufacturing should be selected properly depending upon the basis of the above elements. Un-biased foodstuff is good as excipient for TCM placebos preparation. The placebo should be made in dosage-form similar to that of the testing drug as possible, if there are difficulties for simulating them in appearance and smell completely. However, its potential pharmacological activity meeting to the acceptance of researchers should be ensured.

[Observation on therapeutic effect of runmushu oral liquid in treating xerophthalmia in postmenopausal women]

OBJECTIVE

To objectively evaluate the therapeutic effect and safety of Runmushu Oral Liquid (RMS) for the treatment of xerophthalmia in postmenopausal women.

METHODS

Seventy-two postmenopausal women (144 eyes) with xerophthalmia of aqueous tear deficiency type were assigned to two groups. Patients in the treated group were treated with RMS (consisted of prepared and crude rehmannia root, figwort, lilyturf root, dendrobium stem, wolfberry fruit, chrysanthemum and sticktight) orally combining with local applying of Hialid eye drops; while those in the control group were treated with Hialid eye drops alone. Changes of subjective symptoms and objective indices in the two groups were observed and compared before and after 1-month treatment.

RESULTS

After 1 month of treatment, the total effective rate was 86.1% (62/72) in the treated group and 66.7% (48/72) in the control group, showing significant difference between them (P < 0.01). Significant differences between groups were also shown in improvements of total scores of subjective symptoms (P < 0.01), scores of tear film break-up time (BUT) and Schirmer I test, these indices in the treated group were better (P < 0.01). However, the improvement of cornea fluorescin staining scores was insignificant different between groups (P > 0.05).

CONCLUSION

RMS with artificial-tears can alleviate the eye symptoms, prolong the BUT, promote the secretion of tears in treating postmenopausal women xerophthalmia, showing a therapeutic effect superior to that by artificial-tears alone.

Anti-diabetic properties of three common Bidens pilosa variants in Taiwan

Bidens pilosa L. var. radiata (BPR), B. pilosa L. var. pilosa (BPP), and B. pilosa L. var. minor (BPM) are common variants of a plant often used as a folk remedy for diabetes in Taiwan. However, the three variants are often misidentified and little is known about their relative anti-diabetic efficacy and chemical composition. In this paper, we have first developed a method based on GC-MS and cluster analysis with visualization to assist in rapidly determining the taxonomy of these three Bidens variants. GC-MS was used to determine the chemical compositions of supercritical extracts, and differences and similarities in the variants were determined by hierarchical cluster analysis. Next, the HPLC profiles of the methanol crude extracts in the Bidens plants and evaluated anti-diabetic effects of methanol crude extracts were compared, as well as three polyacetylenic compounds of the Bidens plants using db/db mice. Single-dose and long-term experiments showed that the BPR extract had higher glucose-lowering and insulin-releasing activities than extracts from the other two variants, and that cytopiloyne was the most effective pure compound among the three polyacetylenic compounds. BPR extract and cytopiloyne also significantly reduced the percentage of the glycosylated hemoglobin A1c in db/db mice. Besides, both animal studies and HPLC analysis demonstrated a good correlation between anti-diabetic efficacy of the Bidens extracts and the particular polyacetylenes present.

[Effects of Qinggan Huoxue Recipe and its separated recipes on urokinase-type plasminogen activator and plasminogen activator inhibitor-1 fibrinolytic system in rats with alcoholic liver fibrosis]

OBJECTIVE

To study the action mechanisms of Qinggan Huoxue Recipe (QGHXR), a compound traditional Chinese herbal medicine, and its separated recipes by observing their effects on expressions of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in rats with alcoholic liver fibrosis (ALF).

METHODS

A total of 150 SD rats were divided into three groups: blank group, carbon tetrachloride (C(4)) group and ALF-inducing group. Rats in the ALF-inducing group were administered with a mixture diet (56% alcohol 10 mL/kg, corn oil 2 mL/kg, pyrazole 25 mg/kg) once daily and intraperitoneally injected with 0.3 mL/kg 25% solution of C(4) in olive oil twice weekly. The C(4) group was intraperitoneally injected with equal volume of C(4) and olive oil as the ALF-inducing group and ingested normal saline (12 mL/kg per day). The blank group was intraperitoneally injected with and ingested saline in equal volumes of the above. At the end of the eighth week, the survived rats in the ALF-inducing group were divided into four subgroups: untreated group, QGHXR group, Qinggan Recipe (QGR) group and Huoxue Recipe (HXR) group. The three treated groups were given corresponding drugs respectively (4.75, 1.5, 3.25 g/kg). The blank group, CCl(4) group and untreated group were given normal saline in equal volume (5 mL/kg per day). All rats were anaesthetized and killed at the end of the twelfth week. The activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the serum were analyzed. Pathological changes in liver tissues were observed by hematoxylin and eosin staining and Masson staining. The expressions of uPA and PAI-1 were evaluated with Western blotting, immunofluorescence, and real-time polymerase chain reaction.

RESULTS

There existed obvious liver fibrosis in liver tissues in the untreated group as compared with the blank group (P<0.01), and the activities of ALT and AST and the expressions of uPA and PAI-1 also increased in the untreated group. QGHXR and its separated recipes could improve the degree of liver fibrosis (P<0.01). QGHXR and its separated recipes could degrade the activity of ALT as compared with the untreated group; QGHXR and its separated recipes advanced the expression of uPA, and decreased the expression of PAI-1 significantly as compared with the untreated group. The effect of QGHXR was the best among the three recipes.

CONCLUSION

QGHXR and its separated recipes may improve ALF in rats by decreasing the expression of PAI-1 and advance the expression of uPA. The effect of QGHXR is the best among them.

[Study on Luo Han Shen reducing blood glucose diabetic model mice]

OBJECTIVE

to study the function of luo han shen on reducing the blood glucose of the diabetic model mice.

METHODS

124 male Kunming mice (28-32 g) were involved. Alloxan (200 mg/kg) was injected by intraperitoneal injection to establish diabetic model once a day, total two days. The fasting blood glucose of mice were tested 5 days later, greater than 10.0 mmol/L and less than 25 mmol/L as the diabetic model mice. The model mice were divided randomly into four groups based on the fasting blood glucose level(the model control group, the low-dose group, the middle-dose group, the high-dose group), 12 mice each group, given basic diet and diets containing 5%, 10%, 20% luo han shen respectively. 24 normal mice were divided randomly into two groups based on the fasting blood glucose level (the control group and the positive control group), 12 mice each group, given basic diet and diet containing 20% luo han shen respectively. The blood glucose and glucose tolerance were tested 6 weeks later.

RESULTS

After training, the fasting blood glucose level of the high-dose group mice reduced insignificantly (P < 0.05), and was also lower than that of the model control group (P < 0.05). Compared to the model control group and the low-dose group,the blood glucose level at 0, 0.5, 2h and the blood glucose area under the curve of the high-dose group were significantly lower. Compared to the model control, the blood glucose level at 0.5 h of the middle-dose group was significantly lower (P < 0.05). The value of other groups had no significant difference.

CONCLUSION

Luo han shen can reduce the blood glucose level and improve the glucose tolerance of diabetic model mice.