Effects of Moxa (Folium Artemisiae argyi) Smoke Exposure on Heart Rate and Heart Rate Variability in Healthy Young Adults: A Randomized, Controlled Human Study

Antiviral Effects of Artemisinin and Its Derivatives against SARS-CoV-2 Main Protease: Computational Evidences and Interactions with ACE2 Allelic Variants

Fighting against the emergent coronavirus disease (COVID-19) remains a big challenge at the front of the world communities. Recent research has outlined the potential of various medicinal herbs to counteract the infection. This study aimed to evaluate the interaction of artemisinin, a sesquiterpene lactone extracted from the Artemisia genus, and its derivatives with the SARS-CoV-2 main protease. To assess their potential use against COVID-19, the interactions of the main active principle of Artemisia with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main protease (Mpro) was investigated through in silico probing. Our results showed that artemesinin and its derivatives manifested good oral absorption and bioavailability scores (0.55). They potently bound to the Mpro site of action—specifically, to its Cys145 residue. The selected compounds established two to three conventional hydrogen bonds with binding affinities ranging between −5.2 and −8.1 kcal/mol. Furthermore, artemisinin interactions with angiotensin converting enzyme 2 (ACE2) were dependent on the ACE2 allelic variants. The best score was recorded with rs961360700. A molecular dynamic simulation showed sufficient stability of the artemisinin–Mpro complex on the trajectory of 100 ns simulation frame. These binding interactions, together with drug-likeness and pharmacokinetic findings, confirmed that artemisinin might inhibit Mpro activity and explain the ethnopharmacological use of the herb and its possible antiviral activity against SARS-CoV-2 infection inducing COVID-19. Nevertheless, it interacted differently with the various ACE2 allelic variants reported to bind with the SARS-CoV-2 spike protein.

Chemical Fingerprint Profiles and Pharmacodynamic Investigation for Quality Evaluation of Moxa Smoke by UHPLC in a Rat Model of Superficial Infection

Introduction

Moxibustion, a traditional Chinese medicine technique, involves the use of moxa smoke from Folium Artemisia argyi to treat various disorders, especially superficial infections. However, there is a higher health risk for people exposed to high levels of moxa smoke for extended durations. Here, we report the first ultra-high-performance liquid chromatography (UHPLC) fingerprint profiles and pharmacodynamic evaluation of moxa smoke, as well as evaluation of its aqueous solution on a rat model of superficial infection.

Methods

A novel method for moxa smoke fingerprint profiling was developed using UHPLC under characteristic wavelength. Chromatographic peaks were further analyzed by ultra-high-performance liquid chromatography quadrupole-time-of-flight mass spectrometry (UHPLC-QTOF/MS). 12 sample batches obtained from various Chinese provinces were then analyzed using similarity evaluation, clustering analysis, and principal component analysis. The pharmacodynamics of moxa smoke and moxa aqueous solution were investigated on a rat model of acute skin wound infection.

Results

UHPLC fingerprint profiles of 12 batches of moxa smoke were generated at 270 nm wavelength and 21 chromatographic peaks extracted as common peaks. Similarity between the 12 batches ranged from 0.341 to 0.982. Based on cluster analysis, the 12 batches of moxa smoke samples were clustered into five groups. Principal component analysis showed that the cumulative contribution of the three principal components reached 90.17%. Eigenvalues of the first, second, and third principal components were 10.794, 6.504, and 1.638, respectively. The corresponding variance contribution rates were 51.40%, 30.97%, and 7.80%, respectively. Pharmacological analysis found that wound healing was slow in the model group relative to the mupirocin ointment, moxa smoke, and aqueous moxa smoke solution groups. Histological analysis revealed markedly reduced tissue inflammation in rats treated with moxa smoke or its aqueous solution.

Conclusions

Moxa smoke and its aqueous solution significantly promote wound healing upon superficial infection. A novel quality control method for moxa smoke was established and evaluated for the first time. As its main effects are unchanged, the transformation of moxa smoke into aqueous moxa smoke improves safety and is a simple and controllable process.

Ultrasonic device developed for non-invasive moxibustion therapy

Background

Recently, some adverse effects of moxibustion has been reported such as burns, smoke, allergies, and so on. To overcome the adverse effects of traditional moxibustion, an ultrasonic moxibustion device (UMD) was designed, simulated, fabricated, and tested. The objective of this study is to provide detailed information about the main design parameters, simulation outcome, and performance-test results.

Methods

The main components of the UMD are a 1-MHz ultrasonic transducer (UT) with concave lens, and its applicator. The acoustic pressure and temperature distribution of the UT was simulated and described graphically using COMSOL software, which is based on the finite element method (FEM). Experimental verification of the temperature distribution was performed on the skin of pork. The temperature-change profiles of pork in relation to increase of therapy time were obtained at an unfocused point (2 mm) and at a focal distance of 13 mm. For the performance test, moxibustion therapy was conducted on the abdominal skin of mice for 120 min using the new UMD and its histological images were acquired to analyze the skin-tissue damage.

Results

The FEM simulation of temperature distribution and acoustic pressure agreed with the experimental outcome. Histological images showed that there was no skin-tissue damage to the mouse abdomens after therapy. The results clearly show that the newly developed UMD can overcome the disadvantages of traditional moxibustion therapy and achieve the proposed design parameters.

Conclusion

The FEM simulation and performance tests provided valuable information about developing future UMDs. In addition, its performance can be compared with traditional moxibustion therapy for future study.

Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications

Traditional Chinese medicine (TCM) is a systematic healthcare system developed from clinical experience based on a scientific model of regulation. TCM relies on unique theories and practices to treat diseases and enhance health. These practices include Chinese herbal medicine and dietetics, acupuncture and moxibustion, and other non-medication therapies such as Chinese bodywork or manual therapy, known as "Tuina", and traditional biofeedback exercises, known as "Qigong" and "Taijiquan". The integration of TCM in Western health systems and research requires a rational communicable theory, scientific proof of efficacy and safety, and quality control measures. Understanding the structural concepts of the TCM language makes possible the parallelism to Western physiology, and the inherent rational use of the reflex therapeutic systems, anti-inflammatory mechanisms and mental training involved, for example, in acupuncture and "Qigong". The results of TCM clinical trials and fundamental research on its nature and mechanisms have encouraged the development and application of well-designed research strategies such as double blinding in acupucture to overcome limitations and resistances in integrating these practices into the existing biomedical paradigms of the West. This review aims to overview some TCM theoretical concepts and the evidence-based clinical application of TCM's leading practices to create an easy-to-consult and condensed source of information, available for the healthcare community, facilitating the understanding and communication between conventional health professionals and TCM practitioners and acupuncturists.

Analysis of the Components in Moxa Smoke by GC-MS and Preliminary Discussion on Its Toxicity and Side Effects

Moxibustion plays an important role in the prevention and treatment of diseases and the promotion of human health. In this study, the components in moxa smoke from Jiangxi Poai Biotechnology Co., Ltd., namely, Qing moxa sticks, were absorbed by five solvents (cyclohexane, ethyl acetate, n-butanol, anhydrous ethanol, and water) and identified by gas chromatography-mass spectrometry. The identification results of the smoke from the Qing moxa sticks that was absorbed in liquid are as follows: a total of 294 compounds were identified, including 139 in cyclohexane, 145 in ethyl acetate, 60 in n-butanol, 89 in anhydrous ethanol, and 77 in water, and of those, 112 toxic compounds were identified. Furthermore, Ingenuity Pathway Analysis software and the PubChem database were successfully applied to analyze the toxic compounds. There were 812 target proteins related to the toxic components, 25 molecular networks, and 54 biological pathways. The results showed that the toxic compounds of moxa smoke may have some side effects on the heart, liver, and kidney of humans. This study revealed that the components of moxa smoke are complex and diverse. Due to the findings of toxic compounds in moxa smoke, we recommend that moxibustion rooms should be equipped with ventilation equipment or enough artificial ventilation to ensure the health of patients and practitioners.

Effects of electroacupuncture on functional indices and pS6 expression following acute sciatic nerve crush injury in rats

OBJECTIVE

The aim of this study was to investigate the effect of electroacupuncture (EA) on recovery from acute sciatic nerve crush injury and the expression of pS6 in rats.

METHODS

A total of 108 adult male Sprague-Dawley rats were randomly divided into control, model, EA and EA+rapamycin (EA+Rapa) groups. 28 rats were allocated to undergo measurement of sciatic functional index (SFI); one rat in the EA+Rapa group was unsuccessfully modelled and excluded because of an anaesthetic problem. The remaining 80 rats were allocated to undergo Western blot detection of S6 ribosomal protein (pS6, ser240/244). The model was created by mechanical clamping of the sciatic nerve stem. EA stimulation at GB30 and ST36 for 15 min separately was applied once daily for rats in the EA and EA+Rapa groups. For rats in the EA+Rapa group, rapamycin, a mammalian target of rapamycin (mTor) pathway inhibitor, was injected intramuscularly (1 mg/kg/day) near the site of crush injury in the sciatic nerve and an equivalent amount of dimethyl sulfoxide was injected in the other three groups every other day. After treatment for 7, 14, 28 and 42 days post-operation, the SFI of 27 rats was obtained to evaluate recovery of motor function and five rats from each group per stage were used for Western blot detection of pS6.

RESULTS

The SFI values showed that EA could significantly promote recovery of the injured sciatic nerve but rapamycin hindered the therapeutic effect of EA. Moreover, immunoblotting indicated that EA improved the expression of pS6 in the area of the sciatic nerve crush injury and local injection of rapamycin near the injured sciatic nerve decreased its expression. The pS6 level correlated with the extent of recovery of the injury.

CONCLUSIONS

This study indicated that EA may activate the mTOR signalling pathway to enhance expression of pS6 and facilitate recovery following sciatic nerve crush injury.

Does Moxa Smoke Have Significant Effect on the Acupuncturist's Respiratory System? A Population-Based Study

OBJECTIVES

To evaluate the safety of moxa smoke, especially to provide quantitative information and details for the occupational prevention of acupuncturists.

METHODS

We combined the questionnaire-based cross-sectional survey and lung function testing-based historical retrospective cohort research to investigate the safety of moxa smoke exposure (MSE) among acupuncturists. A mathematical regression model was established to quantitatively evaluate the relationship between moxa smoke exposure and the respiratory health of the acupuncturist. The smoke exposure time of the acupuncturist and the prevalence of abnormal respiratory symptoms or diseases were also evaluated.

RESULTS

(1) The cross-sectional research showed that the incidence of expectoration (18.7%) and rhinitis (22.7%) was the most common respiratory symptom and disease after MSE. No statistical difference was found between smoke exposure time of the acupuncturist and the prevalence of abnormal respiratory symptoms or diseases, except the prevalence of rhinitis and shortness of breath (P < 0.01). Regression model for the incidence of first three symptoms (expectoration, shortness of breath, and wheezing) from the cross-sectional survey indicated that the weight coefficients of factors associated with moxa smoke were lower than those of factors unrelated to moxa smoke, such as gender and personal history of respiratory diseases. (2) Historical retrospective cohort research showed that there was no significant difference in the % predicted PEF. No statistic difference was found between the exposed and nonexposed group in large airway function indexes (% predicted FEV1, % predicted FVC, and % predicted FEV1/FVC) and small airway function indexes (% predicted FEF25, % predicted FEF50, % predicted FEF75, and % predicted MMEF), either. Especially, the % predicted MVV among males (106.23 ± 2.92 vs. 95.56 ± 1.92, P < 0.01 and % predicted VC among females (100.70 ± 1.59 vs. 95.91 ± 1.61, P < 0.05) between the two groups had statistical significance, but did not cause pulmonary ventilation dysfunction.

CONCLUSIONS

MSE has no significant effect on the respiratory health of acupuncturists.

Lung Function Decline after 24 Weeks of Moxa Smoke Exposure in Rats

OBJECTIVE

Moxibustion is a complementary therapy that has been used for thousands of years. Burning moxa produces smoke and inhalable particulates. Recent research has indicated that smoke inhalation is associated with negative lung effects. This study aimed to evaluate the lung function of rats after moxa smoke exposure at different concentrations.

METHODS

Using a randomised block experiment design, 28 male Wistar rats were randomly divided into three moxa smoke groups (opacity) (n=7): low concentration (27.45 mg/m3), medium concentration (168.76 mg/m3), and high concentration (384.67 mg/m3) with a control group. Rats in the moxa smoke groups were exposed in an automatic dynamic exposure device separately with different concentrations for 20 min/d, 6d/week, for 24 weeks. Rats in the control group were exposed in the same space without moxa smoke. Lung function was evaluated by the AniRes 2005 animal pulmonary function analysing system. Statistical Product and Service Solutions 18.0 software was used for data analysis.

RESULTS

In the study, no deaths were found in any group. There was no difference of forced expiratory volume in one second/forced vital capacity percentage (FEV1/FVC%), inspiratory resistance (Ri), and expiratory resistance (Re) among each group after 24 weeks of moxa smoke exposure (P>0.05). Compared with the control group (0.33 ml/cmH20), dynamic compliance (Cdyn) was reduced in the medium (0.29 ml/cmH20) and high (0.25 ml/cmH20) concentration groups (P<0.05); however, Cdyn in the low concentration group (0.29 ml/cmH20) was not significantly affected.

CONCLUSION

Moxa smoke exposure at low concentrations did not affect the rat's lung function. Moxa smoke of medium and high concentrations destroyed the lung function represented by decreased Cdyn. However, moxa smoke of low concentrations (27.45 mg/m3) is much higher than the concentration in a regular moxibustion clinic (3.54 mg/m3). Moxa smoke at higher concentrations might destroy the lung function. The safety evaluation of moxa smoke requires further research.

The effects of particle density in moxa smoke on the ultrastructure of knee cartilage and expressions of TNF-α, IL-1b, BAX, and Bcl-2 mRNA in a rat model for osteoarthritis

BACKGROUND

The effectiveness of smokeless moxa and other means to reduce exposure are extensively investigated with regards to the health consequences of inhalation of moxa smoke, and clinical studies indicate that classical moxibustion is superior to smokeless moxa. This study aims to quantify the effects of particle density in moxa smoke on the clinical outcome with an established model, demonstrated to be effective for classical moxibustion.

OBJECTIVES

The purpose of this study is to explore the effects of particle density in moxa smoke on the ultrastructure of knee cartilage and expression of cytokine, tissue necrosing factor-alpha (TNF-α), interleukin 1 beta (IL-1b), apoptosis regulator, B-cell lymphoma-2 (Bcl-2), and BAX in a rat model for inflammatory joint disease.

METHODS

Fifty healthy experimental rats were randomly divided into five groups, including normal control, model control, and moxa exposure groups with low, medium, and high particle density, and n = 10/group. In addition, a knee osteoarthritis model was duplicated in the model control and moxa exposure groups. Finally, the ultrastructure of knee cartilage was observed using transmission electron microscopy, and messenger RNA (mRNA) expressions of TNF-α, IL-1b, BAX, and Bcl-2 were determined with quantitative fluorescence methodology.

RESULTS

In the model control and moxa exposure groups, knee cartilage indicated that histologic changes with the degree of injury were inversely proportional to moxa smoke density. The mRNA expressions of TNF-α, IL-1b, and BAX in synovial fluid, as an acute phase reactant, were similarly inversely related to moxa smoke density, but significantly increased. In contrast, Bcl-2, as an antiapoptotic, was substantially decreased in the model, while its levels were directly proportional to moxa smoke density. Besides, the ratio of Bcl-2/BAX mRNA was sharply decreased in the model group, but with levels proportional to moxa smoke density.

CONCLUSIONS

A correlation was found between the particle density in moxa smoke and degree of injury to knee cartilage, favoring higher particle densities. This can be partially related to the suppression of the inflammatory effects of TNF-α, IL-1b, enhancement of the antiapoptotic effects of Bcl-2, and, nevertheless, suppression of the apoptotic effects of BAX. Finally, the protective effect of antiapoptotic is one of the key mechanisms for an ambient moxa smoking environment.

Differential innervation of tissues located at traditional acupuncture points in the rat forehead and face

OBJECTIVES

To compare the neural pathways associated with the tissues located at different traditional acupuncture points in the rat forehead and face using the cholera toxin B subunit (CTB) neural tracing technique.

METHODS

After injection of CTB into the tissues at GB14, ST2 and ST6 in the rat, the neural labelling associated with each acupuncture point was revealed by fluorescent immunohistochemistry of the nervous system, including the trigeminal ganglion (TRG), cervical dorsal root ganglia (DRG), spinal cord and brain.

RESULTS

The CTB labelling included sensory neurons and their transganglionic axonal terminals, as well as motor neurons. The labelled sensory neurons associated with GB14, ST2 and ST6 were distributed in both the TRG and cervical DRG, and their centrally projected axons terminated in an orderly fashion at their corresponding targets in the spinal trigeminal nucleus and cervical spinal dorsal horn. In addition, labelled motor neurons were observed in the facial motor nucleus, trigeminal motor nucleus and cervical spinal ventral horn, in which facial motor neurons projected to the tissues located at all three acupuncture points. Trigeminal motor neurons innervated both ST2 and ST6, while spinal motor neurons only correlated with ST6.

CONCLUSIONS

These results indicate that the tissues located at each of these three traditional acupuncture points in the rat forehead and face has its own sensory and motor connection with the nervous system in a region-specific pattern through distinct neural pathways. Understanding the neuroanatomical characteristics of acupuncture points from the peripheral nervous system to the central nervous system should help inform acupuncture point selection according to the demands of the clinical situation.