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ObjectiveTo explore the clinical efficacy and safety of Fuzheng Huaji Longbi decoction in treating benign prostatic hyperplasia （BPH） in the patients with the syndrome of healthy Qi deficiency and blood stasis. MethodA total of 94 BPH patients were randomized into control and observation groups， with 47 patients in each group. The control group was treated with doxazosin mesylate sustained-release tablets， and the observation group with Fuzheng Huaji Longbi decoction on the basis of the therapy in the control group. After eight weeks， the international prostate symptom score （IPSS）， quality of life （QOL） score， residual urine volume （RUV）， maximum urinary flow rate （Qmax）， TCM syndrome score， TCM symptom score， electrocardiogram， and liver and kidney function were determined to evaluate the clinical efficacy and safety of the two groups. ResultAfter 8 weeks of treatment， the total response rate in the control group was 63.64% （28/44）， which was lower than that （84.44%， 38/45） in the observation group （χ2=5.026， P<0.05）. The clinical efficacy in the observation group was higher than that in the control group （Z=-2.17， P=0.030）. The treatment in both groups decreased the IPSS， QOL score， RUV， and TCM syndrome scores and increased the Qmax （P<0.05）. Moreover， the observation group had lower IPSS， QOL score， RUV， and TCM syndrome score （P<0.05） and higher Qmax than the control group after treatment （P<0.05）. The treatment in the observation group decreased all the TCM symptom scores （P<0.05）， while that in the control group only decreased the frequency of urination at night and the scores of dysuria， weak urine stream， and post-urinary drainage （P<0.05）. After treatment， the observation group had lower frequency of urination at night and lower scores of mental fatigue， cold limbs， lower abdominal discomfort， and loose stool than the control group （P<0.05）. No adverse events associated with the administration of Fuzheng Huaji Longbi decoction were observed during the treatment period. ConclusionFuzheng Huaji Longbi decoction is effective in treating BPH in the patients with the syndrome of healthy qi deficiency and blood stasis. It can relieve the clinical symptoms and improve the quality of life， being a safe and reliable choice for clinical application.
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ObjectiveTo observe the clinical effect of Yiqi Liangxue Shengji Formula （益气凉血生肌方， YLSF） on recurrence of angina pectoris and quality of life at eight weeks after perecutaneous coronary intervention （PCI）. MethodsEighty-two coronary artery disease （CAD） patients with qi deficiency and blood stasis and binding of stasis and heat syndrome who had underwent PCI were randomly divided into two groups with 41 patients each in the treatment group and the control group. Based on conventional western medicine after PCI， patients in the treatment group orally took YLSF granules while those in the control group were administered with placebo， one dose daily for 8 weeks. The recurrence rate of angina pectoris and readmission rate within eight weeks after PCI were recorded. Before and after treatment， total traditional Chinese medicine （TCM） syndrome score， Seattle Angina Questionnaire （SAQ） scores （physical limitation， angina stability， angina frequency， treatment satisfaction and disease perception）， and the SF-36 scores for quality of life （physical and mental health） were evaluated. The adverse reactions during medication in both groups were recorded. ResultsWithin eight weeks after PCI， the recurrence rate of angina pectoris in the treatment group （4/41， 9.76%） was significantly lower than that in the control group （11/41， 26.83%， P＜0.05）. The readmission rate in the treatment group was 2.44% （1/41）， while that in the control group was 12.20% （5/41）， with no significantly statistical difference （P＞0.05）. After treatment， total TCM syndrome score significantly decreased in both groups， while in terms of quality of life， the SAQ scores on domains of angina stability， angina frequency and disease perception as well as SF-36 total scores， physical health and mental health scores significantly increased （P＜0.05 or P＜0.01）. Compared between the two groups， total TCM syndrome score was significantly lower in the treatment group than the control group （P＜0.01）， while no significant differences were found in SAQ scores and SF-36 total， physical and mental health scores （P＞0.05）. No adverse reactions occurred in both groups during the treatment period. ConclusionYLSF can reduce the recurrence rate of angina pectoris within eight weeks after PCI for coronary artery disease， and can improve the TCM syndrome score， and have sound safety， with comparable effect to that of placebo in improving postoperative short-term quality of life.
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Objective@#To explore the differential expression profiles of DNA methylation sites/regions and potential molecular mechanisms in the peripheral blood of coronary heart disease (CHD)-induced unstable angina pectoris patients with or without Qi deficiency and blood stasis syndrome, and to provide scientific evidence for the conbination of disease and syndrome.@*Methods@#According to the pre-determined inclusion and exclusion criteria, the study subjects were enrolled and divided into two groups namely CHD-induced unstable angina group (G group) and healthy control group (J group) to conduct “disease” analysis, while G group was further divided into Qi deficiency and blood stasis syndrome group (case group) and non-Qi deficiency blood stasis syndrome group (control group) to perform “syndrome” analysis. The general data and clinical information of the study subjects were collected. The peripheral venous blood was extracted on an empty stomach, and the Illumina Infinium MethylationEPIC BeadChip (850K methylation chip) was used to detect the differential expressionprofiles of DNA methylation in each group, ChAMP software (V 2.14.0) was used for the differential methylation data analysis, with a threshold of the adjusted P value (adj.P.val) < 0.01. Gene Ontology (GO) and Kyoto Encyclopedia of Genomes (KEGG) were employed for the functional and pathway enrichment analyses of related mapped genes.@*Results@#A total of 263 differentially methylated CpG positions (DMPs) were screened out between G and J groups, including 191 hypermethylated positions such as cg05845204 and cg08906898, and 72 hypomethylated positions such as cg26919182 and cg13149459. These positions were mainly mapped to 148 genes encompassing RNA binding motif protein 39 (RBM39), acetyl-CoA acyltransferase 2 (ACAA2), protein phosphatase 1 regulatory subunit 12B (PPP1R12B), and the dual-specificity tyrosine phosphorylation-regulated kinase 2 (DYRK2). GO functional enrichment analysis revealed that the genes of the DMPs were primarily enriched in protein localization to chromosomes, regulation of cell morphogenesis, negative regulation of calcium-mediated signals, etc. KEGG pathway analysis suggested that the genes were mainly enriched in fatty acid metabolism and endocytosis pathways. In addition, a total of 23 differential methylation regions (DMRs) were identified, with overlapping genes such as transmembrane protein 232 (TMEM232), ribosomal protein large P1 (RPLP1), peroxisomal biogenesis factor 10 (PEX10), and forkhead box N3 (FOXN3) recognized. It was found that GO functions were mainly enriched in the negative regulation of Ras protein signal transduction, small GTPase-mediated signal transduction, negative regulation, etc. A total of 1 703 differential methylation sites were screened out between case and control groups, including 444 increased methylation positions such as cg05573767 and 1 259 decreased methylationpositions such as cg19938535, and cg03893872. These positions were mapped to 1 108 genes such as ribosomal protein S6 kinase A2 (RPS6KA2), leucine rich repeat containing 16A (LRRC16A), and hedgehog acyltransferase (HHAT). According to the GO functional enrichment analysis, the genes relating to the DMPs were mainly enriched in biological functions such as transmembrane receptor protein serine/threonine kinase signaling pathway and axonogenesis. The KEGG pathway enrichment analysis suggested the involvement of Rap1 signaling pathway, adenosine 5’-monophosphate-activated protein kinase (AMPK) signaling pathway, etc. A total of 21 DMRs were identified, including 22 overlapping genes such as mucin 4 (MUC4), three prime repair exonuclease 1 (TREX1), and LIM homeobox 6 (LHX6). GO analysis demonstrated that the genes primarily participated in molecular functions such as positive regulation of transmembrane transport, regulation of fatty acid metabolism, and copper ion binding.@*Conclusion@#This study reveals the methylation patterns of DMPs and DMRs in patients with Qi deficiency and blood stasis syndrome caused by CHD-induced unstable angina pectoris. Potential epigenetic regulation of fatty acid metabolism, Rap1 signaling, and other molecular functions are involved in the development of CHD between the "disease" and "syndrome".
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The present study systematically sorted out the existing research on Qilong Capsules in the treatment of ischemic stroke with Qi deficiency and blood stasis syndrome and comprehensively evaluated its clinical evidence and value to highlight the advantages and characteristics of products and provide references for the decision-making of national pharmaceutical management departments. Based on the evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, and pharmacoeconomics, the qualitative and quantitative evaluation of "6+1" dimensions of safety, effectiveness, economy, innovation, suitability, and accessibility, as well as characteristics of traditional Chinese medicine(TCM) was performed with multi-criteria decision analysis(MCDA) mo-del using the information, such as public data, literature data, pharmaceutical research, and questionnaire survey, and CSC v2.0 was used to calculate the clinical value of Qilong Capsules. The evaluation results were grade A, B, C, or D. Spontaneous reporting system(SRS) monitoring data, literature reports, clinical trials, and other multi-source safety evidence showed that the main adverse reactions of this drug included dry mouth, nausea, and rash, and no severe adverse reactions was found. The evidence was sufficient with small and controllable known risks, and the safety was grade A. Meta-analysis showed that Qilong Capsules combined with conventional western medicine in the treatment of acute ischemic stroke was superior to the control group in improving neurological deficits, clinical total response rate, patients' activities of daily living, and hemorheological indexes. The level of evidence was high with manifest clinical significance, and the effectiveness was grade A. The results of pharmacoeconomic research showed that Qilong Capsules combined with conventional western medicine in the treatment of ischemic stroke were advantageous in cost-effectiveness as compared with conventional western medicine alone, but the incremental effect was not significant. The quality evaluation results of the economic report were comparatively clear, and the economy was grade B. Aiming at major cerebrovascular diseases in the society and giving full play to the advantages of TCM, Qilong Capsules focused on the inheritance of classics and scientific and technological innovation, and innovation was grade B. The results of the questionnaire survey showed that the technical characteristics and drug application could meet the medication needs of clinical doctors and patients, and the suitability was grade B. The price level of this drug was comparatively high and the affordability was good since the treatment cost accounted for a small proportion of disposable income. The drug accessibility was good with a wide range of drug sales, sufficient production capacity, and sustainable medicinal materials resources, and was grade B. This drug was derived from the classic prescription Buyang Huanwu Decoction with rich experience of human application, which could regulate Qi and blood circulation, and the section of TCM characteristics was grade B. Based on the evidence evaluation results of "6+1" dimensions of Qilong Capsules, the comprehensive evaluation of clinical value was class A. It is suggested that it can be transformed into relevant policy results of basic clinical medication management according to procedures.
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Humans , Activities of Daily Living , Capsules , Ischemic Stroke , Medicine, Chinese Traditional , QiABSTRACT
Stroke is the leading cause of death and disability. Therefore， it is critical to develop the approaches for improving recovery and neural repair after stroke. Recovery after stroke involves complex interrelated systems of neural repair. The whole process of neural repair requires a series of coordinated interactions， such as response of neuronal cell body to traumatic stimuli， neural stem cell proliferation and migration， axoplasmic transport of signaling molecules， construction of cytoskeleton， and formation of axonal growth cone， to achieve regeneration and growth. As a potential new target for the treatment of neurologic defects， neural remodeling has important research significance in both the specific mechanism of neural repair and the clinical treatment of neurologic defects. After brain injury， single therapy is often ineffective due to the complex mechanism of internal repair， and thus comprehensive therapy becomes the development direction to improve the brain repair. Invigorating qi and promoting blood can promote nerve function remodeling after injury through neural protection， angiogenesis， neurogenesis， loop reconstruction， and cytokine regulation， playing a key role in nerve repair after stroke. Its mechanism is associated with autophagy， immunomodulation， and microRNA regulation， which fully embodies the multi-pathway， multi-target， and overall regulation characteristics of invigorating Qi and activating blood. Therefore， it is of theoretical and guiding significance to study the brain function rehabilitation after stroke by invigorating qi and activating blood.
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ObjectiveTo study the clinical efficacy of dapagliflozin combined with Shexiang Baoxinwan （SXBXW） in the treatment of acute heart failure with reduced ejection fraction （HFrEF） and syndrome of Qi deficiency and blood stasis. MethodA total of 176 patients hospitalized due to acute HFrEF （syndrome of Qi deficiency and blood stasis） were selected and randomized into control group， SXBXW group， dapagliflozin group， and SXBXW + dapagliflozin group （the latter three groups were called the intervention groups）. The New York Heart Association （NYHA） class， 6-minute walk test （6MWT） score， Kansas City Cardiomyopathy Questionnaire （KCCQ） score， traditional Chinese medicine （TCM） syndrome score， N-terminal pro-brain natriuretic peptide （NT-proBNP）， soluble suppression of tumorigenicity 2 （sST2）， interleukin-6 （IL-6）， and hypersensitive C-reactive protein （hs-CRP） of the patients were evaluated and measured at the time of admission， 1 week after treatment， and 2 weeks of treatment. Furthermore， the hospital stay， in-hospital mortality， and 30-day re-admission rate were recorded. Statistical analysis was performed to evaluate the efficacy of each group. ResultAfter 1 week of treatment， the SXBXW group exhibited superior NYHA class， KCCQ score， TCM syndrome score and curative effect， IL-6， and hs-CRP to the control group （P<0.05， P<0.01）. After 2 weeks of treatment， the SXBXW group showed superior TCM syndrome score， TCM curative effect， and hs-CRP （P<0.05， P<0.01） to the control group. The dapagliflozin group was superior to the control group in terms of TCM syndrome score， NT-proBNP， and sST2 （P<0.05， P<0.01） after 1 week of treatment and in terms of NYHA class， KCCQ score， NT-proBNP， sST2， and hospital stay （P<0.05， P<0.01） after 2 weeks of treatment. The SXBXW + dapagliflozin group exhibited better efficacy than the control group in terms of NYHA class， 6MWT score， KCCQ score， TCM syndrome score and curative effect， NT-proBNP， sST2， IL-6， and hs-CRP （P=0.014） after 1 week of treatment and in terms of NYHA class， KCCQ score， TCM syndrome score and curative effect， NT-proBNP， sST2， IL-6， hs-CRP， and hospital stay （P<0.01） after 2 weeks of treatment. ConclusionSXBXW and dapagliflozin have good therapeutic effect on acute HFrEF and syndrome of Qi deficiency and blood stasis， and their combination demonstrated better therapeutic effect， with good safety and tolerability.
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Cardiovascular diseases， with high incidence and high mortality， belong to the category of "chest impediment and heart pain" in traditional Chinese medicine （TCM）. Chinese medicines have unique effect on the prevention and treatment of cardiovascular diseases with little side effects. Huoxin pills， one of the National Essential Drugs， is formulated based on the basic pathogenesis of weak pulse at Yang and wiry pulse at Yin and the pathological basis of myocardial ischemia and hypoxia and used for treating angina pectoris of coronary heart disease （Qi deficiency and blood stasis syndrome）. This medicine is derived from the classic famous prescription and is composed of ten precious Chinese medicinal herbs. It can replenish Qi， activate blood， and warm collaterals to diffuse impediment by enhancing myocardial contractility and cardiac output to improve micro-circulation and increase coronary blood flow， regulating immune functions， alleviating inflammation， detoxifying， and tranquilizing mind. Clinically， it is suitable for patients with angina pectoris caused by the lack of heart Yang， chest tightness， shortness of breath， palpitation， fear of cold for limbs and so on， especially for the elderly with Yang deficiency or the patients with a history of myocardial infarction. On the basis of the available research reports， this paper explains the formula meaning of Huoxin pills from the perspective of the basic pathogenesis of coronary heart disease and predicts its action targets， location and links. Furthermore， we expound the mechanism of action of Huoxin pills based on basic research and clinical evidence-based research， aiming to provide data support and evidence for the clinical application of this medicine.
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Metastasis is the main cause of poor prognosis of malignant tumors， and intervention with metastasis is the key measure in the treatment of malignant tumors. Hematogenous metastasis， the most common tumor metastasis， falls into the category of "Chuanshe" in traditional Chinese medicine （TCM）， with Qi deficiency and blood stasis as the critical pathogenesis. In the fight against malignant tumors， TCM emphasizes the reinforcement of healthy Qi and the elimination of pathogenic factors， exhibiting its action advantages of multiple targets， multiple mechanisms， and multiple levels. Extensive clinical evidence has shown the exact efficacy of Chinese herbal compounds designed for invigorating Qi and activating blood in delaying the progression of tumor disease and prolonging the survival period of patients. In view of the important role of hematogenous metastasis in the prognosis of tumors， more and more studies have explored the effects and mechanisms of Chinese herbal compounds capable of invigorating Qi and activating blood in intervening in hematogenous metastasis. This paper summarized the relevant literature reports in China and abroad on the intervention of Chinese herbal compounds capable of invigorating Qi and activating blood in the hematogenous metastasis of malignant tumors， in order to provide a theoretical basis for the clinical application of Qi-invigorating and blood-activating therapy in the treatment of malignant tumors. It has been found that Chinese herbal compounds formulated for invigorating qi and activating blood are effective in hindering several key steps in hematogenous metastasis through various mechanisms， including regulating the expression of cell adhesion molecules， inhibiting extracellular matrix degradation and angiogenesis， enhancing the killing effect of immunity， and improving blood hypercoagulability and hyperviscosity. Furthermore， the combination of invigorating Qi and activating blood targets the pathogenesis essence （Qi deficiency and blood stasis， characterized by sthenia in origin and asthenia in superficiality） of malignant tumor much better. Some comparative studies have demonstrated that the anti-metastasis effect of Qi-invigorating and blood-activating therapy is significantly stronger than that of the Qi-invigorating or blood-activating therapy alone， and such combination avoids the possible risk of the metastasis of malignant tumors triggered by the use of either of them. This study has provided some reference for the current clinical application of TCM for improving the prognosis of malignant tumors.
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ObjectiveTo evaluate the effect and safety of Buyang Huanwutang in treatment of connective tissue disease-associated pulmonary fibrosis in the patients with syndrome of Qi deficiency and blood stasis and explore the possible anti-fibrosis mechanism of Buyang Huanwutang. MethodSixty-six patients with connective tissue disease-associated pulmonary fibrosis with syndrome of Qi deficiency and blood stasis were randomized to receive either Buyang Huanwutang combined with routine therapy or routine therapy for 4 weeks. The primary outcome indicator was change in forced vital capacity （FVC） from the baseline， and the secondary outcome indicators included the changes in percentage of predicted forced vital capacity （FVC%pred）， percentage of forced expiratory volume in first second to predicted value （FEV1%pred）， King's Brief Interstitial Lung Disease （K-BILD） total score， 6 minute walking distance （6MWD）， hydroxyproline （HYP）， matrix metalloproteinase （MMP）， tissue inhibitor of metalloproteinase-1 （TIMP-1）， and transforming growth factor-β （TGF-β） from baseline. Patients in line with the inclusion criteria were included in the primary analysis， and sensitivity analysis was performed after multiple imputation of missing data. Safety set was adopted for safety analysis. ResultThe 66 patients （included in the sensitivity analysis） meeting the inclusion criteria included 34 in the observation group and 32 in the control group， and 60 patients finally received the whole trial intervention （included for primary analysis）. Compared with the baseline， the FVC increased in the observation group and decreased in the control group after intervention （P<0.01）， which was consistent between the sensitivity analysis and the primary analysis. The changes in FVC%pred， FEV1%pred， 6MWD， and K-BILD total score from baseline in the observation group were superior to those in the control group （P<0.01）， with consistent results between the sensitivity analysis and the primary analysis. TIMP-1 in the observation group decreased compared with baseline （P<0.05）， while TIMP-1 in the two groups showed no significant changes from the baseline The observation group outperformed the control group in the changes in HYP， MMP-9， and TGF-β from baseline （P<0.05）. The common adverse events were cough， diarrhea， nausea， rash， and upper gastrointestinal tract infection， the incidence of which showed no statistical difference between the two groups. ConclusionBuyang Huanwutang can improve lung function， motor function， and quality of life in patients with connective tissue disease-associated pulmonary fibrosis and has good safety. The mechanism may be related to the reduction of TGF-β， MMP-9， and TIMP-1 levels and maintaining of MMP-9/TIMP-1 balance.
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Protective effect of Qilong Capsules(QL) on the myocardial fibrosis and blood circulation of rats with coronary heart disease of Qi deficiency and blood stasis type was investigated. Sleep deprivation and coronary artery ligation were used to construct a disease-symptom combination model, and 60 SD rats were divided into sham operation(sham) group, syndrome(S) group, disease and syndrome(M) group and QL group randomly. The treatment group received administration of QL 0.4 g·kg~(-1)·d~(-1). Other groups were given the same amount of normal saline. The disease indexes of each group [left ventricular end diastolic diameter(LVESD), left ventricular end systolic diameter(LVEDD), left ventricular ejection fraction(LVEF), left ventricular axis shortening rate(LVFS), myocardial histopathology, platelet morphology, peripheral blood flow] and syndrome indexes(tongue color, pulse, grip power) were detected. In sham group, cardiomyocytes and myocardial fibers were arranged neatly and densely with clear structures. The tongues' color in sham were light red, and the pulse shape were regular. RGB is a parameter reflected the brightness of the image of the tongue. In the S group, the amplitude and frequency of the animal's pulse increased accompanied by decreasing R,G,B, however, the decreased R,G,B was accompanied by reduced pulse amplitude in M group. And in M group, we observed fuzzy cell morphology, hypertrophied myocytes, disordered arrangement of cardiomyocytes and myocardial fibers, reduced peripheral blood flow and increased collagen volume fraction(CVF). Increased LVESD and LVEDD, and decreased LVEF and LVFS represented cardiac function in S group was significantly lower than that in sham. In QL group, the tongue's color was red and the pulse was smooth. The myocardial fibers of the QL group were arranged neatly and secreted less collagen. It improved the blood circulation in the sole and tail, and reversed the increasing of LVEDD, LVESD and the decreasing of LVEF and LVFS of M group. Platelets in M and S group showed high reactivity, and QL could decrease aggregation risk. In conclusion, Qilong Capsules has an obvious myocardial protective effect on ischemic cardiomyopathy, which may inhibit the degree of myocardial fibrosis and reduce platelet reactivity.
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Animals , Rats , Capsules , Cardiomyopathies/drug therapy , Fibrosis , Myocytes, Cardiac , Qi , Rats, Sprague-Dawley , Stroke Volume , Ventricular Function, LeftABSTRACT
Astragali Radix-Angelicae Sinensis Radix （AA） is a basic pair of drugs mainly targeting the syndrome characteristics of Qi and blood diseases. LI Dong-yuan's Danggui Buxuetang （DBT） is composed of AA， which is mainly used to tonify Qi and generate blood， with main indications of Qi deficiency and blood deficiency， blood heat and so on. It is favored by doctors because of its refined prescription and remarkable curative effect. However， there are many compatibility ratios of AA in different prescriptions in ancient books， and their efficacy and indications are also slightly different. This research showed that DBT also had the effect of invigorating Qi and activating blood， and the previous study of the group showed that 3∶1 compatibility ratio of the two herbs in the total amount of 36 g had more obvious effect of invigorating Qi and activating blood. By consulting the relevant literature， it was found that the drug pair had a certain effect of invigorating Qi and activating blood in various compatibility ratios such as 1∶1， 3∶1， 1∶5， 3∶2， 2∶1， 5∶1. The corresponding pharmacological effect mainly included regulating the energy metabolism of substances， regulating immune function， reducing blood viscosity， anti-oxidation stress， anti-inflammation， lowering blood lipids， lowering blood sugar， protecting heart function， protecting blood vessel wall， intervening angiogenesis， fighting against organ tissue fibrosis and so on. Regardless of the AA single-medicine's activating blood effect and the theory that "Qi circulation leads to blood circulation" or the drug pair's manifestation in modern pharmacological effects， all of these have confirmed that AA's effect of invigorating Qi and activating blood does exist， and the difference of action performance caused by different ratios of AA is closely related to dosage and proportion， which needs further study. Based on the study focusing on the effect of tonifying Qi and generating blood， it is easy to ignore the effect of invigorating Qi and activating blood， which limits the clinical application of the latter. Therefore， the tonifying Qi and activating blood circulation effect of the drug pair is reviewed in this paper， so as to provide a theoretical basis for its clinical rational drug use and related research.
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Objective:To systematically sort out and summarize the medication rules of clinical prescriptions for coronary heart disease with heart failure of Qi deficiency and blood stasis syndrome，and to provide reference for selecting prescriptions and medications for the treatment of coronary heart disease （CHD） with traditional Chinese medicine （TCM）. Method:All relevant literature concerning the treatment of CHD with compound TCM prescriptions for Qi deficiency and blood statis syndrome from 2000 to 2020 were retrieved from the China National Knowledge Network （CNKI），WanFang database （WanFang），and VIP journal database （VIP），and the names of prescriptions and drug components were extracted，followed by the frequency of drug use and drug category. Association rules of high-frequency drugs were analyzed by SPSS 18.0，and systematic clustering analysis was conducted by SPSS 21.0. Result:Finally，41 qualified literature articles covering 35 prescriptons and 66 drugs were included in the study. The total frequency of the drugs was 433 times. Among them，there were a total of 25 traditional Chinese medicines with a frequency of ≥5 times. The top 3 frequently used Chinese medicines were Astragali Radix （8.8%），Salviae Miltiorrhizae Radix et Rhizoma （7.2%），Chuanxiong Rhizoma （5.8%）. A total of 15 types of drugs were involved，among which tonic drugs （31.4%），blood promoting and blood stasis drugs （28.2%），and hydration and dampening drugs （7.6%） were used most frequently. The association rule analysis of traditional Chinese medicines with frequency of ≥ 5 showed that there were 13 pairs of binomial associations in 25 traditional Chinese medicines，with Astragali Radix in combination with Salviae Miltiorrhizae Radix et Rhizoma，Chuanxiong Rhizoma，Carthami Flos，et al. There were 8 groups of three associations，with Astragali Radix，Salviae Miltiorrhizae Radix et Rhizoma，and Chuanxiong Rhizoma as the main combinations. A systematic clustering analysis showed that the clustering effect was best when the 25 traditional Chinese medicines were clustered into 5 categories. Conclusion:The treatment of coronary heart disease with heart failure of Qi deficiency and blood stasis syndrome is based on replenishing qi and activating blood circulation，supplemented by warming yang，diuresis，and phlegm-resolving drugs，which can enhance the clinical efficacy. Two basic prescriptions of Buyang Huanwutang and Si junzitang are extracted. Other combinations of prescriptions and drugs can provide references for the clinical treatment of coronary heart disease with heart failure.
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Interventional or thrombolytic therapy for acute myocardial infarction （AMI） has the effect of opening occluded coronary arteries. However， due to no myocardial regurgitation， ischemia/reperfusion injury and microvascular structure and function destruction， leading to myocardial fibrosis following AMI， ventricular remodeling， and even cardiac failure may occur. Collaterals doctrine is used to guide the investigation into traditional Chinese medicine pathogenesis and clinical treatment of myocardial fibrosis following AMI. Consequently， it proposes the pathogenesis characteristic of "Qi deficiency and blood stasis， collaterals obstruction" and medication principle of "dispersing and dredging"， to develop the formula of Tongxinluo. Fundamental and clinical researches have demonstrated it can effectively protect the structure and function of myocardial microvascular endothelial cells， improve no reflow and reperfusion injury， and inhibit myocardial fibrosis after AMI， which further supports scientific value of the collaterals doctrine.
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Objective:To discuss clinical effect of Zhuyu Zhixuetang to chronic endometritis （CE） with syndrome of Qi deficiency and blood stasis and to study improvement effect to pregnancy outcome. Method:One hundred and forty-four patients were randomly divided into two groups， patients in control group were 72 cases and in observation group were 72 cases. In control group， 66 patients completed the therapy because of 4 falling off or missing visit and 2 eliminated， and in observation group， 65 patients completed the therapy because of 3 falling off or missing visit and 5 eliminated. In two groups. anti-infection treatment was gicen to patients. Patients in control group got Fuke Qianjin Pian， 6 tablets/time， 3 times/day. Patients in observation group got Zhuyu Zhixuetang， 1 dose/day. The treatment was continued for 3 months and the follow up was recorded for 6 months. Before and after treatment， changes of menstrual volume， period and cycle were recorded. And hysteroscopy and color Doppler ultrasound of vagina were made， and endometrial morphology and endometrial receptivity were evaluated ［endometrial thickness， resistance index （RI）， pulsation index （PI） and blood flow index （FI）］ were evaluated， and pathology of endometrial were tested. And scores of syndrome of Qi deficiency and blood stasis were graded， levels of interleukin-1 <italic>β</italic> （IL-1<italic> β</italic>）， IL-6 and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） and T-lymphoid subsets （CD3<sup>+</sup>， CD4<sup>+</sup>， CD8<sup>+</sup>） in peripheral blood were measured. Pregnancy and miscarriage were recorded and the safety was evaluated. Result:After treatment， menstrual volume， menstrual period， cycle and complete normal rate of menstruation in observation group were all higher than those in control group （<italic>P</italic><0.05）. Endometrial thickness and FI were more than those in control group （<italic>P</italic><0.01）， RI and PI were lower than RI and PI in control group （<italic>P</italic><0.01）. And compared with control group， levels of IL-1<italic>β</italic>， IL-6， TNF-<italic>α</italic> and CD8<sup>+ </sup>were less （<italic>P</italic><0.01）. And levels of CD3<sup>+</sup>， CD4<sup>+</sup> and CD4<sup>+</sup>/ CD8<sup>+</sup> were higher than the data in control group （<italic>P</italic><0.01）. During 6 months follow-up， pregnancy rate in observation group was 46.97% （31/66） was higher than 27.69% （18/65） in control group （<italic>χ</italic><sup>2</sup>=5.197， <italic>P</italic><0.05）. Total effective rate of endometrial morphology was 96.97% （64/66） higher than 86.15% （56/65） in control group （<italic>χ</italic><sup>2</sup>=4.981， <italic>P</italic><0.05）. Total effective rate endometrial pathology was 95.45% （63/66） higher than 84.62% （55/65） in control group （<italic>χ</italic><sup>2</sup>=4.304， <italic>P</italic><0.05）. Total effective rate of comprehensive clinical effect was 93.94% （62/66） higher than 81.54% （55/65） in control group （<italic>χ</italic><sup>2</sup>=4.696， <italic>P</italic><0.05）. There was no adverse reactions related to traditional Chinese medicine. Conclusion:Zhuyu Zhixuetang can regulate menstruation， relieve clinical symptoms， improve endometrial morphology under hysteroscopy， regulate systemic and local immune inflammatory response， improve CP， thus improve pregnancy outcome， with better comprehensive effect and safety.
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Objective:To explore the correlations of the severity of heart failure related to coronary heart disease arising from Qi deficiency and blood stasis with cardiac function indexes， energy metabolism indexes， coagulation function indexes， and inflammatory factors， in order to provide a scientific basis for further research on the biological foundation of this disease. Method:Two hundred patients with heart failure related to coronary heart disease of Qi deficiency and blood stasis syndrome were collected and then classified into mild， moderate and severe groups according to their scores of Qi deficiency and blood stasis syndrome. Meanwhile， 40 healthy persons confirmed by physical examination during the same period were included into the control group. Such biological indexes as cardiac function indexes， energy metabolism indexes， coagulation function indexes， and inflammatory factors were determined in patients of each group for comparison. Then the Spearman rank correlation analysis was conducted to figure out the correlations between differential indexes and the severity of Qi deficiency and blood stasis syndrome， followed by the determination of risk factors for the severity of Qi deficiency and blood stasis syndrome by ordered logistic regression analysis. Result:The cardiac function indexes， energy metabolism indexes， coagulation function indexes， and inflammatory factors in patients with heart failure related to coronary heart disease arising from Qi deficiency and blood stasis varied significantly. There were significant statistical differences in the levels of N-terminal pro-B-type natriuretic peptide （NT-ProBNP）， 6-minute walk test （6MWT）， heart-type fatty acid-binging protein （H-FABP）， prothrombin time （PT）， activated partial thromboplastin time （APTT）， tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， and nitric oxide （NO） among the mild， moderate， and severe groups （<italic>P</italic><0.05）. The severity of Qi deficiency and blood stasis syndrome was positively correlated with NT-ProBNP （<italic>r</italic>=0.144）， PT （<italic>r</italic>=0.173）， and APTT （<italic>r</italic>=0.144）， but negatively with 6MWT （<italic>r</italic>=-0.287）. The 6MWT［odds ratio（OR）=0.995， 95% confidence interval（CI） 0.991-0.998），<italic>P</italic><0.01］ and APTT（OR=1.088，95%CI 1.021-1.157，<italic>P</italic><0.01） were independent risk factors affecting the severity of heart failure related to coronary heart disease arising from Qi deficiency and blood stasis. Conclusion:The severity of heart failure related to coronary heart disease of Qi deficiency and blood stasis syndrome is closely related to NT-ProBNP， 6MWT， H-FABP， PT， APTT， TNF-<italic>α</italic>， and NO. Moreover， 6MWT and APTT can be used as independent risk factors to evaluate the severity of patients with heart failure related to coronary heart disease due to Qi deficiency and blood stasis.
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Objective:To discuss clinical effect of Shexiang Tongxin pills to syndrome of Qi deficiency and blood stasis in ischemic heart failure （IHF） and to study the mechanism to myocardial fibrosis and vascular regeneration. Method:One hundred and forty patients were randomly divided into observation group （70 cases） and control group （70 cases） with the same cases. 66 patients in control group finish the therapy （3 patients fall off or lost visit， 1 were eliminated）. 65 patients in observation group completed the therapy （4 patients were falling off， 1 were eliminated）. Both groups patients got combined treatment according to the guiding. Patients in control group got simulated medicine of Shexiang Tongxin pills， 2 pills/time， 3 times/day. Patients in observation group got Shexiang Tongxin pills， 2 pills/time， 3 times/day. The treatment was continued for 24 weeks. Before and after treatment， the left ventricular ejection fraction （LVEF）， cardiac output （CO）， end diastolic diameter （LVEDd）， left posterior wall thickness （LVPW）， left ventricular mass index （LVMI） and left ventricular remodeling index （LVRI） were measured by echocardiography. And scores of six minute walking test （6 MWT）， Lee's heart failure score， Qi deficiency and blood stasis syndrome score and Minnesota Heart Failure Quality of life questionnaire （MLHFQ） were graded. And levels of N-terminal B-type natriuretic peptide （NT-proBNP）， transforming growth factor-β1 （TGF-β1）， soluble ST2 （sST2）， matrix metalloproteinase-2 （MMP-2）， matrix metalloproteinase inhibitor-2 （TIMP-2）， insulin-like growth factor-1 （IGF-1）， vascular endothelial growth factor （VEGF）， angiopoietin1 （Ang1） and angiopoietin2 （Ang2）， and the safety was evaluated. Result:The total clinical effect in observation group was 90.77% （59/65） higher than 74.24% （49/66） in control group （χ2=6.179， P<0.05）. Levels of LVEF， CO， LVRI， 6 MWT， TIMP-2， IGF-1， VEGF and Ang1 were higher than those in control group （P<0.01）. And levels of LVEDd， LVPW and LVMI were lower than those in control group （P<0.05）， levels of NT-proBNP， TGF-β1， sST2， MMP-2 and Ang2 were lower than those in control group （P<0.01）， scores of Lee's heart failure score， Qi deficiency and blood stasis syndrome score and MLHFQ were lower than those in control group （P<0.01）. Besides， there was no adverse reactions caused by Shexiang Tongxin dropping pills. Conclusion:On the basis of conventional western medicine treatment， Shexiang Tongxin drop pills can improve the ventricular remodeling， improve the heart function， reduce the clinical symptoms， increase the exercise tolerance and quality of life of the patients by affecting the myocardial fibrosis and vascular regeneration factor， which has better clinical efficacy and safety.
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OBJECTIVE To explore the curative effect and mechanism of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome. METHODS The patients with coronary heart dis?ease of Qi deficiency and blood stasis syndrome were treated with Yiqi Huoxue decoction for 3 months, and the changes of cardiac function were observed. 61 serum samples (including 29 cases of disease group and 32 cases of Yiqi Huoxue expression group) were analyzed by non labeled proteomics. The disease group was used as the control group, and the protein with expression level difference of more than 1.2 folds (P<0.05) was screened. The molecular function, biologi?cal pathway and protein interaction of the different proteins were analyzed by bioinformatics, so as to identify the molecu?lar and biological pathway of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome. RESULTS Clinical treatment found that Yiqi Huoxue decoction can improve TCM syndrome score and left ventricular ejection fraction, regulate blood glucose and blood lipid levels, prolong thrombin time, and improve heart function. The results of proteomic quantitative analysis showed that there were 69 proteins with different expression levels in the disease group. Bioinformatics analysis results showed that Yiqi Huoxue decoction may regulate ApoA1, alpha-2 and other proteins to act on HDL assembly, platelet degradation, PI3K Akt signaling pathway, and then play a therapeutic role in coronary heart disease with Qi deficiency and blood stasis syndrome. CONCLUSION Yiqi Huoxue decoction can effectively improved the heart function decline caused by Qi deficiency and blood stasis syn?drome of coronary heart disease. It mainly act on energy metabolism and platelet activation pathway by activating HDL assembly and platelet degradation signal pathway proteins. This study can provide reference for the follow-up treatment mechanism of Qi deficiency and blood stasis syndrome of coronary heart disease.
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Compound Renshen Buqi Granules have been widely used to treat chronic heart failure(CHF) due to Qi deficiency and blood stasis, but the mechanism of action remains unclear. This paper explored the pathogenesis of CHF due to Qi deficiency and blood stasis and the intervention mechanism of Compound Renshen Buqi Granules based on quantitative proteomics for uncovering the biological basis. SD rats were divided into the normal control(N) group, normal+Compound Renshen Buqi Granules(ND) group, model(M) group, model+Compound Renshen Buqi Granules(D) group, and positive control(Y) group. The rat model of CHF due to Qi deficiency and blood stasis was established by ligation of the left anterior descending(LAD) coronary artery and chronic sleep deprivation. The rats in the ND group and D group were provided with Compound Renshen Buqi Granules, while those in the Y group received valsartan. Six weeks later, the serum was sampled and the data-dependent acquisition(DDA) was employed for the non-targeted quantitative proteomics analysis of the differences in protein expression among groups, followed by the targeted analysis of differentially expressed proteins(DEPs) generated by data-independent acquisition(DIA). Compared with the N group, the rats in the M group pre-sented with decreased body weight, grip strength, and pulse amplitude and increased RGB value on the tongue surface. The pathomorphological examination revealed inflammatory cell infiltration, cell degeneration and necrosis, tissue fibrosis, etc. After the intervention with Compound Renshen Buqi Granules, multiple indicators were reversed. As demonstrated by proteomics results, there were 144 and 111 DEPs found in the M group and ND group in comparison with the N group. Compared with the M group, 107 and 194 DEPs were found in the D group and the Y group, respectively. Compared with the ND group, 119 DEPs were detected in the D group. As illustrated by DIA-based verification, the quantitative results of six proteins in each group were consistent with those by DDA. The syndrome indicators and pathomorphological examination results demonstrated that the protein expression profile of rats with CHF due to Qi deficiency and blood stasis changed obviously. However, Compound Renshen Buqi Granules were able to reverse the differential expression of immune proteins to regulate CHF of Qi deficiency and blood stasis syndrome, which has provided clues for figuring out the pathogenesis of CHF due to Qi deficiency and blood stasis and the intervention mechanism of Compound Renshen Buqi Granules.
Subject(s)
Animals , Rats , Heart Failure/drug therapy , Medicine, Chinese Traditional , Panax , Proteomics , Qi , Rats, Sprague-DawleyABSTRACT
Diabetes mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia. Its main complications of diabetes, such as diabetic angiopathy, have seriously affected the quality of life for patients, and have become an important cause of death and disability. The underlying pathological changes include macrovascular lesions and microvascular lesions. Diabetic macrovascular lesions mainly involve thoracic aorta, coronary artery, carotid artery, cerebral artery and peripheral blood vessels, etc., and the common clinical diseases include coronary heart disease, stroke, peripheral neuropathy, lower extremity arteriosclerosis, etc. Diabetic microvascular lesions mainly involve the heart, brain, kidney and other microvessels. Nowadays, various new oral hypoglycemic agents and insulin have emerged in the society and are widely used in clinical practice. However, traditional Chinese medicines(TCMs) have stable curative effect, less side effect, and can improve glucose metabolism, lipid metabolism, insulin resistance, oxidative stress, expression of inflammatory cytokines, vascular endothelial injury, microcirculation disorders, balance of fibrinolysis system and blood coagulation system, and improve the syndromes of TCMs, etc. They have been widely recognized and applied in the prevention and treatment of diabetic angiopathy. A profound understanding on the etiology, pathogenesis and treatment of diabetic angiopathy has been formed in Chinese medicine. Therefore, in this paper, we would summarizes the understanding on Chinese medicine for diabetic angiopathy and the mechanism of Yiqi Huoxue prescription in the treatment of diabetic angiopathy in the past three years.
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Objective:To observe clinical effect of Tiaopi Huxin decoction to chronic heart failure (CHF) and to study mechanism of action of anti-inflammatory and anti ventricular remodeling.Method:One hundred and forty patients were randomly divided into control group (70 cases) and observation group (70 cases) by random number table. And during the study, there were four patients for falling off and missing visit, two eliminated patients in control group, and 64 patients finished the study, and there were six patients for falling off and missing visit in observation group, so 64 patients finished the study. Two groups of patients got losartan potassium tablets, 50 mg/time, 1 time/day, metoprolol tablets, 200 mg/time, 1 time/day, spironolactone tablets, 20-40 mg/time, 1 time/day, control group Jingshe Yiqi granule 1 bag/time,3 times/day,flushed with boiling water, patients in observation group added Tiaopi Huxin decoction, 1 dose/day. The courses of treatment were 12 weeks. Before and after treatment, left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDd), leftventricular end-stolic diameter (LVEDs), stroke volume (SV), cardiac output (CO) and ratio of peak value of early diastolic velocity of mitral valve and peak velocity of late diastolic mitral valve (E/A) were recorded by echocardiography. And scores of Lee's heart failure, Qi deficiency and blood stasis, Minnesota Heart Failure Quality of life questionnaire (MLHFQ) and 6 minutes' walking test（6 MWT）were graded. And levels of N-terminal B-type natriuretic peptide (NT-proBNP), galactose lectin-3, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-17, transforming growth factor (TGF) - β and matrix metalloproteinase-9 (MMP-9) were detected.Result:After treatment, LVEDd and LVEDs were lower than that in control group (P<0.05). LVEF, SV, CO and E/A were higher than those in control group (P<0.05). And scores of Lee's heart failure, Qi deficiency blood stasis and MLHFQ were lower than those in control group (P<0.01). And 6 MWT was more than that in control group (P<0.01). And levels of NT-proBNP, galactose lectin 3, IL-17, IL-6, TNF-α, TGF-β and MMP-9 were lower than those in control group (P<0.01). Effect of cardiac function was better than that in control group (Z=2.191, P<0.05).Conclusion:On the basis of conventional western medicine treatment and according to theory of heart and spleen, Tiaopi Huxin decoction can improve the clinical symptoms and signs of heart failure, and it had effect of anti-inflammatory, and can improve ventricular remodeling, improve the exercise tolerance and quality of life of patients, improve the prognosis of heart failure, and its clinical effect is better than that of Western medicine alone.