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ObjectiveTo explore the clinical efficacy and safety of the combination of Erchentang and Bixie Fenqingyin in the treatment of patients with acute cerebral infarction accompanied by hyperuricemia of phlegm and blood stasis blocking collaterals syndrome to provide a new method and evidence for the treatment of acute cerebral infarction with hyperuricemia. MethodA total of 132 eligible patients with acute cerebral infarction accompanied by hyperuricemia of phlegm and blood stasis blocking collaterals syndrome admitted to the Putuo Hospital of Shanghai University of Traditional Chinese Medicine（TCM） from May 2021 to May 2022 were randomly divided into a Chinese medicine group， a western medicine group， and a control group， with 44 cases in each group. All three groups received routine western medical treatment for acute cerebral infarction. Additionally， the Chinese medicine group received Erchentang combined with Bixie Fenqingyin， the western medicine group received Benzbromarone tablets， and the control group did not receive any uric acid-lowering treatment. The treatment duration was four weeks. The modified Rankin Scale （mRS） score after three months of onset， as well as the National Institutes of Health Stroke Scale （NIHSS） scores， TCM syndrome scores， serum uric acid （SUA） levels， serum C-reactive protein （CRP） and interleukin-6 （IL-6） levels， serum superoxide dismutase （SOD） and malondialdehyde （MDA） levels， and other safety indicators were observed before and after treatment. ResultA total of 129 cases completed the trial observation， with 43 cases in the Chinese medicine group， 42 cases in the western medicine group， and 44 cases in the control group. The rate of good prognosis in the Chinese medicine group （83.7%，36/43） was higher than that in the western medicine group （64.3%，27/42） and the control group （40.9%，18/44） （χ2=4.184，16.930，P<0.05）， and the western medicine group was superior to the control group （χ2=4.707，P<0.05）. After treatment， the NIHSS scores， TCM syndrome scores， SUA， CRP， IL-6， and MDA levels of the patients in all three groups decreased， while the SOD levels increased compared with those before treatment （P<0.05）. Among them， the improvement in NIHSS score was better in the Chinese medicine group and the western medicine group than in the control group （P<0.05）. The Chinese medicine group showed the greatest improvement in TCM syndrome （P<0.05）， while the western medicine group showed the greatest reduction in uric acid levels （P<0.05）. No significant abnormalities in safety indicators were observed before and after treatment in the three groups， and no serious adverse reactions were reported. ConclusionThe combination of Erchentang and Bixie Fenqingyin can significantly improve the prognosis， early neurological deficits， and TCM syndromes of patients acute cerebral infarction accompanied by hyperuricemia of phlegm and blood stasis blocking collaterals syndrome. It can also lower uric acid levels and inhibit inflammatory and oxidative stress reactions.
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Objective To investigate the anti-hyperuricemia effects of Bixie deacidification fang on hyperuricemia mice and its mechanism of renal protein transport. Methods The effects of Bixie deacidification fang were investigated on hyperuricemia mice induced by potassium oxonate. Bixie deacidification fang was administered to hyperuricemia mice daily at doses of 220, 440 and 880 mg/kg for 10 days, and allopurinol (5mg/kg) was given as positive control. Serum and urine levels of uric acid and creatinine were determined by colorimetric method. Simultaneously, protein levels of urate transporter 1 (URAT1) and organic anion transporter 1 (OAT1) in the kidney were analyzed by Western blot. Results Compared with the model group, high-dose of Bixie deacidification fang inhibited xanthine oxidase (XOD) activities in serum (18.12±1.33 u/L) and that in liver (70.15±5.20 u/g protein) (P<0.05), decrease levels of serum uric acid (2.04 ± 0.64mg/L) (P<0.05) and serum creatinine (0.35±0.18µmol/L) and blood urea nitrogen (BUN)(8.83±0.71mmol/L) (P<0.05), ncreased levels of urine uric acid (38.34±8.23mg/L), urine creatinine (34.38±1.98mmol/L), down-regulated of URAT1 and up-regulated of OAT1 protein expressions (P<0.05) in the renal tissue of hyperuricemia mice. Conclusion Bixie deacidification fang recipe may promote the excretion of uric acid in the kidney by up-regulating the expression of OAT1 protein to promote the excretion of uric acid, and down-regulating the expression of URAT1 protein to inhibit the reabsorption of uric acid.
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Objective:To observe the clinical efficacy of modified Bixie Shengshitang on acute gouty arthritis due to hot and humid syndrome. Method:According to the random number table method， 130 cases were randomly divided into control group and observation group， with 65 cases in each group. All of the cases were given the basic non-drug therapy. The control group was given colchicine， while observation group was given modified Bixie Shengshitang + colchicine for 14 d. Before treatment and at 3， 7 and 14 d after treatment， total symptom score （TSS） and traditional Chinese medicine （TCM） syndrome were observed between the two groups， respectively. Blood uric acid （BUA）， urinary uric acid （UUA）， erythrocyte sedimentation rate （ESR）， proinflammatory factors ［tumor necrosis factor-α （TNF-α）， interleukin-1 （IL-1）， interleukin-8 （IL-8）］ and anti-inflammatory factors ［interforon gamma receptor （IFN-γ）， interleukin-4 （IL-4）， interleukin-18（IL-18）］ in serum and joint fluid were detected before and after treatment. The clinical efficacy and safety of the two groups were compared. Result:The total effective rate was 96.9% （62/64） in observation group， which was higher than 80.6% （50/62） in control group （χ2=5.713， P<0.05）. Compared with control group at 3， 7 and 14 d after treatment， TSS and TCM syndrome scores in observation group were significantly reduced （P<0.05）. Compared with control group after treatment， BUA， ESR， TNF-α， IL-1β， IL-8 and UUA， IFN-γ， IL-4 and IL-18 were significantly decreased in observation group （P<0.05）. There was no serious adverse event during the study period. The incidence of adverse reactions was 54.7% （35/64） in observation group， which was lower than 82.3% （51/62） in control group （χ2=9.326， P<0.05）. Conclusion:Modified Bixie Shengshitang can significantly alleviate the clinical symptoms of patients with acute gouty arthritis due to hot and humid syndrome， and adjust levels of uric acid and inflammatory cytokines， with a low recurrence rate.
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In the Qing dynasty Cheng Zhongling based on the Cheng's Bixie-Fenqing formula of Yang Tan, a doctor in the Southern Song dynasty, retained the original Sichuan Bixie and Acorus tatarinowii, and add Phellodendron chinense, and Semen plantaginis to form Cheng's Bixie-Fenqing formula. It had the function of get rid of dampness and heat, and is a classic prescription for stranguria, like the treatment of white turbidity. The author retrieved the related literature of Cheng's Bixie-Fenqing formula in recent years, analyzed the composition and clinical application of Cheng's Bixie-Fenqing formula, and summarized the advantages and disadvantages of the existing researches, providing reference for the further development of Cheng's Bixie-Fenqing formula.
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In the Qing dynasty Cheng Zhongling based on the Cheng's Bixie-Fenqing formula of Yang Tan, a doctor in the Southern Song dynasty, retained the original Sichuan Bixie and Acorus tatarinowii, and add Phellodendron chinense, and Semen plantaginis to form Cheng's Bixie-Fenqing formula. It had the function of get rid of dampness and heat, and is a classic prescription for stranguria, like the treatment of white turbidity. The author retrieved the related literature of Cheng's Bixie-Fenqing formula in recent years, analyzed the composition and clinical application of Cheng's Bixie-Fenqing formula, and summarized the advantages and disadvantages of the existing researches, providing reference for the further development of Cheng's Bixie-Fenqing formula.
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The Dioscorea hypoglauca rhizome and D. spongiosa rhizome in "China Pharmacopoeia" are often used as Bixie in clinically, with the function of removing dampness, clearing away turbidness and dispelling wind to remove pain, and has been widely used in stranguria marked by chyluria, joint stiffness and rheumatic arthralgia. It has obvious curative effect and broad application prospect. However, in recent years the progress of research is slow for its miscellaneous sources, chaotic varieties and lack of relevant quality assessment. The previous research on Bixie is mainly reflected in the chemical compositions, mainly including steroids, diarylheptanoids and lignans and so on. Among them, steroidal saponins are the main components and the main effective substances for their pharmacological activities. Recent studies have shown that Bixie and its main components have significant effects in anti-trioxypurine, anti-inflammation, analgesia and anti-osteoporosis, and have made great progress, providing an experimental basis for the research and development of clinical drugs. But the specific substance and specific mechanism of its pharmacological action are not clear, and need further exploration. By consulting the relevant literature at home and abroad, the author has summarized the chemical constituents, quality evaluation, pharmacological action of Bixie, hoping to provide a reference for further research, development and utilization of Bixie.