Discussion on the Scientific Connotation of Fortifying Spleen， Resolving Phlegm and Dispelling Stasis in the Treatment of Coronary Heart Disease under the Guidance of Dysfunctional High-Density Lipoprotein / 中医杂志

The key pathogenesis of coronary heart disease （CHD） is spleen deficiency and phlegm stasis， and dysfunctional high-density lipoprotein （dys-HDL） may be the biological basis for the occurrence of CHD due to spleen deficiency and phlegm stasis. Considering the biological properties and effects of high-density lipoprotein （HDL）， it is believed that the structure and components of HDL are abnormal in the state of spleen deficiency which led to dys-HDL； and dys-HDL contributes to the formation of atherosclerotic plaques through two major pathways， namely， mediating the dysfunction of endothelial cells and mediating the foaminess of macrophages and smooth muscle cells， thus triggering the development of CHD. It is also believed that dys-HDL is a microcosmic manifestation and a pathological product of spleen deficiency， and spleen deficiency makes foundation for the production of dys-HDL； dys-HDL is also an important biological basis for the phlegm-stasis interactions in CHD. The method of fortifying spleen， resolving phlegm， and dispelling stasis， is proposed as an important principle in the treatment of CHD by traditional Chinese medicine， which can achieve the therapeutic purpose by affecting the changes in the structure and components of dys-HDL， thus revealing the scientific connotation of this method， and providing ideas for the diagnosis and treatment of CHD by traditional Chinese medicine.

Cinobufagin Combined with Thalidomide/Dexamethasone Regimen in the Treatment of Patients with Newly Diagnosed Multiple Myeloma of Phlegm and Stasis Obstruction： A Retrospective Study / 中医杂志

ObjectiveTo investigate the efficacy and safety of cinobufagin tablets combined with thalidomide/dexamethasone （TD） regimen in the treatment of newly diagnosed multiple myeloma （NDMM） with phlegm and stasis obstruction. MethodsThe clinical data of 50 patients with NDMM of phlegm and stasis obstruction who were hospitalized at the Jiangsu Province Hospital of Chinese Medicine from June 1st， 2015 to July 31th， 2019 were retrospectively analyzed， and they were divided into a control group （bortezomib/dexamethasone-containing regimen， 27 cases） and an observation group （cinobufagin tablets combined with TD regimen， 23 cases）. The clinical efficacy and safety were compared between the two groups after two or three courses of treatment. The primary outcomes were clinical remission rate including overall response rate and deep remission rate， one-year and two-year overall survival rate， and adverse effects. The secondary outcomes were the proportion of plasma cells in bone marrow， hemoglobin， β2-microglobulin， lactate dehydrogenase， serum creatinine， blood urea nitrogen， bone pain score， and KPS functional status score （KPS score） before and after treatment. ResultsIn terms of clinical efficacy， there was no statistically significant difference （P＞0.05） in the overall response rate ［the observation group 69.57%（16/23） vs the control group 70.37% （19/27）］ and deep remission rate ［the observation group 56.52% （13/23） vs the control group 55.56% （15/27）］ between groups after the treatment. The one-year overall survival rates of the observation group and the control group were 90.9% and 92.4%， and the two-year overall survival rates were 81.8% and 80.9% respectively， with no statistically significant differences between groups （P＞0.05）. During the treatment， no renal function injury occurred in both groups. The incidence of peripheral nerve injury in the observation group was 8.70%， which was lower than 48.15% in the control group （P＜0.01）. After the treatment， the proportion of myeloma plasma cells， β2-microglobulin， serum creatinine level， and bone pain score decreased， while the hemoglobin level and KPS score increased in both groups （P＜0.05 or P＜0.01）. Compared between groups after treatment， the bone pain score of the observation group was lower than that of the control group， while the KPS score was higher than that of the control group （P＜0.05）. ConclusionThe clinical efficacy of cinobufagin tablets combined with TD in the treatment of NDMM is equivalent to bortezomib/dexamethasone-containing regimen， but the former is more helpful in relieving the pain and improving the quality of life， and has better safety.

Analysis of the Treatment Strategy of Heart Failure with Preserved Ejection Fraction Based on ZHANG Boli's Theory of “Damp-turbidity and Phlegm-rheum Type of Diseases” / 中医杂志

Professor ZHANG Boli believed that the core pathogenesis of heart failure with preserved ejection fraction （HFpEF） is weak pulse at yang and wiry pulse at yin. By referring to the theory of “damp-turbidity and phlegm-rheum type of diseases”， he proposed that yin pathogens of damp-turbidity and phlegm-rheum may damage yang qi in each stage of HFpEF， thus aggravating the trend of weak pulse at yang and wiry pulse at yin， which played an important role in the deterioration of HFpEF. Therefore， Professor ZHANG Boli advocated that importance should be attached to the elimination of yin pathogen and the protection of yang qi during the various stages of HFpEF in order to delay the aggravation of weak pulse at yang and wiry pulse at yin； he put forward the idea of staged treatment that “yin pathogen should be dispelled and yang qi should be demonstrated”； and he formulated the treatment strategy of treating the disease as early as possible， eliminating pathogens and protecting yang， interrupting the disease trend， using warm-like medicinals， and activating blood circulation， to enrich the theoretical system of traditional Chinese medicine in the treatment of HFpEF.

Effect of Modified Cangfu Daotantang on Glucose and Lipid Metabolism in Simple Obese Children with Phlegm Dampness and Stagnation / 中国实验方剂学杂志

ObjectiveTo observe and compare the intervention effect of modified Cangfu Daotantang on glucose and lipid metabolism in simple obese children with phlegm dampness and stagnation. MethodA total of 60 children with simple obesity were randomly divided into two groups according to the simple randomization method of the random number table. The odd number was included in the test group， and the even number was included in the basic treatment group， with 30 cases in each group. On the basis of signing the informed consent notice， the treatment group was given modified Cangfu Daotantang combined with basic treatment， while the control group was only given basic treatment. After three months of treatment， the body mass index （BMI）， glucose and lipid metabolism level ［total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， fasting plasma glucose （FPG）， fasting insulin （FINS）， and homeostasis model assessment-insulin resistance （HOMA-IR）］， the change in the total score of traditional Chinese medicine （TCM） syndromes， and the effective rate of treatment were observed and compared. ResultAfter treatment， the BMI of the observation group and the control group decreased significantly （P<0.01）. Compared with the control group， the BMI level in the observation group decreased significantly （P<0.05）. After treatment， the levels of TC， TG， and LDL-C in the observation group and the control group decreased significantly （P<0.01）. Compared with the control group， the levels of TC， TG， and LDL-C in the observation group decreased significantly （P<0.05）. In addition， the level of TC in the observation group improved significantly compared with that in the control group （P<0.01）. The levels of FPG， FINS， and HOMA-IR in the observation group and the control group were significantly lower than those before treatment （P<0.05）. After treatment， compared with the control group， the levels of FPG， FINS， and HOMA-IR in the observation group were significantly reduced （P<0.05）. The level of FPG in the observation group was significantly improved compared with that in the control group （P<0.01）. After treatment， the total score of TCM syndromes in the two groups decreased significantly （P<0.01）. Compared with the control group， the total score of TCM syndromes in the observation group was lower （P<0.01）. After treatment， the total effective rate of treatment was 86.67% （26/30） in the observation group and 73.33% （22/30） in the control group. By rank sum test， the total effective rate of the observation group was better than that of the control group （Z=-2.100， P<0.05）. ConclusionModified Cangfu Daotantang combined with basic treatment can effectively reduce the BMI of obese children and improve their glucose and lipid metabolism. It has good clinical effects and high clinical application value， which is worth further in-depth research and promotion.

Evaluation of Clinical Efficacy of Modified Houpo Dahuangtang in Moderate and Severe ARDS Patients Based on Electrical Impedance Tomography / 中国实验方剂学杂志

ObjectiveTo evaluate the clinical efficacy of modified Houpo Dahuangtang in moderate and severe acute respiratory distress syndrome （ARDS） patients with phlegm-heat accumulation，and monitor the pulmonary ventilation changes of patients before and after treatment by electrical impedance tomography（EIT）. MethodThe 62 cases of moderate and severe ARDS patients with phlegm-heat accumulation who required mechanical ventilation in the department of intensive care unit （ICU） in Chongqing Hospital of Traditional Chinese Medicine from September 2021 to June 2022 were selected，and divided into an experimental group（31 cases）and a control group（31 cases）using a random number table. On the basis of regular Western medicine treatment，the experimental group received modified Houpo Dahuangtang and the control group received warm water by a nasogastric tube for seven days. The changes in the clinical efficacy of traditional Chinese medicine（TCM），the oxygenation index［arterial oxygen partial pressure （PaO2）/fractional inspired oxygen（FiO2），P/F］，lactic acid（Lac），acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score，compliance，plateau pressure，gas distribution parameters monitored by EIT（Z1，Z2，Z3 and Z4），inflammatory factors［interleukin-6 （IL-6），IL-10， tumor necrosis factor-α （TNF-α） and C-reactive protein （CRP）］ of both groups before and after treatment were recorded. Besides， the mechanical ventilation time， length of stay in ICU， 28-day mortality and incidence of adverse reactions（delirium，abdominal pain and diarrhea）in the two groups were also observed. ResultThere was no significant difference in the baseline indexes of patients in the two groups，and thus the two groups were comparable. After treatment for one week， the total effective rate for TCM syndromes in the experimental group was 90.30%（28/31）， higher than the 67.74%（21/31）in the control group（Z=-2.415，P<0.05）.Compared with the same group before treatment， the plateau pressure and Lac decreased （P<0.01）and the compliance and P/F increased （P<0.01） in experimental group， while the Lac decreased （P<0.05）and the P/F increased （P<0.05）， and the compliance and plateau pressure did not change significantly in the control group. After treatment，the plateau pressure and inflammatory factors in the experimental group were lower than those in the control group（P<0.05）， but the compliance and P/F in the experimental group were higher than those in the control group（P<0.05）， and the gas distribution parameters Z1，Z2，Z3，Z4，Z1+Z2，and Z3+Z4 monitored by EIT in the experimental group were all higher than those in the control group （P<0.05）. There was no significant difference in mechanical ventilation time， ICU hospitalization time， 28-day mortality， delirium， abdominal pain， diarrhea and other adverse reactions between the two groups. ConclusionModified Houpo Dahuangtang can significantly improve the P/F，pulmonary ventilation in gravity-dependent regions and pulmonary compliance，reduce the release of inflammatory factors in moderate and severe ARDS patients. Compared with conventional methods，EIT can timely monitor the pulmonary ventilation changes in ARDS patients，which suggests its clinical feasibility.

The coronary heart disease of phlegm-stasis cementation syndrome in mini-swine based on platelet proteomics / 药学学报

Based on the technology of platelet proteomics, the key regulatory proteins and pathogenesis of coronary heart disease with phlegm and blood stasis syndrome were explored and analyzed. Based on the previous laboratory research, the model of coronary heart disease in mini-swine with phlegm-stasis cementation syndrome was duplicated. The model was judged by the changes in blood lipid and myocardial tissue characteristics. Furthermore, the platelet proteins were studied by quantitative proteomics, and the differentially expressed proteins were screened. The critical regulatory proteins and biological pathways of coronary heart disease with phlegm-stasis cementation syndrome were analyzed by bioinformatics. After ten weeks of modeling, the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low density lipoprotein (VLDL-C), triglyceride (TG), creatine kinase (CK) and creatine kinase-MB (CK-MB) in the model group were significantly increased, reflecting the pathological changes such as increased blood lipid, abnormal coagulation function and myocardial ischemia in the model group. In addition, compared with the sham group, there were 26 up-regulated proteins and 8 down-regulated proteins in the platelets of the model group. Combined with bioinformatics analysis, it was found that differential proteins mainly involved in glycolysis/gluconeogenesis, pyruvate metabolism, lipid and atherosclerosis, Ras protein signal transduction. Among them, lactate dehydrogenase B (LDHB), alcohol dehydrogenase 5 (ADH5), neuroblastoma ratsarcoma viral oncogene homolog (NRAS) and Kirsten ratsarcoma viral oncogene homolog (KRAS) play a central role when interacting with other proteins and simultaneously participate in multiple action pathways. The results showed that LDHB, ADH5, NRAS, and KRAS may be the marker proteins in CHD with phlegm-stasis cementation syndrome by regulating glycolysis/gluconeogenesis, pyruvate metabolism, lipid and atherosclerosis, Ras protein signal transduction and other biological processes.

Mechanism of Banxia Baizhu Tianma decoction to prevent the development of prehypertension and excessive phlegm-dampness syndrome in rats based on metabonomics technology / 药学学报

The alterations of serum biological endogenous chemicals in rats with phlegm dampness accumulation syndrome of prehypertension (PHT) were interfered by Banxia Baizhu Tianma decoction (BBT), and the metabolic regulatory pathway of BBT was clarified using serum metabonomics analysis. To replicate the rat model of prehypertension phlegm dampness syndrome, blood pressure, behavioral markers, and serum biochemical markers of rats were collected. BBT's effectiveness in controlling blood pressure and blood lipids was assessed, and changes in endogenous small molecules in rat serum were determined using UPLC-Q-Orbitrap MS metabolic analysis. The results showed that BBT could regulate 9 metabolites, including arachidonic acid, cholic acid, glycodeoxycholic acid, N-adenosyltyrosine, arginine, lysophosphatidylethanolamine (20:0/0:00), lysophospholipid (P-18:0), lysophospholipid (18:0), lysophospholipid (22:5(7Z,10Z,13Z,16Z,19Z)). MetaboAnalyst was used to analyze the metabolic pathway. There were 7 metabolic pathways closely related to the change of blood pressure in rats, among which arachidonic acid metabolic pathway was the most critical. The metabolism difference foreign body in the model rats tends to return to the normal level, which provides a research basis for the mechanism of BBT from the perspective of metabonomics. This study was approved by the Experimental Animal Welfare Ethics Review Committee of Shandong University of Traditional Chinese Medicine (approval number: SDUTCM20211103001).

Clinical Efficacy of Qimai Qinlou Prescription in Treating Elderly Community-acquired Pneumonia （Non-severe） with Qi and Yin Deficiency and Phlegm-heat Obstructing Lung Syndrome / 中国实验方剂学杂志

ObjectiveTo evaluate the clinical efficacy of Qimai Qinlou prescription in the treatment of elderly community-acquired pneumonia （CAP） （non-severe） with Qi and Yin deficiency and phlegm-heat obstructing lung syndrome and its impact on immune-inflammatory factors. MethodA total of 120 eligible patients were randomly divided into an observation group （60 cases） and a control group （60 cases）. Both groups received intravenous cefoxitin sodium. In addition， the observation group received oral Qimai Qinlou prescription， while the control group received an oral placebo simulating Qimai Qinlou prescription. The treatment course was 14 days. The disappearance time of major clinical symptoms and signs was recorded. Traditional Chinese medicine （TCM） syndrome scores and the Clinical Research Outcome （CAP-CRO） scale scores for pneumonia of the two groups were compared. Chest computed tomography （CT） scans were performed， and peripheral blood levels of procalcitonin （PCT）， interleukin-6 （IL-6）， serum amyloid A （SAA）， high-sensitivity C-reactive protein （hs-CRP）， CD4+， CD8+， and CD4+/CD8+ were measured. The conversion rate to severe condition during hospitalization， readmission rate within 30 days after discharge， and safety evaluation were recorded. ResultAfter treatment， the observation group showed significantly shorter time of fever， cough， expectoration， and disappearance time of lung moist rales than the control group （P<0.01）. The TCM syndrome scores， CAP-CRO scores in all dimensions， and total scores in both groups were significantly reduced as compared with those before treatment （P<0.01）. After treatment， the observation group had a more significant reduction than the control group （P<0.01）. The levels of PCT， IL-6， SAA， and hs-CRP in both groups were significantly reduced as compared with those before treatment （P<0.01）. After treatment， the observation group showed a more significant reduction than the control group （P<0.01）. There was no statistically significant difference in the changes of CD4+， CD8+， and CD4+/CD8+ in the control group before and after treatment. However， in the observation group， CD4+ and CD4+/CD8+ levels significantly increased （P<0.01）， while CD8+ level significantly decreased （P<0.01） after treatment. After treatment， CD4+ and CD4+/CD8+ in the observation group significantly increased （P<0.01）， and CD8+ significantly decreased as compared with those in the control group （P<0.01）. At 7， 10， and 14 days after treatment， the curative rates in the observation group were 53.33% （32/60）， 85.00% （51/60）， and 91.67% （55/60）， respectively， which were higher than 31.67% （19/60）， 61.67% （37/60）， and 68.33% （41/60） in the control group （χ2=5.763， 8.352， 10.208， P<0.05）. After treatment， the total effective rate of CT scanning in the observation group was 93.33% （56/60）， higher than 80.00% （48/60） in the control group （χ2=4.615， P<0.05）. The conversion rate to severe condition during hospitalization in the observation group was 3.33% （2/60）， lower than 15.00% （9/60） in the control group （χ2=4.904， P<0.05）. The readmission rate within 30 days after discharge in the observation group was 8.33% （5/60）， lower than 23.33% （14/60） in the control group （χ2=5.065， P<0.05）. No serious adverse drug reactions were observed in either group during the treatment period. ConclusionQimai Qinlou prescription can enhance immune function， alleviate inflammatory reactions， significantly relieve clinical symptoms， shorten the duration of the disease， improve the curative rate and CT scanning efficacy， prevent disease progression， reduce the readmission rate in the short term， and is clinically safe for the treatment of elderly patients with non-severe CAP with Qi and Yin deficiency and phlegm-heat obstructing lung syndrome. It is worthy of further research and application.

Clinical Effect of Erchentang and Bixie Fenqingyin Combined on Patients with Acute Cerebral Infarction with Hyperuricemia with Syndrome of Phlegm and Blood Stasis Blocking Collaterals / 中国实验方剂学杂志

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.

Wendantang Treats Inflammation in Obesity （Syndrome of Phlegm-dampness） by Regulating PI3K/Akt/mTOR Pathway-mediated Adipocyte Autophagy / 中国实验方剂学杂志

ObjectiveTo observe the effects of Wendantang on the expression of inflammatory cytokines， autophagy markers， and key molecules of phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway in the adipocytes of the rat model of obesity （syndrome of phlegm-dampness） and to explore the material basis of inflammation in obesity （syndrome of phlegm-dampness） and the underlying mechanism of Wendantang intervention. MethodA total of 126 SD rats were randomized into 2 groups： 16 rats in the blank group and 110 rats in the modeling group. The blank group was fed with a basic diet while the modeling group with a high-fat diet to establish the animal model of obesity （syndrome of phlegm-dampness） for 8 weeks. After successful modeling， 48 obese rats were selected according to their body mass and randomized into a model control group， an orlistat （ORLI， 32.40 mg·kg-1） group， a rapamycin （RAPA， 2 mg·kg-1） group， and low-， medium-， and high-dose （4.45， 8.90， 17.80 g·kg-1， respectively） Wendantang groups， with 8 rats in each group. In addition， 8 rats were randomly selected from the blank group to be set as the normal control group. The corresponding agents in each group were administrated by gavage and the model and control groups were administrated with equal amounts of distilled water once daily for 6 weeks. The body mass， Lee's index， body fat ratio， and obesity rate were measured or calculated. The expression of UNC51-like kinase-1 （ULK1）， Beclin1， human autophagy-related protein 5 （Atg5）， p62， and microtubule-associated protein 1 light chain 3 （LC3） Ⅰ/Ⅱ （markers of autophagy in adipocytes） was detected by the immunohistochemical two-step method. Enzyme-linked immunosorbent assay （ELISA） was employed to determine the expression of tumor necrosis factor （TNF）-α， interleukin-6 （IL-6）， IL-1β， monocyte chemotactic protein-1 （MCP-1）， IL-4， IL-10， IL-13， and transforming growth factor （TGF）-β in adipocytes. Western blot was employed to measure the protein levels of classⅠ-PI3K， phosphatidylinositol triphosphate （PIP3）， Akt， mTORC1， ULK1， TSC1， and TSC2 in adipocytes. ResultCompared with the blank group， the modeling group showed increased body mass and Lee's index （P<0.01）， the obesity rate >20%， and phlegm-dampness syndrome manifestations such as physical obesity， decreased mobility， decreased appetite， lusterless and tight fur， loose stools， decreased responsiveness to the outside world， and decreased water intake. Compared with the normal control group， the model control group showed increased body mass， Lee's index， body fat ratio， adipocyte autophagy marker expression， pro- and anti-inflammatory cytokine levels （P<0.05， P<0.01）， down-regulated protein levels of classⅠ-PI3K， PIP3， Akt， mTORC1， TSC1， and TSC2 （P<0.01）， and up-regulated protein level of ULK1 （P<0.01）. The intervention groups showed lower body mass， body fat ratio， adipocyte autophagy marker protein expression， and protein levels of TNF-α， IL-6， IL-1β， MCP-1， IL-4， and IL-13 than the model control group （P<0.05， P<0.01）. Moreover， the RAPA and Wendantang （medium and high dose） groups showed lowered levels of IL-10 and TGF-β （P<0.01）， and the ORLI group showed down-regulated expression of TGF-β （P<0.01）. The expression of key molecules of the signaling pathway was up-regulated （P<0.05， P<0.01） while that of ULK1 was down-regulated （P<0.01） in all the intervention groups. Compared with the RAPA group， the Wendantang groups showed up-regulated expression of all autophagy marker proteins in adipocytes （P<0.01）. In addition， the low-dose Wendantang group showed elevated levels of inflammatory cytokines （except TNF-α） （P<0.05， P<0.01） and down-regulated expression of all key molecules of the signaling pathway （P<0.05， P<0.01）. The levels of inflammatory cytokines （except IL-16， MCP-1， and IL-10） were elevated in the medium-dose Wendantang group （P<0.05， P<0.01）. The expression of key molecules except PI3K of the signaling pathway was down-regulated in the medium- and high-dose Wendantang groups （P<0.05， P<0.01）. Compared with the ORLI group， low- and medium-dose Wendantang groups showed up-regulated expression of autophagy markers in adipocytes （P<0.01）， and the low-dose group showed elevated levels of inflammatory cytokines （IL-6， IL-4， and TGF-β） （P<0.01） and down-regulated expression of all key molecules of the signaling pathway （P<0.01）. The medium-dose Wendantang group showed up-regulated expression of IL-4 （P<0.01） and down-regulated expression of key molecules except PI3K of the signaling pathway （P<0.05， P<0.01）. The high-dose Wendantang group showed increased body mass， up-regulated expression levels of autophagy markers （ULK1， LC3 Ⅰ/Ⅱ） （P<0.05， P<0.01）， down-regulated expression of PIP3， mTORC1， and TSC1 （P<0.05， P<0.01）， and lowered levels of Beclin1， Atg5， TNF-α， and IL-13 （P<0.05， P<0.01）. ConclusionThe inflammation in obesity （syndrome of phlegm-dampness） is closely associated with the PI3K/Akt/mTOR pathway-mediated adipocyte autophagy. Wendantang can treat the chronic inflammation in obese rats with the syndrome of phlegm-dampness by regulating this signaling pathway and thus improve adipocyte autophagy.

Biological connotation of "phlegm-turbidity" theory in hepatocellular carcinoma microenvironment based on abnormal lipid metabolism / 临床肝胆病杂志

There is still a lack of effective strategies for the prevention and treatment of liver cancer, and a deep understanding of its pathogenesis may help to develop new treatment methods. Due to the abnormal changes of lipid metabolism in the development and progression of liver cancer, such process is closely associated with the "phlegm-turbidity" theory in traditional Chinese medicine (TCM). Starting from the changes of lipid metabolism in hepatocellular carcinoma microenvironment, this article discusses the association of the abnormal changes of lipid metabolism in tumor cells and immune cells with the "phlegm-turbidity" theory and the clinical efficacy of phlegm-eliminating therapies in clinical practice. Since the "phlegm-turbidity" theory in TCM plays an important role in the pathogenesis and pathological changes of liver cancer, the analysis of its theoretical connotation helps to clarify pathological mechanism, thereby providing a theoretical basis for the role of TCM in the prevention and treatment of liver cancer.

Effect of Synergistic Treatment with Qingjin Huazhuo Formula （清金化浊方） on Thrombotic Events in Hospitalized Patients of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Phlegm Heat Stasis Obstructing in the Lung Syndrome： A Retrospective Cohort Study / 中医杂志

ObjectiveTo analyze the effect and possible mechanism of the synergistic treatment with Qingjin Huazhuo Formula （清金化浊方， QHF） on the occurrence of thrombotic events in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and phlegm heat stasis obstructing in the lung syndrome. MethodsIn a retrospective cohort study， 305 AECOPD inpatients with the syndrome of phlegm heat stasis obstructing in the lung were included. According to whether using QHF （the course of treatment ≥ 7 days）， they were divided into the exposure group （193 cases） and the non-exposure group （112 cases）. Totally， 109 pairs of cases were obtained by 1∶1 propensity score matching （PSM）. After matching， the occurrence of thrombotic events during hospitalization， the remission of main symptoms or signs （including cough， expectoration， wheezing， cyanosis） after 10 days （±3 days） of treatment， and the difference of the indicators including D-dimer， percentage of neutrophils （NEUT%）， C-reactive protein （CRP）， arterial partial pressure of oxygen （PaO2）， and arterial partial pressure of carbon dioxide （PaCO2） before treatment and after 10 days （±3 days） of treatment during the first auxiliary examination. ResultsAfter matching， the incidence of thrombotic events during hospitalization in the exposure group （5 cases， 4.59%） were lower than that of the non-exposure group （15 cases， 13.76%， P＜0.05）. The exposure factor that taking QHF for 7 days or above was a protective factor for thrombotic events in AECOPD hospitalized patients with phlegm heat stasis obstructing in the lung syndrome （RR = 0.333， 95% CI 0.126 to 0.885）. The remission rates of cough （100/109， 91.74%）， expectoration （103/109， 94.50%）， wheezing （102/109， 93.58%）， and cyanosis （97/109， 88.99%） in the exposure group were significantly higher than those in the non-exposure group （90/109， 82.57%； 94/109， 86.24%； 89/109， 81.65%； 86/109， 78.90%） after treatment （P＜0.05）. After treatment， the levels of D-dimer， NEUT%， CRP and PaCO2 in both groups significantly decreased （all P＜0.05）， and the level of PaO2 significantly increased （P＜0.05）. The difference of the levels of D-dimer， NEUT% and PaO2 in the exposure group before and after treatment were larger than those in the non-exposure group （P＜0.05）， while the pre-post difference of CRP and PaCO2 were not significantly different between the two groups （P＞0.05）. ConclusionThe synergistic treatment with QHF can effectively reduce the occurrence of thrombotic events， alleviate the clinical symptoms or signs such as cough， expectoration， wheezing， and cyanosis， and can improve lung function in hospita-lized patients with AECOPD and phlegm heat stasis obstructing in the lung syndrome. Its mechanism may be related to improving blood coagulation and inflammatory status.

Research advances in mechanism of lipid infiltration of coronary heart disease and simultaneous treatment of phlegm and blood stasis based on phlegm-blood stasis correlation theory / 中国中药杂志

Atherosclerosis(AS) is the key pathological basis of coronary heart disease(CHD), and lipid infiltration is a classical theory to explain the pathological mechanism of AS. The theory highlights that the occurrence and development of AS are closely related to abnormal lipid metabolism, with the essence of the pathological reaction caused by the invasion of lipids into arterial intima from plasma. Phlegm and blood stasis are physiologically homologous and subject to pathological co-existence. Phlegm-blood stasis correlation is the basic theory to explain the pathogenesis characteristics of CHD and has important guiding significance for revealing the mecha-nism of lipid infiltration of CHD. Phlegm is the pathological product of abnormal metabolism of Qi, blood, and body fluid, and a gene-ral summary of a series of abnormally expressed lipid substances. Among them, turbid phlegm invades the heart vessels, gradually accumulates, and condenses to achieve the qualitative change from "invisible pathogen" to "tangible pathogen", which corresponds to the mechanism of lipid migration and deposition in the intima of blood vessels, and is the starting factor of the disease. Blood stasis is the continuous development of phlegm, and it is a result of pathological states such as decreased blood fluidity, increased blood coagulation, and abnormal rheology. The fact that blood stasis caused by phlegm accords with the pathological process of "lipid abnormality-circulatory disturbance" and is the central link of the disease. Phlegm and blood stasis aggravate each other and lead to indissoluble cementation. The phlegm-blood stasis combination serves as common pathogen to trigger the disease, which is the inevitable outcome of the disease. Based on the phlegm-blood stasis correlation theory, the simultaneous treatment of phlegm and blood stasis is established. It is found that this therapy can simultaneously regulate blood lipid, reduce blood viscosity, and improve blood circulation, which can fundamentally cut off the biological material basis of the reciprocal transformation between phlegm and blood stasis, thus exerting a significant curative effect.

Role of brown adipose tissue in phlegm-dampness metabolic syndrome based on infrared thermal imaging / 中国中药杂志

This study aimed to explore the infrared manifestation and role of brown adipose tissue(BAT) in phlegm-dampness me-tabolic syndrome(MS), and to provide objective basis for clinical diagnosis and treatment of phlegm-dampness MS. Subjects were selected from the department of endocrinology and ward in the South District of Guang'anmen Hospital, China Academy of Chinese Medical Sciences from August 2021 to April 2022, including 20 in healthy control group, 40 in non phlegm-dampness MS group and 40 in phlegm-dampness MS group. General information, height and weight of the subjects were collected and body mass index(BMI) was calculated. Waist circumference(WC), systolic blood pressure(SBP) and diastolic blood pressure(DBP) was measured. Triglyceride(TG), high density lipoprotein cholesterol(HDL-C), fasting blood glucose(FBG), fasting insulin(FINS), leptin(LP), adiponectin(ADP) and fibroblast growth factor-21(FGF-21) were detected. The infrared thermal image of the supraclavicular region(SCR) of the subjects before and after cold stimulation test was collected by infrared thermal imager and the changes of infrared thermal image in the three groups were observed. In addition, the differences in the average body surface temperature of SCR among the three groups were compared, and the changes of BAT in SCR were analyzed. The results showed compared with the conditions in healthy control group, the levels of WC, SBP, DBP, TG and FPG in MS groups were increased(P<0.01), and the HDL-C level was decreased(P<0.01). Compared with non phlegm-dampness MS group, phlegm-dampness MS group had higher conversion score of phlegm dampness physique(P<0.01). According to the infrared heat map, there was no difference in the average body surface temperature of SCR among the three groups before cold stimulation. while after cold stimulation, the average body surface temperature of SCR in MS groups was lower than that in healthy control group(P<0.05). After cold stimulation, the maximum temperature of SCR and its arrival time in the three groups were as follows: healthy control group(3 min)>non phlegm-dampness MS group(4 min)>phlegm-dampness MS group(5 min). The thermal deviation of SCR was increased and the average body surface temperature of left and right sides were higher(P<0.01) in healthy control group and non phlegm-dampness MS group, while the thermal deviation of SCR did not change significantly in the phlegm-dampness MS group. Compared with that in healthy control group, the elevated temperature between left and right sides was lower(P<0.01, P<0.05), and compared with that in non phlegm-dampness MS group, the elevated temperature of left side was lower(P<0.05). The changes of the average body surface temperature of SCR in the three groups were in the order of healthy control group>non phlegm-dampness MS group>phlegm-dampness MS group. Compared with the conditions in healthy control group and non phlegm-dampness MS group, FINS, BMI and FGF-21 levels were increased(P<0.01,P<0.05), while ADP level was decreased(P<0.01, P<0.05) in phlegm-dampness MS group. Moreover, the LP level in phlegm-dampness MS group was higher than that in non phlegm-dampness MS group(P<0.01). It was observed in clinical trials that after cold stimulation, the average body surface temperature of SCR in MS patients was lower than that of the healthy people; the thermal deviation of SCR did not change significantly in the phlegm-dampness MS patients, and the difference in their elevated temperature was lower than that in the other two groups. These characteristics provided objective basis for clinical diagnosis and treatment of phlegm-dampness MS. With abnormal BAT related indicators, it was inferred that the content or activity of BAT in SCR of phlegm-dampness MS patients were reduced. There was a high correlation between BAT and phlegm-dampness MS, and thus BAT might become an important potential target for the intervention in phlegm-dampness MS.

Clinical study on the treatment of spleen deficiency and phlegm stasis syndrome in alcoholic cirrhosis with Qinggan Huashi Huoxue Decoction and conventional western medicine / 国际中医中药杂志

Objective:To evaluate the efficacy of Qinggan Huashi Huoxue Decoction combined with conventional Western medicine in the treatment of alcoholic cirrhosis with spleen deficiency and phlegm stasis syndrome.Methods:Randomized controlled trial. A total of 110 patients from Tangshan Fengrun District Hospital of Traditional Chinese Medicine from March 2020 to March 2022 were selected as observation objects and divided into 2 groups with 55 patients in each group by computer random drawing method. The control group was treated with conventional Western medicine, while the observation group was treated with Qinggan Huashi Huoxue Decoction on the basis of the control group treatment. Both groups were treated for 3 months. The traditional Chinese medicine syndrome score was performed before and after treatment, and the levels of proline peptidase (PLD), type Ⅳ collagen (Ⅳ-C) and type Ⅰ procollagen aminopeptidase (PINP) were detected by phthalaldehyde contrast colorimetry, and the levels of pentamylin 3 (PTX3), protein kinase B (Akt) and B cell activating factor receptor (BAFF-R) were determined by ELISA. Adverse events were recorded and clinical efficacy was evaluated.Results:The total effective rate in the observation group was 92.73% (51/55), while that in the control group was 76.36% (42/55), the difference between the two groups was statistically significant ( χ2=5.64, P=0.018). After treatment, the score and total score of costal pain and fullness, swelling and firmness, anorexia, white and greasy tongue coating in the observation group were significantly lower than those in the control group ( t values were 11.02, 7.36, 7.47, 6.38, 9.37, respectively, P<0.01). After treatment, the levels of serum PLD[(143.28±16.38)U/L vs. (160.69±18.35)U/L, t=5.25], Ⅳ-C[(71.93±8.33)μg/L vs. (83.12±9.91)μg/L, t=6.41], and PINP[(32.36±5.32)ng/L vs. (39.02±5.61)ng/L, t=6.39] in the observation group were significantly lower than those in the control group ( P<0.01); The levels of PTX3[(36.82±4.96)ng/L vs. (42.14±5.83)ng/L, t=5.15], Akt[(69.22±7.94)ng/L vs. (77.24±8.63)ng/L, t=5.07], and BAFF-R[(15.29±3.64)ng/L vs. (19.92±4.15)ng/L, t=6.22] in the observation group were significantly lower than those in the control group ( P<0.01). During the treatment period, the incidence of adverse reactions was 12.73% (7/55) in the observation group and 9.09% (5/55) in the control group, with no statistically significant difference between the two groups ( χ2=0.37, P=0.541). Conclusion:Qinggan Huashi Huoxue Decoction combined with conventional Western medicine therapy can improve the Traditional Chinese Medicine syndrome and the degree of liver fibrosis damage in patients with alcoholic cirrhosis with spleen deficiency and phlegm stasis syndrome, inhibit the expression of serum inflammatory factors, and improve clinical efficacy.

Effects of Zhenfang Baiwanzi Decoction combined with alteplase injection on serum inflammatory factors and vascular endothelial active substances in the patients with acute ischemic stroke and syndrome of wind-phlegm invading collaterals / 国际中医中药杂志

Objective:To explore the effects of Zhenfang Baiwanzi Decoction combined with alteplase injection on serum inflammatory factors and vascular endothelial active substances in patients with acute ischemic stroke (AIS).Methods:Randomized controlled trial. A total of 87 patients with AIS admitted to Mengcheng County Hospital of Traditional Chinese Medicine between June 2019 and July 2022 were selected as the observation subjects by prospective cohort study, and they were divided into treatment group (44 cases) and control group (43 cases) according to the last number of medical records. The control group was given thrombolytic therapy with alteplase injection on the basis of routine therapy, and the treatment group was given Zhenfang Baiwanzi Decoction on the basis of the control group. Both groups were treated for 2 weeks. TCM symptoms were scored before and after treatment, and National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit, and Activity of Daily Living Scale (ADL) was applied to evaluate the quality of life. The levels of serum IL-6, CRP, TNF-α, monocyte chemoattractant protein-1 (MCP-1), VEGF, NOS and endothelin-1 (ET-1) were detected by ELISA. The adverse reactions were recorded and the clinical efficacy was evaluated.Results:The total effective rate was 93.18% (41/44) in treatment group and 76.74% (33/43) in control group ( χ2=4.62, P=0.032). After treatment, the scores of hemiparalysis, skin insensitivity, deviated mouth and eye, inhibited speech and headache and dizziness in treatment group were significantly lower than those in the control group ( t=3.38, 3.77, 2.69, 2.60, 2.36, P<0.01 or P<0.05). The NIHSS score was significantly lower than that of the control group ( t=7.53, P<0.01) while the ADL score was significantly higher than that of the control group ( t=2.99, P<0.01). After treatment, the levels of serum IL-6, CRP, TNF-α and MCP-1 in treatment group were significantly lower than those in the control group ( t=6.07, 5.70, 5.30, 3.36, P<0.01), and the levels of VEGF [(364.54±33.04)ng/L vs. (346.86±29.63)ng/L, t=2.63] was significantly lower than that of the control group ( P<0.05), NOS [(20.77±3.12) μmol/L vs. (29.46±5.36) μmol/L, t=9.27] and ET-1 [(85.41±7.09) ng/L vs. (94.11±9.38) ng/L, t=4.89] were significantly lower than those in the control group ( P<0.01). Conclusion:Zhenfang Baiwanzi Decoction combined with alteplase injection can improve the clinical symptoms, reduce levels of inflammatory factors, protect the vascular endothelial function, and enhance the efficacy of patients with AIS.

Effects of Banxia Shumi Decoction on 5-hydroxytryptamine receptor, 5-HT, and 5-HIAA of chronic insomnia rats with internal obstruction of phlegm-dampness / 国际中医中药杂志

Objective:To observe the effects of Banxia Shumi Decoction on 5-HT 1AR, 5-HT 2AR, 5-HT, and 5-HIAA of chronic insomnia (CI) rats with internal obstruction of phlegm-damp (IOPD) type, to investigate the mechanisms of Banxia Shumi Decoction on resolving and draining dampness, guiding yang into yin and tranquilizing mind. Methods:A total of 48 Wistar rats were divided into control group, model group, Banxia Shumi Decoction low-dosage group, medium-dosage group, high-dosage group, and diazepam group according to random number table method, with 8 rats in each group. Except the control group, the CI with IOPD rats model were prepared by the method of "high-fat diet + single-platform water environment" in other groups. The rats in the Banxia Shumi Decoction low-, medium-, high-dosage group were treated with Banxia Shumi Decoction by gavage at the dose of 4.69, 9.38 and 18.75 g/kg respectively, the rats in the diazepam group were given 0.52 mg/kg diazepam aqueous solution by gavage, and the rats in the control group and model group were given the equal volume normal saline, once a day for consecutive 2 weeks. The mRNA expressions of 5-HT 1AR, 5-HT 2AR in rat brain stem were detected by qPCR, the protein expressions of 5-HT 1AR, 5-HT 2AR in rat brain raphe nucleus were detected by Western blot, and the contents of 5-HT and 5-HIAA in rat brain stem were determined by HPLC-MS. Results:Compared with model group, the expression of 5-HT 1AR mRNA significantly increased in the Banxia Shumi Decoction low-, medium-, high-dosage group, and diazepam group ( P<0.01); the expression of 5-HT 2AR mRNA significantly decreased in the Banxia Shumi Decoction high-dosage group and diazepam group ( P<0.05), and the expression of 5-HT 1AR and 5-HT 2AR significantly increased in the Banxia Shumi Decoction high-dosage group and diazepam group ( P<0.05 or P<0.01); 5-HT content significantly increased in the Banxia Shumi Decoction medium-, high-dosage group and diazepam group ( P<0.05 or P<0.01); 5-HIAA content significantly increased in the Banxia Shumi Decoction low-, medium-, high-dosage group, and diazepam group ( P<0.05 or P<0.01). Conclusion:Banxia Shumi Decoction may intervene CI with IOPD type and perform the actions of resolving and draining dampness, guiding yang into yin and tranquilizing mind by regulating the expressions of 5-HT 1AR, 5-HT 2AR, 5-HT and 5-HIAA.

Clinical study of Tongbu Qijing Acupuncture combined with metformin hydrochloride tablet in the treatment of polycystic ovary syndrome combined with insulin resistance of kidney-deficiency phlegm dampness type / 国际中医中药杂志

Objective:To evaluate the effect of Tongbu Qijing Acupuncture combined with metformin hydrochloride tablet on polycystic ovary syndrome (PCOS) combined with insulin resistance (IR) of kidney-deficiency phlegm dampness type.Methods:Randomized controlled trial. 84 patients with PCOS and IR in the hospital were enrolled as the observation objects between November 2019 and November 2021. According to random number table method, they were divided into observation group (Tongbu Qijing Acupuncture combined with metformin hydrochloride tablets) and control group (oral metformin hydrochloride tablets), 42 in each group. All were treated for 3 courses of treatment (1 month/course). TCM syndromes were scored before and after treatment. The height, weight, waist circumference and hip circumference of patients were measured to calculate body mass index (BMI) and waist-hip ratio (WHR). The levels of serum TG, TC, LDL-C and HDL-C were detected by biochemical analyzer, fasting blood glucose (FPG) was detected by glucose oxidase method, fasting insulin (FINS) was detected by electrochemiluminescence method, and insulin resistance index (HOMA-IR) was calculated. The recovery rates of menstruation and ovulation were observed and compared after treatment, and the clinical curative effect was evaluated.Results:There were significant differences in total response rate between observation group and control group [95.24% (40/42) vs. 80.95% (34/42); χ2=4.09, P=0.043]. After treatment, scores of TCM syndromes, BMI and WHR in observation group were significantly lower than those in the control group ( t=20.36, 23.77, 3.44, P<0.01). After treatment, serum FPG [(4.86±0.51) nmol/L vs. (5.41±0.55) nmol/L, t=4.75], FINS [(8.31±0.85) mU/L vs. (10.11±1.02) mU/L, t=8.79] levels and HOMA-IR [(1.88±0.19) vs. (2.44±0.25), t=11.97] in observation group were significantly lower than those in the control group ( P<0.01). After treatment, levels of serum TG, TC and LDL-C in observation group were significantly lower than those in the control group ( t=16.54, 4.81, 5.35, P<0.01), while HDL-C was significantly higher than that of the control group ( t=6.78, P<0.01). After treatment, there were significant differences in recovery rates of menstruation and ovulation between observation group and control group [57.14% (24/42), 47.62% (20/42) vs. 80.95% (34/42), 69.05% (29/42); χ2=5.57, 3.97, P<0.05]. Conclusion:Tongbu Qijing Acupuncture combined with metformin hydrochloride tablet can effectively improve syndromes and signs, regulate glucose-lipid metabolism, reduce IR and promote the recovery of menstruation and ovulation in patients with PCOS and IR.

Clinical study of self-made Huatan Prescription combined with conventional western medicine therapy in the treatment of severe pneumonia of phlegm turbidity / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of external therapy with self-made Huatan Prescription combined with conventional western medicine therapy in the treatment of severe pneumonia of phlegm turbidity obstructing lung.Methods:Randomized controlled trial. A total of 114 patients with severe pneumonia of phlegm turbidity obstructing lung in the hospital between July 2020 and December 2021 were enrolled in this study. The patients were divided into two groups by the random number table method, with 57 in each group. On the basis of conventional western medicine therapy, the treatment group was given external therapy of self-made Huatan Prescription, and the control group was given the placebo. Both groups were applied continuously for 5 days. The TCM syndromes were scored before and after treatment. The disease severity was evaluated by Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ). The levels of WBC and procalcitonin (PCT) were detected by automatic blood analyzer. The levels of serum CRP and IL-6 were detected by ELISA. The adverse reactions during treatment were recorded and the clinical efficacy was evaluated.Results:After treatment, the total respinse rate was 92.98% (53/57) in treatment group and was 70.18% (40/57) in control group ( χ2=9.87, P=0.002). The scores of fever, unconsciousness, cough and expectoration, nausea and vomiting, tongue coating and pulse and total score in treatment group were significantly lower than those in the control group ( t=8.95, 7.30, 6.93, 7.37, 12.02, 12.59, 14.29, P<0.01). SOFA (18.12±3.55 vs. 21.46±3.58, t=5.00) and APACHE Ⅱ (13.39±2.72 vs. 16.52±3.13, t=5.70) in treatment group were significantly lower than those in the control group ( P<0.01). The levels of WBC [(11.12±1.61) ×10 9/L vs. (12.69±1.82) ×10 9/L, t=4.88], PCT [(3.72±0.81) μg/L vs. (5.19±0.92) μg/L, t=9.05], serum CRP [(62.09±11.41) mg/L vs. (91.77±15.54) mg/L, t=11.62] and IL-6 [(193.14±32.28) ng/L vs. (235.68±38.75) ng/L, t=6.37] in treatment group were significantly lower than those in the control group ( P<0.01). During treatment, there were no obvious adverse reactions in both groups. Conclusion:Self-made Huatan Prescription external therapy combined with conventional western medicine therapy can improve the clinical symptoms, inhibit the inflammatory response, relieve the disease condition and improve the prognosis of patients with severe pneumonia of phlegm turbidity obstructing lung safely.

Mechanism of phlegm-stasis co-treatment for myocardial protection in rats with diabetes mellitus by regulating JNK signaling pathway / 国际中医中药杂志

Objective:To observe the intervention mechanism of phlegm-stasis co-treatment for the JNK signaling pathway in the myocardium of diabetes rats.Methods:Totally 50 male SD rats of SPF grade were selected. Diabetes model was established by single intraperitoneal injection of 55 mg/kg streptozotocin (STZ) solution. After continued feeding for 3 weeks, the rats were divided into normal group, model group, alachloramine group, blood stasis removing group, phlegm removing group and phlegm-blood stasis co-treatment group according to random number table method, with 6 rats in each group. Xiaoxianxiong Decoction (4.05 g/kg), Xuefu Zhuyu Decoction (7.02 g/kg), Didang Xianxiong Decoction (8.10 g/kg) were administered to the stomach respectively in the phlegm removing group, the blood stasis removing group and the phlegm-blood stasis co-treatment group. Alachloramine (3 mg/kg) was administered to the stomach by gavage in the alachloramine group. After 8 weeks, HE staining was used to observe the morphological changes of myocardial tissue in diabetic rats. Masson staining was used to observe the deposition of collagen fibers in the myocardial interstitium in rats. The expression of JNK1 protein was determined by immunohistochemistry. JNK1 mRNA, IRS1 mRNA and NLRP3 expression levels were detected by Real-time PCR. Western blot was used to detect the protein expressions of IRS-1, p-Akt and NLRP3.Results:The myocardial cells in the model group were disorganized, with hypertrophy, blurred texture, inflammatory infiltration of interstitium, increased collagen fibers, and focal necrosis. All treatment groups could improve fibrosis, inflammatory infiltration and reduce myocardial collagen deposition in different degrees. Compared with the model group, the mRNA and protein expressions of JNK1 and NLRP3 bodies decreased ( P<0.01), the IRS-1 mRNA and protein increased ( P<0.01), and p-Akt protein expression increased ( P<0.01). Conclusions:The phlegm and stasis co-treatment can effectively improve the cardiomyopathy of diabetes rats, and the effect is better than the phlegm-resolving method or the stasis resolving method alone. The mechanism may be related to the inhibition of JNK signaling pathway activation, reduce the expressions of JNK1 and NLRP3, and increase the IRS-1 and Akt.