Understanding the Concept of Purgation in Siddha Medicine: A Review

Siddha system of medicine is a traditional medicinal system followed in South India. In a human body imbalance of humours causes various diseases with major symptoms. We found out the disease by the signs of symptoms and curable by Siddha medicines. Purgation is one of the major treatments of Siddha system. Purgation medically induced elimination of stools to calm down excessive vitiated Dosha. Though purgation is used in modern system it is mainly confined to gastro intestinal diseases. But in Siddha system purgation is used in first line of treatment for many diseases. In this article, purgation based on medicines, various methods of purgation, procedures of purgation, different diseases, contra indications, signs and symptoms of inadequate purgation, excessive purgation and complication and dietary regimens is explained in a holistic manner. Siddha literature and published papers were explored to found the rationale of purgation treatment. Purgation is one of the advisable therapies for chronic diseases. Purgative medicines making in the form of Kudineer, Kuzhambu and oil. Agasthiyar Kuzhambu is essentially for purgation treatment. This medicine helps to cure fifty four various diseases like fever, cough, bleeding piles etc.

Efficacy of Zhizhuwan Decoction and Its Ingredient-contained Serums on Proliferation and Apoptosis of Rat Colon Interstitial Cells of Cajal / 中国实验方剂学杂志

Objective:To explore the efficacy and molecular mechanism of Zhizhuwan decoction and its ingredient-contained serums on the proliferation and apoptosis of rat colon interstitial cells of cajal (ICC), and make a molecule-level analysis of the possible mechanism of traditional Chinese medicine (TCM) purgation-tonifying therapy in treating slow transit constipation (STC). Method:A total of 40 rats were divided into Atractylodis Macrocephalae Rhizoma(AMR) group, Aurantii Fructus Immaturus（AFI） group, Zhizhuwan group and blank serum group on random basis, with 10 in each group. Baizhu group was given 17.7 g·kg-1·d-1 of AMR decoction by gavage, AFI group was given 8.9 g·kg-1·d-1 AFI decoction by gavage, Zhizhuwan group was given 26.4 g·kg-1·d-1 Zhizhuwan decoction by gavage, and blank serum group was given 3 mL sterile distilled water for 7 consecutive days, once a day. Drug-contained serums and blank serum were collected from blood of the above groups and diluted to 5%, 10%, 15% and 20% concentrations. Each concentration was intervened for 24 h and 48 h, and the amount and status of ICC were observed. The best intervening concentration and time for each group with cell counting kit-8 (CCK-8) were determined. Rat colon ICC was divided into blank control group, blank serum group, AMR group, AFI group and Zhizhuwan group. ICC proliferation for each group was detected with EdU, ICC apoptosis for each group was detected by flow cytometry, and expressions of X-linked inhibitor of apoptosis protein (XIAP) and proliferating cell nuclear antigen (PCNA) were detected by Western blot. Result:Compared with the normal group, the best intervention concentration for blank serum group, AMR group and AFI group was 10%, while that for Zhizhuwan group was 5%. The best intervention times for the above groups were all 24 h. No distinct difference between the effect of blank control group and blank serum group on the proliferation and apoptosis of ICC was observed. In comparison with blank control group and blank serum group, AMR group, AFI group and Zhizhuwan group showed significant changes in ICC proliferation rate (P<0.05，P<0.01). There was a greater increase in ICC proliferation rate of Zhizhuwan group than that of AMR group and Zhizhu group (P<0.05，P<0.01), with no distinct difference between the changes of ICC proliferation rates in AMR group and AFI group. There was no significant difference between the changes of ICC apoptosis rates in AMR group, AFI group and Zhizhuwan group than in blank control group and blank serum group. There were significant increases in the expressions of XIAP and PCNA in AMR group, AFI group and Zhizhuwan group than in blank control group and blank serum group (P<0.05，P<0.01)， but with little difference among the three groups. Conclusion:At certain concentrations, Zhizhuwan, AFI and AMR all have the effect in improving ICC proliferation by increasing XIAP and PCNA expressions, with no evident effect on the apoptosis of ICC, based on TCM purgation-tonifying therapy, Zhizhuwan has the effect in improving ICC proliferation, with a better effect than single administration with AFI or AMR.

Experience in Treatment of COVID-19 by Elimination of Pathogens Through Purgation and Diuresis / 中国实验方剂学杂志

Coronavirus disease-2019 (COVID-19) outbreaks were spreading rapidly around the world in early 2020. This disease is within the category of "damp epidemic" and "damp toxin epidemic" in traditional Chinese medicine, with lung and spleen as the lesion focuses, while dampness and toxin as especially prominent properties. Through clinical observation, we found that dampness would often transform into damp heat during the development and evolution of the disease, and the "triple energizer" treatment was an important therapeutic method, eliminating pathogens through purgation and diuresis: for those with damp-heat accumulation toxin diffused to the triple energizer, we could use Ganlu Xiaodudan as primary prescription, which can spread the upper part, smooth the middle part and infiltrate the lower part, so as to provide a way out for the pathogenic factors and regulate Qi movement. For those with damp-heat in Shaoyang channel, we could use Haoqin Qingdantang to clear heat and promote diuresis, harmonize Shaoyang, eliminate damp-heat and epidemic pathogenic factor. For those with pathogen hidden in membrane source dampness trapping and hidden heat, we could use Dayuanyin to eliminate pathogens between interior and exterior parts, and regulate Qi movement. At the same time we shared three typical cases treated in Wuhan, and conducted an in-depth analysis in this study. Clinically, the method of elimination of pathogens through purgation and diuresis is mainly used in the early and middle stage of this disease. When the disease is still located in Qi system, it also can be applied to mild, ordinary patients and severe patients that have accurate syndrome differentiation. In such cases, it can effectively improve symptoms, reduce pathogenic toxin, truncate and reverse the course of disease, give way to pathogen, and avoid disease aggravating.

Dose-toxicity-effect relationship between licorice combined with rhubarb in purgation / 中国中药杂志

The dose-toxicity-effect relationship between licorice combined with rhubarb in purgation was studied. A total of 108 ICR mice were divided into control group,model group,positive group,low,medium and high-dose rhubarb groups,and low,medium and high-dose rhubarb-liquorice decoction group. After 6 days of continuous administration of loperamide hydrochloride,the constipation model of mice was replicated,and each group was given lactulose,different doses of rhubarb and rhubarb-liquorice decoction for 14 days. After administration,the defecation characteristics,blood biochemistry,liver,kidney and colon pathological changes in each group were compared. Based on the objective weight given by factor analysis,the dose-toxicity-effect relationship was comprehensively analyzed by multi-index scoring method. Two common factors were extracted by factor analysis,representing effect and toxicity respectively. The results showed that rhubarb could exert a diarrhea effect at the dosage of 1/2,2 and 8 times of the high limit set forth in the Chinese Pharmacopoeia,increase the defecation volume and the intestinal tract propulsion rate,reduce the time of anal and the oral transmission,and increase the water content of feces. The combination with licorice could alleviate its diarrhea effect,especially at the dosage of 1/2 times of the high limit set forth in the Chinese Pharmacopoeia. However,rhubarb showed obvious hepatic and colon toxicities at the dosage of 2 and 8 times of the high limit set forth in the Chinese Pharmacopoeia,and the combination with licorice could significantly reduce its toxicity. It shows that licorice has a " mediating" effect on rhubarb by alleviating the purgation property and reducing the toxicity.

Effects of different processed products of Rehmanniae Radix Praparata on gastrointestinal motility in rats with purgation with bitter cold and excessive fatigue type spleen deficiency / 中草药

Objective To compare the effects of prepared Rehmanniae Radix Praparata (RRP) on gastrointestinal motility in rats with purgation with bitter cold and excessive fatigue type spleen deficiency. Methods A total of 80 SD rats were randomly divided into eight groups according to their body weights, which named as control group, model group, nine steamed nine sunned RRP group (RRP ), nine steamed nine sunned (without yellow wine) RRP group (RRP Ⅱ group), nine steamed nine sunned (without Amomi Fructus) RRP group (RRP III group), nine steamed nine sunned (without yellow wine and Amomi Fructus) RRP group (RRP IV group), steamed RRP group (RRP V group), and wine stewed RRP group (VI group). By filling the rats with Rhei Radix et Rhizoma decoction and swimming 2 to 5 min at the same time, with its body sinking as degree, once daily, after obtaining the model of purgation with bitter cold and excessive fatigue type spleen deficiency of the RRP groups I-VI, the spleen deficiency rats’ general physical signs were observed, and the serum D-xylose, GAS, and MTL of the spleen asthenia rats were measured. The effects of different processed products of RRP on gastrointestinal digestion and absorption and intestinal propulsion in rats with spleen deficiency were observed. Results The weight, food intake, and influent amount of model rats were significantly increased after nine steamed and nine sunned RRP treatment (P < 0.01), while the weight, food intake, and water intake of the rats in RRP V and VI groups after administration were decreased compared with the model rats (P < 0.05). By measuring the intestinal propulsion rate, D-xylose, GAS, and MTL content in the serum, the intestinal propulsive rate, the serum D-xylose, GAS, and MTL content of the rats in RRP III, IV, V, and groups were lower than those of the control group (P < 0.01). The intestinal propulsive rate and the content of serum D-xylose in the RRP V group and RRP VI group were lower than that in the RRP group (P < 0.01). The intestinal propulsive rate and the serum D-xylose content in rats of RRP IV group were lower than those in the RRP group (P < 0.05). The serum GAS and MTL content in rats of RRP IV group were lower than those in the RRP group (P < 0.01). Conclusion Nine steamed nine sunned processing method can effectively alleviate the disadvantages of RRP because of its strong flavor and rich spleen.

Pro.SONG Kang's Clinical Experience in Treating Idiopathic Pulmonary Fibrosis / 浙江中医药大学学报

[Objective] To sum up Pro.SONG Kang's clinical experience in treating idiopathic pulmonary fibrosis.[Methods] By following the teacher,summarize the theory and method of the teacher's treatment of idiopathic pulmonary fibrosis.[Result] Pro.SONG Kang according to studying collateral disease theory,thinks that "pulmonary collateral blockage" and "deficiency of collateral"are the basic pathogenesis of idiopathic pulmonary fibrosis,will belong to the" Feibi "," Feiwei ",often with purgation-tonifying to treat the idiopathic pulmonary fibrosis,specific treatment of dissipating phlegm and removing blood stasis,invigorating lung and spleen,nourishing yin and tonifying kidney,aims at the main symptoms,composing prescriptions reasonably,and combining with western medicine treatment according to the illness,and achieves great therapeutic effect in clinic.[Conclusion] Pro.SONG Kang's treatment of idiopathic pulmonary fibrosis has significant curative effect,the clinical experience and prescription drug is worthy of further research and study.

Opinion TCM Treatment of Haze Induced Lung Injury / 浙江中医药大学学报

Objective] From the Chinese point of view of haze-induced lung injury pathogenesis, diagnosis and treatment, it provides theoretical support. [Method] To exogenous disease TCM theory, the nature of the haze of evils, a sense of evil ways and pathogenic characteristics, etc. based on the analysis of the haze of the etiology and pathogenesis of lung injury, the basic pathogenesis are analyzed and discussed. [Results] For haze pathogenic proposed basic principles should be taken to the prevention, prevention is greater than cure, the treatment should be Quxie, and to righten. Work using the method of elimination of pathogens through purgation and churesis.[Conclusion]For haze urgent treatment, prevention and treatment of traditional Chinese medicine for haze-induced lung injury has very important theoretical and practical value.

Theoretical basis of imcompatibility of Euphorbiae Pekinensis Radix and Glycyrrhizae Radix et Rhizoma based on diuretic and purgative effects on mice / 中草药

Objective: To investigate the theoretical basis of incompatibility of Euphorbiae pekinensis Radix (EPR) and Glycyrrhizae Radix et Rhizoma (GRR). Methods: In order to compare the effects of EPR used alone and combined with GRR, the diuretic effect was studied by weighing method to observe the urine output of normal mice, while the purgation effect was studied by observing the defecation time, feces pellets, and feces shape after drug administration. Results: In the equivalent dose range of China Pharmacopoeia 2010, the diuretic effect of EPR powder is stronger than its aqueous extract; GRR aqueous extract did not show any promoting or suppressing effect on the diuresis; Within 1 h after coadministration of EPR powder and GRR aqueous extract, urine output was significantly reduced, suggesting that GRR might inhibit the diuretic effect of EPR; The co-detection of EPR and GRR did not cause the obvious changes of urine output. There was no significant purgative effect of EPR powder alone and coadministered with GRR aqueous extract at the same dose level. Conclusion: The diuretic effect of EPR can be suppressed by GRR in the equivalent dose range of China Pharmacopoeia 2010, suggesting that the sweet and mitigation property of GRR relieving the effect of removing water retention by purgation is one of the incompatibility theoretical basis between EPR and GRR.

Therapy procedures of ‘Les Nga’ practised at National Traditional Medicine Hospital.

The Traditional primary purification and detoxification treatment is known as Les Nga. It means the "five therapies". The five therapeutic means of eliminating toxins from the body are Emesis, Purgation, Nasal irrigation, Enema and Bloodletting. These series of five therapies help remove deep rooted stress and illness causing toxins from the body while balancing the three somatic humors. The Les Nga procedures along with its pre-treatments as specified in gSo-ba rig-pa, when provided in the right time and season can help an individual to lead a better life even at an old age. It is suggested that when one undergoes Les Nga therapy for three times annually, in the right seasons, it expels the toxins, revitalizes the body tissues and prevents the body from falling prey to various diseases and keeps an individual healthy during old age. There is a tendency for the rLung to get aggravated in old age and all therapies that are administered should be to prevent the rLung. Les Nga offers one of the most comprehensive methods of removing toxins from the body. They seek to reverse the direction of the diseases. This cleansing process is achieved through several protocols such as special diets, oilation therapy, steam therapy and cleansing therapies. Towards the therapy’s end, special attention is given to purgation, blood donating, or enema therapy. These therapies can help alleviate pain and diseases in human beings and hence may be established in NTMH for the benefit of all citizens.