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ObjectiveTo compare and evaluate the clinical efficacy of five classical prescriptions for acute attack of bronchial asthma （BA） and cough variant asthma （CVA） in children， and to further compare and assess the effect of them on cold-induced asthma or heat-induced asthma. MethodRandomized controlled trials （RCT） on the treatment of acute attack of asthma with five classical prescriptions （Sanzi Yangqintang， Maxing Shigantang， Shegan Mahuangtang， Xiao Qinglongtang， and Dingchuantang） were retrieved from China Science and Technology Journal Database （VIP）， China National Knowledge Infrastructure （CNKI）， and Wanfang Data （from establishment to August 15， 2021）. The eligible RCT were evaluated and the data were extracted for network Meta-analysis by Stata 16.0. ResultA total of eligible 47 RCT were screened out， involving 5 114 children with acute attack of asthma and 10 intervention measures. Among them， 16 RCT （1 912 children， 6 intervention measures） were about the cold-induced asthma and 10 RCT （1 054 cases， 4 intervention measures） focused on the heat-induced asthma. According to the Meta-analysis， among the 10 interventions， Maxing Shigantang + routine treatment of western medicine demonstrated the most significant effect， and the effect of the interventions was in the following order： Maxing Shigantang + routine treatment of western medicine > routine treatment of western medicine， Shegan Mahuangtang + routine treatment of western medicine> Xiao Qinglongtang + routine treatment of western medicine > Shegan Mahuangtang > Dingchuantang + routine treatment of western medicine. For the cold-induced asthma， the effect of Shegan Mahuangtang + routine treatment of western medicine was remarkable， and for the heat-induced asthma， the corresponding intervention was Dingchuantang + routine treatment of western medicine. Shegan Mahuangtang was outstanding in improving the percentage of forced expiratory volume in the first second in predicted value （FEV1%）. ConclusionThe combination of western medicine with the five prescriptions was more effective than the western medicine alone， particularly the combination with Maxing Shigantang. The combination of Shegan Mahuangtang and western medicine was outstanding in the treatment of cold-induced asthma， while the corresponding intervention for heat-induced asthma was the combination of Dingchuantang and western medicine. However， a large number of RCT with scientific design and higher quality are still needed to verify the conclusion.
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ObjectiveTo explore the mechanism of the combined therapy of lung and intestine （Mahuangtang + Da Chengqitang） in alleviating pulmonary edema in rats with acute lung injury （ALI） induced by lipopolysaccharide （LPS）. MethodWistar rats were randomly divided into blank group， model group， low-， medium-， and high-dose groups with combined therapy of lung and intestine， and positive control group. LPS （10 mg·kg-1） was given （ip） to induce ALI in rats. After modeling， the blank group was given normal saline （25 mL·kg-1）， the combined therapy of lung and intestine treatment groups were given （ig） low- （5 g·kg-1）， medium- （7.5 g·kg-1）， and high-dose （10 g·kg-1） Mahuangtang and Da Chengqitang， and the positive control group was given dexamethasone （5 mg·kg-1）. Medications were administered 0， 8， and 16 h after LPS injection for 3 times. Then lung tissue and serum were collected after administration. The lung tissues were stained with haematoxylin-eosin （HE）， and the pulmonary edema score was evaluated. The dry/wet （D/W） weight ratio of lung tissues in each group was measured， and the content of serum vasoactive intestinal peptide （VIP） in rats was detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the protein levels of aquaporin-1 （AQP1）， AQP5， VIP， cyclic adenosine monophosphate （cAMP）， phosphorylated protein kinase A （p-PKA）， and PKA in lung tissues of rats in each group. The level of VIP mRNA in lung tissues of rats was detected by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the blank group， the model group exhibited obvious lung injury， increased edema score， decreased D/W ratio （P<0.01）， declined AQP1， AQP5， cAMP， and p-PKA/PKA in lung tissues （P<0.05， P<0.01）， elevated VIP content （P<0.01）， and up-regulated levels of VIP protein and mRNA in lung tissues （P<0.05， P<0.01）. Compared with the model group， combined therapy of lung and intestine treatment groups showed alleviated lung injury， increased D/W ratio （P<0.01）， elevated AQP1， AQP5， VIP， cAMP， and p-PKA/PKA in lung tissues （P<0.05， P<0.01）， and up-regulated VIP levels in lung tissues （P<0.05， P<0.01）. ConclusionThe combined therapy of lung and intestine can alleviate ALI-induced lung tissue edema， and the mechanism may be related to the activation of the VIP/cAMP/PKA signaling pathway， which further promotes the expression of AQP1 and AQP5 and enhances the water metabolism of lung tissue.
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ObjectiveTo investigate the effect of combined therapy of lung and intestine （Mahuangtang + Da Chengqitang） on lipopolysaccharide （LPS）-induced acute lung injury （ALI） in rats and its protective mechanism. MethodWistar rats were randomly divided into blank group， model group， low-， medium-， and high-dose groups with combined therapy of lung and intestine ， and dexamethasone group. LPS （10 mg·kg-1） was given （ip） to induce ALI in rats. The general state of rats in each group was observed and recorded. The body temperature of rats in each group was recorded 0-8 h after modeling by means of anal temperature measurement. Serum and lung tissues were collected 24 h after modeling. Serum levels of interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， interleukin-10 （IL-10）， and arginase-1 （Arg-1） were determined by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the protein levels of nuclear factor kappa B p65 （NF-κB p65）， phosphorylated NF-κB p65 （p-NF-κB p65）， NF-κB inhibitor α （IκBα）， and phosphorylated IκBα （p-IκBα） in lung tissues of rats. The levels of classically activated （M1） macrophage marker CD80 and IL-1β and macrophage markers F4/80 and IL-10 were detected by double immunofluorescence. ResultCompared with the blank group， the model group showed increased body temperature and thermal response index （TRI）， elevated serum levels of pro-inflammatory factor TNF-α and IL-1β and anti-inflammatory factor IL-10 （P<0.01）， up-regulated protein levels of p-NF-κB p65 and p-IκBα in lung tissues （P<0.01）， and increased levels of F4/80， CD80， and IL-1β in lung tissues （P<0.01）. Compared with the model group， the lung-intestine combined treatment groups and the dexamethasone group exhibited decreased body temperature and TRI in rats （P<0.01）， declined serum levels of inflammatory factor TNF-α and IL-1β （P<0.05， P<0.01）， elevated serum levels of anti-inflammatory factor IL-10 and Arg-1 （P<0.05， P<0.01）， down-regulated protein levels of p-NF-κB p65 and p-IκBα in lung tissues （P<0.05， P<0.01）， decreased levels of CD80 and IL-1β， and increased levels of IL-10 in lung tissues （P<0.01）， while the level of F4/80 was not significantly changed. ConclusionThe combined therapy of lung and intestine can obviously alleviate the fever and inflammatory state of ALI rats， and the mechanism may be related to the inhibition of NF-κB inflammatory pathway and the polarization of lung tissue macrophages to anti-inflammatory phenotype.
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Based on the ancient Chinese medical literature and modern clinical application literature， Mahuangtang was systematically analyzed， including its origin， composition， processing requirements and others， in order to provide support for the development of this famous classical formula. It was found that there were some doubts about Mahuangtang， such as the original variety， the processing of decoction pieces， and the dose conversion ratio. On the basis of fully considering the actual needs of the development of famous classical formula preparations and the usage habits of modern clinical practice， the development suggestions of the author were as follows：Ephedrae Herba should be selected Ephedra sinica without removing knots， Cinnamomi Ramulus should be selected from Cinnamomum cassia， Glycyrrhizae Radix et Rhizoma should select Glycyrrhiza uralensis and be roasted with honey， and Armeniacae Semen Amarum should be selected as Dan-processed products. The total dose of Mahuangtang was 24 g after conversion according to 1 Liang equal to 3 g as following the transition phenomenon and law. The preparation and usage method was as follows：took 1.8 L of water， first added Ephedrae Herba in water for decocting， evaporated 400 mL of water， removed the upper foam， then added the other three drugs， cooked over gentle heat to 500 mL， filtered the residue， took three times a day， about 160 mL warm decoction once. The major function recorded of Mahuangtang in ancient books was exterior sthenia syndrome of exogenous wind cold， it often used in the clinical treatment of cold， acute bronchitis， bronchial asthma and other diseases through the flexible application of the later doctors.
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<b>Objective::To investigate the effect of Houpu Mahuangtang on airway inflammation and expressions of gene and proteins of Transient receptor potential ankyrin 1, vanilloid 1 (TRPA1, TRPV1) in asthmatic mice. <b>Method::Sixty female Balb/c mice were randomly divided into six groups: control group, model group, low, medium and high-dose Houpu Mahuangtang groups (7, 14, 28 g·kg<sup>-1</sup>) and dexamethasone group (0.002 4 g·kg<sup>-1</sup>), with 10 mice in each group. A mouse model of asthma was replicated by sensitizing and challenging with ovalbumin. The changes of enhanced pause (Penh) following acetylcholine chloride (ACh) inhalation were detected. The pathological changes of the lung tissues were observed. The number of eosinophils (EOS) in peripheral blood and the percentage of EOS in bronchoalveolar lavage fluid (BALF) were detected. Interleukin (IL)-4, IL-13, prostaglandin D<sub>2</sub> (PGD<sub>2</sub>) and substance P (SP) were detected by enzyme-linked immuno sorbent assay (ELISA). The expressions of TRPA1 and TRPV1 gene and protein in lung tissues were detected by Quantitative Real-time polymerase chain reaction (Real-time PCR) and Western blot. <b>Result::Compared with control group, mice of model group showed significantly increased in Penh following ACh inhalation (<italic>P</italic><0.05, <italic>P</italic><0.01), EOS in blood and the percentage of EOS in BALF (<italic>P</italic><0.01). Histopathological changes in lungs showed inflammatory cell infiltration and bronchial mucosa damage. The levels of IL-4, IL-13, PGD<sub>2</sub> and SP in BALF and the expressions of TRPA1, TRPV1 mRNA and protein in lung tissues significantly increased (<italic>P</italic><0.05, <italic>P</italic><0.01). Compared with model group, treatment groups had significant effects in decreasing Penh, relieving lung injury, reducing EOS count in blood and the percentage of EOS in BALF (<italic>P</italic><0.05, <italic>P</italic><0.01), reducing IL-4, IL-13, PGD<sub>2</sub> and SP levels in BALF (<italic>P</italic><0.05, <italic>P</italic><0.01), as well as down-regulating TRPA1 and TRPV1 mRNA and protein expressions in lung tissues (<italic>P</italic><0.05, <italic>P</italic><0.01). <b>Conclusion::Houpu Mahuangtang could reduce airway inflammation, airway responsiveness. In addition to the reduction of levels of Th2 related cytokines, the mechanism of Houpu Mahuangtang might be related to the regulation of TRPA1, TRPV1 mRNA and protein expressions, and the decrease of associated neurofactor levels.
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AIM: To study the difference in main chemical composition and content between Mahuangtang Herb Ephedrae;Radix et Rhizoma Gly Cyrrhizae;Ramulus Cinnamoni;Semen Armeniacea Amarum;dispensing granule and its standard decoction. METHODS: RP-HPLC was used to create fingerprinits with MeOH-0.01 mol/L KH_2PO_4(H_3PO_4 adjusted pH=3),a gradient eluting agent. RESULTS: 26 co-possessing peaks were indicated,the retention time and relative peak area were obtained. CONCLUSION: The difference between Mahuangtang dispensing granule and standard decoction is not obvious,the former is rational.