Identifying complementary and alternative medicine recommendations for anxiety treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines.

Background: Clinical practice guidelines (CPGs) are used to guide decision-making, especially regarding complementary and alternative medicine (CAM) therapies that are unfamiliar to orthodox healthcare providers. This systematic review aimed to critically review and summarise CAM recommendations associated with anxiety management included in the existing CPGs. Methods: Seven databases, websites of six international guidelines developing institutions, and the National Centre for Complementary and Integrative Health website were systematically searched. Their reporting and methodological quality were evaluated using the Reporting Items for practice Guidelines in Healthcare checklist and the Appraisal of Guidelines for Research and Evaluation (2nd version) instrument, respectively. Results: Ten CPGs were included, with reporting rates between 51.4 and 88.6%. Seven of these were of moderate to high methodological quality. Seventeen CAM modalities were implicated, involving phytotherapeutics, mind-body practice, art therapy, and homeopathy. Applied relaxation was included in 70% CPGs, which varied in degree of support for its use in the treatment of generalised anxiety disorder. There were few recommendations for other therapies/products. Light therapy was not recommended for use in generalised anxiety disorder, and St John's wort and mindfulness were not recommended for use in social anxiety disorder in individual guidelines. Recommendations for the applicability of other therapies/products for treating a specific anxiety disorder were commonly graded as "unclear, unambiguous, or uncertain". No CAM recommendations were provided for separation anxiety disorder, specific phobia or selective mutism. Conclusion: Available guidelines are limited in providing logically explained graded CAM recommendations for anxiety treatment and care. A lack of high-quality evidence and multidisciplinary consultation during the guideline development are two major reasons. High quality and reliable clinical evidence and the engagement of a range of interdisciplinary stakeholders are needed for future CPG development and updating. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373694, identifier CRD42022373694.

[Isolation and pharmacological properties of analgesic fraction from venom of Naja Naja atra].

OBJECTIVE: To separate main analgesic fraction from venom of Guangdong Naja naja atra, to establish the basis for the using of Naja naja atra and find new analgesic fraction. METHODS: Affinity chromatography and size exclusion were used to isolate the analgesic fraction from the venom of Naja naja atra, and then to determine its properties by biochemical methods, such as SDS-polyacryamide gel electrophoresis ( SDS-PAGE), HPLC and Mole-toff. RESULTS: HPLC showed its relative purity was 95% (HPLC)and Mw was 6741. 236 Da. We observed that peripheral administration of neurotoxin strongly reduced the mechanical allogynia and thermal hyperalgesia for 24 hours, associated with this neuropathy (L5 spinal nerve ligation). CONCLUSION: The fraction from venom of Naja naja atra has significant analgesic effect and it is worth further developing.

Authentication of the 31 species of Toxic and Potent Chinese Materia Medica (T/PCMM) by microscopic technique, part 2: Three species of seed T/PCMM.

Toxic and Potent Chinese Materia Medica (T/PCMM) are being used more and more in the treatment of various diseases. In view of their toxic side effects and to ensure their safe use, accurate and reliable authentication is indispensable. However, identifying characteristics of T/PCMM are seldom reported, even though modern microscopy can provide ample, unique identifying characteristics from cells found in transverse sections and powders. In particular, no systematic authentication studies on seed T/PCMM have been conducted. In the course of our study on 31 T/PCMM originating from plants, animals, minerals, and secreta, an accurate and convenient method, based on microscopic techniques, has been developed and reported for the authentication of animal T/PCMM. The present study deals with detailed investigations on three species of seed T/PCMM, namely Semen Hyoscyami (Hyoscyamus niger L.), Semen Euphorbiae (Euphorbia lathyris L.), and Semen Strychni (Strychnos nux-vomica L.). The macroscopic characters are here described in detail, and the microscopic characters were conclusively determined by common and polarized light microscopy. Results showed that these three T/PCMM can be easily identified by the present method even when powdered and combined. Thus, the microscopic method is applicable for authentication of the earlier three T/PCMM, and the morphological and microscopic characteristics described here are proposed as parameters to establish the authenticity of these three T/PCMM.

Authentication of the 31 species of toxic and potent Chinese Materia medica (T/PCMM) by microscopic technique, part 1: three kinds of toxic and potent animal CMM.

Microscopic authentication is an effective method for quality control of Chinese Materia Medica (CMM) because of its speed, convenience and low cost. However, the application of modern microscopic technique in quality evaluation of Toxic and Potent Chinese Materia Medica (T/PCMM) of animal origin is seldom reported. This gap in published knowledge is increasingly serious because confusion in T/PCMM has led to serious medical problems in China and other countries in recent years. To ensure the safe and effective use of T/PCMM, an accurate and convenient method, based on macroscopic and microscopic techniques, was developed for the authentication of animal T/PCMM. The color microscopic photos of the crude drug were acquired with the light microscope, and from these their morphological and microscopic characters were described. The present method was successfully applied in the analysis of 31 T/PCMM including 17 samples originating from plants, 3 from animals, 9 from minerals, and the remaining 2 from secreta. The macro- and microscopic characters of three animal T/PCMM, namely Mylabris (Mylabris phalerata or Mylabris cichorii), Huechys (Huechys sanguinea), and Lytta (Lytta caraganae) were conclusively determined and are here presented. The results demonstrated that it was feasible to use the present microscopic characters for the authentication of the above three animal T/PCMM.

[Determination of bufothionine in skin of Bufo bufo gargarizans and Huachansu injection].

OBJECTIVE: To establish a HPLC method for bufothionine in the skin of Bufo bufo gargarizans and Huachansu injection. METHOD: The samples were separated using a Lichrosob C18 column with CH3CN-H2O (10:90) as mobile phase. Flow rate was at 1.0 mL x min (-1) and the detection wavelength was at 225 nm. RESULT: The calibration curve of bufothionine was linear over the range of 0.0772-0.4632 microg and the average recovery was 99. 2%. The contents of bufothionine were fluctuated from 36.4-641.8 microg x g(-1) in the skin of Bufo bufo gargarizans and 22.47-33.16 microg x mL(-1) in Huachansu injection, respectively. CONCLUSION: The contents of bufothionine were greatly different between cultured and wild species. The method was suitable for the quality control of the skin of Bufo bufo gargarizans and its preparation.

[Identification of sea cucumber sold in market].

OBJECTIVE: To identify the variety of the sea cucumber sold in market. METHOD: Figure and bone pieces observed for the microstructures. RESULT: 8 varieties were identified as Lessonothurea Deichmann, Thymiosycia Pearson, Microthele Brandt and Metriatyla Rowe of Holothuria, Bohadschia, Stichopus and Thelenota. CONCLUSION: The bone pieces in ora, anus, back, abdomen and tentacle of sea cucumber are different. They are the important bases to identify sea cucumber.

Authentication of the 31 species of toxic and potent Chinese materia medica by microscopic technique assisted by ICP-MS analysis, part 4: four kinds of toxic and potent mineral arsenical CMMs.

Toxic and Potent Chinese Materia Medica (T/PCMM) is a special and very important category of Chinese medicines. They have long been used in traditional medical practice and are being used more and more widely throughout the world in recent years. As there may be many fatal toxic effects caused by misusing or confusion of T/PCMM, their quality and safety control arouse increasing attention internationally. Researches on the accurate identification to ensure the safe use of T/PCMM are acquired; however, there are few reports on authentication. We are carrying out a series of studies on 31 T/PCMM originating from plants, animals, minerals, and secreta. In our previous studies, we proved that modern microscopic authentication is a simple, fast, effective, low cost, and less toxic method for identifying animal, seed, and flower T/PCMM. In the present study, we focused on the authentication of four kinds of mineral arsenicals, including orpiment (mainly containing As2S3), realgar (mainly containing As4S4), arsenolite, and arsenic trioxide (mainly containing As2O3). We examined the macroscopic and microscopic characteristics of the above minerals and found that they all can be easily identified and authenticated by using light microscopy coupled with polarized microscopy. Moreover, the authentication results for arsenolite and arsenic trioxide are confirmed by ICP-MS analysis. We are sure that the morphological and microscopic characteristics indicated here are indispensable to establishing standards for these four mineral T/PCMMs.

[Effect of Oviductus Ranae on Cyclin D1, CDK6 and P15 expressions in the liver tissue of aged male rats].

OBJECTIVE: To investigate the effect of Oviductus Ranae (OR) on the expressions of CyclinD1, CDK6 and P15 in the liver of aged male rats. METHODS: Eighteen male SD rats were randomly divided into 3 equal groups, namely the OR group, VE group and ageing model group. The rats received subcutaneous injection of D-galactose for 6 weeks to establish the aging models, and another 6 rats were injected daily with normal saline (NS) to serve as the normal control group. From the third week of the experiment, the rats were given oral OR or Vitamin E (VE) accordingly till the sixth week. After completion of the drug administration, all the rats were sacrificed for detecting the expressions of CyclinD1, CDK6 and P15 in the liver tissue by Western blotting. RESULTS: The relative expression levels of CyclinD1, CDK6 and P15 in the liver of the rats in the OR group were 41.73-/+0.54, 23.29-/+0.30 and 1.49-/+0.30, respectively, significantly up-regulated as compared with those in the ageing model group (P<0.01). The expressions of the proteins were obviously down-regulated in the model group in comparison with those in the normal control group. CONCLUSIONS: OR treatment can lower the expressions of Cyclin D1 and CDK6 in the liver to enhance the liver cell proliferation in aged male rats. OR also promotes the expression of P15 through a feedback mechanism to prevent excessive proliferation of the cells. The effect of OR against ageing is mediated possibly by up-regulation of the proteins associated with the cell proliferation in the liver, a mechanism different from that of VE.

Authentication of the 31 species of toxic and potent Chinese Materia Medica by light microscopy, Part 3: two species of T/PCMM from flowers and their common adulterants.

Toxic and potent Chinese Materia Medica (T/PCMM) has become a hot and sensitive topic as more and more people around the world are interested in the safety of herbal medicines. T/PCMM is irreplaceable in treating some diseases; but it can easily cause serious problems if confused with other herbal medicines. Accurate identification is essential to ensure their safe use, but up to now, the literature on the authentication of T/PCMM is scant. Thus, we are undertaking a study of 31 T/PCMM originating from plants, animals, minerals, and secreta. Our previous study established microscopic observation as a simple, fast, accurate, and convenient method for identifying and authenticating animal and seed T/PCMM. This study focused on the authentication of flower T/PCMM as a part of the whole study. The flower T/PCMM studies were derived from two species, Datura metel L. (Flos Daturae) and Rhododendron molle G. Don (Flos Rhododendri Mollis). Other species easily confused with these two were also examined and characterized. Using the microscope camera, normal light and polarized light microscopy, we determined the macroscopic and microscopic features of the flowers; in addition, the oil immersion lens was used to study the pollen grain characteristics. The results demonstrated that flower T/PCMM can be identified and authenticated using a light microscope equipped with an oil immersion lens. This same equipment can be easily used to characterize other herbal flower medicines.