Kaempferia galanga L.: Progresses in Phytochemistry, Pharmacology, Toxicology and Ethnomedicinal Uses.

K. galanga is an aromatic medicinal herb. It is locally to India and distributed in China, Myanmar, Indonesia, Malaysia, and Thailand. K. galanga is a Traditional Chinese Herb Medicine (TCHM), which has been applied to treat cold, dry cough, toothaches, rheumatism, hypertension and so on. In addition, it has been used widely as spices since its highly aromas. The aim of this review is to compile and update the current progresses of ethnomedicinal uses, phytochemistry, pharmacology and toxicology of K. galanga. All the data on K. galanga were based on different classical literary works, multiple electronic databases including SciFinder, Web of Science, PubMed, etc. The results showed that ninety-seven compounds have been identified from rhizome of K. galanga, including terpenoids, phenolics, cyclic dipeptides, flavonoids, diarylheptanoids, fatty acids and esters. Modern pharmacology studies revealed that extracts or secondary metabolites of the herb possessed anti-inflammatory, anti-oxidant, anti-tumorous, anti-bacterial, and anti-angiogenesis effects, which were closely related to its abundant ethnomedicinal uses. In conclusion, although previous research works have provided various information of K. galanga, more in-depth studies are still necessary to systemically evaluate phytochemistry, pharmacological activities, toxicity and quality control of this herb.

Therapeutic effect of oxyberberine on obese non-alcoholic fatty liver disease rats.

BACKGROUND: Berberine (BBR) has been widely used to treat non-alcoholic fatty liver disease (NAFLD). The metabolites of BBR were believed to contribute significantly to its pharmacological effects. Oxyberberine (OBB), a gut microbiota-mediated oxidative metabolite of BBR, has been firstly identified in our recent work. PURPOSE: Here, we aimed to comparatively investigate the anti-NAFLD properties of OBB and BBR. METHODS: The anti-NAFLD effect was evaluated in high-fat diet-induced obese NAFLD rats with biochemical/ELISA tests and histological staining. The related gene and protein expressions were detected by qRT-PCR and Western blotting respectively. Molecular docking and dynamic simulation were also performed to provide further insight. RESULTS: Results indicated OBB remarkably and dose-dependently attenuated the clinical manifestations of NAFLD, which (100 mg/kg) achieved similar therapeutic effect to metformin (300 mg/kg) and was superior to BBR of the same dose. OBB significantly inhibited aberrant phosphorylation of IRS-1 and up-regulated the downstream protein expression and phosphorylation (PI3K, p-Akt/Akt and p-GSK-3ß/GSK-3ß) to improve hepatic insulin signal transduction. Meanwhile, OBB treatment remarkably alleviated inflammation via down-regulating the mRNA expression of MCP-1, Cd68, Nos2, Cd11c, while enhancing Arg1 mRNA expression in white adipose tissue. Moreover, OBB exhibited closer affinity with AMPK in silicon and superior hyperphosphorylation of AMPK in vivo, leading to increased ACC mRNA expression in liver and UCP-1 protein expression in adipose tissue. CONCLUSION: Taken together, compared with BBR, OBB was more capable of maintaining lipid homeostasis between liver and WAT via attenuating hepatic insulin pathway and adipocyte inflammation, which was associated with its property of superior AMPK activator.

[Preventing role of warmth-promotion needling in reducing intracellular Ca2＋ overload of in vitro hippocampal neuronal cells of vascular dementia rats].

OBJECTIVE: To investigate the underlying mechanisms of warming-promotion needling (WPN) for vascular dementia (VD) by observing its effect on the expression of L-type calcium channel current (Ica.L), changes of intracellular [Ca2＋]i in neurons and pathomorphological changes of brain in VD rats. METHODS: One hundred and eight male SD rats were randomized into normal control, model, medication, WPN, uniform reinforcing-reducing needling (URRN), and needle-twirling groups (n＝18 in each group). The VD model was established by repeated occlusion and reperfusion of the bilateral common carotid arteries. Rats of the medication group were treated by gavage of Nimodipine twice a day for 14 days. For rats of the 3 acupuncture groups, WPN or URRN or needle-twirling was applied to "Dazhui" (GV14), "Baihui"(GV20) and "Shuigou"(GV26) for 30 min, once a day for 14 days. Changes of Ica.L in hippocampal neurons were observed by whole-cell patch clamp technique, and levels of [Ca2＋]i in neuronal cells of living brain slice of hippocampal CA1 area were observed by laser confocal microscope. Histopathological changes of hippocampal CA1 area were observed under light microscope after H．E. stain. RESULTS: Compared with the normal control group, the current density of Ica.L, and the intracellular[Ca2＋]i levels were significantly increased (P<0.05), and the I-V curves of Ica.L was apparently shifted down in the model group. In comparison with the model group, the current density of Ica.L was obviously reduced (P<0.05), the I-V curves of Ica.L shifted up and the intracellular Ca2＋ content notably decreased in the medication, WPN, URRN and needle-twirling groups (P<0.05). The effect of WPN was significantly superior to those of URRN and needle-twiiling (P<0.05). H．E. stain showed a reduction in the number of hippocampal neurons, dilation of intercellular space, swelling of cell body, karyopyknosis, disordered arrangement and increased number of gliacytes in the model group, which was apparently milder in the medication and 3 acupuncture groups (the WPN group in particular). CONCLUSION: The WPN can reduce Ica.L current density and [Ca2＋]i content of hippocampal neurons in brain slices of VD rats, which may contribute to its effect in relieving VD by suppressing calcium overload.

[Warming-promotion needling improves learning-memory ability by up-regulating expression of hippocampal nicotinic acetylcholine receptor subunit in rats with vascular dementia].

OBJECTIVE: To investigate the mechanism of Warming-promotion needling underlying improvement of vascular dementia (VD) by observing its effect on learning-memory ability and expression of hippocampal nicotinic acetylcholine receptor(nAChR)subunit proteins and mRNAs in rats with VD. METHODS: Sixty male SD rats were randomized into normal control, model, medication, warming-promotion needling(WPN), uniform reinforcing-reducing needling (URRN), and needle-twirling groups (n=10 in each group). The VD model was established via repeated occlusion and reperfusion of the bilateral common carotid arteries. Rats of the medication group were fed with Nimodipine twice a day for 14 days. For rats of the 3 acupuncture groups, WPN, or URRN or needle-twirling was applied to"Dazhui"(GV14),"Baihui"(GV20) and"Shuigou"(GV26) for 30 min, once a day for 14 days. The learning-memory ability was detected by Morris water maze tests, and the expression levels of nAChR α4, α7 and ß2 subunit proteins and mRNAs in the hippocampus were detected by Western blot and real-time PCR, separately. RESULTS: Compared with the normal group, the escape latency of Morris water maze tests was significantly prolonged (P<0.05), and the number of the original safe-platform quadrant crossing was significantly reduced in the model group (P<0.05). The expression levels of nAChR α4, α7, ß2 subunit proteins and mRNAs (except ß2 mRNA) in the hippocampus were significantly decreased in the model group relevant to the normal group (P<0.05). Following the interventions, the increased escape latency, and the reduced safe-platform quadrant crossing times, and the down-regulated expression levels of hippocampal nAChR α4, α7, ß2 subunit proteins and mRNAs in the medication, WPN, URRN and needle-twirling groups were all reversed (P<0.05). The effects of WPN were significantly superior to those of URRN and needle-twirling in up-regulating nAChR α4, α7, ß2 subunit proteins and mRNAs (P<0.05). CONCLUSION: The warming-promotion needling can improve the learning and memory ability in VD rats, which may be related to its effects in up-regulating the expression of nAChR su-bunits in the hippocampus.

Comparison of anti-inflammatory effects of berberine, and its natural oxidative and reduced derivatives from Rhizoma Coptidis in vitro and in vivo.

BACKGROUND: Berberine (BBR) is the most abundant and major active constituent of Rhizoma Coptidis (RC), which has been widely used to treat inflammatory diseases in traditional oriental medicine. Despite BBR has been found to exhibit pronounced anti-inflammatory effect, the anti-inflammatory activities of its natural derivatives were sparsely dissected out. PURPOSE: To comparatively investigate the anti-inflammatory potential of BBR, and its natural oxoderivative (oxyberberine, OBB) and reduced derivative (dihydroberberine, DHBB) in vitro and in vivo, and delineate the possible underlying mechanism. METHODS: LC-MS/MS was used to identify the natural derivatives of BBR in RC. The potential anti-inflammatory properties of BBR and its natural derivatives were comparatively evaluated in vitro by lipopolysaccharide (LPS)-induced RAW264.7 macrophages cells, and in vivo via three typical acute inflammation murine models. Some important inflammation-related molecules were analyzed by ELISA, qRT-PCR and Western blotting. RESULTS: LC-MS/MS led to the identification of BBR, OBB and DHBB in RC ethyl acetate extract. The in vitro assay indicated that BBR, OBB and DHBB (1.25, 2.5 and 5 µM) pretreatment significantly decreased the levels of pro-inflammatory cytokines tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), interleukin-6 (IL-6), prostaglandinE2 (PGE2) and nitricoxide (NO), and inhibited the mRNA expressions of cyclooxygenase-2 (COX-2) and inducible nitricoxide synthase (iNOS) in a dose-dependent manner, with relative efficiency of OBB > BBR > DHBB. Furthermore, OBB, BBR and DHBB remarkably inhibited the phosphorylation of nuclear factor-κB (NF-κB) p65 and inhibitory kappa Bα (IκBα). In vivo, BBR (20 mg/kg) and OBB (5, 10, and 20 mg/kg) pretreatment significantly ameliorated the xylene-induced ear edema, carrageenan-stimulated paw edema, and acetic acid-elicited vascular permeability in mice in a dose-dependent manner, with OBB exhibiting superior anti-inflammatory effect at the same dose (20 mg/kg). Histopathological analysis indicated that OBB and BBR could markedly attenuate the inflammatory deterioration and decrease the cellular infiltration in paw tissues. Additionally, the carrageenan-induced increases in TNF-α, IL-6, IL-1ß, PGE2 and NO productions, and COX-2 and iNOS mRNA expressions were effectually and concentration-dependently suppressed by OBB and BBR pretreatment. CONCLUSION: The anti-inflammatory activity of BBR and its natural derivatives was in the order of OBB > BBR > DHBB. OBB was for the first time found to be endowed with pronounced anti-inflammatory property, which was probably associated with suppressing the activation of NF-κB signaling pathway, and the subsequent gene expressions and productions of pro-inflammatory mediators. The results might contribute to illuminating the pharmacodynamic underpinnings of RC and provide evidence for developing OBB as a safe and promising natural lead compound in inflammation treatment.

Efficacy and indication optimization of Chinese medicine (Tiao-Chang Ke-Min granules) for diarrhea-predominant irritable bowel syndrome: study protocol for a randomized controlled trial.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic, recurring condition, prevalent in the general population. Current medication treatments usually leave patients undertreated. Nowadays, Chinese medicine (CM) is being considered as a promising treatment approach for IBS. However, due to methodological limitations, there is no strong evidence to support CM. Although IBS relapses are common, the relapse assessment has always been neglected in CM study designs. Meanwhile, in clinical practice and studies, it has been found that certain CM formulas can only benefit certain kinds of patients. Discovering what population and illness characteristics likely respond to outcomes may help improve the effectiveness of CM. The aims of this study are to evaluate the efficacy and safety of Tiao-Chang Ke-Min (TCKM) granules for IBS, especially in reducing IBS symptoms' relapse, by a high-quality randomized controlled trial and then to optimize the indication of the TCKM granules. METHODS/DESIGN: This is a parallel-group, randomized, double-blind, placebo-controlled trial embedded with outcome predictive factors. Eligible patients with diarrhea-predominant IBS will be randomized into either a TCKM granule group or a placebo group. Patients from both groups will receive health education. The treatment duration is 4 weeks and the follow-up is 12 weeks. The primary outcome is global improvement measured with adequate relief (AR). The second outcome measures include time until relief, time until first relapse, total relapse times, long-term effectiveness, individual symptoms, IBS-Symptom Severity Score (IBS-SSS), IBS-Quality of Life Questionnaire (IBS-QOL), and Hospital Anxiety and Depression Scale (HADS). Predictive factors associated with patient and illness characteristics have been widely collected. These factors will be embedded in this trial for further identification. DISCUSSION: This trial may provide high-quality evidence on the efficacy and safety of TCKM granules for IBS and a more accurate indication. Importantly, this trial will provide a new research method for improving the therapeutic effects of CM for clinicians and researchers. To address IBS relapse assessment, a series of special definitions of relapse incidents has been made for this trial. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ID: ChiCTR-IOR-17010600 . Registered on 9 February 2017.

Association between Recreational Physical Activity and the Risk of Upper Urinary Calculi.

OBJECTIVE: Upper urinary calculi (UUC) is considered to be a comprehensive disease associated with many risk factors, but the role of physical activity (PA) is undefined. Here, we conducted a cross-sectional study to investigate this relationship in Asian populations. MATERIALS AND METHODS: Patients diagnosed with UUC were the subjects of study and those who participated in a health examination in local medical center were included as controls. Information was collected through the same standard questionnaire. A metabolic equivalent score (METs) was measured for each kind of activity. OR of UUC in categories of PA were determined by logistic regression. RESULTS: A total of 1,782 controls and 1,517 cases were enrolled. People who took higher PA (5-9.9, 10-19.9, 20-29.9 and >30 METs/wk) weekly were associated with lower risks of UUC than those took lower PA (<4.9 METs/wk) after adjusting for age, ethnicity, body mass index, systolic blood pressure, water intake, history of gout, history of diabetes mellitus, history of supplemental calcium use and history of hypertension (adjusted OR 0.11, 0.32, 0.24, 0.34; 95% CI 0.08-0.15, 0.23-0.43, 0.15-0.40, 0.22-0.53, respectively; p value <0.001). CONCLUSIONS: In our cross-sectional study, PA was associated with UUC.

Structural characterization and macrophage immunomodulatory activity of a novel polysaccharide from Smilax glabra Roxb.

A novel heteropolysaccharide (SGRP1) with great immunomodulatory activity was isolated from the root of Smilax glabra Roxb. by hot water extraction. Physical and chemical analyses showed that SGRP1 had an average molecular weight of 1.26×104Da and was composed of mannose, fucose and glucose in molar ratio of 1.00:3.09:39.41. The glycosidic linkage types of SGRP1 were proven to be (1→3)-linked -α-l-Fuc, (1→3)-linked-α-l-Man, (1→)-linked-α-d-Glc, and (1→6)-linked-α-d-Glc. The in vitro immunomodulatory assays demonstrated that SGRP1 could evidently promote the phagocytosis and increase macrophage-derived biological factors including nitric oxide (NO), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) secretion via JNK and ERK signaling pathways and NLRP3 inflammasome signaling pathway. The data supported that SGRP1 had immunomodulatory potential through activating macrophages and enhancing host immune system function, which enabled it to be a novel immunomodulator for application in immunological diseases or functional food.

Gartanin Protects Neurons against Glutamate-Induced Cell Death in HT22 Cells: Independence of Nrf-2 but Involvement of HO-1 and AMPK.

Oxidative stress mediates the pathogenesis of neurodegenerative disorders. Gartanin, a natural xanthone of mangosteen, possesses multipharmacological activities. Herein, the neuroprotection capacity of gartanin against glutamate-induced damage in HT22 cells and its possible mechanism(s) were investigated for the first time. Glutamate resulted in cell death in a dose-dependent manner and supplementation of 1-10 µM gartanin prevented the detrimental effects of glutamate on cell survival. Additional investigations on the underlying mechanisms suggested that gartanin could effectively reduce glutamate-induced intracellular ROS generation and mitochondrial depolarization. We further found that gartanin induced HO-1 expression independent of nuclear factor erythroid-derived 2-like 2 (Nrf2). Subsequent studies revealed that the inhibitory effects of gartanin on glutamate-induced apoptosis were partially blocked by small interfering RNA-mediated knockdown of HO-1. Finally, the protein expression of phosphorylation of AMP-activated protein kinase (AMPK) and its downstream signal molecules, Sirtuin activator (SIRT1) and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), increased after gartanin treatment. Taken together, these findings suggest gartanin is a potential neuroprotective agent against glutamate-induced oxidative injury partially through increasing Nrf-2-independed HO-1 and AMPK/SIRT1/PGC-1α signaling pathways.

Natural Xanthones from Garcinia mangostana with Multifunctional Activities for the Therapy of Alzheimer's Disease.

Natural xanthones have diversity pharmacological activities. Here, a series of xanthones isolated from the pericarps of Garcinia mangostana Linn, named α-Mangostin, 8-Deoxygartanin, Gartanin, Garciniafuran, Garcinone C, Garcinone D, and γ-Mangostin were investigated. Biological screening performed in vitro and in Escherichia coli cells indicated that most of the xanthones exhibited significant inhibition of self-induced ß-amyloid (Aß) aggregation and also ß-site amyloid precursor protein-cleaving enzyme 1, acted as potential antioxidants and biometal chelators. Among these compounds, α-Mangostin, Gartanin, Garcinone C and γ-Mangostin showed better antioxidant properties to scavenge Diphenyl-1-(2,4,6-trinitrophenyl) hydrazyl (DPPH) free radical than Trolox, and potent neuroprotective effects against glutamate-induced HT22 cell death partly by up-regulating HO-1 protein level and then scavenging reactive oxygen species. Moreover, Gartanin, Garcinone C and γ-Mangostin could be able to penetrate the blood-brain barrier (BBB) in vitro. These findings suggest that the natural xanthones have multifunctional activities against Alzheimer's disease (AD) and could be promising compounds for the therapy of AD.

Traditional Chinese medicine versus western medicine as used in China in the management of rheumatoid arthritis: a randomized, single-blind, 24-week study.

This study is designed to compare the efficacy and safety of traditional Chinese medicine (TCM) with western medicine (WM) in the management of rheumatoid arthritis (RA). This is a 24-week, randomized, multicenter, single-blind study comparing TCM with WM (as used in China) carried out between June 2002 and December 2004 in nine research centers in China, involving 489 patients. Patients were randomized to receive TCM (n = 247), MTX and SSZ (n = 242). MTX was started at a dose of 5 mg to a final dose of 7.5-15 mg weekly. The maintenance dose was 2.5-7.5 mg weekly. The starting dose of SSZ was 0.25 g bid, increasing by 0.25 g a day once a week to a final dose of 0.5-1 g qid. The maintenance dose was 0.5 g tid to qid. Primary end point was the proportion of patients with response according to the American College of Rheumatology 20 % improvement criteria (ACR20) at weeks 24. At 24 weeks, ACR20 responses were 53.0 % in TCM group and 66.5 % in WM group, (P < 0.001) at 24 weeks. ACR 50 responses were 31.6 % of TCM group and 42.6 % in WM group, (P = 0.01). ACR70 responses were 12.6 % in TCM group and 17.4 % in WM group, (P = 0.14). Side effects were observed more frequently in WM group. In this study, ACR20, ACR50 responses at 24 weeks were significantly better in the WM treated group, by intention to treat (ITT) and per protocol analysis. The ACR 70 response showed no significant difference between the two groups. TCM, while effective in treating RA, appears to be less effective than WM in controlling symptoms, but TCM is associated with fewer side effects.

Optimization and characterization of dry powder of fanhuncaoin for inhalation based on selection of excipients.

In this study, dry powder formulations for inhalation of fanhuncaoin, a newly discovered antiinflammatorily active compound isolated from Chinese herb, were designed to optimize the composition and further explore the relationship between the composition, the physical properties and the aerosolization performance. Dry powders were prepared by spray-drying using leucine, chitosan, chitosan oligosaccharide and dipalmitoyl phosphatidylcholine (DPPC) as excipients. Following spray-drying, resultant powders were characterized using scanning electron microscopy, tapped density analysis, laser diffractometry, thermogravimetric analysis and differential scanning calorimetry. The aerosol behaviour of the powders was studied in a Twin Stage Impinger at an airflow rate of 60 l/min using a HandiHaler® inhaler device. Results revealed that the nature and the relative proportion of the excipients greatly influenced the physical characteristics of the powders and their aerodynamic behavior. Among the combinations tested, the composition ratio of fanhuncaoin/leucine/chitosan/chitosan oligosaccharide/DPPC of 10/45/33.75/11.25/0.4 (w/w/w/w/w) prepared in a total solid mass of 1% (w/v) formulation was found to be particularly optimal and exhibited a tapped density of 0.44 g/cm³, an aerodynamic diameter of 2.24 µm and an respirable fraction of 51.29%. In conclusion, optimization of the aerosolization properties of inhalation dry powders could be achieved by appropriately selecting the composition of the particles.

[A literature review on the conceptual framework of sub-health].

OBJECTIVE: To further articulate the conceptual framework of sub-health by way of literature review. METHODS: Published papers and relevant literature about sub-health were collected, the representative publishing about theoretical exploration and practical surveys were focused for analyzing and assessing the category of sub-health, investigative objects, assessing tools, conceptual framework, diagnostic criteria and its operability, foundation support, etc. RESULTS: Sub-health conditions were categorized into three kinds in most documents, namely, the somatic, the mental and the social adaptative sub-health, and the relevant symptoms were classified into three levels. However, contents regarding the homogeneous issues, such as meaning and definition of sub-health, its diagnostic criteria and operability, in different documents were discrepant. CONCLUSION: Discrepancy exists between the theoretical and practical studies of sub-health. And detailed description is needed to articulate the problems respectively on specific and non-specific sub-health. The perspicuity of conceptual framework is the basis of sub-health researches. The authors recommended that to form the framework the four-level hierarchic structure should be adopted; in developing the assessing tool for sub-health diagnosis, besides the basic assessment on concrete conditions, the differential evaluation on the belonging of overall manifestations, subjective complain or objective symptom, should also be paid attention to.

[GC-MS analysis on the chemical constituents of essential oil from bark of Horsfieldia hainanensis].

OBJECTIVE: To analyze the constituents of the essential oil from the bark of Horsfieldia hainanensis. METHODS: The volatile oil was obtained by steam distillation. The chemical constituents were separated and identified by gas chromatography-mass spectrometry (GC-MS). The relative contents were determined by area normalization. RESULTS: The extraction rate of the bark of Horsfieldia hainanensis was 0.14%. 32 compounds were separated and identified, which accounted for 98.62% of the essential oil. The main chemical components of the essential oil were Copaene (25.55%), Naphthalene, 1,2,3,5,6,8a-hexahydro-4,7-dimethyl-1-(1-methylethyl)-(11.14%), Hexanedioic acid, bis(2-ethylhexyl) ester (8.09%) , 9-Octadecenoic acid (7.04%), etc. CONCLUSION: It has provided scientific foundation for exploitation and utilization of Horsfieldia hainanensis.

[Effect of warmth-promotion needling on cerebral SOD, MDA and AChE in vascular dementia rats].

OBJECTIVE: To observe the effect of warmth-promotion needling on cerebral malondialdehyde (MDA) content, superoxide dismutase (SOD) and acetylcholinesterase (AChE) activity so as to explore its underlying mechanism in improving vascular dementia (VD). METHODS: Forty Wistar rats were randomized into control, model, medication, needle-twirling and warmth-promotion groups with 8 cases in each. VD model was established by occlusion of the bilateral common carotid arteries and reperfusion in combination with intraperitoneal injection of sodium nitroprusside (2.5 mg/kg). Warmth-promotion needling was applied to "Dazhui" (GV 14), "Baihui" (GV 20) and "Shuigou" (GV 26). Rats of medication group were intragastric perfusion of Nimodipine suspension (0.0108 g/kg). The treatment was given once daily continuously for 15 days. SOD and AChE activity and MDA content of the brain (right side) tissue were detected with purine oxidase method, hydroxylamine chromatometry and thio-malonylurea method separately. RESULTS: In comparison with control group. SOD activity of model group decreased significantly (P < 0.01), AChE activity and MDA content increased considerably (P < 0.01); while compared with model group, SOD activity of warmth-promotion, needle-twirling and medication groups raised evidently (P < 0.01), AChE activity and MDA content of the later 3 groups lowered significantly (P < 0.05, 0.01). The effects of warmth-promotion group were significantly superior to that of medication group in lowering MDA content and to those of needle-twirling group in raising SOD activity and lowering AChE activity and MDA content (P < 0.05). CONCLUSION: Warmth-promotion needling can function well in resisting lipid peroxidation injury and lowering AChE activity in VD rats, which may contribute to its effect in improving learning-memory ability.

[Analysis on TCM syndrome distribution laws in 319 patients with coronary heart disease].

OBJECTIVE: To study TCM syndrome distribution laws in patients with coronary heart diseases (CHD) by epidemiological investigation. METHODS: A clinical survey was carried out in 319 inpatients with CHD, whose diagnosis was confirmed by coronary arteriography, in the authors' hospital from January 2004 to December 2004. The TCM syndrome distribution laws were analyzed, and the relationship of coronary arteriographic picture with TCM syndrome elements, common symptoms, pulse and tongue figures, as well as the correlation between syndrome typing and blood-lipid levels were analyzed, too. RESULTS: Qi deficiency was the most popular syndrome in patients with CHD (87.1%), blood stasis syndrome and phlegm retention syndrome took the second place, accounting for 79.9% and 78.7% respectively. No significant difference was shown in comparison of tongue and pulse figures with the affected branches of coronary artery, the dark-pale tongue with white greasy fur and taut-slippery pulse being the dominance in patients. The blood-lipid levels in patients with various TCM syndrome types were similar, showing insignificant difference. CONCLUSION: The TCM pathogenesis of CHD takes qi deficiency as the core, blood stasis and phlegm retention as the important pathologic products.

[Effects of "warmth-producing needling for removing obstruction" on hippocampal morphological changes and learning-memory abilities in vascular dementia rats].

OBJECTIVE: To observe the effects of "Warmth-producing Needling for Removing Obstruction" (WPNRO) on the pathomorphological changes of brain and learning-memory abilities in vascular dementia (VD) rats. METHODS: A total of 50 Wistar rats were randomly divided into normal control, model, medication, needle-twirling, and WPNRO groups, with 10 cases in each group. VD model was established by repeated cerebral ischemia-reperfusion via repeated occlusion of the bilateral common carotid arteries under anesthesia (3% embutal 40 mg/kg, i.p.). "Dazhui" (GV 14), "Baihui"(GV 20) and "Shuigou"(GV 26) were punctured with filiform needles and stimulated with twirling technique and WPNRO technique respectively and continuously for 1 min. Animals of medication group were fed with Nimodipine (0.0108 g/kg). The treatment was conducted once daily continuously for 15 days. The rats' learning and memory results were detected respectively with step-down avoidance test in the first 6 days' training and 24 h later. At the end of experiments and after decapitation, the right brain was taken, cut into sections (5 microm) and stained with H & E method for observing structural changes of hippocampus. RESULTS: 1) Behavior reactions: compared with control group, the latency for finding the safe platform and the times of error in model group increased significantly, and compared with model group, both latencies and times of error in WPNRO, needle-twirling and medication groups decreased considerably (P < 0.05, 0.01). In comparison with needle-twirling group, both latencies and times of error in WPNRO group were significantly fewer (P < 0.05, 0.01), and no significant differences were found between WPNRO and medication groups in these two indexes (P > 0.05). It indicated that acupuncture particularly WPNRO could improve both learning and memory abilities in VD rats. 2) Structural changes of neurons in CA1 region of hippocampus: in normal group, the neurons arranged in order and closely, and were normal in the structure; in model group, the neurons arranged obviously in disorder, had karyopyknosis and hyperplasia in glial cells and decreased in the number. In WPNRO group, no evident cellular karyopyknosis or hyperplasia of glial cells was found, and the structure and number of cells were close to those of normal group. In acupuncture and medication groups, fewer neurons, cellular karyopyknosis and hyperplasia of more glial cells were found. CONCLUSION: "Warming-producing Needling for Removing Obstruction" can significantly relieve cerebral ischemia induced disturbance of learning and memory and lessen structural injury of hippocampal neurons in rats.

Adjunctive herbal medicine with carbamazepine for bipolar disorders: A double-blind, randomized, placebo-controlled study.

Chinese herbal medicines possess the therapeutic potential for mood disorders. This double-blind, randomized, placebo-controlled study was designed to evaluate the efficacy and side effects of the herbal medicine called Free and Easy Wanderer Plus (FEWP) as an adjunct to carbamazepine (CBZ) in patients with bipolar disorders. One hundred and twenty-four bipolar depressed and 111 manic patients were randomized to treatment with CBZ alone, CBZ plus FEWP, or equivalent placebo for 12 weeks. CBZ was initiated at 300mg/day and FEWP was given at a fixed dose of 36g/day. Efficacy measures included the Hamilton Rating Scale for Depression, Montgomery-Asberg Depression Rating Scale , Young Mania Rating Scale, Bech-Rafaelsen Mania Scale, and Clinical Global Impression-Severity (CGI-S). CBZ monotherapy produced significantly greater improvement on manic measures at week 2 through endpoint and CGI-S of depression at endpoint compared to placebo. CBZ monotherapy also yielded significantly higher clinical response rates than placebo on bipolar depression (63.8% vs. 34.8%, p=0.044) and mania (87.8% vs. 57.1%, p=0.012). Compared to CBZ monotherapy, adjunctive FEWP with CBZ resulted in significantly better outcomes on the three measures of depression at week 4 and week 8 and significantly greater clinical response rate in depressed subjects (84.8% vs. 63.8%, p=0.032), but failed to produce significantly greater improvement on manic measures and the response rate in manic subjects. There was a lesser incidence of dizziness and fatigue in the combination therapy compared to CBZ monotherapy. These results suggest that adjunctive FEWP has additive beneficial effects in bipolar patients, particularly for those in depressive phase.

[Exploration on establishment and application of soft index survey tools in TCM study].

This paper discussed the concept, categorizations, methods and basic principles for establishing of soft index survey tools (SIST) in clinical medicinal field, pointed out the relation between the connatural theoretical and practical mode of TCM and the establishment of SIST having TCM characteristics, and elaborated several key points which should be paid attention to in the establishment of SIST. It was pointed out that there was broad space for application of SIST in TCM study.

[Application of non-randomized study in the field of traditional Chinese medicine or integrated traditional Chinese and Western medicine].

Non-randomized studies (NRS) have gradually attracted people's attention in the field of clinical medicine. In this paper, the importance of NRS was emphasized on the viewpoints of the coherence of scientific research, the limitation of randomized control trials (RCTs), the immanent characteristics of TCM clinical practice and the actual requirement of complex intervention in clinical practice. And two main points in evaluation and implementation of NRS differed to those in RCTs were put forward, i.e. the first, the full-scale design of the study with the professional characteristics should be described very explicitly, especially the speciality of the objects, intervention elements and indexes for effectiveness evaluation, etc.; the second, the control of bias and evaluation of effectiveness, and their influence on conclusion induction should be fully taken into consideration. At the same time, the key step in improving the quality of NRS of TCM and integrative medicine was preliminary discussed in this paper.