[Advantages, development opportunities, and practice paths of traditional Chinese medicine in prevention and treatment of elderly comorbidities].

This article focused on the significant public health issue of comorbidities in the elderly population and highlighted the important role of traditional Chinese medicine(TCM) in the prevention and treatment of comorbidities in the elderly. It suggested that TCM should fully utilize its advantages in holistic perspective, syndrome differentiation and treatment, and preventive medicine in the process of preventing and treating comorbidities in the elderly. At the same time, in response to the significant shift in the disease spectrum of the elderly, the increasingly innovative concepts in diagnosis and treatment, the growing demand for proactive health by the el-derly population, and the current emphasis on patient-centered evaluation standards, it is necessary to further conduct basic theoretical and experimental research on comorbidities in the elderly using TCM, emphasize clinical research on comorbidities in the elderly, explore appropriate efficacy evaluation systems, improve TCM prevention and treatment strategies and comprehensive intervention programs for comorbidities in the elderly, and leverage the unique role of TCM in the rehabilitation of elderly comorbidity patients. By analyzing the potential of TCM in the field of comorbidities in the elderly, this article is expected to provide new insights for future clinical practice and scientific research.

[Expert consensus for Jingtong Granules in treatment of cervical radiculopathy in clinical application].

With the effects of activating blood and resolving stasis, and moving Qi to relieve pain, Jingtong Granules is widely used in the treatment of cervical radiculopathy in China. Long-term clinical application and related evidence have shown that the prescription has ideal effect in alleviating the pain in neck, shoulder, and upper limbs, stiffness or scurrying numbness, and scurrying pain caused by this disease. However, there is a lack of consensus on the clinical application of Jingtong Granules. Therefore, clinical first-line experts and methodology experts from all over the country were invited to compile this expert consensus. This expert consensus is expected to guide clinicians to use Jingtong Granules in a standardized and reasonable way, improve clinical efficacy, reduce medication risks, and benefit patients. First, according to the clinical experience of experts and the standard development procedures, the indications, syndrome characteristics, clinical advantages, and possible adverse reactions of Jingtong Granules were summarized. Then, through face-to-face interview of clinical doctors in traditional Chinese medicine and western medicine and survey of the clinical application, the clinical problems were summed up, and the consensus was reached with the nominal group method to form the final clinical problems. Third, evidence retrieval was carried out for the clinical problems, and relevant evidence was evaluated. The GRADE system was employed to rate the quality of evidence. Fourth, 5 recommendation items and 3 consensuses items were summarized with the nominal group method. Opinions and peer reviews on the consensus content were solicited through expert meetings and letter reviews. The final consensus includes the summary of evidence on the clinical indications, effectiveness, and safety of Jingtong Granules, which can serve as a reference for clinicians in hospitals and primary health institutions.

[Expert consensus for Jiegu Qili Tablets (Capsules) in treatment of fracture in clinical practice].

Fracture is one of the common diseases in the department of orthopaedics and traumatology. Jiegu Qili Tablets(Capsules) are a Chinese patent medicine commonly used to treat fractures in clinical practice, which has been included in the Class A drugs of the catalog of medicines covered by the National Medical Insurance System. However, no consensus or guideline has yet been developed to guide clinicians based on an evidence-based approach in detail, which has severely limited the clinical value of this drug. According to the guiding principle of evidence as the key, consensus as the supplement, and experience as the reference, a consensus was developed in strict accordance with the steps stipulated in the expert consensus on clinical applications of proprietary Chinese medicines. Based on literature review and questionnaire survey, the consensus was a timely summary of the existing clinical evidence on the treatment of fractures with Jiegu Qili Tablets(Capsules), and incorporated the treatment experience of a number of clinical experts. The preparation process took more than a year and the consensus(GS/CACM 293-2021) was officially released by the China Association of Chinese Medicine in September 2021, with the participation of multidisciplinary experts from 27 organizations of Chinese and Western medicine and research institutions. This article introduces the background and objectives of the consensus in detail, and describes the main process of proposal, drafting, expert consensus, and consultation. In particular, 5 consensus recommendations and 12 consensus suggestions are formed with regard to the key issues of indications, treatment timing, dose, duration, and safety in the clinical application of Jiegu Qili Tablets(Capsules) for the treatment of fractures, which guide and standardize the rational use by clinicians and improve the accuracy and safety of drugs.

Efficacy and Safety of Bushen Huoxue Formula in Patients with Discogenic Low-Back Pain: A Double-Blind, Randomized, Placebo-Controlled Trial.

OBJECTIVE: To assess the efficacy and safety of Bushen Huoxue Formula (BSHXF) for the treatment of discogenic low-back pain (DLBP). METHODS: This was a parallel, double-blind, randomized, clinical trial performed between May 2019 and June 2020. Seventy patients were assigned by computerized random number table to the treatment group (lumbar traction and BSHXF, 35 cases) or the control group (lumbar traction and placebo, 35 cases). The patients received intervention for 3 weeks. Assessment was conducted before treatment and at week 1, 2, 3 during treatment. Primary outcome was the self-reported score of Oswestry Disability Index (ODI). Secondary outcomes included Visual Analog Scale (VAS), clinical efficacy rate by minimal clinically important difference (MCID) as well as lumbar tenderness, muscle tone and lumbar spine mobility. Adverse reactions were recorded. Follow-up was performed at 1 and 3 months after the end of treatment. RESULTS: In the treatment group, ODI score was significantly decreased compared with baseline (P<0.05) and the control group at 2- and 3- week treatment. Similarly, VAS score decreased compared with the baseline (P<0.05) and was lower than that in the control group at 2- and 3- week treatment (P<0.05). The clinical efficacy rate of the treatment group was higher than that of the control group after treatment [32.35% (11/34) vs. 3.13% (1/32), P<0.05). Moreover, the tenderness, and muscle tone, as well as the back extension and left flexion in lumbar spine mobility in the treatment group at 3-week treatment were significantly improved compared with the control group (P<0.05). Follow-up showed that at 1-month after treatment, the treatment group had better outcomes than the control group with regard to a total score of ODI and VAS scores, as well as clinical efficacy rate (all P<0.05). Moreover, VAS score was still significantly lower than the control group at 3-month follow-up (P<0.05). No adverse reactions were reported during the study. CONCLUSION: BSXHF combined with lumbar traction can significantly improve the clinical symptoms including pain intensity, functionality, muscle tone, and lumbar spine mobility in DLBP patients. (Registration No. ChiCTR1900027777).

[Research progress in mechanism of Chinese herbal compounds and monomers in delaying lumbar intervertebral disc degeneration].

Traditional Chinese medicine has unique advantages in the treatment of degenerative bone and joint diseases, and its widely used in clinical practice. In recent years, many scholars have conducted a large number of basic studies on the delay of intervertebral disc degeneration by herbal compound and monomeric components from different perspectives. In order to further elucidate its mechanism of action, this paper summarizes the in vivo and in vitro experimental studies conducted at the level of both herbal compound and single components, respectively, in order to provide references for the basic research on the treatment of lumbar intervertebral disc degeneration by Chinese medicine. A summary shows that commonly used herbal compound prescriptions include both classical prescriptions such as Duhuo Jisheng Decoction, as well as clinical experience prescriptions such as Yiqi Huoxue Recipe. Angelicae Sinensis Radix, Chuanxiong Rhizoma, Rehmanniae Radix Praeparata, Achyranthis Bidentatae Radix, and Eucommiae Cortex were used most frequently. Tonic for deficiency and blood stasis activators were used most frequently. The most utilized monomeric components include icariin, ginsenoside Re, salvianolic acid B and aucubin. The main molecular mechanisms by which herbal compound and monomeric components delay of lumbar intervertebral disc degeneration include improving the intervertebral disc microenvironment, promoting the synthesis of aggregated proteoglycans and type Ⅱ collagen in the intervertebral disc, reducing the degradation of the extracellular matrix, and inhibiting apoptosis in the nucleus pulposus cells, etc. The main signaling pathways involved include Wnt/ß-catenin signaling pathway, MAPK-related signaling pathway, mTOR signaling pathway, Fas/FasL signaling pathway, PI3 K/Akt signaling pathway, NF-κB signaling pathway, JAK/STAT signaling pathway, and hedgehog signaling pathway, etc.

[Study on mechanism of "Epimedii Folium-Paeoniae Radix Alba" in treatment of lumbar disc herniation based on network pharmacology].

The aim of this paper was to investigate the key targets and mechanism of "Epimedii Folium-Paeoniae Radix Alba" in the treatment of lumbar disc herniation by means of network pharmacology. The currently recognized databases and analysis software at home and abroad were used to construct the network from drugs and diseases. The chemical components of Epimedii Folium and Paeo-niae Radix Alba were collected by using databases such as TCMSP, while their active components were determined and the action targets were predicted according to threshold screening and literature reports. The genes for lumbar disc herniation were collected by using GeneCards, OMIM, and DisGeNET databases. The drug targets were mapped to disease targets, and protein interaction network analysis for key targets, GO function enrichment analysis and KEGG signaling pathway enrichment analysis were performed. Finally, 23 active components of Epimedium Folium and 13 active components of Paeoniae Radix Alba were determined, and a total of 624 drug targets were obtained. After standardization, 214 drug targets were obtained. In addition, 306, 2 and 5 related targets of lumbar disc herniation were collected from GeneCards, OMIM, and DisGeNET database, respectively, and a total of 293 disease targets were obtained after deduplication. After the mapping of drug target and disease target, 44 common targets were obtained. PPI protein interaction network analysis showed that IL-6, TNF, AKT1, MAPK1, and VEGFA may be the core targets for the treatment of lumbar disc herniation. GO enrichment analysis identified 56 items(P<0.05), among which biological processes mainly included immune response, apoptosis, etc.; cell components mainly included extracellular space, extracellular region, etc.; molecular functions mainly included cytokine activity, metallopeptidase activity and so on. Through KEGG pathway enrichment analysis, 91 signaling pathways related to inflammation, metabolism, and senescence were identified, mainly including IL-17 signaling pathway and TNF signaling pathway and so on. "Epimedii Folium-Paeoniae Radix Alba" showed the characteristics of multi-channel and multi-target for the treatment of lumbar disc herniation. This study preliminarily explored the key targets for its role and the biological processes and signaling pathways involved. It was found that it may play a therapeutic role by affecting inflammation and immune regulation, which laid the foundation for further experimental verification.

[Efficacy and safety of Shentong Zhuyu Decoction for lumbar disc herniation: systematic review and Meta-analysis].

To evaluate the clinical efficacy and safety of Shentong Zhuyu Decoction in the treatment of lumbar disc herniation, in order to provide evidence for its clinical application. PubMed, Cochrane Library, EMbase, CNKI, WanFang, VIP, CBM and Clinical Trials.gov databases were sysmatically retrieved. Two researchers independently searched, screened and extracted data. Randomized controlled trials in line with the inclusion criteria were included in the study. The article quality was assessed with the bias risk tool in the Cochrane Handbook. Meta-analysis was performed using RevMan 5.3. A total of 604 articles were obtained from the retrieval, and 824 patients in 9 studies were finally selected through screening. The course of treatment was about 1 month, and all of the studies were completed in China. Meta-analysis showed that the efficacy of Shentong Zhuyu Decoction in the treatment of lumbar disc herniation was better than that of the control group(RR=1.19, 95%CI[1.12, 1.26], P<0.000 01), including the comparison with Yaotongning Capsules(RR=1.10, 95%CI[1.02, 1.19], P=0.01) and diclofenac sodium tablets(RR=1.26, 95%CI[1.11, 1.44], P=0.000 4). In VAS pain score, Shentong Zhuyu Decoction had also obvious advantages(MD=-3.70, 95%CI[-6.31,-1.09], P=0.005). In addition, the number of adverse events in the Shentong Zhuyu Decoction group was lower than that in the control group. Shentong Zhuyu Decoction can effectively alleviate discomfort symptoms of patients with LDH. It has an obvious clinical efficacy and less adverse reactions. However, restricted by the quality of the included literatures, prospective, multi-center, large-sample-size randomized controlled trials are still needed to further improve the clinical evidence of the effect of Shentong Zhuyu Decoction in the treatment of LDH.

[Effect of serum of Bushen Huoxue prescription on rabbit with intervertebral disc motion segments in vitro culture].

OBJECTIVE: To compare effect of serum of Bushen Huoxue prescription on rabbit with intervertebral disc motion segments in vitro culture. METHODS: Twenty-four New Zealand white rabbits aged from 4 to 6 months and weighted from 2.5 to 3 kg were divided into medicated group and control group, 7 in each group. Rabbits were excuted under condition of asepsis, 28 spinal motion segments were taken out in each group, and segments were loaded in spinal motion segments in vitro and cultured in culture apparatus. Nutrient solution of medicated group contain 10% serum of Bushen Huoxue prescription, and 10% blank serum in control group. Seven discs between two groups were taken out and observed by histomorphology, proteoglycan PAS/AB stining, collagen II immunohistochemical staining, AGG, Col2aI by PCR test before culture and on the 3th, 7th and 14th day after culture. RESULTS: Histomorphology results showed the formation of medicated group was better than that of control group at 1 week after culture. PAB/AB test results showed content of poteoglycan between two groups were decreased. Imunohistochemical results showed content of collagen II in medicated group were obviously increased than that of control group at 3 days, but decreased obviously at 1 week than that of control group. PCR results showed expression of Agg in medicated group was obviously decreased than that of control group, but no statistical significance between two groups on the 7 th and 14 th day. Expression of Col2aI between two groups at 3 days were increased, and medicated group increased obviously more, while there were no significant difference between two groups. CONCLUSIONS: Serum of Bushen Huoxue prescription could delay intervertebral disc degeneration at short time for it is relate with improving circulation, inhibiting inflammatory, regulating extracellular matrix, so the prescription plays an important role in early prevention and treatment for intervertebral disc degeneration.

[Preliminary study of intervention in effect of Bushen Huoxue recipe on calcification of lumbar vertebra cartilage endplate of the aging gerbils].

OBJECTIVE: To study the effect of Bushen Huoxue decoction on calcification of cartilage endplate in lumbar vertebrae. METHODS: Six healthy male gerbils with 2-month-old were selected as normal control group, and 24 7-month-old healthy male gerbils were fed to 12-month-old to establish the aged gerbil model. Thirty gerbils were randomly divided into five groups as follow: the normal control group (n=6), model group (n=6, normal saline 4 ml/kg, intragastric 30 d), Bushen Huoxue low dose group(n=6, 1.9× 10⁻ ³ ml/g given Bushen Huoxue recipe orally, 30 d), Bushen Huoxue middle dose group(n=6, 3.8× 10⁻ ³ ml/g given Bushen Huoxue recipe orally, 30 d), Bushen Huoxue high dose group(n=6, 7.6× 10⁻ ³ ml/g given Bushen Huoxue recipe orally, 30 d), the intervention group administered for 1.36 g from 7-month-old age, 30 d. The animals were sacrificed at the age of 2 months in the normal control group and 12 months of age in the other groups. The morphology of the lumbar vertebral cartilage endplate, the area of vascular bud, the ratio of non-calcified/calcified layer were analysis by HE chromosome visual method. The expression of type X collagen and BMPs in cartilage endplates were detected by rabbit monoclonal immunohistochemical staining. RESULTS: The relative area of the vascular buds cartilage endplate measurements showed that compared with the model group, middle dose group and normal control group increased (P<0.05), high and low dose groups all had different degrees of increase, but no statistical significance(P>0.05). The ratio of cartilage endplate thickness of non-calcified/calcified showed that compared with the model group, Bushen Huoxue middle dose, normal control group increased, with statistical significance(P<0.05), and high and low dose groups all had different degrees of increase, but there were no statistical significance(P>0.05). Compared with the model group, the expression of type X collagen in the cartilage endplate of the normal group, the Bushen Huoxue low, middle and high dose groups decreased, and had statistical significance(P<0.01); compared with the model group, the expression of BMPs in the normal group, Bushen Huoxue middle dose group increased, with statistically significant(P<0.01), while the high and low dose groups increased in different degrees, but there was no statistical significance(P>0.05). CONCLUSIONS: Bushen Huoxue prescription can delay the calcification of cartilage endplate in the process of aging, suggesting that it can be used as a preventive medicine for early disc degeneration.

[Research on the stability of teaching robots of rotation-traction manipulation].

OBJECTIVE: To evaluate the stability of teaching robot of rotation-traction manipulation. METHODS: Operators were required to get the hang of rotation-traction manipulation and had clinical experience for over 5 years. The examination and data processing of the ten operators in our research were collected by the teaching robot of rotation-traction manipulation. Traction, pulling force, maximum force, pulling time, rotational amplitude and pitch range were recorded and compared for five times(G1, G2, G3, G4 and G5). The qualification rates were analyzed to evaluate the stability of teaching robot of rotation-traction manipulation. RESULTS: Nonconforming items were found in G1 and G2, for instance, pulling force(P=0.074), maximum force(P=0.264) and rotational amplitude (P=0.531). There was no statistically difference. None nonconforming item was found in G3, G4 and G5. All data were processed by SPSS and One-way ANOVA was used to analysis. Pulling force was found statistically different in G1, compared with G4 and G5(P=0.015, P=0.006). Maximum force was found statistically different in G1, compared with G4 and G5 (P=0.021, P=0.012). None differences were found in other comparisons (P>0.05). CONCLUSIONS: The teaching robot of rotation-traction manipulation used in our research could provide objective and quantitative indices and was considered to be an effective tool of assessing the rotation-traction manipulation.

[Comparison of paravertebral soft tissue tension changes in patients with chronic lower back pain treated by sliver needle and traditional Chinese medicine fumigation].

OBJECTIVE: To evaluate clinical significance of waist soft tissue tension detection in treating chronic nonspecific low back pain. METHODS: From August 2011 to March 2012,60 patients with chronic nonspecific low back pain were divided into two groups (sliver needle group and TCM fumigation group) according to propotion of 1:1. In sliver needle group, there were 17 males and 13 females aged from 28 to 55 years old with an average age of (45.70 +/- 4.15), treated with sliver needle; In TCM fumigation group,there were 19 males and 11 females aged from 27 to 55 years old with an average age of (43.03 +/- 5.86), treated with TCM fumigation. Changes of force-displacement distance (FDD), specific absorption rate (S) of two groups were observed before treatment, 1 week and 3 months after treatment respectively, VAS scoring and Roland-Morris disability questionnaire (RMDQ) were used to access clinical effects. RESULTS: (1) VAS score of silver needle group was 4.77 +/- 0.78, 1.99 +/- 1.08 and 2.55 +/- 0.94, respectively before treatment, at 1 week and 3 months after treatment,while VAS score in TCM fumigation group were 4.43 +/- 0.61, 2.48 +/- 0.71 and 3.05 +/- 0.86, respectively. VAS score of two groups after treatment were sigificant decrease than that of before treatment (P < 0.05). There was no sigificant differences between two groups before treatment, but sliver needle group performed well in analgesia than TCM fumigation group, and had obvious differences (P < 0.05). RMDQ score of silver needle group was 13.63 +/- 1.96, 5.87 +/- 2.33 and 6.53 +/- 2.89, respectively before treatment, at 1 week and 3 months after treatment, while RMDQ score in TCM fumigation group were 13.40 +/- 2.01, 6.90 +/- 2.31, 9.23 +/- 2.87, respectively. There was no significant differences between two groups before treatment and 1 week after treatment (P > 0.05), and had obvious differences between two groups at 3 months after treatment (P < 0.01). Both groups could obvious improve dysfunction caused by chronic low back pain, and curative effect of sliver needle groups was more endurable. (2) Following-up at 3 months after treatment, FDD of multifidus, erector spinae of effected side and multifidus of healthy in sliver needle group were obvious increased (P < 0.05); In TCM fumigation group, FDD of multifidus and erector spinae on both side were increased at 1 week after treatment (P < 0.05), but had no significant meaning at 3 months after treatment on health side (P>0.05). There was no significant meaning before treatment (P > 0.05), FDD of multifidus, erector spinae of effected side in sliver needle group were obvious increased at 1 week after treatment (P < 0.05); but no obvious meaning on health side. FDD of both side in sliver needle group were obvious increased at 3 months after treatment. (3) There was correlation among differences of FDD in multifidus and erector spinae, VAS score and differences of RMDQ, and Spearman correlation coefficient R was 0.517, 0.811, 0.746 and 0.625; There was correlation between items of soft tissue tension and sympotoms, function and life quality. Conclusion:Soft tissue tension detection can effectively manifest degree of pain and dysfunction of low back, and improve objectivity of therapeutic evaluation for chronic low back pain.

Experimental research into using bone-strengthening pill to treat ischemic necrosis of femoral head.

OBJECTIVE: To study the use of a bone-strengthening pill to treat ischemic necrosis of the femoral head. METHODS: A model of castration in rats with osteoporosis and a model of ischemic necrosis in the bilateral femoral heads of young rats were used to detect bone density, bone formation measurements, lipid deposition in the femoral head, the distribution of capillaries in the femoral head and other relevant biochemical indices. RESULTS: In model rats, bone-strengthening pills were able to increase the bone density, the unit volume of bony trabeculae, the width of bony trabeculae, and the unit volume of the bony cortex. They could also enhance the mineral apposition rate in the femoral head and the seam width of osteoid deposition. Furthermore, there was a reduction in lipid deposition in the femoral head, and enriched distribution of arteries in the femoral head. Bone-related biochemical detections showed an increase in alkaline phosphatase staining and a decrease in tartaric acidic phosphatase staining. CONCLUSION: The results show that bone-strengthening pills can obviously promote bony growth, cause an increase in bone density, restore blood circulation, inhibit the occurrence and development of bony necrosis, and accelerate the repair of necrotic bones, with no toxic side-effects.

[Effect of removing dampness and promoting diuresis method on IgG, IgM and IL-1beta, IL-8 in serum of rats with autoimmunity induced by nucleus pulposus].

OBJECTIVE: To explore the effects of removing dampness and promoting diuresis method on autoimmune and immuno-inflammatory response caused by nucleus pulposus of rats, in order to provide the basis for the treatment of lumbar disc herniation with Chinese medical immunotherapy. METHODS: Forty male Wistar rats were divided into 4 groups randomly according to body weight layer:sham operation group (group A), model contrast group (group B), colchicine tablets group (group C), modified Qingyao decoction group (group D). There were 10 rats in each group. Nucleus pulposus of coccygeal vertebra was transplanted to the gluteal muscle by operation in groups B, C, D, which can lead to autoimmune and immuno-inflammatory response of rats; the rats of group A were only treated with sham operation. At the 3rd day after operation, the rats were fed through intragastric administration, the group A and B with distilled water (10 ml/kg), the group C and D respectively with suspension of colchicine tablets (10 ml/kg, 0.01 mg/ml) and water-decocted liquid of modified Qingyao decoction (10 ml/kg,1.035 g/ml), once a day and continuous medication for 18 days. All rats were killed at the 21th day after operation. The immunoglobulin G (IgG), immunoglobulin M (IgM) and interleukin-1beta (IL-1beta), interleukin-8 (IL-8) level in serum of different groups were detected by ELISA method. At the same time, surrounding tissues of the transplanted nucleus pulposus were observed by pathological section. RESULTS: The level of IgG, IgM, IL-1beta, IL-8 in serum of group B was significantly higher than that of group A (P < 0.01), while the level of IgG, IgM, IL-1beta, IL-8 in serum of group C, D was significantly lower than that of group B (P < 0.05 or P < 0.01). Moreover, pathological section indicated that immuno-inflammatory response was hardly found in surgical site of group A, while local immuno-inflammatory response of surrounding tissues of the transplanted nucleus pulposus of group C and D was much lighter than that of group B. CONCLUSION: Removing dampness and promoting diuresis method could inhibit autoimmune and immuno-inflammatory response caused by nucleus pulposus of rats.