Efficacy of Yangyin Yiqi Huoxue Granule () in Treatment of Ischemic Stroke Patients with Qi-Yin Deficiency and Blood Stasis Syndrome: A Randomized, Double-Blind, Multicenter, Phase-2 Clinical Trial.

OBJECTIVE: To evaluate the efficacy and safety of Yangyin Yiqi Huoxue Granule (, YYHG) in the treatment of ischemic stroke (IS) patients with qi-yin deficiency and blood stasis syndrome (QYDBSS), and to explore its effective dosage. METHODS: The total of 288 patients were randomly assigned to the YYHG high-dose, YYHG low-dose, positive control (administered Xiaoshuantong Granule, XSTG, ), or placebo control (administered inert granule) groups (72 cases per group) by software-drived competitive block randomization. The trial was conducted for a 28-day period, with a 180-day follow-up period. The primary outcome was the comprehensive curative evaluation, and secondary outcomes were the National Institute of Health Stroke Scale (NIHSS) score, Barthel activities of daily living (ADL) index score, the quality of life index (QLI) score, and the Chinese medicine syndrome (CMS) score. All analyses were done on an intention-to-treat basis. The clinical safety was also assessed. RESULTS: The total of 288 participants were recruited between June 1, 2008 and September 30, 2009, and 287 patients received intervention; the treatment groups were well balanced at baseline. The comprehensive cure rates of YYHG high-dose, low-dose, positive and placebo control groups were 63.38%, 31.94%, 36.11% and 6.14%, respectively; there was a statistical difference between the two groups (P<0.01), while the high-dose YYHG treatment group was significantly higher than the other 3 groups (P<0.01). The improvement of NIHSS, ADL, QLI and CMS scores of the YYHG high-dose and low-dose groups was significantly better than that of the positive control group and the placebo control group (P<0.05). In terms of improving the classification of the NIHSS scale and the assessment of the ADL scale, the YYHG high-dose group was significantly better than the other three groups (P<0.05), and the YYHG low-dose group was better than the placebo control group (P<0.01). At the same time, except for the QLI score, the high-dose group was better than the low-dose group (P<0.05). In terms of safety, adverse reactions after YYHG treatment were generally mild (3.78%), and no serious adverse reactions have been reported. CONCLUSION: YYHG is safe and effective in the treatment of IS patients with QYDBSS.

[Treating ischemic stroke patients of deficiency of qi and yin syndrome and static blood obstructing collaterals syndrome by Yangyin Yiqi Huoxue Recipe: a clinical study of therapeutic effect].

OBJECTIVE: To observe the clinical effect of Yangyin Yiqi Huoxue Recipe (YYHR, the basic recipe of Yangyin Tongnao Granule) in treatment of ischemic stroke patients of deficiency of qi and yin syndrome (DQYS) and static blood obstructing collaterals syndrome (SBOCS). METHODS: Totally 312 patients were assigned to the control group (86 cases) and the treatment group (226 cases) using strati- fied randomized allocation method. Patients in the treatment group were treated with modified YYHR, while those in the control group took Xueshuan Xinmaining. The treatment course was 4 weeks for all. Constituent ratios of the acute stage and the recovery stage of DQYS and SBOCS and their complicated syndromes were observed in the two groups. Changes of the clinical curative effect, clinical symptoms integral, whole blood viscosity ratio, plasma viscosity ratio, hematocrit, erythrocyte sedimentation rate (ESR), total cho- lesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were detected in the two groups before and after treatment. RESULTS: There was statistical difference in constituent ratios of the acute stage and the recovery stage of DQYS SBOCS and its complicated syndromes between the two groups (P < 0.01). DQYS and SBOCS was basic syndrome types of the two groups. The cured and markedly effective rate was 71.24%(161/226) in the treatment group and 43.02% (37/86) in the control group. The total effective rate was 91.15% (206/226) in the treatment group, higher than that of the control group (76.74%, 66/86) with statistical difference (P < 0.01). There was statistical difference in the clinical symptoms integral, whole blood viscosity ratio, plasma viscosity ratio, hematocrit, ESR, TC, TG,HDL-C, and LDL-C (P < 0.05, P < 0.01). CONCLUSIONS: Symptoms of ischemic stroke patients could be improved by modified YYHR. Indices such as the whole blood viscosity, plasma viscosity ratio, hematocrit, ESR, abnormal metabolism of blood lipids were also significantly improved. Pathological changes of blood stasis induced by qi-yin deficiency exist in ischemic stroke patients, and DQYS and SBOCS were basic syndrome types.

Effect of ligustrazine on levels of amino acid neurotransmitters in rat striatum after cerebral ischemia-reperfusion injury.

This study aimed to evaluate the effect of ligustrazine on levels of amino acid transmitters in the extracellular fluid of striatum following cerebral ischemia/reperfusion (I/R) in male Sprague-Dawley rats. A microdialysis cannula guide was implanted into the right striatum. After recovery, animals underwent a sham operation or middle cerebral artery occlusion (MCAO). Those that developed cerebral ischemia after MCAO were randomized to receive propylene glycol salt water and ligustrazine respectively. Striatal fluid samples were collected from all animals at 15-min intervals after treatment and were subjected to HPLC analysis of aspartic acid, glutamic acid, taurine, and γ-amino butyric acid. Upon the last sample collection, animals were sacrificed and brain tissue specimens were collected for triphenyltetrazolium chloride staining and NeuN staining. Compared with the sham operation, MCAO induced significant neurological deficits and increased striatal concentrations of the four neurotransmitters assessed in a time-dependent manner (P < 0.01). Ligustrazine effectively attenuated the detrimental effects of MCAO on the brain. These observations suggest that ligustrazine as a novel cerebral infarction-protective agent may have potential clinical implications for I/R-related brain damage.

Protective effect of Danhong injection on cerebral ischemia-reperfusion injury in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Danhong injection (DH), a Chinese medical product, is used extensively for the treatment of cerebrovascular diseases such as acutely cerebral infarction in clinic. AIM OF THE STUDY: To explore the protective effect and the relevant mechanisms of DH on cerebral ischemia-reperfusion (I/R) injury. MATERIALS AND METHODS: Cerebral I/R injury was induced through four-vessel occlusion (4-VO) or middle cerebral artery occlusion (MCAO). Adult male SD rats were randomly divided into six kinds of groups: normal control group, sham-operated group, I/R injury group, DH-treated groups at doses of 0.5ml/kg, 1.0ml/kg and 2.0ml/kg. The effects of DH on murine neurological deficits and cerebral infarct volume, 6-keto-prostagladin F(1α) (6-keto-PGF(1α)) level, malondialdehyde (MDA) level and superoxide dismutase (SOD) activity in brain tissue, as well as the activities of plasma tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) after I/R were evaluated. Moreover, the expressions of Bcl-2 and Bax protein were detected by immunohistochemistry. RESULTS: There was no significant difference between the control group and the sham-operated group based on the measurement indicators. Compared with the vehicle-treated group, rats treated with DH showed dose dependent reductions in brain infarction size, and improvement of neurological outcome. The level of 6-keto-PGF(1α) and the activities of SOD and plasma t-PA were enhanced significantly, whereas the level of MDA and the activity of plasma PAI were declined significantly. The immunohistochemical staining results also revealed that the expression of Bcl-2 protein was up-regulated and that of Bax protein was down-regulated when exposed to DH. CONCLUSION: DH demonstrates a strong ameliorative effect on cerebral I/R damage in rats by its anticoagulant, antithrombotic, antifibrinolytic and antioxidant activities. Furthermore, suppressing apoptosis through regulating Bcl-2 and Bax protein expressions should be another potential mechanism by which DH exerts its neuroprotective function.

The role of crocetin in protection following cerebral contusion and in the enhancement of angiogenesis in rats.

The protective role of crocetin following cerebral contusion and its effects on the enhancement of angiogenesis in rats was investigated. A total of 60 Sprague-Dawley rats were divided into three groups (n = 20 each): crocetin therapy group (cerebral contusion treated with crocetin), cerebral trauma control group (without treatment), sham operation control group. The effect of crocetin was examined by modified Neurological Severity Scores (mNSS), electron microscopy, terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) procedure, western blotting analysis of Bcl-2 protein expression, microvessel count (MVC), endothelial cell culture and immunocyto-chemistry. The mNSS results indicated that neurological function of therapy group was significantly recovered seven days and fifteen days after the trauma. The TUNEL staining and electron microscopy revealed that crocetin treatment led to an inhibition of neuronal apoptosis 72 h following treatment; this finding was confirmed by western blot analysis of B cell lymphoma/leukemia-2 (Bcl-2) protein expression. Expression levels of vascular endothelial growth factor receptor-2 (VEGFR-2) and serum response factor (SRF) were higher in the crocetin therapy group in comparison to the two other experimental groups. Our results demonstrate that the protective effects of crocetin upon brain injury may be related to its ability to inhibit apoptosis at early stages of the injury and its ability to promote angiogenesis at the sub-acute stage.

Effects of hydroxysafflor yellow A on the experimental traumatic brain injury in rats.

This paper explores the effects of hydroxysafflor yellow A (HSYA) on traumatic brain injury (TBI). Rats were divided into four groups: control, TBI, TBI combined with HSYA, and TBI combined with nimodipine. Saline, HSYA, or nimodipine was i.v. injected at 30 min before and 6 h after the onset of TBI. The contusion volume of brain, mitochondrial ATPase activity, brain malondialdehyde (MDA) content, and the concentrations of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in the blood plasma were investigated. The results showed that the inhibitory rate of HSYA at a dose of 4 mg/kg was 59.2% compared with the TBI group. After the insult by TBI for 48 h, the activity of Na(+), K(+)-ATPase, Ca(2+)-ATPase, and Mg(2+)-ATPase decreased to 31, 35, and 38% of control group. HSYA increased these ATPase activities by 162, 96, and 131% of TBI group. HSYA also increased superoxide dismutase activity and decreased MDA content in the right parietal lobe adjacent to contusion foci in TBI rats. HSYA enhanced the t-PA activity by 64.64%, decreased the PAI-1 activity by 71.88%, and decreased the MMP-9 expression to 49.11% in the hippocampus of the TBI group at 12 h. In conclusion, HSYA may exert a potential therapeutic strategy to improve the outcome following TBI injury.

[Effect of polydatin on dynamic changes of excitatory amino acids in cerebrospinal fluid of cerebral hemorrhage rats].

OBJECTIVE: To observe the effects of polydatin on dynamic changes of excitatory amino acids in cerebrospinal fluid and water content of brain tissue of cerebral hemorrhage rats. And to discuss the therapeutic action and mechanisms of polydatin on brain hemorrhagic injured rats. METHOD: A quantitative determination method of Asp and Glu was established by microdialysis-HPLC. The cerebral hemorrhage model in rats was induced by local injection of type VII collagenase. The dynamic changes of Asp and Glu in cerebrospinal fluid were observed on 0, 6, 12, 24, 36, 48, 60, 72, 84, 96, 108 h of cerebral hemorrhage rats, and then the water content of brain tissue was detected. RESULT: The content of Asp and Glu increased rapidly within 24 h after cerebral hemorrhage, and to the highest in 24 h, then decreased gradually. Compared with the cerebral hemorrhage model group, the content of Asp and Glu increased slowly in polydatin group, and there were significant differences in 12-72 h and 6-84 h (P < 0.01, P < 0.05), but there was no significant difference after 84 h and 96 h. Compared with sham group, water content of brain tissue significantly higher in model group, while significantly lower (P < 0.01) in polydatin group. CONCLUSION: Polydatin can inhibit increasing content of Asp and Glu in cerebrospinal fluid dynamics, and significantly inhibit cerebral edema of cerebral hemorrhage rats. It shows that the mechanisms of anti-cerebral hemorrhage injury of polydatin may be related to increasing of excitatory amino acids after cerebral hemorrhage.

Traditional Chinese drug ShuXueTong facilitates angiogenesis during wound healing following traumatic brain injury.

ETHNOPHARMACOLOGICAL RELEVANCE: ShuXueTong injection is a traditional Chinese drug designed to treat the patients of "blood stasis and stagnation (yu xue yu zhi)", including subacute brain trauma. However, the mechanism of the therapeutic effect of ShuXueTong on traumatic brain injury is unknown yet. AIM OF THE STUDY: We hypothesized that ShuXueTong may promote the brain wound healing by facilitating angiogenesis. Thus this study was designed to explore this hypothesis. MATERIALS AND METHODS: By means of microvessel count, Western blotting, immunocytochemistry, methyl thiazolyl tetrazolium assay and etc., the effect of ShuXueTong on the angiogenesis of brain wound was studied and then its influence on the VEGF/VEGFR-2 pathway were explored. RESULTS: ShuXueTong facilitates angiogenesis in the brain wound and improves the neurological function of the traumatized rats. VEGF expression in the lesion was elevated due to ShuXueTong induction. The in vitro experiment revealed VEGFR-2 and SRF expression in the endothelial cells were enhanced when exposed to ShuXueTong for merely 1d. Moreover, ShuXueTong promoted the endothelial cell proliferation via the VEGF/VEGFR-2 pathway. CONCLUSIONS: The mechanism of the therapeutic effect of ShuXueTong on traumatic brain injury lies at least partly in the enhanced angiogenesis in the lesion.

Protective effects of gastrodin on hypoxia-induced toxicity in primary cultures of rat cortical neurons.

The phenolic glucoside gastrodin is the main component extracted from the rhizome of Gastrodia elata (Orchidaceae), a Chinese herbal medicine, which has long been used for treating dizziness, epilepsy, stroke and dementia. The present study aims to investigate the effect of gastrodin on hypoxia-induced neurotoxicity in cultured rat cortical neurons. Neuron survival and extracellular glutamate level were measured after an insult by hypoxia. Glutamate concentrations were determined by an HPLC-ECD system. The results demonstrated that neurons were significantly damaged by hypoxia for 24 h. When pretreated with gastrodin (100, 200 microg/mL) in hypoxia, neuron survival was significantly increased compared with no gastrodin treatment. Moreover, the enhancement of extracellular glutamate level stimulated by hypoxia was inhibited by pretreatment with gastrodin (100 microg/mL). Further studies demonstrated that gastrodin prevented glutamate- and NMDA-induced neurotoxicity. In addition, gastrodin also inhibited the extracellular glutamate level induced by NMDA insult. These findings suggest that gastrodin has a neuroprotective action against hypoxia in the cultured cortical neuron, and the mechanism may involve a decreasing of the extracellular glutamate level.

The mechanism of 3-methoxy puerarin on decreasing the cerebral ischemia-reperfusion injury in rats.

The aim of this study was to explore the mechanism of 3-methoxy puerarin on decreasing the cerebral ischemia-reperfusion injury in rats. Before the model of cerebral ischemia-reperfusion injury was made, the rats in one group (3-methoxy puerarin group, 3-MP group) were pretreated with 3-methoxy puerarin (100 mg/kg) by gavageing two times per day for seven days. At an hour before operation, the rats in the 3-MP group were additionally given 3-methoxy puerarin by gavageing once. The level of prostacyclin (PGI2) and the expression of endothelin-1 (ET-1) mRNA in cerebral tissue, the activity of plasma tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) were measured. Cerebral tissue pathologic changes were also observed. The levels of PGI2 in cerebral tissue and the activity of plasma t-PA in 3-MP group were significantly higher than those in the group of cerebral ischemia-reperfusion injury (CIRI group) (p<0.01). The activity of plasma PAI and the expression of ET-1 mRNA in cerebral tissue in 3-MP group were significantly lower than those in CIRI group (p<0.01). The cerebral tissue pathologic changes were significant in CIRI group, which were significantly ameliorated in the 3-MP group. The study showed, in the rat model of cerebral ischemia-reperfusion injury, 3-methoxy puerarin can not only increase the level of PGI2 in cerebral tissue and the activity of plasma t-PA, but also inhibit the activity of plasma PAI and the expression of ET-1 mRNA in cerebral tissue. Those findings might be the mechanisms behind the protecting effects of 3-methoxy puerarin on the cerebral ischemia-reperfusion injury.

Effects of gastrodin on amino acids after cerebral ischemia-reperfusion injury in rat striatum.

The aim of this study was to explore the effect of gastrodin on the level of amino acids in the striatum in the rats of cerebral ischemia-reperfusion injury. 30 male SD rats were randomly divided into 3 groups: the group of pseudo-operation (normal control group, NC group), the group of cerebral ischemia-reperfusion injury (CIRI group), and the group of cerebral ischemia-reperfusion injury treated with gastrodin (G group). Cerebral ischemia-reperfusion injury was induced through middle cerebral artery occlusion (MCAO). 10 minutes before the operation, the rats in the G group were injected with gastrodin (50 mg/kg) intraperitoneally once. The rats in the CIRI and NC group were injected with the same volume of 10% propylene glycol normal saline intraperitoneally once. The levels of glutamic acid (Glu), aspartic acid (Asp), gamma-aminobutyric acid (GABA), taurine (Tau) in striatum in the rats of the 3 groups were measured with the method of microdialysis-HPLC techniques. The ratio of Glu to GABA was calculated. The volume of cerebral infarction was quantified. This study showed that gastrodin can decrease the volume of cerebral infarction, ameliorate the cerebral injury in the rats of cerebral ischemia-reperfusion. The mechanisms might be that gastrodin can improve the level of amino acids in striatum.

[Experiment study of tongfu huoxue decoction in the treatment of intracelebral hemorrhage].

OBJECTIVE: To investigate the effects of Tongfu Huoxue decoction on experimental intracelebral hemorrhage and the associated machenisms. METHOD: The cerebral hemorrhage model in rats was induced by local injection of type VII collagenase and they were randomly divided into four groups. The treated groups were treated with Naoxuekang and Tongfu Huoxue decoction. The control groups were only treated with water. The changes of neurological defect were observed. The content of brain water, MDA, NO and the activity of SOD were measured. RESULT: The cerebral hemorrhage rats showed hemiplegia, and the hemorrhage brains showed celebral edema, higher quotient of brain and content of brain water, suggesting the hemorrhage model was established successfully. After the treatment of Tongfu Huoxue decoction, the hemorrhage rats showed smaller hemorrhage volume, the brain tissue from the hemorrhage rats had lower MDA content and the quotient of brain, and also had higher activity of SOD and content of NO. CONCLUSION: Tongfu Huoxue decoction has treatment effects on cerebral hemorrhage.

[Clinical study on Zhuyu Tongfu serial recipe combined with acupuncture and massotherapy in treating hypertensive cerebral hemorrhage].

OBJECTIVE: To observe the clinical efficacy and mechanism of Zhuyu Tongfu (ZYTF) Serial Recipe combined with acupuncture and massotherapy in treating hypertensive cerebral hemorrhage (HCH). METHODS: One hundred and eighteen patients with hypertensive cerebral hemorrhage, on the basis of conventional Western medicine treatment, were randomly divided into ZYTF combined with acupuncture and massotherapy group (treated group) and simple Western medicine group (control group); the clinical efficacy, neurofunction deficit scoring (NDS) alterations and hematoma absorption rate of both groups were observed, and also the plasma superoxide dismutase (SOD) activity, plasma lipid peroxidase (LPO) content, erythrocyte glutathion peroxidase (GSH-Px) activity, hematocrit (Ht) and the whole blood viscosity (Va) change were also observed. RESULTS: In the treated group, the clinical efficacy, NDS improvement and hematoma absorption rate were superior to that of the control group; comparison between the two groups after treatment showed that plasma SOD activity and GSH-Px activity got more elevated and plasma LPO content, Ht and Va more lowered in the the treated group than those in the control group. CONCLUSION: ZYTF combined with acupuncture and massotherapy has better effect, its therapeutic mechanism was possibly correlated to the elevation of plasma SOD activity, GSH-Px activity and lowering of plasma LPO content, Ht and Va.