Background: Chronic severe hepatitis is a critical disease with high mortality. Currently, effective drugs and therapy still lack. Comprehensive and supportive treatment, artificial liver and liver transplantation are the main therapies. A great number of studies on traditional Chinese medicine (TCM) in many ways combined with Western medicine treatment for chronic severe hepatitis have been reported, but the efficacy and safety still lack systematic evaluation.
Objective: To evaluate the efficacy and safety of integrative medicine therapy for chronic severe hepatitis.
Search strategy: Literature was searched from PubMed, the Cochrane Library, the China National Knowledge Infrastructure Database, the Chongqing VIP Chinese Science and Technology Periodical Database, the Chinese Biomedical Literature Database and Wanfang Database. The time limitation ran from the commencement of each database to February 29, 2012.
Inclusion criteria: Randomized controlled trials (RCTs) testing Chinese herbal medicine (CHM) combined with Western medicine (comprehensive and supportive treatment or artificial liver plasma exchange) against Western medicine were included.
Data extraction and analysis: Two authors collected and extracted data independently. The methodological quality of literature was assessed by risk of bias table from Cochrane Collaboration and the data were analyzed by RevMan 5.1 software. Heterogeneity of the included studies was checked by Chi-square test. The efficacy measure was relative risk (RR) or mean difference with a 95% confidence interval (CI).
Results: A total of 45 RCTs involving 4 449 patients with chronic severe hepatitis were included. Quality of all included trials was low. The oral CHM, enema and combined TCM with either Western medicine or plasma exchange were superior to Western medicine alone in improving total effective rate and reducing mortality with significant differences. In laboratory parameters, the integrative medicine treatment group was better than Western control group in reducing the total bilirubin and alanine aminotransferase, but two groups showed equal efficacy in lowering aspartate aminotransferase activity. The oral Chinese medicine combined with Western medicine or plasma exchange was better than Western medicine used alone in improving albumin synthesis and coagulation function, but Chinese medicine enema had no significant effect on the level of plasma albumin. The main side effects of the treatment group were abdominal pain, diarrhea and other intestinal symptoms after enema, while adverse reactions of the control group were mainly due to the plasma exchange.
Conclusion: Integrated Chinese and Western medicine can promote the recovery of liver function and coagulation function, and reduce the mortality rate of patients with chronic severe hepatitis. H
Three-factor designs that are unable to examine the interactions include crossover design and Latin square design, which can examine three factors: an experimental factor and two block factors. Although the two design types are not quite frequently used in practical research, an unexpected research effect will be achieved if they are correctly adopted on appropriate occasions. This article introduced the 3×3 crossover design and the Latin square design by examples.
Chinese herbal property theory (CHPT) is the fundamental characteristic of Chinese materia medica different from modern medicines. It reflects the herbal properties associated with efficacy and formed the early framework of four properties and five flavors in Shennong's Classic of Materia Medica. After the supplement and improvement of CHPT in the past thousands of years, it has developed a theory system including four properties, five flavors, meridian entry, direction of medicinal actions (ascending, descending, floating and sinking) and toxicity. However, because of the influence of philosophy about yin-yang theory and five-phase theory and the difference of cognitive approach and historical background at different times, CHPT became complex. One of the complexity features was the multiple methods for determining herbal property, which might include the inference from herbal efficacy, the thought of Chinese Taoist School and witchcraft, the classification thinking according to manifestations, etc. Another complexity feature was the multiselection associations between herbal property and efficacy, which indicated that the same property could be inferred from different kinds of efficacy. This paper analyzed these complexity features and provided the importance of cognitive approaches and efficacy attributes corresponding to certain herbal property in the study of CHPT.
Three-factor designs that are unable to examine the interactions include crossover design and Latin square design, which can examine three factors, namely, an experimental factor and two block factors. Although the two design types are not quite frequently used in practical research, an unexpected research effect will be achieved if they are correctly adopted on appropriate occasions. Due to the limit of space, this article introduces two forms of crossover design.
Objective: To establish a rat model of diabetes-associated cerebral ischemia due to qi and yin deficiency and blood stasis, and to investigate the effects of Radix Ginseng, Rhizoma Chuanxiong, Rhizoma Polygonati Odorati and Rhizoma Polygonati Sibirici Granule (Shenxiong Yujing Granule), which has the function of strengthening qi, nourishing yin, and activating blood, on proliferation, differentiation and survival of neural cells in rats with diabetes-associated cerebral ischemia.
Methods: Rats were divided into sham-operation, diabetes plus ischemia reperfusion injury model, Shenxiong Yujing Granule and Radix Ginseng and Rhizoma Chuanxiong Granule (Shenxiong Granule) groups with 20 rats in each. The 5-bromo-2'-deoxyuridine (BrdU) incorporation assay and immunohistochemical method were used to investigate the proliferation, differentiation and survival of neural cells in dentate gyrus of rats with diabetes-associated cerebral ischemia.
Results: The number of newly proliferating cells in subgranular zone of dentate gyrus was increased in the model group, but there was no significant difference compared with 7 day treatment with Shenxiong Yujing Granule. Shenxiong Yujing Granule significantly increased the survival rate and promoted the differentiation of newly proliferating neurons after 21-day treatment (P<0.01). In addition, the beneficial effect of Shenxiong Yujing Granule was considerably greater than that of the Shenxiong Granule (P<0.01).
Conclusion: Shenxiong Yujing Granule can increase the survival rate and promote the differentiation of newly proliferating neurons in rats with diabetes-associated cerebral ischemia of dual deficiency of qi and yin and blood stasis obstructing the collaterals. The effect is greater than that of Shenxiong Granule.
Objective: To evaluate the effects of danshensu, the main component of the extract of Chinese medicine Salvia miltiorrhiza, on the proliferation and activation of hepatic stellate cells (HSCs).
Methods: The activation of HSC-T6 was induced by exposure to acetaldehyde. In the meantime, different doses of danshensu were added to the culture medium. After 24 h of treatment with danshensu in acetaldehyde, the viability of HSC-T6 cells was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, the cell cycle was determined through flow cytometry, and the gene transcription levels of plasminogen activator inhibitor-1 (PAI-1), transforming growth factor-β1 (TGF-β1), urokinase-type plasminogen activator (uPA) and matrix metalloproteinase-2 (MMP-2) were analyzed by real-time quantitative polymerase chain reaction.
Results: The proliferation of HSCs induced by 200 μmol/L acetaldehyde could be significantly inhibited by danshensu, and the percentage of HSCs in S phase was significantly increased as compared with the control cells (P<0.05), which were respectively evidenced by MTT assay and flow cytometry. Danshensu down-regulated the mRNA expression of TGF-β1 and PAI-1 and up-regulated the uPA transcription level (P<0.01), while the transcription level of MMP-2 was not significantly affected in HSC-T6.
Conclusion: Danshensu can inhibit the proliferation and activation of HSC-T6, as well as regulate some cytokines involved in extracellular matrix accumulation, which offers a potential therapeutic alternative for liver fibrosis.
Objective: The concepts of cold and hot herbal properties in traditional Chinese medicine (TCM), reflecting the efficacy trends of medicinal herbs, have the Fuzzy characteristics. It is suited for the application of Fuzzy mathematics in research of herbal properties. For a comprehensive evaluation of herbal properties, this work constructed and made a practice of the Fuzzy discrimination model regarding the biological performance of Chinese materia medica.
Methods: Firstly, TCM formulas of cold or hot property were employed for setting the reference values and calculating the membership functions of cold and hot Fuzzy sets with Fisher discriminant. Then the model parameters of cold performance function (CPF) and hot performance function (HPF) were acquired. Second, the experimental data from studies on changes in multisystem indicators of animals given the classical cold formula (Sanhuang Fang) and hot formula (Jiangfugui Fang) were collected to calculate CPF and HPF. Then an experiment of administration of hot property herbs, Rougui (Cortex Cinnamomi) and Xianmao (Rhizoma Curculiginis), and cold property herbs, Huangbai (Cortex Phellodendri) and Zhizi (Fructus Gardeniae) to normal animals and animals with glucocorticoid-induced yang-deficiency or yin-deficiency state was designed. The relative changes in animal states were analyzed by the evaluation model to find the way in which herbal properties are represented.
Results: The HPF values of biological performance were higher than the CPF values in administration of Rougui to animals of normal (0.528>0.221), yang-deficiency (0.203>-0.490) and yin-deficiency (1.750>-0.479) states, and in administration of Xianmao to animals of normal (0.474>-1.601) and yang-deficiency (0.288>-1.923) states, which represented the hot property. The HPF values of biological performance were lower than the CPF values in administration of Huangbai to animals of normal (-0.870<0.798) and yang-deficiency (-0.339<0.194) states, and in administration of Zhizi to animals of yin-deficiency (-1.802<0.354) state, which represented the cold property.
Conclusion: The herbal properties and the biological performance characteristics of herbal formulas are ascertained by using the Fuzzy evaluation model. The personalities, as well as commonalities of herbal properties are key areas for focus because of the multi-approach biological performance of cold and hot property.
Objective: To explore the effects and mechanisms of combining astragaloside IV (the effective component of Astragalus membranaceus) with notoginsenoside R1, ginsenoside Rb1 and ginsenoside Rg1 (the effective components of Panax notoginseng) against oxidative injury in PC12 cells induced by cobalt chloride (CoCl₂).
Methods: CoCl₂ was used to stimulate PC12 cells to induce injury after transdifferentiation with nerve growth factor. Then the PC12 cells were divided into 10 groups and cultured with corresponding drugs. After culture, apoptotic cells were tested by using Hocchst 33258 fluorescent staining, the level of mitochondrial membrane potential (MMP) was analyzed by rhodamine 123 fluorescent staining and the content of reactive oxygen species (ROS) in PC12 cell was measured by dichlorofluorescin diacetate fluorescent staining.
Results: CoCl₂ induced apoptosis along with the obvious decrease of MMP as well as overproduction of ROS in PC12 cells. Astragaloside IV, ginsenosides Rg1, ginsenosides Rb1 and notoginsenoside R1 had inhibition effects in different degree on PC12 cell apoptosis induced by CoCl₂, reduced the overproduction of ROS and the decrease of MMP. The effects of the combination were better than those of active component alone.
Conclusion: Active components extracted from Astragalus and Panax notoginseng can inhibit PC12 cell apoptosis induced by oxidative injury, furthermore, the effects were enhanced by combination of these components, which may be associated with jointly antagonizing the generation of ROS and raising MMP.
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