Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan最新文献

Objective: To assess the effect of Traditional Chinese Medicine (TCM) treatment with syndrome differentiation in patients with severe community-acquired pneumonia (CAP).

Methods: A multicenter, randomized, placebo-controlled trial was conducted. Adult patients with severe CAP were randomly allocated to receive conventional medicine treatment (conventional group) or conventional medicine combine with TCM treatment with syndrome differentiation (combination group) underwent a 28-d treatment time. The primary endpoint was treatment failure. Secondary outcomes included time to clinical stability, 28-d mortality, 90-d mortality, length of hospital stay.

Results: A total of 183 patients were included in the intention-to-treat (ITT) population, with 91 allocated to the combination group and 92 to the conventional group. Patients with treatment failure in the combination group (18/91, 19.8%) were lower compared with the conventional group (34/92, 37.0%). Time to clinical stability was shorter in the combination group (11.8 d) than in the conventional group [17.8 d; HR = 2.08, 95% CI (1.38, 3.14); P = 0.001]. The 28-d mortality was lower in the combination group (17.6%) than in the conventional group (31.5%). There was no difference in the length of hospital stay between the two groups (P = 0.901). Adverse events were evenly distributed between the combination and conventional groups (P = 0.837).

Conclusion: Among patients with severe CAP, TCM treatment with syndrome differentiation reduced treatment failure, time to clinical stability, and the 28-d mortality and the 90-d mortality among patients admitted to the ward, without an increase in complications.

Objective: To confirm the effectiveness and safety of Shi's manipulation in treating acute and subacute neck pain patients.

Methods: This multicenter, positive controlled, randomized clinical trial has trial and control groups. There were 240 patients randomly assigned to the trial group and the control group, and both groups received their respective intervention treatment methods for a period of 12 weeks. The time windows for clinical data collection were before treatment, immediately after treatment, 3-d 1, 2, 4, 8, and 12 -week after treatment, and follow-up was conducted at 26 and 52-week after treatment. The observed indicators used include primary outcome index and secondary outcome index, with the primary outcome index being the assessment of neck pain severity, which is evaluated by patients using Numerical Rating Scale (NRS). Secondary secondary outcome index include, (a) cervical dysfunction index, measured by patients using the Neck Disability Index (NDI) for self-assessment; (b) Cervical activity measurement, measured through the cervical range of motion measurement program on Android mobile system; (c) Satisfaction treatment assessment, determined by the patient's self-evaluation; (d) Safety index, recorded the incidence of adverse reactions and adverse event.

Results: The results showed that these efficacy indices were improved in different degrees in both groups. At immediate after intervention, there was significant difference in NRS, NDI, Cervical Range of Motion (ROM) between the two groups (P < 0.01), the trial group was superior to the control group. At 3-d after intervention, there was significant difference in NRS, NDI, ROM between the two groups (P < 0.01). At 1-week and 2-week after intervention, there was significant difference in NDI and ROM between the two groups (P < 0.01). At 4-week and 6-week after intervention, there was significant difference in NDI, ROM between the two groups (P < 0.05). At 8-week after intervention, there was significant difference in NDI, lateral-bending and axial-rotation ROM between the two groups (P < 0.05). At 12-week after intervention, there was significant difference in NDI between the two groups (P < 0.01). At 26-week and 52-week after intervention, there was significant difference in NDI, NRS between the two groups (P < 0.01). In addition, the adverse reaction of trial group is significantly lower than that of control group (P < 0.05). The satisfaction of patients in the trial group was better than that in the control group (P < 0.01).

Conclusion: Our findings suggest that Shi's manipulation can be a good complementary treatment option in patients with acute and subacute neck pain.

Objective: To explore the association between adjuvant therapy with Traditional Chinese Medicine (TCM) and glycemic control in patients with type 2 diabetes mellitus (T2DM) in the real world.

Methods: In this retrospective cohort study, we consecutively collected medical records of T2DM patients enrolled in the Metabolic Management Center (MMC) from October 2021 to April 2024. Patients were divided into two groups based on the presence or absence of a TCM prescription within 6 months after enrollment in MMC management. Propensity score matching (PSM) was used to balance the differences in covariates between the two groups. The independent efficacy of adjuvant TCM therapy on glycemic control was assessed by univariate and multivariate logistic regression, and then further determined by subgroup analysis.

Results: A total of 580 patients were included, with 441 patients (76.0%) receiving TCM treatment. Before PSM, multivariable logistic regression revealed that adjuvant TCM therapy was significantly associated with a lower incidence of poor glycemic control [odds ratio (OR) = 0.47, 95% confidence interval (CI) (0.30, 0.73)]. After PSM, weighted regression analysis further confirmed this inverse association [OR = 0.60; 95% CI (0.39, 0.92)]. In addition, patients treated with Chinese herbal medicine (CHM) alone [OR = 0.45; 95% CI (0.27, 0.75)], non-drug therapy (NDT) alone [OR = 0.56; 95% CI (0.32, 0.99)], and CHM + NDT [OR = 0.43; 95% CI (0.25, 0.74)] all exhibited a reduced incidence of poor glycemic control compared with those who did not receive TCM treatment.

Conclusion: The adjuvant TCM therapy is beneficial for achieving optimal glycemic control, suggesting that adjuvant TCM therapy may be embraced as a viable glycemic management approach for T2DM patients with poor glycemic control.

Objective: To comprehensively evaluate randomized controlled trials (RCTs) investigating the effects of moxibustion on people with human immunodeficiency virus (HIV) disease.

Methods: A systematic search was conducted across eight electronic databases up to August 20, 2024. The primary outcome were all-cause mortality and acquired immunodeficiency syndrome (AIDS)-related mortality. Two authors independently screened titles and abstracts, and extracted data onto a pre-designed datasheet. Discrepancies were resolved through consensus. The Cochrane risk-of-bias tool 2.0 was used to assess methodological quality, Meta-analysis was performed when appropriate, and the quality of evidence was assessed through Grading of Recommendations, Assessment, Development and Evaluations approach.

Results: Eleven RCTs (n = 834) on moxibustion for HIV/AIDS were included, focusing on individuals with HIV infection (5 RCTs, n = 426), AIDS patients (3 RCTs, n = 223), or both (3 RCTs, n = 185). Complications identified included diarrhea (5 RCTs), pulmonary infection (1 RCT), anxiety and depression (1 RCT) and peripheral neuropathy (1 RCT). The risk of bias in the included RCTs was assessed as either high or uncertain. No trial reported mortality or the incidence of AIDS-related complications following treatment. Wheat-grain sized cone moxibustion was associated with increased CD4+ counts in patients with lung infections [1 RCT, n = 36, mean difference (MD) = 78.83 cells/μL]. Individual studies reported improvements of quality of life, as measured by the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) and WHOQOL HIV instrument, with various moxibustion types, but clinical heterogeneity prevented data pooling. Additionally, some studies reported symptom improvement, each using different criteria for symptom improvement. Moxa stick moxibustion plus Western Medicine compared with Western Medicine alone showed a non-significant trend towards improved symptom resolution [2 RCTs, n = 125, risk ratio = 1.19, 95% confidence interval (0.99, 1.43)]. Moxibustion plus antiretroviral therapy (ART) may reduce gastrointestinal adverse events compared to ART alone [1 RCT, n = 100 14% vs 32%, P < 0.05]. The quality of evidence was low to very low.

Conclusion: This systematic review suggests that moxibustion as an adjunct therapy may have potential benefits in improving immune function and quality of life for HIV/AIDS patients. Limited quality of evidence precludes definitive conclusions, and further high-quality research is needed.

Objective: To elucidate the potential mechanisms and identify bioactive components of Suanzaoren (Ziziphi Spinosae Semen) (ZSS) and it's processed products for insomnia treatment.

Methods: The principal components of ZSS and its processed products were analyzed using Ultra-Performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS). The effects of ZSS on insomnia were assessed in para-chlorophenylalanine (PCPA)-induced rats. Additionally, to investigate the mechanisms of action in insomnia, serum and hippocampal non-targeted metabolomics were performed alongside network pharmacology and molecular docking.

Results: UPLC-Q-TOF-MS was used to analyze the main components of ZSS and its processed products. In the insomnia rat model induced by PCPA, both ZSS and its processed products demonstrated therapeutic effects, with the processed products showing particularly significant effects, significantly increasing the levels of the Gamma-Aminobutyric Acid and melatonin. Non-targeted metabolomics identified 23 and 10 potential differential metabolites in serum and hippocampus, respectively, involving pathways such as lipid metabolism and amino acid metabolism. Network pharmacology identified three core targets, mainly associated with pathways such as Transient Receptor Potential channel regulation, Advanced Glycation End-products-Receptor for Advanced Glycation End-products signaling pathway, and neuroactive ligand-receptor interaction. Molecular docking confirmed that the main active components of ZSS can stably bind to these core targets, thereby exerting an effect in improving insomnia.

Conclusions: Combining in vivo experiments, metabolomics, and network pharmacology, we have identified potential pharmacological mechanisms by which ZSS and its derivatives mitigate insomnia. These findings provide a theoretical foundation for the further development and utilization of ZSS, supporting the innovation of new therapeutic agents for insomnia treatment.

Objective: To identify the main active ingredients of Improved Yupingfeng Powder prescription (IYPFP, ) and investigate its anti-inflammatory effects and underlying mechanisms in ovalbumins (OVA)-induced allergic rhinitis (AR) in mice.

Methods: Bagg Albino/substrain mice were sensitized with OVA emulsified in aluminum hydroxide adjuvant, followed by intranasal challenge to establish AR models. Treatment groups received IYPFP (1.5 or 4.5 g/kg) via daily gavage for 14 d. The nasal mucosa tissues were collected for pathological observation. The expression of OVA-specific immunoglobulin E (IgE), histamine, and interleukin-33 (IL-33) was detected by enzyme-linked immunosorbent assay. IL-5, IL-13, IL-33, suppression of tumorigenicity 2 (ST2), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in the nasal mucosa and lung were detected by quantitative polymerase chain reaction and Western blot. High performance liquid chromatography and ultra-high performance liquid chromatography quadrupole exactive orbitrap mass spectrometry were used to detect the chemical fingerprints of IYPFP, and the chemical compositions of plasma from rats treated with IYPFP at 0.5, 1, 1.5, 2, 3, 4 and 6 h, respectively. Virtual screening of bioactive compounds was conducted through molecular docking targeting IL-33/ST2 pathway proteins.

Results: Eight chemical compounds of IYPFP were accurately identified, they are prim-O-glucosylcimifugin (peak 2), calycosin-7-O-β-D-glucoside (peak 4), cimifugin (peak 5), 5-O-methylvisammioside (peak 6), sec-O-glucosylhamaudol (peak 12), calycosin (peak 15), formononetin (peak 19), and magnolin (peak 21). Compared with the OVA model group, IYPFP alleviated the nasal symptoms, improved nasal mucosal injury and downregulated the levels of OVA-specific IgE, histamine and IL-33. Additionally, IYPFP reduced the levels of IL-5, IL-13, TNF-α, IL-33, and ST2 in the lungs, but upregulated IFN-γ. Molecular docking confirmed that eight representative compounds of IYPFP had good binding properties with IL-5, IL-13, IFN-γ, histamine, IL-33 and ST2, and were able to inhibit the activation of the IL33/ST2 inflammatory pathway.

Conclusion: This study demonstrates that IYPFP ameliorates AR by modulating IL-33/ST2 pathway which provides a theoretical basis for the clinical treatment of patients with AR.

Objective: To investigate the effect of electroacupuncture (EA) on regulatory functions of one specific exosomal circRNA of Enhancer of Zeste Homolog (CircEZH) and its potential mechanisms of action in type 2 diabetes (T2DM).

Methods: Mice were fed a high-fat diet (HFD) and intraperitoneally injected with streptozotocin to create the T2DM model and then were used for two experiments involving the following groups: experiment 1 (control group, T2DM group, T2DM+EA group, 10 mice per group) and experiment 2 [control group, T2DM group, T2DM+ CircEZH1-siRNA (20 nmol/20 g) group, 10 mice per group]. Exosomal size, distribution, and morphology were evaluated via transmission electron microscopy and nanoparticle tracking analysis. The expression of CircEZH1 and CircEZH2 in exosomes was assessed by quantitative real-time polymerase chain reaction. Insulin expression was assessed by enzyme-linked immunosorbent assay, immunofluorescence, and western blotting. The effects of exosomal CircEZH1 knockout and overexpression in Min6 cells were assessed by cell counting kit-8 and flow cytometry. Meanwhile, the effect of CircEZH1 knockout on insulin sensitivity was assessed by glucose tolerance test (GTT) and insulin tolerance test (ITT) in vivo.

Results: EA treatment significantly reduced the serum insulin level and cell apoptosis in pancreatic tissue in a T2DM model. EA treatment markedly upregulated CircEZH1 expression in the exosomes of T2DM mice. Further study showed that CircEZH1 overexpression resulted in increased Min6 cell viability and decreased Min6 cell apoptosis when compared with the levels in an overexpression control group. In Min6 cells with CircEZH1 knockout, the opposite trends were identified. CircEZH1-knockout Min6 cells also showed reduced insulin expression. In vivo, CircEZH1-knockout T2DM mice displayed damaged insulin sensitivity, which was demonstrated by elevated levels of fasting blood glucose and decreased glucose tolerance in the GTT and insulin sensitivity in the ITT.

Conclusions: EA can affect CircEZH1 expression specifically in the exosomes in β cells in the pancreatic islets to improve T2DM. Exosomal CircEZH1 is a potential therapeutic candidate to treat T2DM.

Objective: To elucidate the potential mechanisms of Shizhi Fang (SZF, ) in the treatment of uric acid nephropathy (UAN).

Methods: SZF-containing serum was prepared from six male rats and analyzed using ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS). Network pharmacology was employed was integrated with UPLC-Q-TOF-MS to predict SZF targets for the treatment of UAN, which were subsequently validated through in vivo experiments. Sixty male Bagg Albino Laboratory-Bred Mouse, substrain c mice were randomly allocated into six groups: Normal, Model, Febuxostat, and three SZF dosage groups. Except for the Normal group, all mice were administered potassium oxonate (250 mg/kg) and adenine (50 mg/kg) via gavage to induce UAN. Four hours post-administration, the Febuxostat group received Febuxostat (6 mg/kg), while the SZF groups received low (0.234 g/kg), medium (0.468 g/kg), or high (0.936 g/kg) doses of SZF. The Normal and Model groups were given an equivalent volume of saline. All treatments were conducted over a period of four weeks. Urine and blood samples were collected for biochemical analysis, and kidney tissues were subjected to histopathological examination and Western blot analysis.

Results: Nine prototype compounds and 30 metabolites were identified in SZF serum. Network pharmacology analysis revealed 195 drug targets and 1608 disease targets, with 76 common drug-disease targets, including signal transducer and activator of transcription 3 (STAT3), proto-oncogene tyrosine-protein kinase Src (SRC), matrix metalloproteinase-9 (MMP9), Caspase 3, and toll-like receptor 4 (TLR4) as key targets. Gene Ontology analysis identified 325 biological processes, 48 cellular components, and 72 molecular functions, while Kyoto Encyclopedia of Genes and Genomes analysis identified 113 pathways. Molecular docking demonstrated strong binding affinities between active compounds and their targets. In the animal study, SZF treatment alleviated pathological damage and improved serum and urine biochemical markers compared to the Model group (P < 0.05, P < 0.01, P < 0.001). Western blot analysis showed a significant reduction in phosphorylated-STAT3, phosphorylated-SRC, MMP9, TLR4, and Caspase3 expression in renal tissues of SZF-treated mice (P < 0.001).

Conclusion: SZF may exert therapeutic effects on UAN through multiple targets and pathways.

Cervical radiculopathy (CR) poses a significant challenge due to its debilitating impact on physical function, daily activities, psychological well-being, and social engagement. Traditional Chinese Medicine (TCM) has emerged as a valuable approach in managing CR. This study aims to present a comprehensive clinical practice guideline for the management of CR through TCM. Utilizing internationally recognized guideline standards, we meticulously developed this guideline. The Grading of Recommendations Assessment, Development, and Evaluation approach was employed to rigorously assess evidence quality and recommendation strength. Recommendations were formulated through the nominal group technique. Expert consensus identified nine clinical questions and twenty-three outcome indicators. After careful consideration of evidence quality, balance of benefits and harms, patient preferences, costs, clinical feasibility, accessibility, and clinical acceptability, the guideline working group formulated seventeen recommendations. These recommendations encompass various aspects such as diagnosis, TCM syndrome types, Chinese medicine compounds, Chinese patent medicines, acupuncture, manual therapy, traditional exercise therapy, surgical indications, and preventive measures. The majority of recommendations were weakly suggested or consensus-based, with the exception of acupuncture and manual therapy, which received strong recommendations. This guideline serves as a valuable resource for enhancing clinical decision-making and contributing to the comprehensive management of patients with CR.

Objective: To reevaluate systematic reviews and Meta-analysis (SR/MAs) on the efficacy and safety of acupuncture in treating arrhythmias.

Methods: SR/MAs of acupuncture treatment for arrhythmias were retrieved from four English databases (PubMed, Embase, Web of Science, Cochrane Library) and four Chinese databases ?(China National Knowledge Infrastructure? Database, China Science and Technology Journal Database, Wanfang Data and Chinese Biomedical Literature Database) up to December 2023. Data were extracted according to predefined criteria. The methodological quality of included SR/MAs was assessed using the A Measurement Tool to assess systematic Reviews 2, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Grading of Recommendations, Assessment, Development, and Evaluation were used to assess the reporting quality and evidence quality of the included SR/MAs.

Results: A total of 10 SR/MAs were included, involving 8 types of arrhythmias (atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, atrial premature beat, ventricular premature beat, sinus tachycardia, sinus bradycardia, and sick sinus syndrome) and 10 outcome indicators. The evaluation of efficacy and safety showed that acupuncture can effectively improve the average heart rate and clinical efficacy of patients with various types of arrhythmias, reduce the number of premature beats in patients with premature beats based on 24-h dynamic electrocardiography, increase the rate of sinus rhythm conversion in patients with atrial fibrillation, shorten the time to convert to sinus rhythm, etc., without serious adverse reactions. The results of methodological quality, reporting quality, and evidence quality of the included SR/MAs showed that the methodological quality evaluation was very low; reporting quality evaluation included 5 items rated as "somewhat deficient" and 5 items rated as "relatively complete"; evidence quality evaluation included 0 items rated as high, 4 items rated as medium, 13 items rated as low, and 17 items rated as very low.

Conclusion: Acupuncture as an adjuvant treatment for arrhythmias is clinically effective. However, due to the low quality of existing evidence, further improvement in the quality of original research design and SR/MAs is needed to provide strong scientific evidence and clear conclusions.