主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

Table of Content

    30 March 2021, Volume 44 Issue 3 Previous Issue    Next Issue
    Voice of Guidance
    Solutions and advantages of TCM constitution to problems in comprehensive healthcare*
    Wang Qi
    2021, 44 (3):  197-202.  doi: 10.3969/j.issn.1006-2157.2021.03.001
    Abstract ( 244 )   PDF (948KB) ( 130 )   Save
    With the development of economy, society, and China's national health strategy, people pay more and more attention to health problems. This paper provides new elaboration of the definition of comprehensive healthcare, points out some problems and macro countermeasures of comprehensive healthcare, and focuses on the role and advantages of TCM constitution theory in comprehensive healthcare. The paper discusses the relationship between TCM constitution and preventive medicine from the following three perspectives. First, constitution type identification is the starting point of preventive medicine. Second, the correlation between constitution and disease provides the basis for preventive medicine. Third, adjustment of constitution is the means of preventive medicine. Based on such relationship, TCM constitution is widely used in the prevention and control of chronic diseases and public health services. The proposal of the health plan based on the nine types of TCM body constitution provides a way for TCM constitution theory to address problems of comprehensive healthcare.
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    Expert Opinion
    Evaluation of studies of prevention and treatment of combined allergic rhinitis and asthma syndrome with TCM*
    Cui Hongsheng, Lyu Mingsheng, Wang Ji, Bi Weibo, Gong Xuefeng
    2021, 44 (3):  203-208.  doi: 10.3969/j.issn.1006-2157.2021.03.002
    Abstract ( 150 )   PDF (762KB) ( 73 )   Save
    The combined allergic rhinitis and asthma syndrome (CARAS) is not only a typical allergic disease but a common and refractory disorder of the respiratory system with high prevalence rate and complex pathogenesis. Due to limited therapies, CARAS is prone to recurrent attacks. Traditional Chinese medicine (TCM), characterized by overall pattern differentiation and systemic therapy, has been proved to be valuable in the treatment of CARAS. Literature on CARAS was reviewed in terms of its etiology, pathogenesis, and treatment with TCM. Based on that, it is concluded that the special-diathesis constitution is the primary constitution of patients with CARAS, that latent pathogen attacks the lung is the core pathogenesis, constitution-disease-pattern differentiation is the way of diagnosis and treatment in clinical prevention and treatment, and the randomized controlled trial and large-sample real-world research would be the directions of future clinical study.
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    Theoretical Studies
    Discussion of “macules out of yangming and papules out of taiyin” from the perspective of qi transformation*
    Wu Zhongde, Zhu Xing
    2021, 44 (3):  209-214.  doi: 10.3969/j.issn.1006-2157.2021.03.003
    Abstract ( 381 )   PDF (852KB) ( 96 )   Save
    “Macules out of yangming and papules out of taiyin” is a summary of the view that “macules are caused by heat toxin in yangming and papules are caused by wind heat in taiyin” proposed by Lu Zixian, a physician in the Qing Dynasty. However, the understanding of yangming and taiyin in later generations was mostly limited to the idea that “the lung governs the skin and body hair, and the stomach governs the muscles”, but neglected the meaning of yangming and taiyin in terms of the six meridians. This paper analyzes the occurrence and treatment of macules and papules from the perspective of qi transformation. Based on analysis and discussion of related previous medical cases, it is believed that both the invasion of yangming and taiyin by pathogens and the deficiency of the two meridians can lead to qi transformation disorder, forming macules and papules. Meanwhile, due to the exterior-interior relationship between yangming and taiyin, macules and papules can be transformed into each other to a certain extent. Therefore, it is necessary to differentiate whether the disease is of cold or heat, deficiency or excess pattern on the whole in clinical practice, so as to seek a better treatment plan for macules and papules.
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    Analysis of mechanism of inflammation-cancer transformation from damp-heat theory*
    Tian Lin, Lin Cuili, Sun Yueming, Ke Xiao, Huang Minghan, Yang Chunbo
    2021, 44 (3):  215-220.  doi: 10.3969/j.issn.1006-2157.2021.03.004
    Abstract ( 230 )   PDF (752KB) ( 74 )   Save
    Damp-heat is a common pathogenic factor clinically, which is characterized by stickiness and greasiness. Inflammatory cells and inflammatory mediators constitute the local inflammatory microenvironment. The formation, invasion and metastasis of tumors are based on the persistent existence of inflammatory microenvironment. The characteristic stickiness of damp-heat suggests that it may be an important factor for the persistent and refractory inflammatory microenvironment. At the same time, the transformation into toxin from dampness-heat pathogenic qi is similar to the inflammation-cancer transformation, and there is a close relationship between them. The main pathogenic substances of tumor, such as phlegm and stasis, are essentially from the source of damp-heat, which participates in the whole process of the inflammation-cancer deterioration as an initiating factor. Therefore, on the basis of analyzing the etiology and pathogenesis of inflammatory microenvironment, this paper discusses in-depth the pathological mechanism of the inflammation-cancer transformation from the perspective of the damp-heat theory, providing important theoretical basis for clinical diagnosis and treatment.
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    Discussion on establishing the intelligent TCM clinical decision-making and curative effect evaluation model based on the TCM pattern scale*
    Chen Zhihui, Zhang Huiyong, Pei Yupeng, Yang Guanlin, Yu Li, Zhang Zhe, Xiao Lei, Liu Jidong
    2021, 44 (3):  221-225.  doi: 10.3969/j.issn.1006-2157.2021.03.005
    Abstract ( 135 )   PDF (547KB) ( 48 )   Save
    TCM pattern scale is turning TCM patterns into the clinical curative effect evaluation parameters, but it still faces a lot of bottlenecks such as poor standardization, inadequate clinical application, and lack of “pattern differentiation-diagnosis-treatment-evaluation” integration. How to effectively apply the scale in clinical settings has become a problem worthy of attention and in need of solution. Artificial intelligence's ability of deep learning and integration of big data has inspired the present researchers to put forward the hypothesis that integrates the existing scales, methodology of scale development and artifical intelligence. TCM scales may be used as the way for TCM artificial intelligence to access deep learning materials, and artificial intelligence as the means of clinical application of TCM pattern scale. The research provides reference for the development of intelligent TCM clinical decision making and efficacy evaluation.
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    Ancient names and theoretical connotation of “menstruation”*
    Wang Zilu, Wang Yanfei, Shi Wei, Li Guangwen, Wang Dongmei, Liu Jinxing
    2021, 44 (3):  226-231.  doi: 10.3969/j.issn.1006-2157.2021.03.006
    Abstract ( 214 )   PDF (830KB) ( 76 )   Save
    There were many terms with different meanings to refer to menstruation in ancient books on Chinese medicine. To sort out the changes in the names of menstruation and their connotations is very important for correct understanding of the theoretical connotations of menstruation in medical literature. This article reviews a wide range of literature ranging form the four major TCM classics to important literature related to TCM gynecology in the Ming and Qing dynasties, collects and summarizes the names and interpretations of menstruation, and identifies four different theoretical connotations of the names of menstruation in different literature. Some names describe the phenomenon of uterine bleeding, some emphasize the periodic physiological phenomena of uterine bleeding, some refer solely to the blood discharged during menstruation and others mean the fine substances that run in the body to nourish the body.
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    TCM Constitutions
    Discussion of the relationship between TCM body constitution and pelvic floor muscle strength of puerpera based on preventive medicine*
    Gong Yuhang, Zhang Xuejuan, Dang Wenshan, Wu Ahua, Yuan Xiaoxiao
    2021, 44 (3):  232-237.  doi: 10.3969/j.issn.1006-2157.2021.03.007
    Abstract ( 142 )   PDF (744KB) ( 35 )   Save
    Objective To explore the correlation between postpartum pelvic floor muscle strength and body constitution in traditional Chinese medicine (TCM), and to provide reference for the prevention and treatment of pelvic floor dysfunction from the perspective of TCM. Methods 1 060 postpartum women were selected who had their routine follow-up 42-60 days after delivery at the outpatient department of Children's Hospital of Shanxi (Women Health Center of Shanxi) from March and August 2019 to investigate their general condition, TCM constitution and pelvic floor muscle strength. By univariate analysis and binary logistic regression analysis, TCM constitution types that affect pelvic floor muscle function were identified so as to understand the correlation between pelvic floor muscle strength and TCM constitution of puerperae in Taiyuan. Results This investigation of 1 060 puerperae's constitution in TCM showed that the top three constitution types of the postpartum women were yin-deficiency, qi-deficiency and blood-stasis types. In the pelvic floor muscle examination, the detection rates of type I and type II pelvic floor muscle fiber damage were 45.7% and 38.9% respectively. After the general condition factors of puerperae were controlled, binary logistic regression analysis showed that qi-deficiency constitution and wetness-heat constitution were risk factors for type I pelvic floor muscle damage (P<0.05), while qi-deficiency constitution, phlegm-wetness constitution and blood-stasis constitution were risk factors for type II pelvic floor muscle damage (P<0.05). Conclusion The decrease in pelvic floor muscular strength of puerperae in Taiyuan is related to qi-deficiency, wetness-heat, phlegm-wetness and blood-stasis constitution types in TCM.
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    Constitution characteristics and Chinese herbal prescription of patients susceptible to new coronavirus pneumonia based on data mining*
    Chen Ziqin, Chen Jia, Chen Bei, Zhang Yanlin, Wang Kunxiu, Luo Zhihui, Gu Xiaolei, Yan Peng, Chen Song
    2021, 44 (3):  238-244.  doi: 10.3969/j.issn.1006-2157.2021.03.008
    Abstract ( 206 )   PDF (1835KB) ( 42 )   Save
    Objective To explore the predominant constitution of patients with novel coronavirus pneumonia (COVID-19) and the optimal Chinese medicine diagnosis and treatment plan. Methods Patients diagnosed with COVID-19 and treated in the Second Hospital of Jingzhou were included in the study. Descriptive analysis was made of the constitution survey of hospitalized patients with COVID-19, and statistical analysis was made of effective Chinese medicine prescriptions to mine their core herbs. Results The analysis of the constitutional characteristics of patients susceptible to COVID-19 showed that the proportion of those with wetness-heat constitution was the highest. The statistical analysis of effective prescriptions used during the treatment period of COVID-19 showed that all the effective prescriptions involved a total of 152 herbs, among which the most frequently used was Houpo (Magnolia Bark, Cortex Magnoliae Officinalis). It appeared in 51 prescriptions and the most frequently prescribed dose was 15 grams. In terms of the four properties and five flavors of the herbs, the most commonly used are herbs cold in nature (45.55%) and bitter in flavor (41.55%). In terms of meridian tropism, the most frequently entered meridian was the lung meridian (26.28%). In terms of indications, the herbs most commonly used were those to dissolve phlegm and relieve cough and panting (19.39%). Association rules analysis uncovered 5 core herbs and cluster analysis 3 herb combinations. Conclusion The constitution susceptible to the novel coronary pneumonia was the wetness-heat constitution. During the treatment period, both herbs cold and those warm in property were used to regulate both the lung and the spleen. The treatment principles included mainly these to dispel dampness and remove turbidity, and to free and regulate qi movement. The core herbs were derived from the classic formula Dayuan Yin (Membrane-source Decoction) modified to eliminatie internal disease causes, external causes and causes that are neither internal nor external.
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    Science & Technology Theme
    Establishment and evaluation of disease-pattern rat model with IBS-D and spleen-kidney yang deficiency*
    Su Xiaolan, Liu Qian, Han Boyu, Zhang Tao, Mao Xinyong, Guo Song, Du Sijing, Yang Yang, Wang Xin, Wei Wei
    2021, 44 (3):  245-251.  doi: 10.3969/j.issn.1006-2157.2021.03.009
    Abstract ( 108 )   PDF (1339KB) ( 39 )   Save
    Objective To establish and evaluate a rat model with both a Western medicine disease, i.e. diarrhea-predominant irritable bowel syndrome (IBS-D) and a Chinese medicine pattern, i.e. spleen-kidney yang deficiency. Methods Eighteen suckling SD rats were randomly selected from 72 male suckling SD rats as the normal group, and the remaining 54 rats were separated from their mothers for 21 days to construct the IBS-D disease model. After the mother-child separation, the 54 rats were fed regularly for 1 week in adaptation. Then, they were randomly divided into high-dose, mid-dose and low- dose Fanxieye (Senna Leaf, Folium Senae) groups, 6 rats in each group. Each group were further divided into three groups and were given Fanxieye by gavage for 2,4 and 6 weeks respectively to establish the rat model with IBS-D and spleen-kidney yang deficiency. The macroscopic signs, visceral hypersensitivity, biological parameters and histopathological changes of rats in different groups were collected and analyzed to evaluate the model at the 2nd, 4th and 6th week since intragastric administration of Fanxieye. Results After 6 weeks of gavage with Fanxieye, compared with the normal group, rats in the high-dose Fanxieye group ate less, drank more, and had lower anal temperature, reduced grip strength, shorter weight-bearing swimming time, increased number of pellet-like feces, increased visceral sensitivity, and reduced levels of serum D-xylose, adrenocorticotropic hormone (ACTH) and serum cortisone (CORT) , all with statistical significance(P<0.05). There were no obvious histopathological changes in intestinal mucosa in each group. Conclusion The rat model with IBS-D and spleen-kidney yang deficiency can be constructed by mother-child separation superimposed with Fanxieye by gavage. Specifically, mother-child separation combined with high-dose Fanxieye by gavage for 6 weeks is an ideal method to establish such model.
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    Chinese Medicinal Pharmacology
    Influence of envoy herbs on the effect mechanism of Xuefu Zhuyu Tang in treating NAFLD*
    Cai Piao, Song Li, Liu Jiaxin, Tang Songqi, Huang Wei
    2021, 44 (3):  252-258.  doi: 10.3969/j.issn.1006-2157.2021.03.010
    Abstract ( 117 )   PDF (3223KB) ( 49 )   Save
    Objective To explore the influence of envoy herbs on the effect mechanism of Xuefu Zhuyu Tang (Blood Stasis Expelling Decoction, XFZYT) in the treatment of NAFLD. Methods C57BL/6J ApoE-/- mice models of NAFLD were established by intraperitoneal injection of subclinical lipopolysaccharide (LPS) (4ng/kg) combined with high-fat diet. During the establishment of the models, XFZYT, XFZYT minus the envoy herbs Niuxi (Two-toothed Achyranthes Root, Radix Achyranthis Bidentatae) and Jiegeng (Platycodon Root, Radix Platycodonis) (XFZYT-NJ) , and XFZYT minus Niuxi (XFZYT-N), were given by gavage to different groups of mice respectively for 28 days. Flow cytometry was used to detect the number of CD14+CD11b+Ly6G+ cells in whole blood. Immunofluorescence (IF) was used to observe neutrophil infiltration. Enzyme-linked immunosorbent assay (ELISA) was used to detect plasma keratin C-X-C motif chemokine ligand 1 (CXCL1) and macrophage inflammatory protein-2 also known as C-X-C motif chemokine ligand 2 (CXCL2), and myeloperoxidase (MPO) and CXCL2 content in liver tissue. Results Compared with the model group, the proportion of CD14+CD11b+Ly6G+ cells in the peripheral blood of mice in the XFZYT group was reduced (P<0.05). Such reduction was greater in the XFZYT group than in the XFZYT-NJ(P<0.05) group. XFZYT had the most significant effect of reducing neutrophil infiltration in liver tissue, compared with its variant formulas. While both XFZYT and its variant formulas reduced CXCL1 and CXCL2 in peripheral blood and MPO and CXCL2 in liver tissue (P<0.05), the former demonstrated greater reduction in CXCL2 in peripheral blood and MPO and CXCL2 in liver tissue than XFZYT-NJ(P<0.05). Conclusion XFZYT could prevent the formation of nonalcoholic fatty liver in C57BL/6J ApoE-/- mice. Its mechanism may be closely related to chemotaxis and activation of neutrophils in liver tissues. The envoy herbs could significant affect such mechanism.
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    Clinical Studies
    Discussion on the relationship between endometriosis and depression and anxiety*
    Zhao Ruihua, Zhang Yongjia
    2021, 44 (3):  259-265.  doi: 10.3969/j.issn.1006-2157.2021.03.011
    Abstract ( 137 )   PDF (982KB) ( 73 )   Save
    Endometriosis, a chronic, highly recurrent and life-long disease, falls into the category of abdominal mass in traditional Chinese medicine. Blood stasis is the basic pathogenesis of EMs and qi stagnation is a key process in EMs formation. Qi stagnation of women is attributable to qi constraint. EMs brings great physical and mental sufferings to patients because of its long disease course, severe symptoms, easy recurrence and unpredictable curative effects. EMs is often accompanied with depression and anxiety symptoms, which can in turn promote the occurrence and development of EMs by amplifying somatic symptoms, reducing therapeutic effects and activating immunosuppression. This is in line with the traditional Chinese medicine understanding of “depression leads to stasis” and “stasis obstructs qi movement”. Based on this, we argue that there is interaction and mutual causality between EMs and depression and anxiety. That qi constraint leads to blood stasis is the main pathogenesis of EMs. Resolving constraint and invigorating blood is the basic treatment. We explore the relationship between EMs and depression and anxiety to emphasize the important role of depression and anxiety in EMs treatment and prognosis, draw clinicians' and researchers' attention to mental health problems of EMs patients, and provide new ideas for TCM diagnosis and treatment strategies of EMs. In this way, the idea of “shifting the essence and changing qi” can be applied to chronic disease management to form TCM management plans of EMs with biopsychosocial characteristics.
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    Discussion on the etiology and pathogenesis of psoriasis vulgaris*
    Liu Aimin, Zhang Buxin, Zhao Wei, Xu Shengdong
    2021, 44 (3):  266-271.  doi: 10.3969/j.issn.1006-2157.2021.03.012
    Abstract ( 105 )   PDF (771KB) ( 70 )   Save
    Based on a review of the understanding of psoriasis-like diseases such as ganxian (干癣, chronic eczema) and baibi (白疕, psoriasis) by generations of TCM physicians, it is believed that the proposal of the three patterns of “blood heat, blood dryness, and blood stasis” in the classic treatment plan was great inheritance and innovation of pattern differentiation and treatment of psoriasis. However, there were still limitations in ideas of pattern differentiation, which made it difficult to objectively and comprehensively reveal the etiology and pathogenesis of psoriasis. In accordance with the theory of correspondence between human beings and nature in Neijing (Internal Classic), incorporating clinical practice and modern research, and based on the holistic “heaven-earth-man” pattern differentiation and the idea of “seeking the root to treat the disease”, the present research discussed the etiology and pathogenesis of psoriasis in an objective and in-depth manner. It was pointed out that cold was an important factor in the occurrence and development of psoriasis. The reason for and mechanism of the fact that psoriasis is often severe in winter and mild in summer were explained. In addition, both the proposed “new plan” and “classic plan” for pattern differentiation and treatment of psoriasis were discussed thoroughly. It is believed that the new plan enjoys both breadth and depth in its ideas of pattern differentiation, is more objective and practical than the classic plan, and warrants validation and promotion.
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    Clinical efficacy and safety observation of Luofengning Formula II Granules in the treatment of patients with chronic heart failure and diuretic resistance*
    Yang Xueqing, Wang Xian
    2021, 44 (3):  272-279.  doi: 10.3969/j.issn.1006-2157.2021.03.013
    Abstract ( 139 )   PDF (922KB) ( 39 )   Save
    Objective To investigate clinical efficacy and safety of Luofengning (Collateral-Wind-Calming) Formula II Granules (LFNFIIG) in the treatment of patients with chronic heart failure with diuretic resistance. Methods 70 patients with chronic heart failure and diuretic resistance were randomly divided into the treatment group (n=35) and the control group (n=35). Parameters such as 24-hour urine volume, body weight, plasma levels of NT-proBNP, typical heart failure symptom quantitative score, Torasemide dosage, efficacy evaluation standard of patients with heart failure, and electrolyte, liver and kidney function and other safety parameters were used to appraise the clinical efficacy and safety before and after 2 weeks of treatment respectively. There was no significant difference in the 24-hour urine volume, body weight and plasma NT proBNP levels between the two groups before treatment (P> 0.05). Results After 2 weeks of treatment, the 24-hour urine volume, body weight, plasma levels of NT-proBNP of two groups were improved with statistical significance (P<0.01 or P<0.05) compared with before treatment. After treatment, the 24-hour urine volume of treatment group was higher than that of the control group and the plasma level of NT-proBNP and weight of the treatment group were significantly lower than those of the control group (P<0.05). There was no significant difference in the total effective rate between the two groups (P> 0.05), but the treatment group demonstrated better efficacy. After treatment, edema and oliguria of the treatment group were reduced obviously (P<0.05) compared with the control group. However, the other self-reported symptoms of the treat group were not significantly improved, and the differences between the two groups were not statistically significant (P> 0.05). After treatment, the dosage of torasemide used by the two groups was significantly lower than that before treatment (P<0.01) and torasemide dosage of the treatment group was significantly lower than that of the control group (P<0.05). After treatment, safety parameters such as Cr and Na+ of the treatment group were better than those of the control group and the difference was statistically significant (P<0.05). Conclusion LFNFIIG can improve the diuretic resistance and heart function of patients without side effects and with a good safety profile during the treatment.
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    Acupuncture & Moxibustion
    Inflammatory regulation mechanism of moxibustion on rats with diminished ovarian reserve based on Nrf2/HO-1 signaling pathway*
    Wang Qian, Lu Ge, Li Hongxiao, Shi Ling, Liang Shangjie, Shen Meihong
    2021, 44 (3):  280-288.  doi: 10.3969/j.issn.1006-2157.2021.03.014
    Abstract ( 115 )   PDF (2248KB) ( 35 )   Save
    Objective To explore whether the protective effect of moxibustion on ovary of rats with diminished ovarian reserve (DOR) is related to the inflammatory regulation mediated by nuclear factor erythroid2-related factor 2 (Nrf2) /hemeoxygenase1 (HO-1) signaling pathway. Methods Fifty female rats were randomly divided into blank group, multi-glycosides of Tripterygium wilfordii (GTW) group, moxibustion group, all-trans retinoic acid (ATRA) group and dimethyl sulfoxide (DMSO) group, 10 in each group. The GTW group, moxibustion group, ATRA group and DMSO group were treated with Tripterygium wilfordii polyglycoside tablet suspension by gavage to establish DOR rat model. The blank group were given the same amount of normal saline by gavage daily. The moxibustion group was treated by moxibustion at bilateral BL23 on alternate days and CV4 and CV12 on the other days for 10 minutes each time one hour after intragastric administration. The ATRA group received intraperitoneal injection of ATRA suspension 30 minutes after intragastric administration and moxibustion intervention together with the moxibustion group 30 minutes later. The DMSO group received intraperitoneal injection of the same volume of DMSO solution 30 minutes after intragastric administration and the same moxibustion treatment as the ATRA group. The weight and the estrous cycle of rats were observed every morning. After the intervention, the coefficients of ovarian organs of the rats were calculated, the histological structure of ovaries was observed with HE staining, the changes in serum sex hormones and inflammatory factors were detected by ELISA, the expression levels of Nrf2, HO-1 protein and mRNA were detected by immunohistochemistry and PCR respectively. Results Compared with the blank group, the ovarian coefficients of rats in the GTW group decreased significantly (P<0.05), the detection rate of estrous cycle disorder increased significantly (P<0.01), the serum levels of FSH, T, INF-γ increased (all P<0.01), the levels of AMH(P<0.01, P<0.05) and IL-4(all P<0.01) decreased, and the expression levels of Nrf2 and HO-1 protein (all P<0.01) and mRNA (all P<0.05) in ovarian tissues decreased significantly. Compared with the GTW group, the ovarian coefficients of rats in the moxibustion group and the DMSO group increased (all P<0.05), the detection rates of estrous cycle disorder decreased (all P<0.01), the serum levels of FSH, T, INF-γ decreased (all P<0.01), the levels of AMH (P<0.01,p<0.05)and IL-4 increased (all P<0.01), the expression levels of Nrf2 and HO-1 protein and mRNA in ovarian tissues increased significantly (all P<0.01). Compared with the moxibustion group, the ovarian coefficients of rats in the ATRA group decreased (P<0.01), the detection rate of estrus cycle disorder increased (P<0.01), the serum levels of FSH, T, INF-γ increased (all P<0.01), the levels of AMH and IL-4 decreased (P<0.05, P<0.01), the expression levels of Nrf2 and HO-1 protein (all P<0.01) and mRNA (all P<0.05) in ovarian tissues decreased. Conclusion Moxibustion can attenuate the inflammatory injury induced by GTW in DOR rats and protect the ovary by activating Nrf2 / HO-1 signaling pathway.
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