最新刊期
      卷 45 ， 期 12 ， 2022

        Special Theme: Diabetic Kidney Disease

      • TONG Xiaolin,HUANG Yishan
        Vol. 45, Issue 12, Pages: 1189-1195(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.001
        摘要：Diabetic kidney disease (DKD) is the main microvascular complication of diabetes mellitus, which poses a major threat to national health. At present, there remains an unmet need for treatment strategies to prevent, arrest, treat and reverse DKD. Traditional Chinese medicine (TCM) is a unique health resource in China as well as the source of original medical innovation. It emphasizes the holistic concept and treatment based on syndrome differentiation, and has the characteristics of multi-level and multi-target treatment, which plays a key role in the prevention and control of DKD. In recent years, TCM has made remarkable achievements in the theoretical, clinical and mechanism innovation of DKD. However, problems such as insufficient evidences of evidence-based medicine and unclear scientific connotation of TCM theory are still the key factors hindering the further development of TCM. Future studies should anchor the improvement of TCM clinical efficacy, and focus on the clinical pain-point and difficult problems of DKD and optimization of evidence chain for the complete period of DKD prevention and control. In addition, it’s necessary to clarify scientific connotation of TCM theory and improve the precision of TCM with the help of modern technology. Ultimately, supported by the achievements in scientific research, we will improve the TCM diagnosis and treatment system of DKD, and contribute TCM strength to solving the clinical difficult problems of DKD.  
        关键词：diabetic kidney disease;traditional Chinese medicine;prevention and control strategy   
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        发布时间：2023-01-05
      • LIU Peng,SHEN Zhengri,WANG Chen,WANG Yun,QIU Xinping,LI Ping
        Vol. 45, Issue 12, Pages: 1196-1204(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.003
        摘要：ObjectiveWe aimed to analyze the effects of the traditional Chinese medicine (TCM) Tangshen Formula, according to TCM method of benifiting qi and nourishing yin, promoting blood circulation for removing obstruction in collaterals, on renal fibrosis of diabetic kidney disease through farnesoid X receptor(FXR)/vimentin/α-smooth muscle actin(α-SMA) pathway in vivo and in vitro.Methods(ⅰ) Eight-week-old male db/db mice were randomly divided into the model group and the Tangshen Formula group(3.6 g/kg), once a day for 12 weeks, and db/m mice with the same genetic background were used as the control group. The general state and body weight of the mice were observed, blood glucose was monitored, and serum creatinine (Scr), blood urea nitrogen (BUN), and urine albumin-to-creatinine ratio were calculated. PAS staining and Masson staining were used to observe the changes in kidney morphology and structure. Western blotting and laser confocal microscopy were used to detect the expression levels of FXR, vimentin, and α-SMA in kidneys. (ⅱ) Sodium palmitate (PA)-stimulated mouse tubular epithelial cell (mTEC) injury model was constructed in vitro, and after intervention with Tangshen Formula(250 or 500 mg/L), the expression levels of FXR, vimentin, and α-SMA in mTECs were detected by Western blotting and laser confocal microscopy. Moreover, FXR was silenced to explore the molecular mechanism by which Tangshen Formula inhibits cellular fibrosis in mTECs.Results(ⅰ) Tangshen Formula significantly reduced Scr levels and renal pathology in db/db mice. Western blotting analysis and laser confocal microscopy showed that Tangshen Formula upregulated FXR and downregulated vimentin and α-SMA in the kidneys of db/db mice. (ⅱ)Western blotting analysis and laser confocal microscopy also showed that Tangshen Formula significantly upregulated FXR and downregulated vimentin and α-SMA in PA-induced mTECs. FXR silencing significantly suppressed the effects of Tangshen Formula on cellular fibrosis and the expression of vimentin and α-SMA.ConclusionTangshen Formula can reduce renal fibrosis in diabetic nephropathy, and its mechanism is related to the regulation of the FXR/vimentin/α-SMA pathway.  
        关键词：diabetic kidney disease;Tangshen Formula;benifiting qi and nourishing yin;promoting blood circulation for removing obstruction in collaterals;renal fibrosis;farnesoid X receptor/vimentin/α-smooth muscle actin pathway;db/db mice;tubular epithelial cells   
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        发布时间：2023-01-05
      • WANG Yiping,ZHANG Lei,CHENG Meng,ZHANG Haiyin
        Vol. 45, Issue 12, Pages: 1205-1212(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.004
        摘要：ObjectiveWe aimed to analyze the differential expression of urinary exosome miRNAs in diabetes kidney disease (DKD) patients with dampness-heat syndrome in chronic kidney disease Ⅲ to Ⅳ stage by small RNA sequencing technology.MethodsThis study was conducted at the First Affiliated Hospital of Anhui University of Chinese Medicine from April 2021 to April 2022. In total, 80 subjects were enrolled, including 40 DKD patients with dampness-heat syndrome and 40 healthy controls. The urinary exosomes of 10 subjects in both groups were selected for miRNA high-throughput sequencing, and selected the differentially expressed miRNAs were selected according to |log2(Fold Change)|≥1 and q value<0.05. Differentially expressed miRNAs were selected by the following criteria: the mean expression level (TPM) in at least one group was > 2, |log2(fold change)|≥ 2, and at least one sample in the DKD group has TPM> 0 and verified by quantitative RT-PCR.ResultsBy comparing the 80 subjects’ data to the database, 302 miRNAs expressed in healthy controls and 386 miRNAs expressed in DKD patients. In total, 97 differentially expressed miRNAs were screened, in including 84 upregulated and 13 downregulated miRNAs. Of these, 10 miRNAs were selected for verification. RT-PCR result showed that the expression levels of miR-664a-5p, miR-320b, and miR-199a-5p were significantly different between the two groups(P<0.01). The areas under the ROC curve of miR-664a-5p, miR-320b, and miR-199a-5p in the diagnosis of dampness-heat syndrome in DKD patients were 0.886, 0.923, and 0.761, respectively.ConclusionWe found differences in miRNA expression levels in urinary exosomes between DKD patients with dampness-heat syndrome and controls. The urinary exosome levels of miR-664a-5p, miR-320b, and miR-199a-5p can be used for the diagnosis of DKD patients with dampness-heat syndrome.  
        关键词：diabetes kidney disease;dampness-heat syndrome;urine;exosomes;miRNA;difference   
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        发布时间：2023-01-05
      • WANG Xiuge,YAN Guanchi,JIN Di,ZHAO Yunyun,YU Miao
        Vol. 45, Issue 12, Pages: 1213-1222(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.005
        摘要：ObjectiveWe aimed to observe the effects and underlying mechanism of Jiedu (removing toxicity) Tongluo (dredging collateral) Baoshen (protecting kidney) Formula on renal pathology in diabetic kidney disease (DKD) rats and on HBZY-1 cell proliferation.Methods(ⅰ)From 85 healthy Sprague-Dawley male rats, 10 rats were randomly selected as the normal group. Other rats were fed with a high-fat diet and injected with streptozotocin (STZ) to induce DKD. DKD rats were randomly divided into the model group, the irbesartan group(16 mg/kg), and the Jiedu Tongluo Baoshen Formula groups (low-, medium-, and high-dose groups at 0.5, 1.0, and 2.0 g/kg, respectively). The normal group and the model group were given the same volume of normal saline. All rats were continuously dosed for 8 weeks. The pathological morphology of renal tissue was observed by light microscopy and transmission electron microscopy. Western blotting analysis was conducted to detect the expression of autophagy-related proteins homolog of yeast Atg6 (Beclin-1), autophagy-related proteins microtubule-associated protein 1 light chain 3 (LC3Ⅱ/LC3Ⅰ), ubiquitin-binding protein P62 (P62), and autophagy related 5 homolog (ATG5) in renal tissue. (ⅱ)HBZY-1 cells were cultured. The cells were divided into the control group (low glucose, 5.5 mmol/L), the model group (high glucose, 30 mmol/L), the Jiedu Tongluo Baoshen Formula groups (low-, medium-, and high-dose groups, at 50, 100, and 200 mg/L, respectively), and the irbesartan group(5 μmol/L). The cell proliferation rate was detected by the CCK8 assay, and the cell migration ability was detected by the scratch assay. The expression levels of autophagy-related proteins (LC3Ⅱ/LC3Ⅰ, P62, and ATG5) were determined by Western blotting analysis. At the same time, the expression levels of AMP-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), unc-51 like kinase 1 (ULK1), and their phosphorylated proteins (p-AMPK, p-mTOR, and p-ULK1) were detected.Results(ⅰ)Compared with the model group, Jiedu Tongluo Baoshen Formula improved the pathology and ultrastructure of renal basement membrane, mesangial, and tubular epithelial cells in rats with DKD and increased the number of autophagosomes and autolysosomes. Compared with the normal group, the protein expression levels of Beclin-1, LC3Ⅱ/LC3Ⅰ, and ATG5 in the model group decreased and the protein expression of P62 increased (P<0.01); after intervention with Jiedu Tongluo Baoshen Formula, the protein expression levels of Beclin-1, LC3Ⅱ/LC3Ⅰ, and ATG5 in renal tissue increased and the protein expression levels of P62 decreased (P<0.05, P<0.01). (ⅱ) In HBZY-1 cells induced by high glucose, Jiedu Tongluo Baoshen Formula inhibited cell proliferation, increased the protein expression levels of LC3Ⅱ/LC3Ⅰ, ATG5, p-ULK1, and p-AMPK and decreased the protein levels of P62 and p-mTOR compared with the model group (P<0.05, P<0.01).ConclusionThe mechanism of Jiedu Tongluo Baoshen Formula in improving renal pathology and inhibiting the proliferation of HBZY-1 cells induced by high glucose may be related to the regulation of AMPK/mTOR/ULK1 pathway and the improvement of autophagy.  
        关键词：Jiedu Tongluo Baoshen Formula;diabetic kidney disease;AMPK/mTOR/ULK1 pathway;mesangial cell;autophagy;rats   
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        发布时间：2023-01-05
      • LIAN Xinyi,LIU Hongfang,MIAO Guizhen,CAO Bailong,CUI Zhaoli
        Vol. 45, Issue 12, Pages: 1223-1229(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.002
        摘要：ObjectiveWe aimed to investigate the clinical efficacy of Qidi Tangshen (QDTS) Granule in treating proteinuria in chronic kidney disease (CKD) stage Ⅲ, diabetes kidney disease (DKD) patients with syndrome of dual deficiency of qi and yin or stagnation of heat and blood stasis. We also analyzed the effects of QDTS Granule on podocyte slit pore membrane protein(nephrin and podocin).MethodsIn total, 64 CKD stage Ⅲ, DKD patients with dual deficiency of qi and yin or stagnation of heat and blood stasis were divided into two groups by random number table(32 cases in each group). The experimental group was given basic treatment (lowering blood glucose, blood pressure, and blood lipid levels and providing dietary guidance) and QDTS Granule, while the control group was given basic treatment and the same dosage of placebo. The course of treatment lasted for three months. The clinical efficacy, the effective rate of TCM symptoms, the urine albumin-to-creatinine ratio (UACR), blood glucose levels, blood lipid levels, and urinary nephrin and podocin levels were compared between the two groups.ResultsThe total effective rates of clinical efficacy in the experimental group and the control group were 77.42% (24/31) and 24.14% (7/29), while the effective rate of TCM symptoms were 64.52% (20/31) and 37.93% (11/29), respectively (P<0.05). After treatment, UACR was significantly decreased in the experimental group (P<0.05). The increase in urinary podocin levels was smaller in the experimental group than in the control group (P<0.05). No obvious adverse reactions were reported during the study.ConclusionQDTS Granule is effective in the treatment of DKD patients with microalbuminuria who have dual deficiency of both qi and yin or stagnation of heat and blood stasis and could reduce urinary protein excretion, which might be related to the protective effect of QDTS Granule on glomeruli.  
        关键词：proteinuria;urinary nephrin;urinary podocin;Qidi Tangshen Granule;diabetic kidney disease   
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        发布时间：2023-01-05

        Theoretical Studies

      • ZHANG Xiaole,CHENG Fafeng,LI Ting,HAN Zucheng,TIAN Laqun,LIU Haixia,WANG Qingguo,WANG Xueqian
        Vol. 45, Issue 12, Pages: 1230-1235(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.006
        摘要：Ephedra has a pungent taste, which has the characteristics of upward and outward divergence. It promotes and dredges nutrient qi and defensive qi and stimulates yang qi. ZHANG Zhongjing often used ephedra to treat superficies syndrome tightened by wind-cold and yang qi crown closure in the body. Therefore, later Chinese medicine doctors mostly classified ephedra as a herbal medicine with strong effects of relieving superficies syndrome with pungent and warm properties, and believed that ephedra was as powerful as tiger and wolf, which limited the clinical application of this Chinese herb. We introduce the " tong" theory of traditional Chinese medicine, and use this theory to systematically explain the function of ephedra. Based on the medicinal properties of ephedra, we analyzed ZHANG Zhongjing′s usage law of ephedra in Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber. Combined with the elucidation of physicians of later generations, we found that ephedra is widely used and has the function of " tong orifices, tong nutrition qi and defensive qi, tong sanjiao, tong yang qi, tong static blood and bi(arthralgia), eliminating masses, and tong qi movement." Among them, " tong orifices" includes dredging the nine orifices and inducing resuscitation; " tong nutrition qi and defensive qi" includes sweating, relieving superficies, and clearing and dredging sweat pores; " tong sanjiao " includes governing diffusion and dredging the upper jiao, adjusting the lifting and lowering of the middle jiao, and closing and opening the lower jiao; " tong yang qi" includes dispersing heart yang, invigorating kidney yang, dredging yang and restoring the pulse, and dredging suppressed yang qi; " tong static blood and bi (arthralgia)" includes removing blood stasis and treating bi disease; and " tong qi movement" includes invigorating qi movement and dispersing stagnated liver qi to relieve qi stagnation. The main purpose of this paper is (ⅰ) to clarify that ephedra can be used to treat many diseases and syndromes and (ⅱ) to provide a new idea for broadening the scope of clinical application of ephedra.  
        关键词：ephedra;"tong" theory;Treatise on Cold Pathogenic Diseases;Synopsis of Golden Chamber   
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      • BI Lei,LIU Xin,CUI Yiran
        Vol. 45, Issue 12, Pages: 1236-1241(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.007
        摘要：The property of traditional Chinese materia medica is an important part of Traditional Chinese Medicine. This research summarizes the development of research on the property of traditional Chinese materia medica under the theory of matter, which is mainly classified into "the study of medicine" and "the supplement of organism" . The research provides solid substances for the property of traditional Chinese materia medica and establishes the "medicine-organism" combination, which can be regarded as a solid substance classification method based on the property of traditional Chinese materia medica. On the one hand, the current research has not fully demonstrated the value of solid substance; on the other hand, it also reflects the differences in performance, essence, purpose, and method compared with previous studies. The hypothesis of "solid substances carry the property of traditional Chinese materia medica" in the research has its own boundary. Based on the essence of the property of traditional Chinese materia medica and the current research hypotheses, this paper discusses the possible research directions, in order to provide a reference for the study of the property of traditional Chinese materia medica.  
        关键词：property of traditional Chinese materia medica;the theory of matter;solid substance;thoughts   
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        TCM Constitutions

      • LONG Liqun,ZHU Yanbo,CHEN Pipi,ZHAO Xinyuan,LI Yuqiong
        Vol. 45, Issue 12, Pages: 1242-1248(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.008
        摘要：ObjectiveWe aimed (ⅰ) to explore the correlation between the public′s acute stress reaction(ASR) and the constitution of traditional Chinese medicine (TCM) during the COVID-19 epidemic and (ⅱ) to provide a basis for adjusting the constitution bias and improving the public′s ability to cope with COVID-19 under the normalized management of the epidemic.MethodsFrom February 3 to February 15, 2022, an electronic questionnaire survey was conducted using a combination of convenient sampling and snowball sampling. Statistics of basic information (gender, age, marital status, educational background, the likelihood of believing that they are infected, the likelihood of believing that people around them are infected, whether the location is a risk area, and whether they have been vaccinated against COVID-19), the scores of the Stanford Acute Stress Reaction Questionnaire (SASRQ), and TCM constitution transformation scores of each subscale of a 30-Item Short Version of Constitution in Chinese Medicine Questionnaire (CCMQ-30) were calculated. Those with a SASRQ score of ≥40 were included in the ASR group, and those with a SASRQ score of <40 were included in the non-ASR group. The basic information and TCM constitution of the two groups were compared. Spearman correlation analysis and multiple linear regression analysis were performed to examine the correlation between the total SASRQ score and the transformation score of each CCMQ-30 subscale.ResultsA total of 1 218 questionnaires were collected, of which 116 invalid questionnaires were excluded, so 1 102 samples were included in the final analysis. The effective rate of the questionnaire was 90.48%. (ⅰ)There were 892 people in the non-ASR group and 210 people in the ASR group. There were no significant differences in gender, age, marital status, educational background, whether the location was a risk area, the possibility of infection, and vaccination between the two groups (P>0.05), while there were significant differences in the possibility of believing that people around them are infected (P<0.05); the proportion of people who perceived the possibility of infection was higher in the ASR group than in the non-ASR group. (ⅱ)There were significant differences in the scores of nine TCM constitutions between the ASR group and the non-ASR group (P<0.05). Correlation analysis showed that the total SASRQ score was negatively correlated with balanced constitution (r=-0.353, P<0.01), while it was positively correlated with eight biased constitutions; ordered based on the correlation from strong to weak, these constitutions were the following: qi-stagnation, qi-deficiency, blood-stasis, phlegm-dampness, inherited special, yin-deficiency, dampness-heat, and yang-deficiency (r=0.235 to 0.367, P<0.01).(ⅲ) Multiple linear regression analysis controlling for the interaction of biased constitutions showed that qi-stagnation(β′=0.214, P<0.01), qi-deficiency (β′=0.139, P<0.05), and inherited special constitution(β′=0.088, P<0.01) were the independent influencing factors of ASR. Further control for confounding variables yielded similar result.ConclusionQi-stagnation, qi-deficiency, and inherited special constitution have a great influence on public ASR. It is suggested to focus on adjusting qi-stagnation, qi-deficiency, and inherited special constitution to improve public physical and mental health under the normal management of the COVID-19 epidemic.  
        关键词：acute stress reaction;TCM constitution;COVID-19   
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        发布时间：2023-01-05

        Chinese Medicinal Pharmacology

      • WU Meijianzong,QIN Jiajia,LIU Haiquan
        Vol. 45, Issue 12, Pages: 1249-1256(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.021
        摘要：ObjectiveWe aimed to investigate the effect of icariin on osteogenic differentiation of rat adipose stem cells.MethodsAdipose stem cells from SPF female Sprague-Dawley rats were isolated and cultured. Surface markers were detected, and the osteogenic and adipogenic differentiation were determined by alizarin red and oil red O staining. Third-passage adipose stem cells were divided into the blank group, the resveratrol group (100 μmol/L), and the icariin Ⅰ to Ⅳ groups (1, 10, 50, and 100 μmol/L). After 21 days of culture, the mRNA and protein expression levels of the LIM domain protein Ajuba(Ajuba), Runt-related transcription factor 2 (Runx2), and alkaline phosphatase (ALP) were determined by qRT-PCR and Western blotting analysis, respectively.ResultsOf the cultured third-passage adipose stem cells, 95% were positive for the surface marker CD90 and 9.26% were positive for CD34. Orange calcified nodules could be observed after alizarin red staining after 21 days of osteogenic induction, and red lipid droplets could be observed after oil red O staining after 21 days of adipogenic induction. Both resveratrol and 100 μmol/L icariin could promote the mRNA and protein expressions of Runx2 and ALP in adipose stem cells, and compared with resveratrol, the same concentration of icariin showed a significant promoting effect (P<0.01). Both resveratrol and icariin could inhibit the mRNA and protein expression of Ajuba. There was no significant difference in Ajuba mRNA and protein expression in the 50 μmol/L and 100 μmol/L icariin groups compared with the 100 μmol/L resveratrol group, and there was no significant difference in Ajuba protein expression in the 10, 50, and 100 μmol/L icariin groups.ConclusionIcariin and resveratrol can promote osteogenic differentiation and inhibit adipogenic differentiation of rat adipose stem cells. They had the same inhibitory effect on adipogenic differentiation, while icariin had a stronger promoting effect on osteogenic differentiation than resveratrol.  
        关键词：adipose-derived stem cells;icariin;resveratrol;osteogenic differentiation;adipogenic differentiation;osteoporosis   
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      • LIU Jinlian,LYU Meiyu,NAN Haipeng,DI Songrui,LIANG Weican,WANG Linyuan,ZHANG Jianjun,WANG Chun
        Vol. 45, Issue 12, Pages: 1257-1265(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.011
        摘要：ObjectiveWe aimed to observe the effect of lowering urate level of Qinglishire (clearing heat and promoting diuresis) Prescription (QLSR) (glabrous greenbrier rhizome, plantain seed, Indian bread, chicory, kudzuvine root, and medical cyathula root) in rats with hyperuricemia with syndrome of internal retention of damp-heat.MethodsThe rat model of hyperuricemia was established by feeding rats with high-fat and high-sugar diet and administering potassium oxonate and oil or alcohol every other day. Sprague-Dawley rats were divided into six groups: the normal group, the model group, the Simiao Pill group (1.2 g/kg), and the QLSR low-, medium-, and high- dose groups (1.25, 2.5, and 5.0 g/kg, respectively). We observed the general state of rats. Serum uric acid(UA), urea nitrogen(BUN), creatinine(Scr), IL-2, IL-4, IgG, IgM, NO, endothelin-1(ET-1), thromboxane(TX)-B2, and 6-keto-PGF1α levels and hepatic Na+ -K+ -ATPase levels were determined. The protein expression levels of ATP-binding cassette sub-family G member 2 (ABCG2) and urate transporter 1 (URAT1) in kidney tissuewere determined by Western blotting analysis; the mRNA expression levels of ABCG2, URAT1, and glucose transporter 9 (GLUT9) in rat kidney tissue were detected by PCR; and the protein contents of AQP3 and AQP4 in gastric tissuewere detected by immunohistochemistry.Results(ⅰ)Compared with the model group, QLSR low-, medium-, high- dose and Simiao Pill decreased serum UA, ET-1, TX-B2, IL-4 and gastric AQP4 (P<0.01, P<0.05), and increased hepatic Na+ -K+ -ATPase(P<0.01).Serum NO was increase in QLSR high-dose group (P<0.01)and serum 6-keto-PGF1α was increased in QLSR medium-dose group (P<0.01). Gastric AQP3 were increased in QLSR medium- and high- dose groups(P<0.05). Serum IgG were decreased in all QLSR groups (P<0.01, P<0.05), while serum IgM were decreased in QLSR medium-, high- dose and Simiao Pill group (P<0.01, P<0.05). (ⅱ) Simiao Pill and QLSR medium- and high- dose downregulated URAT1 mRNA expressions (P<0.01, P<0.05). QLSR low-, medium-, high- dose and Simiao Pill all downregulated expressions of LUT9 mRNA(P<0.05, P<0.01), upregulated expressions of ABCG2 mRNA (P<0.01), and downregulated URAT1 protein expression(P<0.05, P<0.01).ConclusionQinlishire Prescription had the effects of lowering blood uric acid levels. The mechanism was related to the downregulation of URAT1 gene and protein expressions, the upregulation of ABCG2 gene and protein levels, and the downregulation of GLUT9 gene expression.  
        关键词：hyperuricemia;syndrome of internal retention of damp-heat;method of clearing heat and promoting diuresis;urate transporters;pharmaceutical/food resource;rats   
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        Acupuncture and Moxibustion

      • ZHANG Mingjian,LIU Jun,LIN Miao,LU Guangtong,LIU Jin,CHEN Hao,SHE Yanfen,FAN Xisheng,ZHANG Juncha,SHI Xuliang
        Vol. 45, Issue 12, Pages: 1266-1276(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.012
        摘要：ObjectiveWe aimed to investigate the thermal characteristics of conception vessel, governor vessel, and thoroughfare vessel acupoints in patients with primary dysmenorrhea (PD) with syndrome of cold coagulation and blood stasis(hereinafter called "PD" ) using infrared thermal imaging technology.MethodsSubjects were recruited from October 2020 to October 2021 and divided into the PD group (n=35) and the healthy group (n=42). Conception vessel, governor vessel, and thoroughfare vessel acupoints and bilateral stomach meridian, spleen meridian, and bladder meridian (through the first side line) acupoints below the trunk umbilical level were studied. Infrared thermography was used to observe the changes in infrared radiation at various test points in PD patients 1-3 days before menstruation, on the first day of menstruation, and on the third day after the end of menstruation.ResultsDuring the menstrual cycle, infrared radiation of acupuncture points located at abdoman showed no significant difference between the PD group and the healthy group(P>0.05). Compared with the healthy group, during menstruation in the PD group we observed (i) xuánshū (DU5), mìngmn (DU4), and yoshù (DU2) of the governor vessel and (ii) qìhǎishù (BL24), dàchángshù (BL25), gunyuánshù (BL26), zhōnglǚshù (BL29), báihuánshù (BL30), shènshù (BL23) (right), pánggungshù (BL28) (right), shàngliáo (BL31) (left), zhōngliáo (BL33) (left), xiàliáo (BL34) (right), and huìyáng (BL35) (right) of the bladder meridian, the infrared radiation of the above acupoints was significantly decreased (P<0.05). Before menstruation in the PD group we observed zhōnglǚshù (BL29), huìyáng (BL35), zhōngliáo (BL33) (left), xiàliáo (BL34) (left), and báihuánshù (BL30) (right) of the bladder meridian, the infrared radiation was significantly reduced (P<0.05). We tested several acupoints in PD patients. No acupoints showed significant difference in infrared radiation between the PD group and the healthy group after menstruation(P>0.05).ConclusionSpecific reactions were mainly observed in lumbosacral acupoints following the governor vessel and in the bladder meridian through the first side line. Infrared radiation was decreased, in agreement with the current understanding of the etiology and pathogenesis of cold coagulation and blood stasis syndrome in traditional Chinese medicine. Acupuncture and moxibustion could be used at these specific acupoints to dissipate cold, remove stasis, and relieve pain.  
        关键词：primary dysmenorrhea;syndrome of cold coagulation and blood stasis;infrared thermal imaging;conception vessel;governor vessel;thoroughfare vessel   
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        Clinical Study

      • ZHOU Yanyan,GAO Zhan,DING Jiasen,WANG Zhong,CHEN Haote,SHAO Kuiqing
        Vol. 45, Issue 12, Pages: 1277-1281(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.013
        摘要：Traditional Chinese medicine(TCM) is based on the belief that the transformation of qi and blood strength and weakness is the process of human growth and aging, while the disorder of qi and blood is the root of the development of disease. " Women take blood as the basis and qi for use." Menstruation, pregnancy, birth, and breast milk are based on qi and blood. Postpartum women are often in the states of qi and blood deficiency and blood stasis due to qi deficiency. In older women, the liver blood and kidney essence gradually decline, and qi and blood are also insufficient. According to the characteristics of the population and symptoms of female stress incontinence, it is believed that disorder of qi and blood is the basic pathogenesis of the disease, and the diagnosis should be based on the characterization of qi and blood. It is believed that the disorder of qi and blood in the five organs is the basis of the pathology, while stasis and dampness are important pathological products of the development of female stress incontinence. Therefore, when diagnosing, we should distinguish between the amount of qi and blood strength and the degree of qi stagnation and blood stasis; when treating, we should pay attention to invigorating the spleen and dispersing the stagnated liver qi, benefiting qi to activate blood circulation, and invigorating qi for ascending to restore urinary function. In addition, modern research based on TCM constitution, microscopic syndrome differentiation, and pharmacological analysis provides a scientific basis for the treatment of female stress incontinence by targeting qi and blood.  
        关键词：stress incontinence;qi-blood theory;disorder of qi and blood;female   
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        发布时间：2023-01-05
      • LIU Qian,WANG Shiheng,QIN Peijie,WANG Liuqing,LIU Xuechun,AN Hong,LI Yu,LIU Meihan,ZHAO Zhupei,SHI Xueqin,ZHU Tingyu,ZHANG Fengxia,LIU Jianfeng,WANG Liying,GUO Hua,XU Tao,ZHANG Limei,ZOU Xu
        Vol. 45, Issue 12, Pages: 1282-1287(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.015
        摘要：ObjectiveWe aimed to compare the diagnostic value of hand color and shape and diagonal earlobe crease in the diagnosis of coronary heart disease.MethodsA total of 326 subjects were included, and the diagnosis of coronary heart disease was carried out by hand examination and based on the earlobe fold and compared with coronary angiography result.ResultsCompared with the coronary angiography result, the sensitivity and specificity of manual diagnosis based on hand color and shape were 80.2% and 68.7%, respectively; 31.3% were misdiagnosed and 19.8% were missed. The positive predictive value was 63.3%, the negative predictive value was 83.8%, and the accuracy rate was 73.3%. The sensitivity and specificity of the earlobe crease were 58.8% and 53.8%, respectively; the misdiagnosis rate was 46.2% and the missed diagnosis rate was 41.2%. The positive predictive value was 46.1%, the negative predictive value was 66.0%, and the accuracy rate was 55.8%. The diagnostic effect of color appearance and hand diagnosis was significantly better than that of the earlobe crease.ConclusionDiagnosis based on hand color and shape is effective in diagnosing coronary heart disease and has great clinical application value.  
        关键词：diagnosis based on hand color and shape;diagonal earlobe crease;coronary angiography;coronary artery heart disease;diagnosis   
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        发布时间：2023-01-05
      • ZHANG Tong,SUN Yingying,XUAN Yanhong,ZHANG Hongliang,HE Wenting
        Vol. 45, Issue 12, Pages: 1288-1294(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.014
        摘要：ObjectiveWe analyzed the clinical characteristics, survival of alpha-fetoprotein-producing gastric carcinoma (AFPGC) patients, and traditional Chinese medicine (TCM) treatment on them to improve TCM clinicians′ recognition of AFPGC.MethodsWe retrospectively collected the clinical and survival characteristics of patients with gastric cancer who were pathologically diagnosed and treated with TCM from January 2012 to December 2018, including 46 patients with AFPGC and 363 patients with common gastric cancer, according to the eligibility criteria. To compare and analyze the survival of patients with different alpha-fetoprotein (AFP) levels, we performed COX multivariate analysis of the prognostic factors of AFPGC patients and an analysis of TCM treatment principles and prescriptions.ResultsAFPGC patients accounted for 4.1% of all gastric cancers patients. Compared with common gastric cancer, the proportion of AFPGC was found to be higher in Uyghur and Kazakh patients than in Han patients (P<0.001). AFPGC patients also showed marked invasion depths (P=0.032), higher ratio of lymphatic metastasis or distant metastasis(P=0.016, P<0.001), and had lower chances of receiving chemotherapy and surgery (P=0.018, P=0.001, respectively). The proportion of liver and peritoneal metastases was also higher in AFPGC patients (P<0.001, each). The medium overall survival (mOS) of AFPGC patients was 11 (95% CI: 7-14)months, while that for common gastric cancer was 33(95% CI: 26-45) months. AFPGC patients had a three-fold increased hazard ratio for death in common gastric cancer patients(HR=3.00, P<0.001). The survival rates of AFPGC patients at 1, 3, and 5 years were 46.7%, 11.1%, and 2.3%, lower, respectively, than that of the common gastric cancer patients (P<0.001). We conducted subgroup analysis according to the level of AFP, < 20 μg/L, 20-300 μg/L, and > 300 μg/L. The mOS of the three groups of patients was 33.0, 14.0, and 6.5 months, and the difference was significant (P<0.001). Radical surgery and AFP level were independent prognostic factors in AFPGC patients, and radical surgery could reduce the risk of death in AFPGC patients by 61.2%. Patients with AFP >300 μg/L had a 1.98-fold higher risk of death than patients with AFP 20-300 μg/L (P=0.029, P=0.048). The principles of TCM treatment include strengthening the spleen, replenishing qi, and removing phlegm from the stomach. We analyzed the frequency of anti-tumor TCM in the prescriptions of the patients at the first visit and found that the main drugs were used to strengthen vital qi and tonify.ConclusionAFPGC has unique clinical characteristics: poor biological behavior; prone to the liver, lymph node, and peritoneal metastasis; late-stage diagnosis; and a lower chance of receiving surgery and chemotherapy than ordinary gastric cancer. Survival is significantly worse than that of common gastric cancer and is significantly negatively correlated with AFP level. Radical resection is the only method that can improve the prognosis of AFPGC.  
        关键词：alpha-fetoprotein-producing gastric carcinoma;survival curve;COX multivariate analysis;traditional Chinese medicine therapy   
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        发布时间：2023-01-05
      • CHANG Lei,ZHUO Zhili,LU Wenping,CUI Yongjia,ZHANG Dongni
        Vol. 45, Issue 12, Pages: 1295-1302(2022) DOI: 10.3969/j.issn.1006-2157.2022.12.016
        摘要：ObjectiveWe aimed(i) to observe the changes in progression free survival (PFS), quality of life, and traditional Chinese medicine (TCM) syndrome score in the treatment of patients with endocrine resistance in breast cancer, and (ii) to investigate the effect Shugan Yishen (dispersing stagnated liver qi and invigorating kidney qi) Recipe on serum exosome microRNA-221 (miR-221) and phosphatase and tensin homolog (PTEN) expression levels in patients with endocrine resistance in breast cancer.MethodsA randomized controlled was used to study a total of 60 patients with endocrine resistance in breast cancer with a pattern of thoroughfare-controlling vessels disharmony. The experimental group adopted the treatment of Shugan Yishen Recipe (be taken after decocted by water twice a day) combined with standardized treatment of western medicine, and the control group adopted only standardized treatment of western medicine(30 cases in each group). Observe patients until disease progression, death, or the end of study. Follow-up to observe PFS and assess Functional Assessment of Cancer Therapy-Breast(FACT-B) scores and changes in TCM syndrome scores. Five patients from each group were selected for exploratory studies, and peripheral blood was collected at the time of enrollment and 2 weeks after enrollment respectively, to detect serum exosome miR-221 expression levels and serum PTEN expression levels.ResultsBaseline was consistent between the two treatment groups. (ⅰ)The intermediate PFS (mPFS) in the trial group was 8.000(95% CI: 2.814-13.186)months, and the mPFS in the control group was 4.000(95% CI: 2.271-5.729)months. The differences of FACT-B scores of before and after treatment of both groups were not significant. The improvement rate of TCM syndrome score of the experimental group was better than that of the control group(P<0.05). Tumor size was a risk factor for recurrence in patients with endocrine resistance in breast cancer. (ⅱ)Serum exosome miR-221 levels were found to be significantly downregulated after treatment in the experimental group than before treatment(P<0.05) and not significantyly lowered in the control group. The PTEN expression level in the experimental group was significantly higher than before treatment(P<0.05), and the difference between before and after treatment in the control group was not obvious.ConclusionShugan Yishen Recipe can prolong PFS in patients with endocrine resistance in breast cancer and improve TCM syndrome. Its mechanism may be to reverse endocrine resistance of breast cancer by regulating the exosome miR-221/PTEN axis.  
        关键词：breast cancer;endocrine resistance;exosome;Shugan Yishen Recipe;Xiaoyao Powder;Lichong Decoction;miR-221   
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