Features analysis on Traditional Chinese Medicine syndromes in patients with diabetic peripheral neuropathy

Objective

To study the features of the distribution and differentiation of Traditional Chinese Medicine (TCM) syndromes in patients with diabetic peripheral neuropathy (DPN).

Methods

We collected clinical data on illness course, age, fasting blood glucose, saccharogenic hemoglobin, TCM syndromes, tongue, and pulse of 238 DPN patients. Differentiated main syndromes (Yin deficiency and exuberant heat, invasion of spleen by damp-heat, deficiency of both Qi and Yin, and deficiency of both Yin and Yang) and accompanying syndromes (blood stasis and phlegm-dampness) of diabetes were also recorded. The features of DPN syndromes were then analyzed.

Results

Among the four main syndromes of diabetes, deficiency of both Yin and Yang was the most common in the 238 DPN patients, of which 89%-96% had blood stasis.

Conclusion

The method of differentiating syndromes of diabetes can be applied to DPN patients. Deficiency of both Yin and Yang, often accompanied by blood stasis, is commonly seen.     

Herb–drug pharmacokinetic interaction between radix astragali and pioglitazone in rats

Ethnopharmacological relevance

Radix astragali (RA) was the most frequently used traditional Chinese medicine (TCM) according to the statistics on 52 anti-diabetic formulas recorded in New National Traditional Chinese Medicine; it was employed in 34 out of the 52 formulas. The aim of this study was to elucidate potential pharmacokinetic interaction between RA and pioglitazone, and to provide guidance for clinical medicine safety.

Materials and methods

A specific and rapid UPLC–MS/MS method was established to quantify pioglitazone in rat plasma. Then healthy and type 2 diabetes mellitus (T2DM) rats were each divided into control and RA decoction (RAD) administration groups—healthy, healthy-RAD, T2DM, T2DM–RAD; pharmacokinetics of pioglitazone was carried out after RAD was administrated to rats for 7 days.

Results

The established UPLC–MS/MS method was rapid, specific, and precise. Between healthy and healthy-RAD groups, half-life (T_1/2), area under the curve (AUC _0–t), Vz/F, and Cl/F showed mild yet statistically significant differences; no significant difference for any above parameter was detected between T2DM and T2DM–RAD groups.

Conclusion

RAD co-administration did not affect the pharmacokinetics of pioglitazone especially in diabetic groups; RA and pioglitazone might be feasible herb–drug co-effectiveness.     

Screening and identification of potential biomarkers and establishment of the diagnostic serum proteomic model for the Traditional Chinese Medicine Syndromes of tuberculosis

Ethnopharmacological relevance

Chemotherapy is the mainstay of modern tuberculosis (TB) control. Traditional Chinese Medicine (TCM) can enhance the effect of anti-TB drug, promote the absorption of the foci in the lung and reduce drug toxicity. In TCM, the determination of treatment is based on ZHENG (also called TCM syndrome). To establish a diagnostic model by using proteomics technology in order to identify potential biomarkers for TCM syndromes of TB.

Materials and methods

The surface-enhanced laser desorption ionization time of flight mass spectrometer (SELDI–TOF MS) combined with weak cation exchange (WCX) magnetic beads was used to screen serum samples from 71 cases of deficiency of lung yin syndrome (DLYS), 64 cases of fire (yang) excess yin deficiency syndrome (FEYDS) and 45 cases of deficiency of both qi and yin syndrome (DQYS). A classification model was established by Biomarker Pattern Software (BPS). Candidate protein biomarkers were purified by reverse phase-high performance liquid chromatograph (RP-HPLC), identified by MALDI–TOF MS, LC–MS/MS and validated by ProteinChip Immunoassays.

Results

A total of 74 discriminating m/z peaks (P<0.001) among three TCM syndromes of TB were detected. A diagnostic model for the TCM syndrome of TB based on the five biomarkers (3961.7, 4679.7, 5646.4, 8891.2 and 9416.7 m/z) was established which could discriminate DLYS, FEYDS and DQYS patients with an accuracy of 74.0%, 72.5%, and 96.7%, respectively. The candidate biomarker with m/z of 9416.7 was identified as a fragment of apolipoprotein C-III (apoC-III) by MALDI–TOF-MS and LC–MS/MS.

Conclusion

The TCM syndrome diagnostic model of TB could successfully distinguish the three TCM syndromes of TB patients. This provided a biological basis for the determination of treatment based on different TCM syndromes of TB. ApoC-III was identified as a potential biomarker for TCM syndromes of TB and revealed the biochemical basis and pathogenesis of TCM syndromes in TB.     

Clinical and pathological analysis on Traditional Chinese Medicine syndromes in children with immunoglobulin A nephropathy

Objective

To evaluate the common Traditional Chinese Medicine (TCM) syndromes and analyze their relationship to clinical and pathological manifestations in children with IgA nephropathy.

Methods

Forty five children diagnosed as having primary IgA nephropathy by renal biopsy for the first time were enrolled in this trial, and their TCM syndromes were evaluated and the distribution of TCM syndromes was observed. All the sick children were growed? according to clinical manifestations and pathological damages, and the differences in TCM syndromes were compared between the groups.

Results

The first 5 TCM symptoms were common cold, hyperhidrosis, red dry throat, dark yellow urine and lassitude. In the acute nephritis group, edema and aching pain in loin and knees were significant (P=0.021 and P=0.000). In the severe pathological damage group, edema was obvious (P= 0.004), and 24 h urinary protein was positively correlated with edema (P=0.015) while negatively with common cold (P=0,007). The score of mesangial cell proliferation was correlated with edema, red dry throat and common cold (P=0.006, 0.013 and 0.029 respectively). The score of segmental pathological change was positively correlated with edema (P=0.039).

Conclusion

Common cold, hyperhidrosis, red dry throat, dark yellow urine, lassitude and other symptoms of qi deficiency of the spleen and lung mainly seen in children with IgA nephropathy may bear a close relationship to clinical manifestations and pathological damages.     

Clinical efficacy and safety of Traditional Chinese Medicine combined with Western Medicine in patients with diabetic acute ischemic stroke

Objective

To observe the clinical efficacy and safety of Traditional Chinese Medicine (TCM) combined with Western Medicine (WM) in patients with diabetic acute ischemic stroke.

Methods

Ninety patients with diabetic acute ischemic stroke were randomly divided into a treatment group and a control group. The 45 patients in the treatment group were given standardized treatment with TCM combined with WM. They received corresponding oral Chinese decoctions three times daily, according to their TCM syndromes, along with basic western medical treatment. The 45 patients in the control group were given non-standardized treatment with TCM combined with WM. They received an oral Chinese decoction for promotion of blood circulation to inhibit hemostasis, regardless of their TCM syndromes, along with basic western medical treatment. The treatments lasted for 4 weeks. Scores were evaluated on the National Institutes of Health Stroke Scale (NIHSS) score, activity of daily life (ADL) scores, and TCM symptoms before treatment and 2 and 4 weeks after treatment.

Results

Analysis of variance for repeated measurements showed that there were significant differences in NIHSS and ADL score before and after treatment in both groups (P<0.05). There were also significant differences between the scores at 2 and 4 weeks after treatment. There were significant differences in TCM syndrome scores before and after treatment in both groups (P<0.05). There were also significant differences between the scores at 2 and 4 weeks after treatment. The χ² test showed no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusion

Standardized treatment was superior to non-standardized treatment for clinical efficacy of TCM combined with WM in patients with diabetic acute ischemic stroke, and the superiority was more obvious in improving neural dysfunction, ADL score, and TCM symptoms. The adverse reactions were similar in the two treatment groups.     

Therapeutic effect in patients with coronary heart disease based on information analysis from Traditional Chinese Medicine four diagnostic methods

Objective

To study information gained by Traditional Chinese Medicine (TCM) four diagnostic methods and characteristics of syndrome development before and after treatment in patients with coronary heart disease, and to probe into assessment indexes of therapeutic effects with distinctive TCM features.

Methods

Information from the four diagnostic methods before and after treatment in 100 patients with coronary heart disease was collected using the TCM interrogation scale, a pulse condition instrument, a tongue-face diagnosis instrument, and a voice diagnosis information collection system. Changes in the four diagnostic method results from before and after treatment were analyzed with frequency analysis and t-test methods.

Results

Before treatment, deficiency syndrome complicated with hyperactivity of pathogenic factors was most common. After treatment, deficiency syndrome was most common. This change from complex syndromes to single syndromes indicates disease and syndrome alleviation. Frequencies of symptoms gained by interrogation after treatment for syndrome of deficiency of heart-Qi, syndrome of deficiency of heart-Yin, and turbid phlegm syndrome were all less severe than those before treatment. Parameters of face color, color on all sub-regions of tongue, color of tongue fur, septic and greasy fur, and lip color after treatment all had significant changes. After treatment, part of the voice diagnosis parameters in the deficiency of heart-Yin and turbid phlegm syndromes had significant changes, but no significant changes were found in the deficiency of heart-Qi syndrome.

Conclusion

Use of the TCM four diagnostic methods can provide an effective basis for TCM syndrome diagnosis, observation of development of state of illness, and evaluation of clinical therapeutic effects.     

A quantification model of Traditional Chinese Medicine syndromes in children with idiopathic precocious puberty and early puberty

Objective

To establish a quantification model of Traditional Chinese Medicine (TCM) syndromes by sampling patients undergoing idiopathic precocious puberty (IPP) and early puberty.

Methods

A questionnaire for classifying and quantifying TCM syndromes was designed and administered. All the results were analyzed; the relationship between 3 types of syndrome and 47 symptoms were summated. Meanwhile, the frequency distribution of each symptom or sign was aggregated. Fuzzy mathematics was used to develop a quantification model of TCM syndromes.

Results

We found that precocious puberty had 3 types of syndrome, including hyperactivity of fire due to Yin deficiency (Syndrome I), depressed liver Qi transforming into fire (Syndrome II), and end retention of damp heat (Syndrome III). In the IPP group, Syndrome I was the most common principal syndrome (100%). Forty-six patients (43.81%) were diagnosed with Syndrome I accompanied by Syndrome II and 11 (10.48%) were diagnosed with Syndrome I accompanied by Syndrome III. In the early puberty group, Syndrome I was also the main syndrome (98.39%). The degrees of most symptoms were mild to moderate. Reddened tongue was the most common tongue manifestation (62.86% prevalence) in the IPP group. The most common pulse manifestations were slippery pulse, thread pulse, and taut pulse. The Asymptotic Normalization Coefficient (ANC) method was used to quantify the TCM syndromes in 167 cases. Diagnostic accuracy rate reached 91%, comparable to expert diagnosis.

Conclusion

We find that there are 3 types of syndrome in the IPP group and in the early puberty group. Syndrome I (hyperactivity of fire due to Yin deficiency) is the main syndrome in the two groups. ANC may be an appropriate for quantification model of TCM syndromes.     

Effect of houttuynia cordata aetherolea on adiponectin and connective tissue growth factor in a rat model of diabetes mellitus

Objective

To determine the effect of Houttuynia cordata Aetherolea on connective tissue growth factor and adiponectin in a rat model of diabetes mellitus (DM).

Methods

DM was induced in rats using streptozotocin (STZ) and high glucose-lipid animal feed. Animals were then treated with Houttuynia cordata Aetherolea for 8 weeks. Changes in connective tissue growth factor and adiponectin levels in rats were observed.

Results

Connective tissue growth factor and adiponectin levels in rats with DM improved after Houttuynia cordata Aetherolea treatment.

Conclusion

Houttuynia cordata Aetherolea had a positive effect on rats with DM by reducing levels of connective tissue growth factor and increasing adiponectin levels.     

Expression of the psoriasis-associated antigen,Pso p27, is inhibited by Traditional Chinese Medicine

Aim of the study

Pso p27 is shown to be an autoantigen in psoriasis and the objective of the present study was to investigate whether Traditional Chinese Medicine (TCM) would influence the expression of Pso p27.

Materials and methods

Skin biopsies obtained from psoriatic patients before and after treatment with TCM were analyzed for the presence of Pso p27 antigen by indirect immunofluorescence using murine monoclonal antibodies against Pso p27.

Results

A significant reduction in the amount of Pso p27 in the psoriatic skin was obtained after treatment with TCM for 3 months.

Conclusions

The presence of Pso p27 in psoriatic skin is reduced when psoriatic patients are treated with TCM.     

Plasma metabolic biomarkers for syndrome of phlegm and blood stasis in hyperlipidemia and atherosclerosis

Objective

To explore the plasma metabolite profiles in patients with the syndrome of phlegm and blood stasis in hyperlipidemia and atherosclerosis (As), and to search for the metabolic biomarkers of the syndrome.

Methods

The plasma metabolite profiles of 31 patients with the syndrome of phlegm and blood stasis in hyperlipidemia and As, 6 patients with syndromes without phlegm and blood stasis, and 10 healthy subjects were analyzed by gas chromatography-mass spectrometry (GC-MS). Partial least squares-discriminant analyses (PLS-DA) were used to carry out the pattern-recognition analyses of the data. The plasma metabolic biomarkers of patients were obtained by variable importance plot value (VIP value) and Student's t-test. The structures of biomarkers were defined by the National Institute of Standards and Technology (NIST) database.

Results

PLS-DA score plots of plasma metabolomes did not show overlap between the phlegm-blood stasis syndrome group and syndromes without phlegm and blood stasis group, whereas significant differences in the concentrations in the plasma of 5 metabolites were found (P<0.05). They were identified as urine, isoleucine, glucuronic acid, palmitic acid and glycerol by searching in NIST database. The concentrations of four metabolites in the plasma of patients with syndrome of phlegm and blood stasis were higher than those with syndromes without phlegm and blood stasis, whereas the glycerol concentration was lower.

Conclusion

Compared with patients with syndromes without phlegm and blood stasis, five metabolites showed abnormal levels in patients with the syndrome of phlegm and blood stasis. These metabolites could be diagnostic and prognostic biomarkers.     

A promising approach for understanding the mechanism of Traditional Chinese Medicine by the aggregation morphology

Objective

Previous work has found that the Traditional Chinese Medicine (TCM) form aggregates in the aqueous solution, and the activities of two Chinese herbal formulae against three cardiovascular targets were aggregates-related. This paper further studied the molecular morphology composed of aggregation and single active molecule in TCM.

Methods

We take Pueraria lobata (Willd.) Ohwi (PUE) as an example. By means of dynamic light scattering (DLS), transmission electron microscopy (TEM), and high performance liquid chromatography–mass spectrometry (HPLC–MS), the mechanism and active components of the aggregates in PUE have been studies. Besides the relationship between aggregation and therapeutic activities in the vivo level has been studied by hemorheological method.

Results

Puerarin, daidzein, daidzin, genistein, these cardiovascular bioactive compounds existed in the aggregates. Three kinds of aggregation processes by the bioactive molecules in the solution were elucidated: (1) the aggregation of single molecule oneself; (2) the aggregation between different single molecules; (3) the aggregation between different single molecules and the primary metabolites. Furthermore, the therapeutic activity of PUE solution was aggregates-related in vivo level.

Conclusions

The aggregation morphology of molecules in TCM might be a promising way to study the mechanism of TCM, even to develop an approach of new nanomedicine of TCM.     

Prescription pattern of Chinese herbal products for hypertension in Taiwan: A population-based study

Ethnopharmacological relevance

Traditional Chinese medicine (TCM) has been commonly used in Asia country. The aim of this study is to analyze the utilization of TCM among hypertensive patients in Taiwan.

Materials and methods

The use of TCM for primary hypertensive patients was evaluated using a randomly sampled cohort of 1,000,0s recruited from the National Health Insurance Research Database in 5-year period from 2006 to 2010.

Results

Overall, 49.7% (n=42,586) of primary hypertension utilized TCM and 12.1% (n=5132) of them used TCM for the treatment of hypertension. Among the top 10 most frequently prescribed herbal formulae, Tian-Ma-Gou-Teng-Yin, Gout-Teng-San, Liu-Wei-Di-Huang-Wang and its derivatives were found to be the most common herbal formulae prescribed by TCM doctors for the treatment of hypertension in Taiwan.

Conclusion

This study showed the utilization pattern of Chinese herbal product in patients with hypertension. Further researches and clinical trials are needed to evaluate the efficacy of these Chinese formulae or its ingredients in treating hypertension.     

The Korean traditional medicine Gyeongshingangjeehwan inhibits adipocyte hypertrophy and visceral adipose tissue accumulation by activating PPARα actions in rat white adipose tissues

Aim of the study

Gyeongshingangjeehwan (GGEx), which is a polyherbal drug composed of four medicinal plants, has traditionally been used as anti-obesity drug in Korean local clinics. Thus, we investigated the effects of GGEx on visceral adiposity and examined whether adipose peroxisome proliferator-activated receptor α (PPARα) activation is involved in this process.

Materials and methods

After Obese Otsuka Long-Evans Tokushima Fatty (OLETF) rats and differentiated 3T3-L1 adipocytes were treated with GGEx, we studied the effects of GGEx on not only visceral white adipose tissue (WAT) mass and adipocyte size, but also the expression of adipocyte marker and PPARα target genes.

Results

Administration of GGEx to obese rats for 8 weeks decreased visceral WAT weight by 30% and the size of adipocytes in mesenteric WAT by 31% without weight changes of other organs. Concomitantly, GGEx increased mRNA levels of PPARα target genes responsible for fatty acid β-oxidation in mesenteric WAT whereas decreased mRNA expression of adipocyte markers, such as PPARγ, aP2 and leptin. Serological studies demonstrated that plasma levels of free fatty acids and triglycerides as well as insulin and glucose were decreased following GGEx treatment. Consistent with the in vivo data, GGEx increased PPARα reporter gene activity and induced the mRNA expression of PPARα target genes involved in mitochondrial fatty acid β-oxidation in 3T3-L1 cells. GGEx also inhibited triglyceride accumulation in these cells.

Conclusion

These results suggest that GGEx promotes the reductions in visceral fat mass and adipocyte size in obese animals, and that this event may be mediated by adipose PPARα activation.     

Androgenic effect of honeybee drone milk in castrated rats: Roles of methyl palmitate and methyl oleate

Ethnopharmacological relevance

Numerous honeybee (Apis mellifera) products have been used in traditional medicine to treat infertility and to increase vitality in both men and women. Drone milk (DM) is a relatively little-known honeybee product with a putative sexual hormone effect. The oestrogenic effect of a fraction of DM has recently been reported in rats. However, no information is available on the androgenic effects of DM. The purpose of the present study was to determine the androgen-like effect of DM in male rats and to identify effective compounds.

Materials and methods

A modified Hershberger assay was used to investigate the androgenic effect of crude DM, and the plasma level of testosterone was measured. The prostatic mRNA and protein expression of Spot14-like androgen-inducible protein (SLAP) were also examined with real-time PCR and Western blot techniques. GC–MS and NMR spectroscopic investigations were performed to identify the active components gained by bioactivity-guided fractionation.

Results

The crude DM increased the relative weights of the androgen-dependent organs and the plasma testosterone level in castrated rats and these actions were flutamide-sensitive. DM increased the tissue mRNA and protein level of SLAP, providing further evidence of its androgen-like character. After bioactivity-guided fractionation, two fatty acid esters, methyl palmitate (MP) and methyl oleate (MO), were identified as active compounds. MP alone showed an androgenic effect, whereas MO increased the weight of androgen-sensitive tissues and the plasma testosterone level only in combination.

Conclusion

The experimental data of DM and its active compounds (MO and MP) show androgenic activity confirming the traditional usage of DM. DM or MP or/and MO treatments may project a natural mode for the therapy of male infertility.     

Correlation between tobacco and alcohol use and Traditional Chinese Medicine constitutions: an analysis based on a sample from general population of China

Objective

To investigate the relationship between smoking and drinking and constitution types from Traditional Chinese Medicine (TCM) theory.

Methods

The Constitution in Chinese Medicine Questionnaire (CCMQ) was used. A sample of 8448 subjects from nine provinces and municipalities was chosen from the database of the TCM constitution and health status survey. Constituent ratio and correspondence analysis were used to find the relationship between smoking and drinking and TCM constitution.

Results

There was an association between smoking and drinking and the Gentleness, phlegm-dampness, and dampness-heat type constitutions. People that did not smoke tobacco or drink alcohol tended to have Yang-deficiency, Yin-deficiency, Qi-depression, Qi-deficiency, special diathesis, or blood-stasis type constitutions.

Conclusion

There was a significant correlation between tobacco and alcohol use and TCM constitutions. To improve patient health, more attention should be paid to tobacco and alcohol control.     

Pomegranate flower ameliorates fatty liver in an animal model of type 2 diabetes and obesity

Aims of the study

Fatty liver is the most common cause of abnormal liver function tests. We investigated the effect and its underlying mechanism of pomegranate flower (PGF), a traditional antidiabetic medicine, on fatty liver.

Materials and methods

At the endpoint of treatment of male Zucker diabetic fatty (ZDF) rats with PGF extract (500 mg/kg, p.o. × 6 weeks), liver weight index, hepatic lipid contents (enzymatic colorimetric methods) and droplet accumulation (Oil Red O staining) were determined. Gene profiles (RT-PCR) were analyzed in the liver of ZDF rats and in human liver-derived HepG2 cell line.

Results

PGF-treated ZDF rats showed reduced ratio of liver weight to tibia length, hepatic triglyceride contents and lipid droplets. These effects were accompanied by enhanced hepatic gene expression of peroxisome proliferator-activated receptor (PPAR)-alpha, carnitine palmitoyltransferase-1 and acyl-CoA oxidase (ACO), and reduced stearoyl-CoA desaturase-1. In contrast, PGF showed minimal effects on expression of genes responsible for synthesis, hydrolysis or uptake of fatty acid and triglycerides. PGF treatment also increased PPAR-alpha and ACO mRNA levels in HepG2 cells.

Conclusion

Our findings suggest that this Unani medicine ameliorates diabetes and obesity-associated fatty liver, at least in part, by activating hepatic expression of genes responsible for fatty acid oxidation.     

Antidiabetic effect of total flavonoids from Sanguis draxonis in type 2 diabetic rats

Ethnopharmacological relevance

Sanguis draxonis (SD) is a kind of red resin obtained from the wood of Dracaena cochinchinensis (Lour.) S. C. Chen (Dracaena cochinchinensis). It is a Chinese traditional herb that is prescribed for the handling of diabetic disorders, which is also supported by an array of scientific studies published in recent years. Although chemical constituents of this plant material have also been previously evaluated ( 33 and 37), it still remains poorly understood which constituent is the major contributor to its antidiabetic activities. Moreover, very little is known about the molecular mechanisms underlying antidiabetic activities of SD. Flavonoids exist at a high level in SD. The aim of this study is to evaluate the antidiabetic effects of total flavonoids from SD (SDF) in type 2 Diabetes mellitus (T2DM) rats.

Materials and methods

T2DM rats were induced by 4 weeks high-fat diet and a singular injection of streptozotocin (STZ) (35 mg/kg). Then T2DM rats were treated with SDF for 21 days, using normal saline as the negative control. For comparison, a standard antidiabetic drug, metformin (200 mg/kg), was used as a positive control. Three weeks later, relative biochemical indexes were determined and histopathological examinations were performed to assess the antidiabetic activities of SDF.

Results

SDF not only exhibited a significant hypoglycemic activity, but also alleviated dyslipidemia, tissue steatosis, and oxidative stress associated with T2DM. Moreover, considerable pancreatic islet protecting effects could be observed after SDF treatment. Further investigations revealed a potential anti-inflammation activity of SDF by determining serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP).

Conclusions

This study demonstrates both hypoglycemic and hypolipidemic effects of SDF in T2DM rats, suggesting that flavonoids are the major active ingredients accounting for the antidiabetic activity of SD. Alleviating chronic inflammation responses and protecting pancreatic islets are possible mechanisms involved in the antidiabetic activity of SDF.