Transcriptomic and metabolomic analysis of the effects of Zhenwu decoction on kidney yang deficiency pattern in chronic kidney disease

Objective:To explore the kidney yang deficiency pattern(KYDP)in a chronic kidney disease(CKD)rat model and the mechanisms underlying the effects of Zhenwu decoction(ZWD)by conducting tran-scriptomic and metabolomic analyses.Methods:Adriamycin(ADR)combined with hydrocortisone(HC)was used to induce CKD with KYDP in rats.ADR was injected into the tail vein twice.HC was injected intramuscularly for 8 weeks.ZWD was administered by gavage for 8 weeks.The general condition was observed,24-h urine protein was detected,serum corticosterone,triiodothyronine,thyroxine,TSH,testosterone,cAMP,and cGMP levels were determined,and pathological analysis was conducted.Transcriptomic and metabolomic analyses were conducted to screen differentially expressed genes(DEGs),differentially expressed metabolites(DEMs),and differentially expressed pathways(DEPs).The core DEMs and DEGs were input to Metab-oanalyst 5.0 to identify the pathways affected by ZWD.Results:In the HC group,KYDP symptoms were observed.Compared with control group,the levels of 24-h urine protein,TSH,and cGMP significantly increased(all P<0.01),and corticosterone,triiodothyronine,thyroxine,and cAMP significantly decreased(all P<0.01)in the HC group.After ZWD intervention,the levels of above-mentioned indicators could be reversed to some extent.Pathological analysis in the HC group revealed kidney lesions.DEGs in the ZWD group were mainly associated with pathways such as nucleotide synthesis and endocrine pathways.In the ZWD group,differences in biosynthesis of unsat-urated fatty acids and butanoate metabolism were observed.The following pathways were significantly affected by ZWD:arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.Conclusion:ZWD can be used to treat KYDP in CKD through regulating arachidonic acid metabolism,valine,leucine,and isoleucine biosynthesis,linoleic acid metabolism,and alpha-linolenic acid metabolism.

An Intervention Study of Zhenwu Decoction in Taiyanghanshui Hypertension

[Objectives]To study the therapeutic effect and mechanism of Zhenwu decoction on Taiyanghanshui hypertension based on the theory of five movements and six qi.[Methods]First of all,under the guidance of the theory of five movements and six qi,Zhenwu decoction was used to clinically intervene in the hypertensive patients with deep and taut pulse and grade 1-2,and the clinical effect of Zhenwu decoction on hypertensive patients with Taiyanghanshui was observed.[Results]Zhenwu decoction can effectively reduce systolic blood pressure and diastolic blood pressure in patients with Taiyanghanshui hypertension.[Conclusions]Under the guidance of the theory of five movements and six qi in traditional Chinese medicine,Zhenwu decoction can effectively treat Taiyanghanshui hypertension.

Clinical Research of Zhenwu Decoction Combined with Tingli Dazao Xiefei Decoction in the Treatment of Chronic Heart Failure with Edema Syndrome due to Yang Deficiency

[Objectives]The paper was to investigate the clinical effects of Zhenwu Decoction combined with Tingli Dazao Xiefei Decoction in the treatment of chronic heart failure with edema syndrome due to yang deficiency.[Methods]Eighty patients with chronic heart failure were randomly divided into 2 groups(control group and treatment group),with 40 cases in each group.The patients in the control group were treated with conventional western medicine for 14 d,and the patients in the treatment group were treated with Zhenwu Decoction and Tingli Dazhao Xiefeng Decoction on the basis of the control group for 14 d.The curative effect of traditional Chinese medicine(TCM)syndrome score,left ventricular ejection fraction(LVEF),plasma N-terminal brain natruretic peptide precursor(NT-proBNP)and New York Heart Association(NYHA)functional class were compared between the two groups before and after treatment.Minnesota living with heart failure questionnaire in the principle of Chinese civilization and traditional medicine characteristics(C-MLHF)at admission and 1 month after discharge were compared between the two groups.[Results]After treatment,the total effective rate of TCM syndrome score in the treatment group was 82.50%,and that in the control group was 67.50%.The curative effect of TCM syndrome score in the treatment group was better than that in the control group(P<0.05).After treatment the LVEF in both groups was increased compared with that before treatment,and the NT-proBNP level was decreased compared with that before treatment(P<0.05),and those in the treatment group were better than those in the control group.The total effective rate of cardiac function in the treatment group was 87.50%,and that in the control group was 65.00%.The improvement of cardiac function in the treatment group was better than that in the control group(P<0.05).One month after discharge,C-MLHF scores in both groups were decreased compared with those before treatment,and that in the treatment group was lower than in the control group(P<0.05).[Conclusions]Zhenwu Decoction combined with Tingli Dazao Xiefei Decoction based on traditional western medicine treatment could improve the clinical efficacy,symptoms and quality of life of patients in the treatment of chronic heart failure with edema syndrome due to yang deficiency.

Meta-analysis for efficacy of modified Zhenwu Decoction combined with westernmedicine in treatment of heart failure

Objective： To carry out a systematic evaluation of the efficacy of modified Zhenwu Decoction combined withwestern medicine in the treatment of heart failure. Methods： Literature was retrieved in China KnowledgeResource Integrated Database （CNKI）, Chinese scientific journal database （VIP）, Wanfang Data Resource System（WANFANG DATA）, PubMed and other traditional Chinese medicine related periodicals by retrieval methods ofsubject terms combined with free words and computer retrieval combined with manual retrieval. Literature wasscreened strictly according to the inclusion criteria.The quality of the included literature was evaluated according tothe quality standard of Jadad scale and Cochrane collaboration network bias risk assessment tool. The literaturedata was extracted. RevMan5.3 software was used to analyze data and the curative effect of modified ZhenwuDecoction combined with western medicine was objectively evaluated. Results： The response rate of theexperimental group was better than that of the control group [OR = 3.69,95% IC （2.36,5.79）]. The value of EF inthe experimental group was higher than that in the control group after treatment [MD = 5.85, 95% IC （3.90, 7.79） ].The Lee, score of the experimental group was lower than that of the control group after treatment [MD = -1.37,95% IC （-2.23, -0.52） ]. The value of BNP in the experimental group was less than that in the control group aftertreatment [MD = -114.48, 95%IC （-186.28, -42.68）]. The life quality score in the experimental group was less thanthat of the control group after treatment [MD = -8.44, 95%IC （-11.73, -5.15）]. Conclusion： The curative effect ofmodified Zhenwu Decoction combined with western medicine in the treatment of heart failure is better than thesimple western medicine treatment.So modified Zhenwu Decoction combined with western medicine in thetreatment of heart failure is worthy of clinical promotion. However, the results of this study still need further validation by more high quality randomized double blind controlled clinical trial because the overall quality of theresearch included.