Research progress in the treatment of diabetic kidney disease with Chinese medicine enema

Chinese medicine enema is an effective guiding method to treat diabetic kidney disease,a common chronic complication of diabetes,by regulating the function of the intestines to increase clearing and lower turbidity.We reviewed the treatment of diabetic kidney disease(DKD)with traditional Chinese medicine enemas and found that commonly used traditional Chinese medicines included Rhei Radix Et Rhizoma(Rheum palmatum L.),Ostrea concha(Ostrea gigas Thunberg),Taraxaci Herba(Taraxacum mongolicum Hand.-Mazz.),Astmgali Radix(Astragalus membranaceus Bge.var.mongholicus(Bge.)Hsiao),Salviae Miltiorrhizae Radix Et Rhizoma(Salvia miltiorrhiza Bge.),and Aconiti Lateralis Radix Praeparata(Aconitum carmichaelii Debx).The mechanism of the adjuvant therapeutic effect on DKD may relate to regulating intestinal flora,inhibiting inflammation and oxidative stress and protecting against kidney injury.

Research progress of external therapies of traditional Chinese medicine in the treatment of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is a common chronic liver disease characterized by diffuse hepatic steatosis.With the improvement of people's living standard,the incidence rate of NAFLD has been increasing,which has become one of the global health problems in 21st Century.However,there is no specific drug or standard treatment for NAFLD,which brings challenges to treatment.Acupuncture,moxibustion,massage and other external therapies based on the characteristics of traditional Chinese medicine have obvious curative effect in the clinical treatment of NAFLD,but the mechanism has not been systematically explained,which makes the clinical promotion evidence insufficient.This paper aims to summarize the researches on the treatment of NAFLD by external therapies of traditional Chinese medicine in recent years,and analyze its possible mechanism,so as to provide a scientific theoretical basis for future basic experiments and clinical research,and form a set of standardized clinical diagnosis and treatment scheme with the characteristics of traditional Chinese medicine.

A new perspective of traditional Chinese and western medicine as a potential remedy to improve intestinal flora in the treatment of chronic kidney disease

Intestinal flora imbalance is closely related to the occurrence and development of various diseases,however,the relationship between intestinal flora and chronic kidney disease has also become a hot topic.Intestinal flora imbalance,intestinal pathogenic bacteria and toxins increase,causing renal damage,chronic kidney disease patients also have a decrease in intestinal beneficial bacteria,an increase in pathogenic bacteria,more and more experimental studies show that the treatment of chronic Kidney disease is closely related to maintaining the balance of intestinal flora.However,at this stage,it has not been widely used in clinical practice by improving the protection of intestinal flora imbalance and delaying the deterioration of renal function.Therefore,this paper mainly discusses the research on the improvement of intestinal flora imbalance in the treatment of chronic kidney disease by traditional Chinese and Western medicine,and provides a new perspective for the treatment of chronic kidney disease.

An investigation of the influence of intestinal flora in external traditional Chinese medicine therapy

External therapy,which has been used for millennia to treat disease,has now become the newest member of complementary and alternative therapies.A growing number of clinical studies and animal experiments have shown that external therapy exerts a positive effect on the intestinal flora.In this paper,we review the research related to external therapy on various systemic diseases and focus on changes in the intestinal flora.We found that studies on external therapy are dominated by acupuncture and tuina,primarily aimed at the treatment of digestive and neurological diseases.However,the deeper mechanism of regulation of the intestinal flora by external therapy has not yet been experimentally confirmed.

Exploring the molecular mechanism of Suoquan pill in the treatment of diabetic kidney disease based on network pharmacology,molecular docking,in vitro experiment

Background:Diabetic kidney disease(DKD)is a microvascular complication of diabetes mellitus and is the main cause of end-stage renal failure.Suoquan pills(SQP)has a variety of pharmacological activities and multiple therapeutic effects,and it is used clinically as a basic formula for the treatment of DKD.Methods:Public databases were used to identify SQP compounds and the potential targets of SQP and DKD.A drug-component-therapeutic target network was constructed.Protein-protein interaction network analysis,Gene Ontology functional analysis,and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were used to analyse the potential molecular mechanisms of SQP based on common targets of drugs and diseases.Molecular docking simulations were conducted to confirm the binding abity of the core compounds to key targets.The efficacy and predicted molecular mechanisms of SQP were validated using cell counting kit-8 assay,flow cytometry,and western blotting with HK-2 cells as a model.Results:Network pharmacology analysis showed that 26 compounds and 207 potential targets of SQP were involved in the treatment of DKD;boldine,denudatin B,pinocembrin,kaempferoid,and quercetin were considered core compounds,and epidermal growth factor receptor(EGFR)and proto-oncogene,non-receptor tyrosine kinase(SRC)were considered key targets.Gene Ontology enrichment analysis indicated that protein phosphorylation and negative regulation of apoptotic processes are important biological processes in the treatment of DKD by SQP.Molecular docking confirmed the excellent binding abilities of boldine,denudatin B,kaempferide,and quercetin to EGFR and SRC.The results of in vitro experiments showed that treatment with an ethanolic extract of SQP significantly protected HK-2 cells from high glucose-induced cell damage.In addition,the SQP ethanol extract inhibited the phosphorylation of EGFR and SRC,suppressed the apoptosis rate,and regulated apoptosis-related proteins in HK-2 cells under high glucose stress.Conclusion:This study systematically and intuitively illustrated the possible pharmacological mechanisms of SQP against DKD through multiple components,targets,and signalling pathways,especially the inhibition of EGFR and SRC phosphorylation and apoptosis.

Integrative techniques using acupuncture,Chinese herbal medicine,diet,and supplements for polycystic ovary syndrome:a case report

Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.

Qiming granule in treating type 2 diabetic kidney disease patients:study protocol for a randomized controlled trial

Background:Diabetic kidney disease(DKD)is a chronic renal microvascular complication associated with abnormal glucose metabolism.According to traditional Chinese medicine(TCM)theory,Qi and Yin deficiency with blood stasis(the name of TCM symptoms,its main clinical features are fatigue,dry mouth,red or pale tongue,weak pulse,etc.)is the primary TCM syndrome of DKD,and Qiming granule(QMG)is suitable for the treatment of Qi and Yin deficiency with blood stasis syndrome.In view of this,we designed a randomized controlled trial to assess whether QMG is efficacious and safe in treating DKD patients.Methods:This protocol is for a randomized,double-blind,placebo-controlled,parallel group,six-centre clinical trial.A total of 180 participants will be randomized into the QMG group or placebo group,with a 1:1 ratio.The study will last for 50 weeks,including a 2-week run-in period,24 weeks of intervention,and 24 weeks of follow-up.The experimental intervention will be QMG,and the control intervention will be a placebo.The primary outcome will be the 24h urinary albumin excretion ratio and the change in the albumin-to-creatinine ratio.The secondary outcome will be evaluation of renal function,fundus changes,management of blood lipids,TCM symptom improvement and safety assessments.Adverse events will be recorded during the trial.Discussion:This study is a randomized controlled trial to test the effectiveness and safety of QMG for DKD patients.The findings of this study will help to provide evidence-based recommendations in treating DKD patients.Trial registration:Chinese Clinical Trial Registry,ChiCTR-TRC-12002953.Registered 23 December 2012.

Network pharmacology and verification experiment-based prediction of active components and potential targets of Alpiniae Oxyphyllae Fructus-Saposhnikoviae Radix(Yizhiren-Fangfeng)for treatment of diabetic kidney disease

Background:In this study,we analyzed the potential active components,related crucial targets and possible signaling pathway mechanisms of Alpiniae Oxyphyllae Fructus and Saposhnikoviae Radix(AOF-SR)herb pairs in the treatment of diabetic kidney disease(DKD)using network pharmacology and verification experiments.Methods:The active compounds and potential targets of AOF-SR were derived from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform,The Encyclopedia of Traditional Chinese Medicine,and PubChem databases,and the potential therapeutic targets of DKD were derived from the OMIM,Drugbank,and DisGeNET databases.The“compounds-diseases-targets”network was constructed using Cytoscape 3.6.0.ClusterMaker functionality in Cytoscape is being used to screen important targets for AOF-SR treatment of DKD.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis of important targets were performed using DAVID database.In addition,according to the predicted results of network pharmacology,HK-2 cells were used to construct DKD model for verification experiment.HK-2 cells were divided into control group,high glucose(HG)group and AOF-SR(HG+AOF-SR)group to detect survival rate and expression of key proteins in NF-κB and PI3K/Akt signaling pathways.Results:A total of 38 compounds were selected from AOF-SR,of which 23 were Alpiniae Oxyphyllae Fructus and 15 were Saposhnikoviae Radix.Through enrichment analysis of 82 important targets,88 signaling pathways were identified;some of these pathways,such as the NF-κB,PI3K-Akt,IL-17,and JAK/STAT signaling pathways,regulate the pathological process of DKD.In verification experiment,the HK-2 cells survival rate was higher in the HG+AOF-SR group than in the HG group(P<0.05).Moreover,western blotting results showed that the expression levels of NF-κB,p-PI3K,and p-Akt in HG+AOF-SR group were significantly lower than those in HG group(P<0.05).Conclusion:Overall,this study revealed the active compounds,important targets and possible mechanisms of AOF-SR treatment for DKD,and conducted preliminary verification experiments on its correctness,provided novel insights into the treatment of DKD by AOF-SR.

New Goals and Strategies of Chinese Medicine in Prevention and Treatment of Chronic Kidney Disease

Chronic kidney disease(CKD) is a clinical syndrome with a series of clinical manifestations and metabolic disorders caused by many diseases, which are characterized by progressive deterioration or irreversible damage of renal structures and functions. With the progress of epidemiological research, CKD has brought about huge economic and psychological burdens. There is a considerable risk of cardiovascular events or death than progression to end-stage renal disease for patients. Particular attentions should be paid to the new goals of reducing cardiovascular events and all-cause mortality. It is important to analyze the etiology and pathogenesis according to patients' ages, regions, primary disease as well as different stages of disease, and choose the appropriate therapeutic strategies accordingly. In clinical practice, due to the uncertainty of therapeutic effects ofmodern medicine based on the risk factors, it is necessary to use Chinese medicine(CM) to delay the disease progression and reduce comorbidities. Turbid toxin and blood stasis are two critical pathological factors worthy of concerns in the theory of CM. In addition, appropriate use of CM may help improve the quality of life of patients with CKD.

Mechanism underlying treatment of diabetic kidney disease using Traditional Chinese Medicine based on theory of Yin and Yang balance

The pathogenic mechanism of diabetic kidney disease(DKD) is complex. The development of DKD cannot be fully explained by a single mechanism.Traditional Chinese Medicine(TCM) has been applied extensively for the treatment of DKD in China.However, studying the mechanism of DKD using theories and methods that are appropriate for TCM characteristics and searching for theoretical bases for TCM clinical application are topics that still need to be explored and researched. Activation of the transforming growth factor(TGF)-β1/Smad and PI3 K/Akt/mTOR signaling pathways functions as a self-protection mechanism against renal microinflammation in DKD. However, the persistent abnormal overactivation of reactions causes secondary cell dysfunction, cell apoptosis, increased extracellular matrix(ECM) secretion, and eventually renal fibrosis. During this process, the dysregulation of self-balance among a variety of signaling pathways and the loss of self-feedback regulatory mecha-nisms downstream of these signaling pathways are critical causes of the occurrence and development of DKD. TCM may both inhibit the expression or activation of "hyperactive" signaling pathways(NFB, Smad3, and PI3 K/Akt/mTOR) and increase the expression or activation of "deficient" signaling pathways(Smad7 and PTEN) to restore balance to cells with an abnormal pathophysiological status and achieve the goal of DKD treatment.

Analysis of Clinical Evaluation of Response to Treatment of Parkinson's Disease with Integrated Chinese and Western Medicine Therapy

Objective： To analyze the clinical evaluation of Parkinson＇s disease （PD） patients receiving integrated Chinese and Western medicine therapy. Methods： One hundred and twenty patients were enrolled and randomly allocated to a control group or treatment group. Patients in the two groups received placebo and Bushen Huoxue Granule （补肾活血颗粒, BHG）, respectively. Both groups received baseline levodopa and benserazide （Madopar）. The effects of treatment were assessed monthly during the 9-month treatment. Means of evaluation included Unified PD Rating Scale （UPDRS） scores （Ⅱ and Ⅲ）, sleep scale score, 10 m turn back test （getting up time, 10 m × 2 times, and turning time）, timing motor test （TMT）-Ieft and TMT-right, which were treated as the dependent variables; and age, sex, duration of PD, Hoehn and Yahr （H-Y） stage and Madopar dosage of admitted PD patients were as the independent variables. Multiple linear regression was used to analyze these factors. Results： H-Y stage significantly affected UPDRSⅡ score, UPDRS Ⅲ score, and getting up time （P〈0.01）. Madopar dosage and H-Y stage significantly affected the 10 m × 2 times （P〈0.05 or P〈0.01）. Madopar dosage significantly affected the sleep scale score （P〈0.05）. There were also significant correlations between age and TMT-left or TMT-right （P〈0.01）, and duration of PD and TMT-right （P〈0.05）. Conclusions： The six assessed means of clinical evaluation （including UPDRS Ⅱ and UPDRS Ⅲ scores, sleep scale score, getting up time, 10 m × 2 times, and turning time） are sensitive indexes in all PD patients. H-Y stage and Madopar dosage are the major factors influencing means of clinical assessment of PD treatment.

Understanding and Therapeutic Strategies of Chinese Medicine on Gut-Derived Uremic Toxins in Chronic Kidney Disease

Chronic kidney disease （CKD） is a major disease that threatens human health. With the progression of CKD, the risk of cardiovascular death increases, which is associated with the elevated levels of uremic toxins （UTs）. Representative toxins such as indoxyl sulfate and p-cresyl sulfate are involed in CKD progression and cardiovascular events inseparable from the key role of endothelial dysfunction. The therapeutic strategies of UTs are aimed at signaling pathways that target the levels and damage of toxins in modem medicine. There is a certain relevance between toxins and ＂turbid toxin＂ in the theory of Chinese medicine （CM）. CM treatments have been demonstrated to reduce the damage of gut-derived toxins to the heart, kidney and blood vessels. Modern medicine still lacks evidence-based therapies, so it is necessary to explore the treatments of CM.

Traditional Chinese Medicine Based on Zheng Differentiation versus Angiotensin Receptor Blocker/Angiotensin?converting Enzyme Antagonist in Efficacy of Treating Diabetic Kidney Disease: A Meta?analysis of Randomized Clinical Trials

Objective: To compare the efficacy of traditional Chinese medicine(TCM) based on Zheng differentiation with angiotensin receptor blocker/angiotensin-converting enzyme inhibitor(ARB/ACEI) in treating diabetic kidney disease(DKD) from the aspects of decreasing urinary microalbumin, declining 24-h urinary protein, reducing endpoint events, and renal function protection. Methods: The Chinese Biomedical Literature Database(CBM), the Chinese Academy of Sciences database(CNKI), the VIP Chinese journal database, Wanfang DATA, Medline database, Cochrane library, excerpt medical database(Embase), and Web of science were used for literature searching. The reviewer manager5.3 software was utilized to analyze the data. Results: Twenty-four studies including 1956 participants were involved in this review. Results showed that TCM had a better effect(mean difference [MD],-23.20, 95% confidence interval [CI],-30.60 to-15.79, P < 0.00001) than ARB/ACEI on lowering urinary albumin excretion rate(UAER) and urine albumin-to-creatinine ratio(MD-4.56 mg/mmol, 95% CI,-5.76 to-3.36, P < 0.00001). Moreover, the advantage of decreasing UAER was greater as the follow-up period become longer(P = 0.04). TCM also had a better effect in 24-h urinal protein, decreasing 0.36 g/24 h(95% CI,-0.45 to-0.27, P < 0.00001) more than the control in shorter follow-up period(ranged from 12 to 24 weeks) subgroup but only 0.08 g/24 h(95% CI,-0.13 to-0.03, P = 0.0006) in the longer follow-up period(>24 weeks) subgroup. TCM worked as well as ACEI/ARB in reducing endpoint events(relative risk, 0.67, 95% CI, 0.20–2.224, P = 0.51)and decreasing urinary albumin concentration(UAC)(MD,-16.50, 95% CI,-46.28–13.28, P = 0.28). As for protecting renal function, TCM had an equal effect to AECI/ARB in improving creatinine clearance ratio(MD,-3.30, 95% CI,-6.66–0.03, P = 0.05) or estimated glomerular filtration rate(MD, 1.00, 95% CI,-0.59–2.58, P = 0.22). However, TCM had a better effect in releasing the glomerular hyperfiltration state(MD,-9.64, 95% CI,-14.45 to-4.84, P < 0.0001). Conclusions: TCM based on Zheng differentiation can work as well as ACEI/ARB in treating DKD and even better in decreasing urinary microalbumin and releasing glomerular hyperfiltration. It is a good alternative treatment of DKD.

Computational network pharmacological research of Chinese medicinal plants for chronic kidney disease

The interaction between drug molecules and target proteins is the basis of pharmacological action.The pharmacodynamic mechanism of Chinese medicinal plants for chronic kidney disease(CKD) was studied by molecular docking and complex network analysis.It was found that the interaction network of components-proteins of Chinese medicinal plants is different from the interaction network of components-proteins of drugs.The action mechanism of Chinese medicinal plants is different from that of drugs.We also found the interaction network of components-proteins of tonifying herbs is different from the interaction network of components-proteins of evil expelling herbs using complex network research approach.It illuminates the ancient classification theory of Chinese medicinal plants.This computational approach could identify the pivotal components of Chinese medicinal plants and their key target proteins rapidly.The results provide data for development of multi-component Chinese medicine.

Integrative Chinese and western medicine on atherosclerosis of coronary heart disease: what are the new control strategies?

How to control and prevent atherosclerosis(AS) remains a global issue that needs to be deeply discussed. The innovation concept of AS and coronary heart disease(CHD) in western medicine provides a good opportunity to develop the traditional Chinese medicine etiology and new control strategies accordingly. This article reviewed and refined the updated control strategies of AS of CHD integrated Chinese and western medicine based on the innovation concept and therapeutic guideline of AS and CHD during the last 10 years.

Management of Chronic Kidney Disease in China Calls for The Implementation of Expert Patient Program with Traditional Chinese Medical Interventions

Chronic kidney disease was closely related with unhealthy lifestyle;therefore a strategy focused both on daily life and medical process,like the Expert Patients Program,was of great value in the prevention and treatment of chronic kidney disease.In China,however,obstacles still existed in the process of implementing the program.Adding traditional Chinese medical interventions to the program assisted both patients and physicians to understand and to accept this new trend in management of chronic disease better.The combination with traditional Chinese medical interventions showed a solution for successfully implementing the Expert Patients Program and provided a new strategy for prevention and control of chronic kidney disease.

Tonifying Kidney, Lung, and Spleen Combined with Western Medicine for Stable Chronic Obstructive Pulmonary Disease: A Systematic Review

Introduction:This study aimed to evaluate the clinical effectiveness and safety of tonifying kidney,lung,and spleen(TKLS)combined with Western medicine for stable chronic obstructive pulmonary disease(COPD).Materials and Methods:Randomized controlled trials(RCTs)of TKLS for stable COPD were searched from four databases including Pub Med,the Cochrane Library,China Biology Medicine,and China National Knowledge Infrastructure from inception to December 2017.Two reviewers independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.Rev Man5.3 software was used for meta-analysis.Results:Fourteen RCTs involving 1339 patients with stable COPD were included.Five of the included articles described the specific method of randomization,1 of them was double-blind method research,and 1 of them was single-blind method research.Compared with the conventional Western medicine(CWM)group,the use of TKLS,if combined with CWM demonstrated significantly improved effective rate(relative risk=1.25,95%confidence interval[CI]:1.18–1.33,P<0.00001),decreased traditional Chinese medicine syndrome score(mean difference[MD]-5.72,95%CI:-8.31 to-3.14,P<0.0001),Decreased St George's Respiratory Questionnaire total score(MD-7.39,95%CI:-10.46 to-4.31,P<0.00001),increased 6-min walk distance in meters(MD 78.46,95%CI:60.18–96.73,P<0.00001),increased forced expiratory volume 1%(MD 6.49,95%CI:3.64–9.33,P<0.00001),increased CD4(MD 9.84,95%CI:6.73–12.94,P<0.00001),CD8(MD-1.84,95%CI:-3.62 to-0.06,P=0.04)and CD4/CD8(MD 0.26,95%CI:0.20–0.32,P<0.0001),and increased immunoglobulin M(MD 0.15,95%CI:0.10–0.20 P<0.00001)..Conclusions:For stable COPD,TKLS combined with CWM is superior to CWM alone with regard to clinical effectiveness,symptoms,and quality of life.The above conclusion needs to be validated by further well-designed,multicentric,large-scale,double-blinded RCTs.

Iridoids modulate inflammation in diabetic kidney disease: A review

In recent years,preclinical research on diabetic kidney disease (DKD) has surged to the forefront of scientific and clinical attention.DKD has become a pervasive complication of type 2 diabetes.Given the complexity of its etiology and pathological mechanisms,current interventions,including drugs,dietary modifications,exercise,hypoglycemic treatments and lipid-lowering methods,often fall short in achieving desired therapeutic outcomes.Iridoids,primarily derived from the potent components of traditional herbs,have been the subject of long-standing research.Preclinical data suggest that iridoids possess notable renal protective properties;however,there has been no summary of the research on their efficacy in the management and treatment of DKD.This article consolidates findings from in vivo and in vitro research on iridoids in the context of DKD and highlights their shared anti-inflammatory activities in treating this condition.Additionally,it explores how certain iridoid components modify their chemical structures through the regulation of intestinal flora,potentially bolstering their therapeutic effects.This review provides a focused examination of the mechanisms through which iridoids may prevent or treat DKD,offering valuable insights for future research endeavors.

Clinical efficacies,underlying mechanisms and molecular targets of Chinese medicines for diabetic nephropathy treatment and management

Diabetic nephropathy(DN) has been recognized as a severe complication of diabetes mellitus and a dominant pathogeny of end-stage kidney disease,which causes serious health problems and great financial burden to human society worldwide.Conventional strategies,such as renin-angiotensinaldosterone system blockade,blood glucose level control,and bodyweight reduction,may not achieve satisfactory outcomes in many clinical practices for DN management.Notably,due to the multi-target function,Chinese medicine possesses promising clinical benefits as primary or alternative therapies for DN treatment.Increasing studies have emphasized identifying bioactive compounds and molecular mechanisms of reno-protective effects of Chinese medicines.Signaling pathways involved in glucose/lipid metabolism regulation,antioxidation,anti-inflammation,anti-fibrosis,and podocyte protection have been identified as crucial mechanisms of action.Herein,we summarize the clinical efficacies of Chinese medicines and their bioactive components in treating and managing DN after reviewing the results demonstrated in clinical trials,systematic reviews,and meta-analyses,with a thorough discussion on the relative underlying mechanisms and molecular targets reported in animal and cellular experiments.We aim to provide comprehensive insights into the protective effects of Chinese medicines against DN.

Chinese Medicine Might Be A Promising Way for A Solution to Arsenic Nephrotoxicity

Arsenic from environmental contamination is a risk factor for kidney disease,and the clinical use of arsenic also triggers a new concern that the potential kidney damage caused by exposure to clinical doses of arse nic trivale nt.So far,the un dergoi ng mecha nisms con tributi ng to arse nic n ephrotoxicity mostly remain unclear,and universally accepted methods for preventing this complication are limited too.Ancient Chinese medical scientists recognized the toxicity of arsenic long ago,and there were some records of Chinese herbs against arsenic poisoning in ancient books of Chinese medicine.In the past decade,several herbal formulations,as well as some potentially active compounds extracted from Chinese herbs,have been employed to prevent arsenic nephrotoxicity both in vivo and in vitro and showed better therapeutic effects.The present paper thus summarizes and discusses these Chinese medicine methods in preventing such a public health problem.In addition,we call for large,well-desig ned,randomized,and controlled clinical trials to be performed to further assess the efficacy and safety of these potential methods of Chinese medicine against arsenic nephrotoxicity.