Thinking and Strategy on the Diagnosis and Treatment of Functional Gastrointestinal Disorders with Integrative Medicine

The functional gastrointestinal disorders (FGIDs) are a group of diseases mainly manifested as gastrointestinal functional disorders,including 45 kinds of different diseases,such as functional dyspepsia(FD), irritable bowel syndrome (IBS),functional constipation

Brain functional connectivity network studies of acupuncture： a systematic review on resting-state fMRI

Background： Functional magnetic resonance imaging （fMRI） is a novel method for studying the changes of brain networks due to acupuncture treatment. In recent years, more and more studies have focused on the brain functional connectivity network of acupuncture stimulation. Objective： To offer an overview of the different influences of acupuncture on the brain functional connec- tivity network from studies using resting-state fMRI. Search strategy： The authors performed a systematic search according to PRISMA guidelines, The database PubMed was searched from January 1, 2006 to December 31, 2016 with restriction to human studies in English language. Inclusion criteria： Electronic searches were conducted in PubMed using the keywords ＂acupuncture＂ and ＂neuroimaging＂ or ＂resting-state fMRI＂ or ＂functional connectivity＂, Data extraction and analysis： Selection of included articles, data extraction and methodological quality assessments were respectively conducted by two review authors. Results： Forty-four resting-state fMRI studies were included in this systematic review according to inclu- sion criteria. Thirteen studies applied manual acupuncture vs. sham, four studies applied electro- acupuncture vs. sham, two studies also compared transcutaneous electrical acupoint stimulation vs. sham, and nine applied sham acupoint as control. Nineteen studies with a total number of 574 healthy subjects selected to perform fMRI only considered healthy adult volunteers. The brain functional connec- tivity of the patients had varying degrees of change. Compared with sham acupuncture, verum acupunc- ture could increase default mode network and sensorimotor network connectivity with pain-, affective- and memory-related brain areas. It has significantly greater connectivity of genuine acupuncture between the periaqueductal gray, anterior cingulate cortex, left posterior cingulate cortex, right anterior insula, limbic/paralimbic and precuneus compared with sham acupuncture. Some research had also shown that acupuncture could adjust the limbic-paralimbic-neocortical network, brainstem, cerebellum, subcortical and hippocampus brain areas. Conclusion： It can be presumed that the functional connectivity network is closely related to the mech- anism of acupuncture, and central integration plays a critical role in the acupuncture mechanism.

Understanding “medicine and food homology”,developing utilization in medicine functions

Chinese medicine is a very big concept of medicine. In Shennong era, medicine and food do not divide.＂Medicine and food homology＂, which is called ＂Chinese medicine and dietary application＂, refers to that many foods are drugs, and there is no absolute demarcation line between them.

Correlations among Persistent Viral Infection,Heart Function and Chinese Medicine Syndromes in Dilated Cardiomyopathy Patients

Objective：To investigate the correlations among persistent viral infection,heart function and Chinese medicine（CM） difined-syndromes in patients with dilated cardiomyopathy（DCM）.Methods：Fifty patients with DCM in the First Affiliated Hospital of Zhejiang Chinese Medical University from October 2009 to December 2011 were selected as the research subjects,and 30 healthy people were simultaneously selected as the normal control group to detect persistent viral infections after admission.The CM syndrome type and grade of heart function were then evaluated.The expression level of Coxsackie adenovirus receptor（CAR） was detected using the flow cytometry（FCM） technique,coxsackie virus RNA（CVB-RNA） using reverse transcription polymerase chain reaction（RTPCR）,and the plasma brain natriuretic peptide（BNP） level with a Triage meter plus diagnosis instrument.Finally,the parameters such as left ventricular end diastolic diameter（LVEDd） and left ventricular ejection fraction（LVEF） were measured by ultrasonic cardiogram.Person correlation analysis was used for measured data,Spearman correlation analysis for rating data,and the Chi-square test for numerical data.Results：CVB-RNA was positive in 22 patients（44%） with DCM,while only 6 cases（20%） were CVB-RNA-positive in the normal control group,with a significant difference between the two groups（P〈0.01）.The expression level of CAR was significantly elevated in the DCM group compared with the normal control group（P〈0.01）.In CVB-RNA-positive patients（22 cases）,the expression level of CAR was significantly higher than in CVB-RNA-negative patients（28 cases;P〈0.01）.In the DCM patients,there was a positive correlation between the CAR expression and the BNP level（r=0.34,P〈0.05）,while no significant difference was found between the CAR expression and the LVEF and LVEDd（r=-0.32,0.30,P〉0.05）.There was no clear correlation between virus infection and the CM syndrome types in DCM patients（r=-0.22,P〉0.05）.According to the sequence of syndrome types：phlegm → qi deficiency → blood stasis → hydroretention with asthenic yang（from low to high）,a positive correlation was existed between the BNP levels and CM syndrome types（r=0.139,P〈0.05）.Conclusion：The expression of CAR on the surface of white cells could be used to detect persistent viral infection.The expression level of CAR and heart function in DCM patients were highly correlated.The expression level of BNP may serve as an objective index for differentiating CM syndromes for patients with DCM.

Effect of a Traditional Chinese Medicine combined therapy on adolescent idiopathic scoliosis:a randomized controlled trial

OBJECTIVE:To evaluate the effectiveness of a combined Traditional Chinese Medicine(TCM) therapy versus conventional treatment on adolescent idiopathic scoliosis.METHODS:One hundred twenty outpatients with mild and moderate adolescent idiopathic scoliosis were randomly divided into a TCM group(TCMG)and a brace group(CG).TCMG patients underwent Daoyin,Tuina,and acupotomology therapies.CG patients were treated with a Milwaukee brace.Each patient's Cobb angle was measured after 12 and 24 months of treatment,and pulmonary function was determined after 12 months of treatment.Average electromyogram(AEMG) ratio of the surface electromyogram was measured after 6 and 12 months of treatment and followed-up after 18 and 24 months.RESULTS:The Cobb angle significantly decreased in both groups after 12 months of treatment compared with before treatment(P< 0.05).The percentages of original Cobb angle in TCMG and CG were51.4%and 47.8%(P > 0.05) after 12 months and62.5%and 34.7%(P < 0.05) after 24 months,respectively.Pulmonary function significantly improved after 12 months in TCMG(P < 0.05) but significantly decreased in CG(P < 0.05).The AEMG ratio was significantly lower(P < 0.01) and tended to remain at1 after stopping treatment in TCMG,but increased in CG(P<0.05).CONCLUSION:TCM combined therapy can prevent the progression of scoliosis.The AEMG ratio is a promising index that could replace radiography in the evaluation of treatment effect and progression in scoliosis.

Cultural stress:The undiagnosed epidemic of our time

Global technologies that have made the world more interconnected have also,inadvertently,amplified the forces of stress that are now with us 24 hours a day,7 days a week.The accumulated impact of this stress I call cultural stress anxiety syndrome and call on integrative medicine practitioners to recognize that it is exacerbating whatever acute stressors are also present in our patients'lives.In this Commentary,I outline seven major components of cultural stress(time pressure,digital intrusion,digital dependency,isolation,sedentary lifestyle,poor sleep and uncertainty),describe their health consequences,and finally,offer cultural stress-specific remedies I have utilized in my own practice,along with studies that affirm their efficacy.My hope is that we,as integrative medicine practitioners who are cognizant of the role that stress plays in disease development,will more fully appreciate the added impact of cultural stress,and advise our patients on the importance of proactive stress management.

Resource diversity of Chinese macrofungi:edible,medicinal and poisonous species

The huge land areas in China provide highly diverse habitats for macrofungi.Of these macrofungi,many are directly related to people’s daily life and have been utilized by ancient Chinese for at least 6800 years.In this study,we evaluate the current known resource diversity of Chinese macrofungi.A total of 1662 taxa are summarized,and all species names and their authorities have been checked and corrected according to authentic mycological databases.Among the 1662 taxa,1020,692,and 480 are considered to be edible,medicinal and poisonous mushrooms,respectively.A few of edible macrofungi in China are commonly used for commercial production.All known medicinal functions are labeled for medicinal species.The most common medicinal functions possessed by Chinese macrofungi are antitumor or anticancer,followed by antioxidant and antimicrobial.A total of 277 Chinese macrofungi are edible simultaneously with certain medicinal functions and without known toxicity.These species could be treated as“Gold Mushrooms”.Contrarily,193 edible and/or medicinal species are also recognized as poisonous mushrooms.To avoid poisoning caused by these species,ingestion either in a proper way or in small amounts is important.However,the mycotoxins metabolized by these poisonous species could be a huge wealth of natural products yet to be explored.How to utilize these Chinese macrofungal resources is a critical to benefit humans worldwide.

Production of Active Compounds in Medicinal Plants:From Plant Tissue Culture to Biosynthesis

Over past decades plant tissue culture has emerged as an alternative of whole plant cultivation in the production of valuable secondary metabolites.Adventitious roots culture of Panax ginseng and Echinacea purpure has reached the scale of 1-10 kL.Some molecular biological techniques,such as transgenic technology and genetic stability are increasingly used in the studies on plant tissue cultures.The studies on elicitors have deepened into the induction mechanism,including signal molecules,functional genes,and so on.More and more biological elicitors,such as A.niger and yeast are used to increase the active compounds in plant tissue cultures.We also discussed the application of synthetic biology in the studies on biosynthesis of artemisinin,paclitaxel,and tanshinon.The studies on active ingredients biosynthesis of medicinal plants provide unprecedented possibilities to achieve mass production of active ingredients.Plant tissue cultures can not only produce active ingredients but also as experimental materials for biosynthesis.In order to improve the contents of active compounds in medicinal plants,following aspects could be carried out gene interference or gene silencing,gene overexpression,combination with chemical synthesis,application of elicitors,and site-directed mutagenesis of the key enzymes.

Protective Effects of Xiongshao Capsule(芎芍胶囊) on Anti-inflammatory Function of High-Density Lipoprotein in AnAtherosclerosis Rabbit Model

Objective： To observe the effects of Xiongshao Capsule（芎芍胶囊, XSC） on anti-inflammatory properties of high-density lipoprotein（HDL）, myeloperoxidase（MPO） and paraoxonase 1（PON1） in serum of atherosclerosis（AS） rabbit model and explore the anti-inflammatory protective effects of XSC on HDL. Methods： Sixty rabbits were randomized into the control, the model, XSC low-, medium-and high-dose（Rhizoma Chuanxiong ＋ Radix Paeoniae rubra ： 0.6＋0.3, 1.2＋0.6, 2.4＋1.2 g·kg-1·day-1, respectively）, and simvastatin（1 g·kg-1·day-1） groups. The model rabbits were fed with high-fat diet and respective drugs for 15 weeks. The blood and thoracic aortas samples were collected at the end of 15 weeks. The levels of serum MPO and PON1 as well as total cholesterol（TC） and free cholesterol（FC） in aorta wall cells were tested by enzyme linked immunosorbent assay. Results： TC and FC in the model group were significantly higher than those in the control group（P〈0.01）. Compared with the model group, TC and FC in the XSC groups were significantly lower（P〈0.05 or P〈0.01）, so was simvastatin group（P〈0.01）. There was no significant difference in PON1 level between groups（P〉0.05）, even between model and control groups（P〉0.05）. The serum MPO level in the model group was significantly higher than that in the control group（P〈0.05）, which was significantly lower in XSC groups as well as simvastatin group（P〈0.05 or P〈0.01）, and no difference was found between XSC groups and simvastatin group（P〉0.05）. Conclusions： XSC can reduce the serum MPO level in AS rabbits to protect the anti-inflammatory function of HDL, maintaining the normal lipid transport function. TC and FC levels in aorta cells decline, and this process initiated by XSC plays an anti-AS role.

Gut Microbiota Brings a Novel Way to Illuminate Mechanisms of Natural Products in vivo

Poor bioavailability and undefined major/direct targets are two major obstacles for herbal medicines and natural products（NPs） to elucidate their precise mechanisms in vivo. Gut microbiota is an important bridge between eukayotic body and environment, which can interact with a majority of medicines with poor bioavailability and mediate their in vivo pharmacological activities. There are two main modes through which gut microbiota may mediate the pharmacological effects of NPs. First, gut microbiota catabolizes the NPs in herbal medicines into secondary metabolites with higher bioavialability and/or higher activity, facilitating the NPs enter circulation and exert beneficial impact at the pathological spot. Second, herbal medicines and NPs can favorably shift the compositional structure of gut microbiota, thereby performing remote functions to diseased organs/tissues via the systemic impaction of gut microbiota. In this review, the potential pathways were summarized through which gut microbes facilitate the pharmacological functions of herbal medicines and NPs and highlight the significance of gut microbiota in clarifying the in vivo mechanisms of herbal medicines and NPs.