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.

Advances in mesenchymal stem cells combined with traditional Chinese medicine therapy for liver fibrosis

Liver fibrosis is a primary cause of liver cirrhosis, and even hepatocarcinoma. Recently, the usage of mesenchyrnal stem cells （MSCs） has been investigated to improve liver fibrosis. It has been reported that the differentiation, proliferation and migration of MSCs can be regulated by traditional Chinese medicine treatment; however, the mechanisms are still unclear. In this article, the authors review the characteristics of MSCs such as multidirectional differentiation and homing, and its application in animal experiments and clinical trials. The authors also list areas that need further investigation, and look at the future prospects of clinical application of MSCs.

Guidance for the clinical evaluation of traditional Chinese medicine-induced liver injury Issued by China Food and Drug Administration

1. Introduction Drug-induced liver injury (DILI), defined as liver injury caused by a drug and/or its metabolites, is a common clinical adverse drug reaction1–4. This type of injury can cause acute liver failure and even death in severe cases5.

Regulating effect of Chinese herbal medicine on the peritoneal lymphatic stomata in enhancing ascites absorption of experimental hepatofibrotic mice

AIM: To observe the regulatory effect of Chinese herbal medicine on peritoneal lymphatic stomata and its significance in treating ascites in liver fibrosis model mice. METHODS: Two Chinese herbal composite prescriptions were used separately to treat the carbon tetrachloride-induced mouse model of liver fibrosis. The histo-pathologic changes of the liver sections (HE and VG stainings) were observed. The peritoneal lymphatic stomata was detected by scanning electron microscopy and computer image processing. The changes of urinary volume and sodium ion concentration were measured. RESULTS: In the model group, lots of fibrous tissue formed in liver and extended into the hepatic lobules to separate them incompletely. In the treated and prevention groups, the histo-pathologic changes of liver was rather milder, only showed much less fibrous tissue proliferation in the hepatic lobules. The peritoneal lymphatic stomata enlarged with increased density in the experimental groups (diameter: PA, 3.07 +/- 0.69 microm; PB, 2.82 +/- 0.37 microm; TA, 3.25 +/- 0.82 microm and TB, 2.82 +/- 0.56 microm; density: PA, 7.11 +/- 1.90 stomata.1000 microm(-2); PB, 8.76 +/- 1.45 stomata.1000 microm(-2); TA, 6.55 +/- 1.44 stomata.1000 microm(-2)and TB, 8.76+/-1.79 stomata.1000 microm(-2)), as compared with the model group (diameter: 2.00+/-0.52 microm density: 4.45+/-1.05 stomata.1000 microm(-2)). After treatment, the urinary volume and sodium ion excretion increased in the experimental groups (PA, 231.28+/-41.09 mmol.L(-1); PB, 171.69 +/- 27.48 mmol.L(-1) and TA, 231.44 +/- 34.12 mmol.L(-1)), which were significantly different with those in the model group (129.33 +/- 36.75 mmol.L(-1)). CONCLUSION: Chinese herbal medicine has marked effects in alleviating liver fibrosis, regulating peritoneal lymphatic stomata, improving the drainage of ascites from peritoneal cavity and causing increase of urinary volume and sodium ion excretion to reduce the water and sodium retention, and thus have favorable therapeutic effect in treating ascites.

Roles of conventional and complementary therapies in recurrent hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is the fifth most common type of cancer and the fourth leading cause of cancer-related deaths in the world.HCC has a reported recurrence rate of 70%-80%after 5 years of follow-up.Controlling tumor recurrence is the most critical factor associated with HCC mortality.Conventional salvage therapies for recurrent HCC include re-hepatectomy or liver transplantation,transcatheter arterial chemoembolization,Y-90,target therapy,and immunotherapy;however,these conventional treatment modalities have yet to achieve consistently favorable outcomes.Meanwhile,previous studies have demonstrated that conventional therapies in combination with traditional Chinese medicine(TCM),acupuncture,moxibustion or dietary supplements could notably benefit patients with HCC recurrence by strengthening and augmenting the overall management strategy.However,systemic reviews related to the interactions between complementary therapies and conventional therapy in recurrent HCC are limited.In this review,we discuss the molecular mechanisms underlying the functions of complementary therapies for recurrent HCC,which include augmenting the local control to improve the congestion status of primary tumors and reducing multicentric tumor occurrence via inducing autophagy,apoptosis or cell cycle arrest.TCM and its derivatives may play important roles in helping to control HCC recurrence by inhibiting epithelial-mesenchymal transition,migration,invasion,and metastasis,inhibiting cancer stem cells,and ameliorating drug resistance.

Traditional Chinese medicine for treatment of liver diseases: progress, challenges and opportunities

Traditional Chinese medicine （TCM） is commonly used in treating liver diseases worldwide, especially in China. The advantages of using TCM for treatment of liver diseases include： protecting hepatocytes, inhibiting hepatic inflammation and antifibrosis in the liver. In this article, we introduce TCM herbal preparations from the Chinese materia medica （such as Fuzheng Huayu） that are typically used for the treatment of liver diseases. Literature surrounding the mechanisms of TCM therapy for treatment of liver diseases is presented and discussed. We propose that side effects of herbal compounds are often under-appreciated, and that more care should be taken in the prescription of potentially hepatotoxic medicines. Further, to deepen the understanding of TCM mechanisms, new techniques and methodologies must be developed. Future studies will lead to the enhancement of clinical outcomes of TCM. As complementary and alternative therapies, TCMs will play an expanding role in the future of liver disease treatment.

Traditional Chinese medicine integrated with chemotherapy for stage Ⅳ non-surgical gastric cancer: a retrospective clinical analysis

OBJECTIVE： Traditional Chinese medicine （TCM） is regarded as an important treatment for gastric cancer patients, especially for those in advanced stage. To evaluate the effects of TCM treatment on gastric cancer patients, the authors performed a retrospective study to report the result of the integrated treatment of TCM with chemotherapy for stage IV non-surgical gastric cancer. METHODS： In this study, 182 patients with stage IV and non-surgical gastric cancer were retrospectively analyzed to evaluate the effects of TCM integrated with chemotherapy. Among the 182 cases, 88 cases received integrated therapy consisting of TCM and chemotherapy, while 94 cases received chemotherapy alone. The overall survival and Karnofsky performance status （KPS） score were measured as the main outcome. RESULTS： The median overall survival of the integrated therapy group and chemotherapy group were 16.9 and 10.5 months, respectively. The 1-, 3- and 5-year survival rates of integrated therapy group vs. chemotherapy group were 70% vs. 32%, 18% vs. 4%, and 11% vs. 0%, respectively. There was a significant difference between the two groups （x2 = 42.244, P 〈 0.001 ）. After six-month treatment, KPS scores of the integrated therapy group and the chemotherapy group were 75.00 ± 14.78 and 60.64 ± 21.39, respectively （P 〈 0.001）. The Cox regression analysis showed that TCM treatment is a protective factor for patients＇ overall survival. CONCLUSION： This study demonstrated that TCM integrated with chemotherapy may prolong overal survival and improve survival rate and life quality of patients with stage IV non-surgical gastric cancer

培元黜浊汤治疗中晚期肝癌临床观察

目的:观察培元黜浊汤治疗中晚期肝癌患者的临床效果。方法:根据纳入和排除标准筛选中晚期肝癌患者60例,将其随机分为两组各30例。对照组予索拉非尼联合苦参注射液治疗,治疗组在对照组基础上联用培元黜浊汤治疗,疗程为3个月。结果:治疗组的胸闷、善太息,情志抑郁,腹胀,大便溏泄,神疲乏力,纳呆中医证候等级改善优于对照组(P<0.05);且淋巴细胞亚群指标水平与生活质量评分的改善均明显优于对照组。治疗组疾病控制率稍高于对照组,AFP指标水平低于对照组,但差异无统计学意义(P﹥0.05);治疗组不良反应发生率36.67%低于对照组的76.67%(P<0.01)。结论:培元黜浊汤联合索拉非尼治疗中晚期肝癌临床疗效显著,可改善患者免疫功能,提高生活质量。

中医非药物疗法治疗糖尿病前期的应用进展

糖尿病前期是指在正常血糖与糖尿病之间的中间高血糖状态,其中包括空腹血糖受损、糖耐量减低及两者混合状态人群。糖尿病前期是一个可逆的过程,积极干预糖尿病前期人群是预防糖尿病发生和发展的关键。中医非药物疗法在治疗糖尿病前期方面效果显著,不良反应较少。

中药足浴联合西药降糖治疗糖尿病周围神经病变临床观察

目的观察中药足浴联合西药降糖治疗糖尿病周围神经病变的临床效果。方法回顾性选取2021年9月—2023年5月江西省宜丰县人民医院收治的糖尿病周围神经病变患者62例,分为西医降糖药常规治疗联合中药足浴治疗组(联合治疗组)、西医降糖药常规治疗组(常规治疗组)两组,各31例。比较两组中医证候积分,凉温感觉阈值,血糖、血脂水平,震动感觉阈值(VPT),疼痛觉阈值,间歇性跛行距离分级。结果联合治疗组患者的疼痛感、麻木感、烧灼感、异样感积分及中医证候总积分,凉感觉阈值、温感觉阈值,空腹血糖、餐后2 h血糖、胆固醇、三酰甘油水平,足背VPT、第一足趾VPT、疼痛觉阈值均低于常规治疗组(P<0.05)。联合治疗组患者的间歇性跛行距离分级1级比率高于常规治疗组,2级、3级、4级比率均低于常规治疗组(P<0.05)。联合治疗组患者的总缓解率96.77%(30/31)高于常规治疗组的70.97%(22/31)(P<0.05)。结论糖尿病周围神经病变应用西医降糖药常规治疗联合中药足浴治疗的临床效果较西医降糖药常规治疗好。

中医非药物疗法治疗骨伤术后疼痛临床观察

目的探讨分析中医非药物疗法治疗骨伤术后疼痛的临床效果。方法选择遂川县中医院于2020年1月—2022年1月收治的60例骨伤术后疼痛患者,采取随机数字表法分组,奇数患者纳入观察组(30例),实施中医非药物疗法,偶数患者纳入对照组(30例),实施常规治疗。对比两组临床疗效、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、视觉模拟量表(VAS)评分、生活质量评分以及关节活动度(ROM)等情况。结果观察组临床总有效率为93.33%(28/30),高于对照组的70.00%(21/30)(P<0.05)。治疗后,观察组SAS、SDS、VAS和生活质量评分以及ROM均优于对照组,差异均有统计学意义(P<0.05)。结论应用中医非药物疗法治疗骨伤,可有效缓解患者疼痛以及因疾病产生的焦虑、抑郁等不良情绪,其关节活动度改善明显,生活质量切实提升,值得临床大力推广、应用。

从肝功能角度探讨中医禁食疗法治疗2型糖尿病的临床研究

目的:随着超重或肥胖的2型糖尿病(Type 2 Diabetes Mellitus,T2DM)的患病群体越来越大,超重或肥胖的T2DM已给患者及其家庭、社会、国家构成了严重经济负担,通过控制体质量进而控制血糖是针对超重或肥胖的T2DM的重要治疗措施。本研究者所在团队创立的中医禁食疗法就是治疗超重或肥胖的T2DM的重要选择,中医禁食疗法通过5 d的禁食结合中药内服及中医综合治疗方法来治疗超重或肥胖的T2DM患者,疗效明显,由于糖、脂类、蛋白质等物质的代谢与肝脏密切相关,在禁食期间,肝脏的代谢负荷会明显增加,肝功能在禁食期间的变化是本研究者所重点关注的方向,本研究的目的是从肝功能角度回顾性研究中医禁食疗法治疗T2DM的安全性与疗效。方法:从既往出院患者中筛选出46例T2DM患者,比较T2DM患者在进行中医禁食疗法治疗前后在空腹血糖、体质量、体质量指数(Body Mass Index,BMI)、肝功能指标(蛋白质代谢功能、胆红素代谢、血清酶)方面的变化情况。结果:46例T2DM患者,进行中医禁食疗法治疗后,在空腹血糖、体质量、体质量指数、总蛋白、球蛋白、γ-谷氨酰基转移酶、碱性磷酸酶、腺苷脱氨酶等方面与治疗前相比明显下降,在天冬氨酸氨基转移酶、总胆红素、直接胆红素、间接胆红素等方面相较于治疗前有上升趋势,而在白蛋白、丙氨酸氨基转移酶、胆碱酯酶、胆汁酸等方面相较于治疗前无显著性改变。结论:中医禁食疗法治疗T2DM安全有效。

当归补血汤配合十枣汤治疗肝硬化顽固性腹水患者临床观察

目的探究当归补血汤配合十枣汤在肝硬化顽固性腹水患者临床治疗中的应用效果。方法选取邳州市中医院2021年3月—2022年3月收治的肝硬化顽固性腹水患者60例为研究对象,采取Excel软件随机分为中药组和西药组,各30例,西药组给予常规西药治疗;中药组给予当归补血汤配合十枣汤治疗。比较2组临床疗效。结果中药组治疗效果优于西药组(P<0.05);中药组治疗满意度高于西药组(P<0.05);中药组不良反应发生率低于西药组(P<0.05)。结论肝硬化顽固性腹水患者服用当归补血汤配合十枣汤治疗可显著提升满意度和治疗效果,调节血清电解质水平,值得临床推广。

清火消痈汤治疗心肝火旺及热毒内蕴型肺痈临床观察

目的研究清火消痈汤治疗心肝火旺及热毒内蕴型肺痈的临床价值。方法以2021年1月—2021年12月为研究周期,抽取研究对象72例,采用随机数字表法分为研究组、对照组,各36例;对照组予西药治疗,研究组予清火消痈汤治疗,对比两组呼吸功能指标和中医证候积分。结果治疗后,研究组二氧化碳分压(PaCO_(2))水平为(41.42±3.75)mm Hg(1 mm Hg≈0.133 kPa),低于对照组的(47.59±5.88)mm Hg(P<0.05);氧分压(PaO_(2))水平为(82.99±6.75)mm Hg,高于对照组的(73.26±2.48)mm Hg(P<0.05)。治疗后,研究组主证积分为(2.44±0.68)分、次证积分为(0.65±0.11)分、总积分为(3.12±0.64)分,均低于对照组的(5.29±1.05)分、(1.89±0.62)分、(7.28±1.75)分(P<0.05)。结论清火消痈汤治疗肺痈效果显著。

中药调节肠道菌群缓解药物性肝损伤的研究进展

药物性肝损伤是由化学药物、膳食补充剂和草药产品等引起的肝脏损伤疾病,其极易发展为肝衰竭,且在其发生发展的同时常伴随肠道菌群的变化。中药多成分、多靶点的治疗特点可以通过调节肠道菌群、改善肠道屏障、降低炎症因子水平等减轻药物性肝损伤。对中药干预肠道菌群缓解药物性肝损伤的作用进行总结,以期对中药治疗药物性肝损伤的机制研究提供参考。

参葛方联合生活饮食运动干预治疗肝功能异常代谢相关脂肪性肝病的临床观察

目的观察参葛方联合生活饮食运动干预治疗肝功能异常代谢相关脂肪性肝病(MAFLD)的临床疗效及对患者血清CD44水平的影响。方法将70例脾虚痰湿兼有血瘀型肝功能异常MAFLD患者随机分为对照组和治疗组,每组35例,两组均给予生活饮食运动干预,治疗组加用参葛方,对照组加用参葛方安慰剂,疗程均为12周。观察临床疗效,比较磁共振成像质子密度脂肪含量(MRI-PDFF)及血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、CD44水平的变化情况。结果(1)最终完成试验者64例,其中治疗组32例、对照组32例。(2)治疗组、对照组总有效率分别为75.0%、46.9%,治疗组临床疗效优于对照组(P<0.05)。(3)治疗前后组内比较,两组MRI-PDFF值降低(P<0.05),治疗组血清CD44水平降低(P<0.05);组间治疗后比较,治疗组MRI-PDFF值、血清CD44水平低于对照组(P<0.05)。(4)治疗前后组内比较,治疗组血清ALT、AST、GGT水平降低(P<0.05),对照组AST水平降低(P<0.05);组间治疗后比较,治疗组血清ALT、AST、GGT水平低于对照组(P<0.05)。(5)治疗前后组内比较,治疗组血清TG、TC、LDL水平降低(P<0.05),对照组TG水平降低(P<0.05);组间治疗后比较,治疗组TG水平低于对照组(P<0.05)。结论参葛方联合生活饮食运动干预治疗脾虚痰湿兼有血瘀型肝功能异常MAFLD患者疗效满意,能有效缓解患者的临床症状,改善肝脏脂质沉积及肝功能异常,调节血脂水平,其机制可能与调节血清CD44表达有关。

我国三级中医医院门诊患者中医药特色服务利用情况调查

目的:调查我国三级中医医院门诊患者中医药特色服务的利用情况,为中医医院的特色化发展提供依据。方法:对全国37家中医医院门诊患者中药饮片和中医非药物疗法的利用情况进行分析。合并中药饮片和中医非药物疗法利用为中医药特色服务利用情况,并采用卡方检验进行不同分层间的差异性分析。结果:共收集7,542例门诊患者,55.81%的患者开具了中药饮片处方,27.95%的患者采用了中医非药物疗法,31.77%的患者在诊疗过程中未采用中医药特色方法治疗。不同地理位置、就诊科室、医生职称患者中医药特色服务利用存在显著性差异(χ^(2)=26.459、393.670、54.343,P<0.01),而不同患者社会人口学特征间差异无统计学意义。结论:我国三级中医医院门诊患者中医药特色服务利用情况良好,但不同科室对中医药技术方法的利用各有侧重。中西部地区中医医院门诊患者中医药特色服务利用情况优于东部地区。职称越高的医生提供中医药特色服务的比例也越高。

铜绿假单胞菌耐药机制及治疗技术研究新进展

铜绿假单胞菌(PA)是最常见的条件致病菌之一,严重危害人类的健康。随着广谱抗生素的大量应用,导致多重耐药菌株的出现,从而使治疗更加棘手。研究发现,免疫力低下的人群容易诱发PA的感染,随着临床耐药PA检出率的增加及抗生素的治疗效果减弱,部分患者的生活质量及预后受到很大影响。PA的感染难以控制的原因是复杂的耐药机制,其中包括生物膜的形成、孔蛋白的介导作用、外排泵以及抗菌灭活酶的产生等。由于抗生素的应用不能有效控制PA的感染,所以针对耐药机制在药物治疗方面进行研究,其中包括外排泵抑制剂、抗生素佐剂、相关灭活酶抑制剂、外膜透化剂。此外,噬菌体疗法、中药疗法、一氧化氮疗法及纳米技术等特殊治疗也展现出良好的治疗效果,疫苗领域及增强自身免疫力也是未来预防PA感染的重要研究方向。因此,研究PA的耐药机制及治疗技术对PA感染的预防和治疗具有深远的意义。

痛泻安肠方治疗肝郁脾虚型腹泻型肠易激综合征临床观察

目的明确痛泻安肠方对肝郁脾虚型腹泻型肠易激综合征(IBS-D)的临床疗效和治疗优势。方法采用单中心、随机、阳性药物对照的临床设计开展探索性研究。共纳入36例肝郁脾虚型IBS-D患者,分为2组,每组18例;治疗组予痛泻安肠方,对照组予阳性对照药匹维溴铵片,2组疗程均为4周。观察2组疗效指标和安全性指标。结果治疗组肠易激综合征严重程度评测(IBS-SSS)总评分和中医证候评分低于对照组(P<0.05)。治疗组改善IBS-SSS总有效率、中医证候疗效总有效率为88.89%(16/18)、83.33%(15/18),略高于对照组的83.33%(15/18)、77.78%(14/18),差异无统计学意义(P>0.05)。此外,2组均无明显不良反应发生,安全性检查未见明显异常。结论痛泻安肠方治疗肝郁脾虚型IBS-D安全有效,在改善患者症状方面具有更好的效果。

中药联合抗肿瘤血管生成药物治疗非小细胞肺癌的研究进展

非小细胞肺癌(NSCLC)是肺癌最为常见的一种病理类型,一半以上的患者确诊时即为进展期肺癌,患者生存期较短。抗肿瘤血管生成药物是目前治疗非小细胞肺癌的重要靶向药物,其临床疗效已获得临床认可,但仍存在耐药性及毒副作用不可耐受的局限性,而中药辨证论治及减毒增效的优点,可减轻药物的不良反应,并提高临床疗效,已成为中西医结合治疗非小细胞肺癌的重要方向。本文主要通过检索2010年1月—2023年6月中国知网、万方、维普及PubMed等数据库中的相关文献,总结近年来不同中药联合各类抗肿瘤血管生成药物治疗NSCLC的相关研究,试从不同角度探讨治疗NSCLC的新思路。