Regulating and tonifying spleen and kidney traditional Chinese medicine in the treatment of chronic uric acid nephropathy: A systematic review

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine for regulating spleen and kidney.Methods:We developed a search strategy and then retrieved the database including CNKI,Wanfang data knowledge service platform,VIP journals resource integration service platform,PubMed,Embasefor randomized controlled trial of regulating spleen and kidney traditional Chinese medicine compared with conventional western medicine in the treatment of chronic uric acid nephropathy.The search deadline was set to June 30,2020.For the included literature,we applied the cochrane collaboration network risk bias assessment tool to evaluate the methodological quality,and evaluated the level of evidence according to GRADE standards.Quantitative data was analyzed by RevMan5.3 software,and trial sequential analysis method was used to analyze its efficiency.Results:A total of 709 cases in 10 articles were included.Compared with the control group,the related traditional Chinese medicine group improved the effective rate[RR=1.45,95%CI(1.32,1.58)],reduced the level of UA[MD=-36.24,95%CI(-41.03,-31.45)],BUN[SMD=-1.27,95%CI(-1.47,-1.07)]and SCR[MD=-36.33,95%CI(-55.79,-16.87),P=0.0003],the difference between the two groups was statistically significant(P<0.05).There was no evidence that a significant adverse reaction occurred.The results of TSA analysis showed that the Chinese medicine group had definite evidence for improving the efficiency.According to the GRADE evaluation criteria,the efficiency,UA,BUN and SCR outcome indicators were extremely low-quality evidence.Conclusions:Traditional Chinese medicine for regulating spleen and kidney in the treatment of chronic uric acid nephropathy improved efficiency,reduced the level of UA,BUN,SCR.Meanwhile,the therapy was proved to be safe.Nevertheless,the conclusions need further high-quality evidence to support.

Liver or kidney:Who has the oar in the gluconeogenesis boat and when?

Gluconeogenesis is an endogenous process of glucose production from noncarbohydrate carbon substrates.Both the liver and kidneys express the key enzymes necessary for endogenous glucose production and its export into circulation.We would be remiss to add that more recently gluconeogenesis has been described in the small intestine,especially under high-protein,lowcarbohydrate diets.The contribution of the liver glucose release,the net glucose flux,towards systemic glucose is already well known.The liver is,in most instances,the primary bulk contributor due to the sheer size of the organ(on average,over 1 kg).The contribution of the kidney(at just over 100 g each)to endogenous glucose production is often under-appreciated,especially on a weight basis.Glucose is released from the liver through the process of glycogenolysis and gluconeogenesis.Renal glucose release is almost exclusively due to gluconeogenesis,which occurs in only a fraction of the cells in that organ(proximal tubule cells).Thus,the efficiency of glucose production from other carbon sources may be superior in the kidney relative to the liver or at least on the level.In both these tissues,gluconeogenesis regulation is under tight hormonal control and depends on the availability of substrates.Liver and renal gluconeogenesis are differentially regulated under various pathological conditions.The impact of one source vs the other changes,based on post-prandial state,acid-base balance,hormonal status,and other less understood factors.Which organ has the oar(is more influential)in driving systemic glucose homeostasis is still inconclusive and likely changes with the daily rhythms of life.We reviewed the literature on the differences in gluconeogenesis regulation between the kidneys and the liver to gain an insight into who drives the systemic glucose levels under various physiological and pathological conditions.

Theoretical Discussion on Treatment of Cubital Tunnel Syndrome Based on Theory of Liver,Spleen and Kidney

Cubital tunnel syndrome is a disease in which ulnar nerve is compressed by its surrounding tissues,and its main clinical manifestations are pain,sensory disturbance and dyskinesia.Its incidence rate is the second highest among peripheral nerve entrapment diseases,and it is one of the common clinical diseases.The theory of liver,spleen and kidney can guide the treatment of cubital tunnel syndrome with traditional Chinese medicine and acupuncture.By discussing the traditional Chinese medicine(TCM)pathogenesis and treatment principles of cubital tunnel syndrome,it provides modern medical theoretical support for TCM treatment of cubital tunnel syndrome.

Professor Fengjie He’s Experience in Treating Polycystic Ovary Syndrome of Kidney Asthenia and Liver Depression

Polycystic ovary syndrome is a common reproductive endocrine metabolic disease in clinic.Professor Fengjie He has accumulated rich clinical experience in the process of diagnosis and treatment of the disease.He believes that the key to the pathogenesis of the disease is the dysfunction of the reproductive axis of“kidney-Tiangui-Chongren-uterus,”which is based on kidney deficiency and involves the liver and spleen.Clinically,patients with kidney deficiency and liver depression are common.The treatment takes tonifying the kidney and regulating the menstrual cycle as the main method,and the clinical effect is very effective.

Effectiveness of tonifying-kidney and regulating-liver therapy on diminished ovarian reserve: a systematic review and Meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the effectiveness of the Traditional Chinese Medicine tonifying-kidney and regulating-liver therapy on diminished ovarian reserve(DOR).METHODS: The literature was comprehensively searched up to August 2019 using four Chinese and three English electronic databases to extract randomized clinical trials(RCTs) comparing Traditional Chinese Medicine tonifying-kidney and regulating-liver prescriptions(combined with hormone therapy or not) with Western Medicine. Data quality evaluation was conducted using the Cochrane risk of bias tool. Meta-analysis was conducted using Revman 5.3 software with effect estimates presented as mean difference(MD), risk ratio(RR), and95% confidence interval(CI).RESULTS: A total of nine RCTs with 512 participants were extracted and eligible for Meta-analysis.There were no significant differences between Chinese medicine and Western Medicine on basal serum follicle-stimulating hormone(FSH) level(MD0.11, 95% CI-0.52 to 0.74, 392 participants, seven trials), anti-Müllerian hormone level(MD 0.48, 95%CI-0.62 to 1.58, 95 participants, two trials), and the FSH and luteinizing hormone ratio(MD 0.01,95% CI-0.95 to 0.96, 115 participants, two trials).Chinese medicine was more effective at improving Traditional Chinese Medicine symptom scores(TCMSS)(MD-2.39, 95% CI-3.83 to-0.94, 160 participants, three trials), effective rate of TCMSS(RR1.18, 95% CI 1.02 to 1.36, 160 participants, three trials), antral follicle count(AFC)(MD 0.55, 95% CI 0.05 to 1.04, 155 participants, three trials), and FSH levels at 3 months post-treatment(MD-4.77, 95% CI-6.09 to-3.45, 137 participants, two trials).CONCLUSION: Compared with Western Medicine,tonifying-kidney and regulating-liver therapy is more effective at relieving symptoms and improving AFC and FSH at 3 months post-treatment.

Research Progress on Chemical Constituents and Pharmacological Effect of Semen Cuscutae

In this paper,by summarizing the literature in recent years,it is considered that the chemical constituents of S.cuscutae are mainly flavonoids.The main pharmacological effects include improving osteoporosis,improving ovarian function,improving drug-induced reproductive toxicity,regulating spermatogenic cell apoptosis,resisting liver fibrosis,resisting inflammation,improving cardiovascular function,protecting fetus,protecting synapses and so on.By summarizing the chemical constituents and pharmacological effects of S.cuscutae,this study aims to better study the mechanism of anti-osteoporosis based on the fact that S.cuscutae has the function of tonifying liver and kidney.

Influence of electroacupuncture therapy of tonifying the kidney and regulating governor vessel on Aβ related degradation enzymes in the hippocampus of a rat model of Alzheimer's disease induced by Aβ_(1-42)

Objective： To explore influence of electroacupuncture（EA） therapy of tonifying the kidney and regulating governor vessel on amyloid beta（Aβ） related degradation enzymes in the hippocampus of a rat model of Alzheimer＇s disease（AD） induced by Aβ（1-42）.Methods： Forty Wistar male rats were randomly divided into 4 groups： a normal group, a sham operation group, a model group and an EA group, 10 rats in each one. The rats in normal group were normally fed. The rats in sham operation group were bilaterally injected in the hippocampus with 5 μL of saline and they were normally fed after the injection. The rats in the model group and the EA group were bilaterally injected in the hippocampus with 5 μL of Aβ（1-42） on each side. Rats in the EA group received EA of 5 Hz continuous wave at the ＂Bǎihuì（百会 GV20）＂ and bilateral ＂Shènshū（肾俞 BL23）＂ for a duration of 15 min per time every day and continuously for 15 days. After 15 days, the hippocampal expression levels of insulin degrading enzyme（IDE）, lipoprotein（LPL）, transthyretin（TTR）, apolipoprotein E（APoE）,a2 macroglobulin（a2 M） and Aβ（1-42） of the 4 groups were tested by Western blot.Results： Compared with the sham operation group, the expression levels of IDE, LPL, TTR, APoE and a2 M in the hippocampus were significantly lower（P〈 0.05, P〈 0.01） and the expression of Aβ（1-42） was significantly higher（P〈 0.01） in the model group. Compared with the model group, the expression levels of IDE, LPL, TTR,APoE and a2 M in the hippocampus of these rats were significantly lower（P〈 0.05,P〈 0.01）, the expression of Aβ（1-42） was significantly higher（P〈 0.01） in the EA group.Conclusion： EA therapy of tonifying the kidney and regulating governor vessel can enhance the expression of IDE, LPL, TTR, APoE, and a2 M in the hippocampus of AD rats injected by Aβ（1-42）, and may consequently promote the degradation of aβ（1-42） to help improve the pathological manifestations of AD and therefore delay its progression.

Strategies for Activating Blood Circulation-Regulating Gan(Liver)-Tonifying Shen(Kidney) Sequential Therapy of Endometriosis-Associated Infertility

Endometriosis(EM) is a major cause of infertility and has a complex pathogenesis,which brings severe challenges in both clinical treatment and scientific research.Current clinical research focuses on the difficult problem of improving the pregnancy rate of EM patients.Our studies found that Chinese medicine has significant advantages in terms of improving the pregnancy rate of EM patients.

从“虚瘀劫肝”论原发性肝癌中医药防治思路

理论创新是中医药发展的源泉,在新理论指导下形成的新方药或新诊治方案是中医药临床防治重大疑难疾病的新突破口。正邪交争,正不胜邪是慢性疾病持续进展的内在驱力和一般特性,慢性肝病持续恶性进展囊括了:肝纤维、肝硬化、肝癌等逐步恶化的病理进程。其在遵循中医“正不胜邪”基本病机的基础也必须有其特殊性和指向性,也可理解为在慢性肝病持续进展的病理状态下将一般性的病机进行指向性和特征性的阐发。肝正虚主要是指维持正常肝再生修复的相关机制和途径异常或紊乱,肝邪胜则是指肝损伤因素持续存在及其下游触发的恶性肝再生状态进行性亢进;而“瘀”作为正邪交争过程中产生的最主要病理产物也在不断推动疾病的恶性发展。在此基础上,从“虚瘀劫肝”论肝癌的病理新认识及补虚(补肾生髓、健脾)祛瘀(疏肝、柔肝、化肝)阻断慢性肝病持续恶性进展以防治肝癌的基本思路,期望有益于疑难肝脏病症的临床防治。

“调肝补肾法”中药制剂抑制乳腺癌细胞增殖的机制探索

目的探究“调肝补肾法”中药制剂对乳腺癌细胞的作用及其机制。方法采用网络药理学方法预测“调肝补肾法”中药制剂的作用机制;CCK8法、单细胞克隆和划痕实验分别检测“调肝补肾法”中药制剂对人乳腺癌细胞MCF-7、T47D增殖活力、克隆形成和迁移能力的影响;蛋白质印迹法检测“调肝补肾法”中药制剂对磷酸化磷脂酰肌醇3激酶(PI3K)、Akt激酶的表达。结果网络药理学筛选出“活性成分-乳腺癌”靶点84个,作用机制与PI3K/Akt、促分裂原活化的蛋白质激酶等信号通路有关。细胞实验表明该“调肝补肾法”可抑制MCF7和T47D细胞的增殖、迁移能力,并降低p-PI3K、p-Akt蛋白表达水平。结论采用“调肝补肾法”中药制剂治疗乳腺癌,可能通过调控PI3K/Akt信号通路抑制人乳腺癌MCF-7和T47D细胞增殖、侵袭迁移。

从发病机制探讨多囊卵巢综合征所致闭经

基于肝脾肾三脏,从肝郁气滞,脾虚痰湿,肾虚精亏及冲任二脉剖析多囊卵巢综合征所致闭经病机;此外,从遗传、环境污染、精神压力、胰岛素抵抗等因素简述现代医学发病机制;以肝气郁滞,疏泄不及,横逆己土作为切入点,浅析脾虚及肾,肾虚血瘀的发展历程。此外,从五行生克制化方面阐明了肾在该病中的主导地位,从肝郁、脾虚、肾亏的中医理论探讨了多囊卵巢综合征致闭经发病过程和病变特点,确立了疏肝理气、健脾燥湿、补肾填精的主要治法,同时对兼有痰浊内生、瘀血阻络者,提出化痰降浊,通络化瘀的治法。

老昌辉中西医结合治疗郁证经验介绍

介绍老昌辉教授中西医结合治疗郁证的临床经验。老昌辉教授认为,郁证发病病因以肾之精气亏虚为本,情志不遂为诱因。病位在肝、脾,久病可及心、肾,为本虚标实之证。辨病要点为其主诉症状及舌苔。治疗全程中西药相结合,攻补兼施。前期或轻症,治以疏肝解郁为主,以逍遥散为主方加减;中期治以平调寒热阴阳为主,以半夏泻心汤加减为主;后期治以补益气血、肝肾,固护其本,以归脾汤或肾气丸为主。中药治疗旨在固本及减少西药的不良反应,配合口服西药的治疗方案贯穿全程,两者结合,提高患者依从性及临床疗效。

中医药防治化疗后骨髓抑制研究进展

中医药防治化疗后骨髓抑制的常用治法有补肾生髓法、健脾养血法、解毒活血法、益气养阴法、疏肝调肝法等,疗效确切,不良反应少,可改善患者生活质量。目前,研究仍存在以下不足:临床研究中符合循证医学原则的多中心随机双盲对照研究较少,中医辨证分型尚缺乏统一的标准和客观依据与规范;中医药防治化疗后骨髓抑制与西医治疗的结合应用还不够充分;关于中医药抗化疗后骨髓抑制在细胞、分子微观水平方面的研究有一定进展,但由于中药方剂成分复杂,明确具体机制存在较大困难,联合用药的协同效应以及治疗效果的科学证据还相对不足。今后,需进一步探索和研究中医药防治化疗后骨髓抑制的临床应用前景,提高临床研究质量,深入研究中医药抗化疗后骨髓抑制的作用机理。

调肝、补肾、健脾方药对慢性心理应激大鼠单胺类神经递质影响的比较研究

目的:观察慢性心理应激反应大鼠血浆和下丘脑多巴胺(DA)、5-羟色胺(5-HT)、肾上腺素(E)、去甲肾上腺素(NE)的变化及调肝、补肾、健脾方药对其影响。方法:Wistar大鼠按体重随机分为6组,即对照组(C),模型组(M),调肝中药(加味四逆散)组(C1),人参总皂甙组(C2),补肾中药(肾气丸)组(C3),健脾中药(四君子汤)组(C4)。采用束缚限制活动空间的方法造成慢性心理应激大鼠模型,所有药物灌胃给药。采用电化学高效液相色谱分析方法检测血浆和下丘脑DA、5-HT、E、NE含量。结果:应激大鼠血浆和下丘脑DA、5-HT含量明显降低(均P<0.01),血浆NE、E含量明显升高(均P<0.01),而下丘脑NE含量无明显变化。血浆5-HT/NE、5-HT/E及下丘脑5-HT/NE均明显降低(均P<0.01)。加味四逆散可以升高应激大鼠下丘脑和血浆中DA、5-HT含量(均P<0.01),并能降低血浆中NE、E含量(均P<0.01),升高下丘脑和血浆5-HT/NE以及血浆5-HT/E(P<0.05或P<0.01)。肾气丸、四君子汤及人参总皂甙虽然对有些指标有影响,但对心理应激的整体调节作用不如加味四逆散。结论:加味四逆散对慢性心理应激大鼠血浆和下丘脑单胺类神经递质的代谢紊乱均有良好的调节作用,调肝、补肾、健脾治法方药中以调肝治法方药的综合调治作用最为显著。

中药复方更年乐对更年期大鼠单胺类神经递质的影响

[目的]探讨补肾疏肝、调补冲任的中药复方更年乐对更年期大鼠单胺类神经递质的影响。[方法]选用11～15月龄雌性SD大鼠 ,按照SD大鼠自然更年期模型的要求 ,将其分为更年期模型组与治疗组 ,另选3月龄大鼠作为青年对照组 ,分别给予生理盐水和更年乐煎剂灌胃处理。检测指标采用高效液相色谱 -电化学法测定下丘脑单胺类神经递质 ,包括去甲肾上腺素 (NE)、多巴胺 (DA)、5-羟色胺 (5-HT)、5 -羟吲哚乙酸 (5 -HIAA)。[结果]更年乐可使模型组大鼠下丘脑升高的5-HT和5-HIAA含量明显下降 (P<0.01～P<0.05) ,使降低的NE含量回升(P<0.05) ,升高的5 -HT/NE比值降至接近青年组水平(P<0.01)。[结论]中药复方更年乐可以调节紊乱的单胺类神经递质水平 ,从而改善下丘脑的功能。

从肝论治高脂血症

中医认为,肝主疏泄,而主一身之气机,具有调畅气机、输布津气、疏脾助化之功。若肝疏泄正常则气之升降有序,出入调畅,津液输布,血液运行无碍,脾胃纳运功能亦正常。若肝失疏泄,则一身之气机皆滞,脂浊之积不可免矣。治以疏肝健脾、活血化瘀法,调肝健脾,注重脏腑相关的整体化治疗,疏通血脉,促进血脂转运及排泄。

调肝健脾补肾方药对反复心理应激大鼠的中枢调整作用

【目的】观察调肝、健脾、补肾方药及人参总皂甙对反复心理应激大鼠中枢的调整作用。【方法】大鼠随机分为6组:正常组、模型组、调肝组、健脾组、补肾组和人参总皂甙组。采用免疫组织化学法检测下丘脑酪氨酸羟化酶(TH)阳性细胞;采用OPA高效液相色谱分析法检测下丘脑、海马酪氨酸(Tyr)含量。【结果】模型组大鼠下丘脑弓状核和下丘脑腹内侧核TH阳性细胞明显增多(P<0.01);补肾组两核TH阳性细胞数量无明显变化;调肝组、健脾组和人参总皂甙组两核TH阳性细胞数量明显增加(P<0.01)。模型组下丘脑与海马Tyr无明显变化;调肝组、健脾组与人参总皂甙组下丘脑Tyr含量明显下降(P<0.01);补肾组与健脾组海马Tyr含量明显升高(P<0.01)。【结论】调肝、健脾方药以及人参总皂甙能增强应激大鼠中枢TH功能,进而增强机体应对应激的能力;而调肝、健脾、补肾方药及人参总皂甙对于调节反复心理应激反应具有共同的中枢机制。

加减归肾丸含药血清对卵巢颗粒细胞凋亡的影响

目的探讨补肾健脾、调肝活血中药加减归肾丸对卵巢颗粒细胞凋亡的影响。方法离体培养大鼠卵巢颗粒细胞,采用加减归肾丸含药血清进行刺激,以补肾健脾的滋肾育胎丸含药血清及尿促性素(HMG)为对照药,6h后流式细胞仪检测颗粒细胞的凋亡率,免疫荧光技术检测BCL-2蛋白的表达。结果加减归肾丸低剂量含药血清组颗粒细胞的凋亡率较其他各组低(P<0.05),加减归肾丸各剂量组颗粒细胞BCL-2蛋白表达与空白组相比有显著性差异(P<0.01),低剂量组与滋肾育胎丸各组相比有显著性差异(P<0.05)。结论具有补肾健脾、调肝活血作用的加减归肾丸含药血清能够抑制颗粒细胞凋亡。

疏肝调脾法与温脾补肾法序贯治疗腹泻型肠易激综合征肝郁脾虚证躯体症状的远期疗效评价

目的:观察评价疏肝调脾法与温脾补肾法序贯治疗腹泻型肠易激综合征肝郁脾虚证的远期疗效。方法:腹泻型肠易激综合征(D-IBS)肝郁脾虚证患者90例,按随机数字表法分为3组:匹维溴铵+蒙脱石散组(西药对照组)、疏肝调脾组与序贯治疗组,每组患者30例。西药对照组给予匹维溴铵50 mg+蒙脱石散3 g,每日3次,疗程8周;疏肝调脾组治予疏肝调脾方,疗程8周;序贯治疗组前4周治法同疏肝调脾组,后4周治予温脾补肾方。3组在治疗前进行腹痛与腹胀、腹泻评分,治疗结束时、结束后3、6、12个月再进行症状评分及单症状与综合疗效评价。结果:治疗结束时,3组腹痛与腹胀评分及腹泻评分均显著低于治疗前(P<0.01);序贯治疗组的腹痛与腹胀评分显著低于西药对照组(P<0.05);疏肝调脾组与序贯治疗组的腹泻评分显著低于西药对照组(P<0.05或P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为60.0%、93.3%、96.7%,具有显著性差异(P<0.01);治疗结束后3月,疏肝调脾组与序贯治疗组的腹痛与腹胀、腹泻评分显著低于治疗前及西药对照组(P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为13.3%、80.0%、86.7%,具有显著性差异(P<0.01);治疗结束后6月,疏肝调脾组与序贯治疗组的腹痛与腹胀、腹泻评分显著低于治疗前及西药对照组(P<0.05或P<0.01);序贯治疗组的腹痛与腹胀、腹泻评分显著均低于疏肝调脾组(P<0.05或P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为6.7%、43.3%、90.0%,具有显著性差异(P<0.01);治疗结束后12月,序贯治疗组的腹痛与腹胀、腹泻评分显著均低于治疗前、西药对照组及疏肝调脾组(P<0.01);西药对照组、疏肝调脾组与序贯治疗组的综合疗效总有效率分别为0、0、66.7%,具有显著性差异(P<0.01)。结论:疏肝调脾法与温脾补肾法序贯治疗腹泻型肠易激综合征肝郁脾虚证具有良好的改善躯体症状的远期疗效。

疏肝健脾法对考试前应激状态相关电位的影响

目的:探讨疏肝健脾的中药制剂对考试前应激状态的调理作用及机理。方法:选取12名参加2007年硕士研究生考试的大四学生,随机分成中药组和对照组,两组进行考试焦虑自评量表、POMS量表、事件相关电位ERP测定。结果:中药组与对照组相比,考试焦虑量表服药前与考试前的差值、考试前与考试后的差值有显著性差异,POSM量表的TMD计分服药前与考试前的差值有显著性差异、在Fz、Pz、CPz电极点的P300的潜伏期考试前与考试后的差值有显著性差异,对照组与中药组相关电位P300的振幅考试前、考试后组间及差值均没有显著性差异。结论:疏肝健脾的中药对考试前应激状态的焦虑与心境状态有一定的调理作用、对考试前应激状态的认知功能有一定调理作用,可以缩短事件相关电位(ERP)P300潜伏期在考试前后的差值。