Association between skin reactions and efficacy of summer acupoint application treatment on chronic pulmonary disease: A prospective study

Sinapis Semen: A review on phytochemistry, pharmacology, toxicity, analytical methods and pharmacokinetics

Sinapis Semen (SS), the dried mature seed of Sinapis alba L. and Brassica juncea (L.) Czern. et Coss., is one of the traditional Chinese medicinal materials with a wide range of pharmacological effects being used for asthma, cough and many other ailments. SS is also widely used in food agriculture, medicine and other industries in North America and South Asia. More recently, the research on SS has gradually intensified and increased. However, there is no systematic review of SS. In this review, through literature exploration and analysis, the research advance on phytochemistry, pharmacology, toxicity, analytical methods and pharmacokinetics of SS was aggregated initially. Total 144 compounds have been isolated and identified from SS. Among them, glucosinolates and their hydrolysates and volatile oils are the main active ingredients and important chemical classification markers. SS has a wide range of pharmacological effects, especially in cough suppressing, asthma calming, anti-inflammatory, neuroprotective, cardiovascular protective, inhibiting androgenic effects, anti-tumor, and skin permeation promoting effects. Sinapine and sinapic acid are the main active ingredients of SS for its medicinal effects. However, SS has a strong skin irritation, presumably related to the time of application, the method of processing, and original medicinal plants. This review will provide useful data for the follow-up research and safe and reasonable clinical application of SS.

Effects of acupoint herbal patching as an add-on to asthma medication during Sanfu days, as the hottest days in summer, on the acute attack, the immunological response, and the pulmonary function in asthmatic children: A meta-analysis

BACKGROUND

A meta-analysis was performed to evaluate the effect of acupoint herbal patching as an add-on to asthma medication during Sanfu days, as the hottest days in summer, on the acute attack, immunological response, and the pulmonary function in asthmatic children.

METHODS

A systematic literature search up to July 2021 was performed and 13 studies included 1166 asthmatic children at the start of the study; 587 of them were using acupoint herbal patching as an add-on to asthma medication during Sanfu days and 579 were given asthma medication only.

RESULTS

Acupoint herbal patching as add-on to asthma medication had significantly lower frequency of acute attack (mean difference [MD], -1.57; 95% confidence interval [CI], -2.28 to -0.85, P < .001), lower asthma relapse (odds ratio, 0.13; 95% CI, 0.04-0.43, P < .001), and higher forced expiratory volume in 1 second (MD, 1.72; 95% CI, 0.89-2.65, P < .001), higher peak expiratory flow rate (MD, 1.15; 95% CI, 0.37-1.93, P = .004), lower immunoglobulin E after treatment (MD, -123.81; 95% CI, -185.60 to -62.02, P < .001), and higher interferon-gamma after treatment (MD, 7.17; 95% CI, 2.42-11.92, P = .003) compared to asthma medication only in asthmatic children.

CONCLUSIONS

Acupoint herbal patching as an add-on to asthma medication during Sanfu days had a significantly lower frequency of acute attack, lower asthma relapse, higher forced expiratory volume in 1 second, higher peak expiratory flow rate, and higher interferon-gamma after treatment in asthmatic children compared to asthma medication only in asthmatic children.

Transdermal delivery of sinapine thiocyanate by gelatin microspheres and hyaluronic acid microneedles for allergic asthma in guinea pigs

Dissolving microneedles (MNs) are an efficient, safe, and generally painless method for transdermal distribution of poorly permeable medicines. Here, dissolving composite MNs were prepared from sinapine thiocyanate (ST)-loaded gelatin microspheres (GMS) and hyaluronic acid (HA). To immobilize ST in MNs, we used a two-step centrifuging and molding method. When ST-GMS/ST-HA MNs were placed on the skin, they showed extraordinary mechanical strength and dissolved slowly. In vitro, skin implantation ability was assessed with fluorescein isothiocyanate staining, which revealed progressive penetration from the puncture site into deeper tissues. The feasibility of transdermal delivery of ST-GMS/ST-HA MNs in allergic asthma guinea pigs was then determined through in vivo pharmacodynamic and pharmacokinetic tests. The results indicated that ST-GMS/ST-HA MNs, in comparison with the traditional subcutaneous application approach, achieved both high efficiency and continuous release of ST. Therefore, this device is promising for the delivery ST for allergic asthma therapy.

Efficacy of Chinese Medicine Acupoint Application Combined with Montelukast on Children with Perennial Allergic Rhinitis: A Randomized Controlled Trial

OBJECTIVE

To evaluate the efficacy of Chinese medicine acupoint application (CMAA) combined with Western medicine for perennial allergic rhinitis (PAR) in children.

METHODS

In this prospective, parallel, randomized, placebo-controlled and single-blind trial from August to September, 2017, 180 children with PAR were randomly assigned to an integrative group (CMAA and Montelukast), CMAA group (CMAA and placebo tablet), or Montelukast group (placebo CMAA and Montelukast). Participants were applied with CMAA for 6 sessions over 2 weeks, and/or Montelukast Chewable Tablet orally once daily for 12 weeks. The changes in severity of symptoms were measured by Visual Analog Scale (VAS) and rhinitis control assessment test (RCAT) at 0, 2, 4 and 12 weeks of treatment. Blood samples were collected for serum interleukin-4, interferon gamma γ and T helper type 1 (Th1)/Th2 flow cytometric analysis at the time points of 0, 4 and 12 weeks.

RESULTS

Eight cases dropped out from the trial, 3 in the integrative group, 2 in the CMAA group and 3 in the Montelukast group. The VAS scores decreased significantly while the RCAT scores increased significantly in all three groups at 4 and 12 weeks compared with baseline (P<0.01 or P<0.05). The VAS scores were significantly lower while the RCAT scores were significantly higher in the integrative and CMAA groups than the Montelukast group at 2 and 4 weeks (P<0.01 or P<0.05). At 2, 4 and 12 weeks, the scores of nasal congestion, sneezing, sleep problem, and rhinitis symptom control in the integrative and CMAA groups increased significantly compared with baseline (P<0.01 or P<0.05). The least percentages of Th2 and the most alleviated Th2 shift (highest Th1/Th2) were observed in the integrative group at 12 weeks compared with the other two groups (P<0.05).

CONCLUSION

The combination of CMAA with Montelukast might be more effective and appropriate than either option alone for children with PAR. (Registered at Chinese Clinical Trial Register, registration No. ChiCTR-IOR-17012434).

Acupoint herbal patching during Sanfu Days on reducing frequency of acute asthma attack in children: A systematic review and meta-analysis

OBJECTIVE

Acupoint herbal patching (AHP) is an external therapy of Traditional Chinese Medicine. This systematic review and meta-analysis sought to evaluate whether AHP during Sanfu Days has additional benefits in children with asthma.

METHODS

A comprehensively electronic literature search was performed in the Cochrane Library, PubMed, Embase, CNKI, VIP, and WanFang databases from their inception to March 2019. Randomized controlled trials that evaluated the AHP during Sanfu Days treatment for pediatric asthma were included. The main outcome measures were frequency of acute asthma attack, relapse of asthma, and pulmonary function.

RESULTS

Eleven trials involving 882 children with asthma were identified. White mustard seed, rhizoma corydalis, and radix kansui were the most frequently used herbs. Adjunctive treatment with AHP significantly reduced the frequency of acute asthma attack (mean difference [MD] -1.62 times/year; 95% confidence intervals [CI] -2.13 to -1.11). Moreover, AHP improved the peak expiratory flow (standardized mean differences [SMD] 0.61; 95% CI 0.39-0.82) and forced expiratory volume in 1 s (SMD 0.48; 95% CI 0.31-0.66).

CONCLUSIONS

Application of AHP during Sanfu Days has additional benefits in reducing the frequency of acute attack and improving pulmonary function in children with asthma. However, the current findings should be interpreted with caution owing to the methodological flaws of the analyzed trials.

Mechanisms of white mustard seed (Sinapis alba L.) volatile oils as transdermal penetration enhancers

We investigated the transdermal drug permeation enhancement properties and associated mechanisms of white mustard (Sinapis alba L.) seed volatile oil (SVO). Using gas chromatography-mass spectrometry, we showed that SVO was composed primarily of allylisothiocyanate and isothiocyanatocyclopropane. Compared with azone, SVO had better penetration-enhancing effects on three model drugs (5-Fluorouracil, Osthole, and Paeonol), with each having different oil-water partition coefficients. Histopathology showed that SVO did not induce skin irritation when the concentration was lower than 2% (v/v), and it induced less irritation than azone. According to attenuated total reflection-Fourier transform infrared spectroscopy and transmission electron microscopy, SVO induced skin lipid structural disorder and increased the distance between the stratum corneum, which is beneficial to the penetration of drugs. Cellular experiments showed that SVO inhibited Ca²⁺-ATPase activity, increased intracellular Ca²⁺ concentration, and changed the membrane potential in HaCaT cells, which promoted drug transfer into the skin. Our findings reveal that SVO is a safe and efficient natural product that has great potential as skin penetration enhancer.

Acupoint herbal plaster for patients with primary dysmenorrhea: study protocol for a randomized controlled trial

BACKGROUND

Primary dysmenorrhea (PD), is one of main gynecological complaints in women of child-bearing age. Common medications for PD do not always achieve satisfactory outcome of pain relief. Hence, both health professionals and patients are seeking help from complementary and alternative medicine. The acupoint herbal plaster (AHP), which appears to be a safe and effective way to alleviate menstrual pain, as well as to improve other PD-related symptoms. Despite similar clinical studies for this condition in the past, no high-quality methodology-based clinical trial has been reported to date. The current study aims to assess the efficacy of the AHP compared with the acupoint placebo plaster (APP) and being placed on a waiting-list control group in patients with primary dysmenorrhea.

METHODS/DESIGN

This study is a randomized, single-center, placebo-controlled clinical trial. A total of 180 women with PD will be included and randomly allocated to the AHP, APP and waiting-list (WL) groups in a 1:1:1 ratio. Patients in the AHP group will be provided with herbal plasters (Shaofuzhuyu decoction) on various acupoints: Shenque (CV8), Guanyuan (CV4), Qihai (CV5), Ciliao (BL32) and Zigong (EX-CA1). Women in the APP group will receive placebo plasters on the same acupoints, and no intervention will be given to the WL group until completion of the study. The primary outcome will be pain intensity reduction measured by a Visual Analog Scale (VAS), with other outcome measurements including the Cox Menstrual Symptom Scale (CMSS), the 12-Item Short Form Health Survey (SF-12) and the Participant Global Impression of Change (PGIC). All assessments will be performed at baseline, each menstrual cycle during the treatment course and the follow-up course. Any adverse events will be recorded throughout the study.

DISCUSSION

This is the first study to compare the changes in menstrual pain after three different interventions: the active intervention (AHP), the placebo intervention (APP), and a period of no intervention (WL). This three-arm randomized controlled trial (RCT) aims to investigate the relative contributions of the specific (AHP vs. APP) and non-specific (APP vs. WL) effects to the overall clinical effects of the active AHP on women with PDM. The scientific and rigorous methodology design of this trial should gather good evidence to assess the curative effects and safety of the AHP on PD. Moreover, the results of this study may provide evidence-based references for the treatment of menstrual pain in future.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ID: ChiCTR-TRC-16008701. Registered on 22 July 2016.

In Vivo Study on Site of Action of Sinapine Thiocyanate following Acupoint Herbal Patching

Objective. To investigate the site of action of sinapine thiocyanate (ST), following acupoint herbal patching (AHP). Methods. Twenty Wistar rats were randomized into five groups (groups A, B, C, D, and E), and all groups received the same AHP in vivo. Skin samples were excised at 2 h, 4 h, 6 h, 10 h, and 26 h after AHP administration from group A to group E separately and the concentrations of ST in the skin were determined using a liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) method. A pharmacokinetic profile of ST following AHP was performed at the same time in a group of five Wistar rats to detect plasma levels at the same time intervals. Results. The mean ± SD ST concentrations (ng/ml) at 2 h (group A), 4 h (group B), 6 h (group C), 10 h (group D), and 26 h (group E) after AHP administration were 250.01±61.99, 61.01±30.41, 40.12±26.94, 78.66±59.43, and 19.55±18.95, respectively. No ST was detected in rats’ plasma samples at the same time points. Conclusions. The site of action of ST following AHP is in the skin.