Anti-hypersensitivity effects of Shu-jing-huo-xue-tang, a Chinese herbal medicine, in CCI-neuropathic rats

Mahuang Fuzi Xixin decoction: A potent analgesic for neuropathic pain targeting the NMDAR2B/CaMKIIα/ERK/CREB pathway

Neuropathic pain (NeP) is a condition charactesized by nervous system injury or dysfunction that affects a significant portion of the population. Current treatments are ineffective, highlighting the need for novel therapeutic approaches. Mahuang Fuzi Xixin decoction (MFXD) has shown promise for treating pain conditions in clinical practice; however, its potential against NeP and the underlying mechanisms remain unclear. This study identified 35 compounds in MFXD using ultra-high performance liquid chromatography coupled with high-resolution mass spectrometry (UHPLC-HRMS). The analgesic effects of MFXD on chronic constriction injury (CCI) rats were evaluated through the detection of mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL). The analgesic effects of MFXD in rats with chronic constriction injury (CCI) were evaluated by measuring the mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL). Low-dose MFXD (L-MFXD) group (4.8 g/kg) and high-dose MFXD (H-MFXD) group (9.6 g/kg) exhibited significantly higher MWT and TWL values than the CCI group on days 11 and 15 post-CCI surgery, substantiating the remarkable analgesic efficacy of MFXD. Network pharmacology analysis identified 58 key targets enriched in pathways such as long-term potentiation (LTP) and glutamatergic synapse. The MCODE algorithm further identified core targets with significant enrichment in LTP. Molecular docking revealed that mesaconitine, rosmarinic acid, and delgrandine from MFXD exhibited high binding affinity with NMDAR2B (-11 kcal/mol), CaMKIIα (-14.3 kcal/mol), and ERK (-10.8 kcal/mol). Western blot and immunofluorescence confirmed that H-MFXD significantly suppressed the phosphorylation levels of NMDAR2B, CaMKIIα, ERK, and CREB in the spinal cord tissue of CCI rats. In conclusion, this study demonstrates that MFXD possesses potent analgesic effects on NeP by suppressing the NMDAR2B/CaMKIIα/ERK/CREB signalling pathway. This study unlocks a path toward potentially revolutionising NeP treatment with MFXD, encouraging further research and clinical development.

Usage Patterns of Traditional Chinese Medicine for Patients with Bipolar Disorder: A Population-Based Study in Taiwan

BACKGROUND

Patients with bipolar disorder (BD) receive traditional Chinese medicine (TCM) for clinical needs unmet with psychotropic medications. However, the clinical characteristics of practices and outcomes of TCM in BD are not fully understood. This cohort study investigated the clinical characteristics, principal diagnoses, TCM interventions, and TCM prescriptions in patients with BD.

METHODS

Data for a total of 12,113 patients with BD between 1996 and 2013 were withdrawn from Taiwan's longitudinal health insurance database 2000 (LHID 2000). The chi-square test was used for categorical variables, and the independent t-test was used for continuous variables. A p-value less than 0.05 indicated significance.

RESULTS

One thousand three hundred nineteen patients who visited TCM clinics after the diagnosis of BD were in the TCM group, while those who never visited TCM were in the non-TCM group (n = 1053). Compared to the non-TCM group, patients in the TCM group had younger average age, a higher percentage of female individuals, more comorbidities of anxiety and alcohol use disorders, and higher mood stabilizer usage rates. The TCM group exhibited pain-related indications, including joint pain, myalgia, myositis, headache, and sleep disturbances. Corydalis yanhusuo and Shu-Jing-Huo-Xue-Tang were the most useful single herbs and herbal formulae.

CONCLUSIONS

Physicians need to be aware of the use of TCM in patients with BD.

Use of Chinese Herbal Medicine Was Related to Lower Risk of Osteoporotic Fracture in Sarcopenia Patients: Evidence from Population-Based Health Claims

Introduction

With population aging, sarcopenia and its accompanying risk of osteoporotic fracture has drawn increased attention. Nowadays, while Chinese herbal medicine (CHM) is often used as complementary therapy for many medical conditions, its effect against likelihood of osteoporotic fracture among sarcopenia subjects was not fully elucidated yet. We therefore conducted a population-level study to compare osteoporotic fracture risk for sarcopenia persons with or without CHM use.

Methods

Using the patient record from a nationwide insurance database, we recruited persons with newly diagnosed sarcopenia and simultaneously free of osteoporotic fracture between 2000 and 2010. Propensity score matching was then applied to randomly select sets of CHM users and non-CHM users. All of them were tracked until end of 2013 to measure the incidence and adjusted hazard ratios (HRs) for new new-onset fracture in multivariable Cox proportional hazards model.

Results

Compared to non-CHM users, the CHM users indeed had a lower incidence of osteoporotic fracture (121.22 vs 156.61 per 1000 person-years). Use of CHM correlated significantly with a lower fracture likelihood after adjusting for potential covariates, and those receiving CHM treatment for more than two years experienced a remarkably lower risk by 73%. Uses of several herbal formulae were correlated to reduced risk of osteoporotic fracture, such as Caulis Spatholobi, Xuduan, Duzhong, Danshen, Shu-Jing-Huo-Xue-Tang, Du-Huo-Ji-Sheng-Tang, Shao-Yao-Gan-Cao-Tang, and Shen-Tong-Zhu-Yu -Tang.

Conclusion

Our study depicted that cumulative CHM exposure was inversely associated with osteoporotic fracture risk in a duration-dependent manner, implying that CHM treatment may be embraced as routine care in preventing incident osteoporotic fracture.

Relationship between Chinese Herbal Medicine Use and Risk of Sjögren’s Syndrome in Patients with Rheumatoid Arthritis: A Retrospective, Population-Based, Nested Case-Control Study

Background and Objectives: Sjögren’s Syndrome (SS) is a common extra-articular feature among subjects with rheumatoid arthritis (RA). While Chinese herbal medicine (CHM) has been used to treat symptoms of RA for many years, few studies have examined its efficacy in guarding against the SS onset. This study aimed to compare risk of SS for RA patients with and without use of CHM. Materials and Methods: Data obtained for this nested case-control study were retrieved from Taiwanese nationwide insurance database from 2000–2013. Cases with SS claims were defined and matched to two randomly selected controls without SS from the recruited RA cohorts. Risk of SS in relation to CHM use was estimated by fitting multiple conditional logistic regression. Results: Patients aged between 20 and 80 years were included and 916 patients with incident SS were matched to 1832 non-SS controls by age, sex and index year. Among them, 28.1% and 48.4% cases ever received CHM therapy, respectively. After adjusting for baseline characteristics, CHM use was found to be related to a lower risk of SS among them (adjusted odds ratio = 0.40, 95% confidence interval: 0.34–0.47). A dose-dependent, reverse association, was further detected between the cumulative duration of CHM use and SS risk. Those receiving CHM therapy for more than 730 days showed a significantly reduced risk of SS by 83%. Conclusions: Findings of this study indicated that the add-on CHM formula, as part of RA care, may be a beneficial treatment for prevention against the incident SS.

The Prescription of Chinese Herbal Medicine and Risk of Endometriosis in Women with Rheumatoid Arthritis: A Population-Based Cohort Study

Purpose

The systemic inflammation is believed to provide an outline of the association between rheumatoid arthritis (RA) and endometriosis. This retrospective cohort study aimed to explore the association of Chinese herbal medicine (CHM) use with the prevention of endometriosis onset in women diagnosed with RA.

Methods

We utilized the claims data from the National Health Insurance of Taiwan from 2000 to 2009 and excluded individuals diagnosed with endometriosis before being diagnosed with RA, using age at clinical diagnosis. After selection and propensity-score matching, a total of 5992 females aged ≧20 years old and with newly diagnosed RA but without endometriosis at baseline were included, which contained 2996 CHM users and 2996 non-CHM users. All of them were followed until the end of 2013 to measure the incidence of endometriosis.

Results

During the study period, we noticed that CHM users had a substantially lower incidence of endometriosis compared to non-CHM users (2.54 vs 5.19 per 1000 person-years). Use of CHM correlated significantly with a lower endometriosis likelihood even after adjusting for potential covariates, with the adjusted hazard ratio of 0.47 (95% confidence interval, 0.35–0.65). A longer duration of CHM use was associated with a reduction in endometriosis risk, especially in those using CHM for more than 730 days. Uses of several herbal products may be associated with a lower risk of endometriosis, like Ge-Gen, Da-Huang, Huang-Qin, Ye-Jiao-Teng, Chuan-Niu-Xi, Shu-Jing-Huo-Xue-Tang, Du-Huo-Ji-Sheng-Tang, Ge-Gen-Tang, Shao-Yao-Gan-Cao-Tang, Ping-Wei-San, Gan-Lu-Yin, and Dang-Gui-Nian-Tong-Tang.

Conclusion

Taken together, adding CHM to conventional therapy may reduce the incidence of endometriosis in women with RA. The therapeutic mechanisms and safety of these natural products may be a direction for future clinical studies.

Chinese Herbal Medicine to Reduce Radiation-Induced Oral Mucositis in Head and Neck Cancer Patients: Evidence From Population-Based Health Claims

BACKGROUND

Subjects with head and neck cancer (HNC) often experience post-treatment side effects, particularly radiation-induced oral mucositis (RIOM). This study aimed to explore the association of Chinese herbal medicine use with the sequent risk of RIOM among them.

METHODS

This cohort study used a nationwide health insurance database to identify subjects newly diagnosed with HNC, aged 20 to 60 years, who received treatment between 2000 and 2007. Among them, a total of 561 cases received CHM after HNC onset (CHM users); the remaining 2395 cases were non-CHM users. All patients were followed to the end of 2012 to identify any treatment for RIOM as the end point. Cox proportional hazards regression was used to compute the adjusted hazard ratio (aHR) of RIOM by CHM use.

RESULTS

During the follow-up period, 183 CHM users and 989 non-CHM users developed RIOM at incidence rates of 40.98 and 57.91 per 1000 person-years, respectively. CHM users had a lower RIOM risk than the non-CHM users (aHR: 0.68; 95% Confidence Interval: 0.58-0.80). The most potent effect was observed in those taking CHM for more than 1 year. Use of Baizhi, Danshen, Shao-Yao-Gan-Cao-Tang, Gan-Lu-Yin, Huangqin, Shu-Jing-Huo-Xue-Tang, and Xin-Yi-Qing-Fei-Tang, was significantly related to a lower risk of RIOM.

CONCLUSION

Findings of this study indicated that adding CHM to conventional clinical care could be helpful in protecting those with HNC against the onset of RIOM. Further clinical and mechanistic studies are warranted.

Use of Chinese Herbal Medicines Is Related to a Reduction in Depression Risk Among Patients With Insomnia: A Matched Cohort Study

Objective: Subjects with insomnia have a higher risk of depression, thus possibly making them live with serious health conditions. To date, information regarding the effect of Chinese herbal medicines (CHMs), a commonly used complementary and alternative medicine, on depression risk among people with insomnia is still unknown. This study aimed to investigate the effect of CHMs on the risk of depression among individuals with insomnia.

Methods: This cohort study used a national health insurance database to identify 68,573 subjects newly diagnosed with insomnia, aged 20–70 years, who received treatment between 1998 and 2010. Using propensity score matching, we randomly selected 26,743 CHMs users and 26,743 non-CHMs users from this sample. All enrollees were followed to the end of 2012 to identify any treatment for depression as the end point. Cox proportional hazards regression was used to compute the adjusted hazard ratio of depression associated with CHMs use.

Results: After utilizing the propensity score matching, we randomly selected 26,743 CHMs users and 26,743 non-CHMs users from this sample. During follow up, 3,328 CHMs users and 6,988 non-CHMs users developed depression at incidence rates of 17.24 and 37.97 per 1,000 person-years, respectively. CHMs users had a lower depression risk than the non-CHMs users (adjusted hazard ratio = 0.44; 95% Confidence Interval, 0.42–0.46). The greatest effect was observed for those taking CHMs for more than 2 years. Gegen, Huangqin, Dan-Shen, Beimu, Dahuang, Shegan, Shu-jing-huo-xue-tang, Ge-gen-tang, Shao-yao-gan-cao-tang and Píng wèi sǎn were significantly associated with a lower risk of depression.

Conclusions: Findings from this study demonstrated that adding CHMs to conventional treatment significantly reduces depression risk among patients with insomnia.

Reduced Stroke Risk among Patients with Atrial Fibrillation Receiving Chinese Herbal Medicines Treatment: Analysis of Domestic Data in Taiwan

Background and objectives: Patients with atrial fibrillation (AF) reportedly have a much higher risk of death due to stroke. Faced with this heavy burden, it remains unclear if the Chinese herbal medicines (CHMs), the most common form complementary and alternative medicine, can lower the risk of stroke for them. This study aimed to evaluate the association of CHMs use with stroke risk among them. Materials and Methods: From a nationwide database, 11,456 AF patients aged ≧ 20 years between 1998 and 2007 were identified. Afterwards, we enrolled 2670 CHMs users and randomly selected 2670 non-CHMs users using the propensity score method. The occurrence of stroke was recorded until the end of 2012. Results: Within the follow-up period, 671 CHMs users and 900 non-CHMs users developed stroke, with incidence rates of 33.02 and 45.46 per 1000 person-years, respectively. CHMs use was associated with a 30% lower stroke risk, especially for those receiving CHMs for over two years. Conclusions: The findings of the present study suggest that adding CHMs to conventional therapy could decrease subsequent stroke risk for AF patients. It is also suggested that prospective randomized trials are needed to further clarify if the detected association revealed in this study supports a causal link, and to identify the specific CHMs that may be beneficial to AF patients.

Adjunctive Chinese Herbal Products Therapy Reduces the Risk of Ischemic Stroke Among Patients With Rheumatoid Arthritis

We performed a retrospective cohort study to investigate the association between the risk of ischemic stroke (IS) and the use of Chinese herbal products (CHP) in combination with western medicine (WM) among patients with rheumatoid arthritis (RA). The data were sourced from the registry for beneficiaries, inpatient and ambulatory care claims, and Registry for Catastrophic Illness from the National Health Insurance Research Database (NHIRD) in Taiwan between 1997 and 2011. Patients, who were newly diagnosed with RA between 1997 and 2010, were classified as the CHP group or non-CHP group depending on the presence of absence the adjunctive use of CHP following a diagnosis of RA. A total of 4,148 RA patients were in both the CHP and non-CHP groups after 1:1 matching. Patients in the CHP group had a significantly lower risk of IS compared to patients in the non-CHP group (adjusted hazard ratio [aHR], 0.67; 95% confidence interval [CI], 0.52-0.86). In the CHP group, patients who used CHP for more than 30 days had a lower risk of IS than their counterparts (aHR: 0.61, 95% CI: 0.40-0.91). Gui-Zhi-Shao-Yao-Zhi-Mu-Tang, Shu-Jin-Huo-Xie-Tang, and Du-Huo-Ji-Sheng-Tang might be associated with a lower risk of IS. Finally, the use of CHP in combination with WM was associated with a decreased risk of IS in patients with RA, especially among those who had used CHP for more than 30 days. A further randomized control trial is required to clarify the casual relationship between these results.

Association of Traditional Chinese Medicine Therapy with Risk of Total Hip Replacement in Patients with Nontraumatic Osteonecrosis of the Femoral Head: A Population-Based Cohort Study

Background

Osteonecrosis of the femoral head (ONFH) contributes to 45% of total hip replacements (THRs) annually in Taiwan. Nontraumatic ONFH (NONFH) is multifactorial; no effective Western medicine is available to delay the disease process. This population-based cohort study investigated the association of traditional Chinese medicine (TCM) therapy with risk of THR in patients with NONFH.

Methods

This retrospective study was conducted using claims data from all insured residents covered by the National Health Insurance from 2000 to 2010. We enrolled 1,680 newly diagnosed ONFH patients who had not undergone THR, before or within 6 months after diagnosis of ONFH; these patients did not exhibit hip fracture or dislocation before the endpoint. In total, 595 propensity score-matched pairs were selected from among 1,028 TCM users and 652 non-TCM users. The association between TCM use and risk of THR was analyzed using a Cox proportional hazard model. Kaplan-Meier and log rank tests were performed to plot the cumulative incidence of THR.

Results

The mean follow-up periods were 5.00 years and 3.57 years for TCM and non-TCM cohorts, respectively. Compared to the non-TCM cohort, the TCM cohort had fewer patients undergoing THR surgery (25.4% vs. 18.2%, adjusted hazard ratio: 0.60, p<0.0001). The risk of reduction was noted in the group aged 30–59 years (adjusted hazard ratio: 0.56, p<0.0001), but there was no association with gender nor socioeconomic status. There was a significantly lower cumulative incidence of THR in TCM users (p<0.0001). Shu-Jing-Huo-Xue-Tang and Yan Hu Suo were the most frequently prescribed formula and single herb, respectively.

Conclusions

NONFH patients using TCM had a lower risk of THR; the risk of reduction was noted in the group aged 30–59 years but was not associated with gender nor socioeconomic status. TCM might be useful in conservative treatment for NONFH.

Effects of Chinese Herbal Medicines on the Risk of Overall Mortality, Readmission, and Reoperation in Hip Fracture Patients

Hip fracture is a major public health concern, with high incidence rates in the elderly worldwide. Hip fractures are associated with increased medical costs, patient dependency on families, and higher rates of morbidity and mortality. Chinese herbal medicine (CHM) is typically characterized as cost-effective and suitable for long-term use with few side effects. To better understand the effects of CHM on hip fracture patients, we utilized a population-based database to investigate the demographic characteristics, cumulative incidence of overall mortality, readmission, reoperation, and patterns of CHM prescription. We found that CHM usage was associated with a lower risk of overall mortality [P = 0.0009; adjusted hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.30-0.73], readmission (P = 0.0345; adjusted HR: 0.67, 95% CI: 0.46-0.97), and reoperation (P = 0.0009; adjusted HR: 0.57, 95% CI: 0.40-0.79) after adjustment for age, type of hip fracture, surgical treatment type, and comorbidities. We also identified the herbal formulas, single herbs, and prescription patterns for the treatment of hip fracture by using association rule mining and network analysis. For hip fracture patients, the most common CHM coprescription pattern was Du-Zhong (DZ) → Xu-Duan (XD), followed by Du-Huo-Ji-Sheng-Tang (DHJST) → Shu-Jing-Huo-Xue-Tang (SJHXT), and Gu-Sui-Bu (GSB) → Xu-Duan (XD). Furthermore, XD was the core prescription, and DZ, GSB, SJHXT, and DHJST were important prescriptions located in cluster 1 of the prescription patterns. This study provides evidence for clinical CHM use as an adjunctive therapy that offers benefits to hip fracture patients.

An Investigation of the Prescription Patterns of Chinese Herbal Products for Chronic Glomerulonephritis Patients: A Hospital-Based Cross-Sectional Study

Chronic kidney disease (CKD) has a high incidence and prevalence worldwide, and chronic glomerulonephritis (CGN) is one of the main causes of CKD. Therefore, it is important to diagnose and treat CGN early. The purpose of this study is to analyze the prescription patterns and frequencies of Chinese herbal products (CHPs) for CGN by using a hospital-based database from the Chang Gung Memorial Hospital (CGMH), a large, tertiary hospital system in Taiwan, and to evaluate the safety and possible efficacy of CHPs by blood test. The International Classification of Disease Ninth Revision (ICD-9) code 582 was used to identify patients with CGN. From 2004 to 2015, a total of 54726 CHP prescriptions for CGN were provided. Association rule mining was used to analyze the prevalent of CHP combination patterns in treating CGN. Jia-Wei-Xiao-Yao-San (JWXYS) and Gorgon (Euryale feroxSalisb.) were the most frequently prescribed herbal formula (HF) and single herb (SH), respectively. The most frequently prescribed combination of CHPs was that of JWXYS with Bu-Yang-Huan-Wu-Tang (BYHWT) in CGMH. In statistical, the level of eGFR in Stage 3a and 3b group was increasing after treatment in 6 and 12 months and might not cause the renal function to worsen within 12-month treatments. To the best of our knowledge, this is the first pharmacoepidemiological study to review CHP treatments for CGN. However, additional studies and clinical trials are needed to provide data on the safety and efficacy of these CHPs.

Characteristics of Chinese herbal medicine usage in ischemic heart disease patients among type 2 diabetes and their protection against hydrogen peroxide-mediated apoptosis in H9C2 cardiomyoblasts

Evidence for long-term use of Chinese herbal medicine (CHM) as an adjuvant treatment in patients with type 2 diabetes (T2D) remains limited. This study aimed to assess the frequency of use, utilization patterns, and therapeutic effects of adjuvant CHM for ischemic heart disease (IHD) in patients with T2D in Taiwan. We identified 4620 IHD patients with T2D. After matching for age, gender, and insulin use, 988 subjects each were allocated to a CHM group and a non-CHM group. There were no differences in baseline characteristics except for comorbidities. The CHM group contained more cases with chronic obstructive pulmonary disease, hepatitis, ulcer disease, and hyperlipidemia. The cumulative survival probability was higher in CHM users than in matched non-CHM users aged 60 years or older (P < .0001, log rank test) regardless of gender (P = .0046 for men, P = .0010 for women, log rank test). Among the top 12 CHM combinations, Shu-Jing-Huo-Xue-Tang and Shao-Yao-Gan-Cao-Tang (13.6%) were the most common. This dual combination improved antiapoptotic activity in H₂O₂-exposed H9C2 cells by enhancing phosphorylation of glycogen synthase kinase-3β and p38 mitogen-activated protein kinase and could increase the survival of myocardial cells. Our study suggests that adjuvant CHM therapy may increase the survival probability and provides a comprehensive list for future investigations of the safety and efficacy of CHM for IHD patients with T2D.

Effects of Chinese herbal medicines on the occurrence of diabetic retinopathy in type 2 diabetes patients and protection of ARPE-19 retina cells by inhibiting oxidative stress

Diabetic retinopathy is a microvascular complication of type 2 diabetes and the leading cause of acquired blindness. In Taiwan, Chinese herbal medicine (CHM) is a popular adjunctive therapy. In this study, we investigated the CHM prescription patterns and their effects. We identified 23,701 subjects with type 2 diabetes in a database, and after matching for age and gender, 6,948 patients each were assigned to CHM and non-CHM groups. In the female subgroups, the cumulative retinopathy probability was lower for the CHM users than that for the CHM non-users (P < 0.001, log-rank test). Among the top 10 CHMs, Jia-Wei-Xiao-Yao-San (JWXYS; 52.9%), Shu-Jing-Huo-Xue-Tang (SJHXT; 45.1%), and Ge-Gen-Tang (GGT; 43.7%) were the most common herbal formulas. Yan-Hu-Suo (48.1%), Ge-Gen (42.1%), and Huang-Qin (HQin; 40.1%) were the most common single herbs. CHM network analysis showed that JWXYS was the core CHM of cluster 1. JWXYS, DS, XF, and SZRT exhibited both of the reductions of H₂O₂-induced phosphorylation of p38 MAPK and p44/42 MAPK (Erk1/2) in human ARPE-19 retina cells. In cluster 2, SJHXT was the core CHM. SJHXT and NX showed both of the phosphorylation reductions. In cluster 3, GGT was the core CHM, and it reduced the phosphorylation of both MAPKs. In cluster 4, HQin was the core CHM, and it also reduced the phosphorylation of both MAPKs. Our study suggests that adjunctive CHM therapy may reduce diabetic retinopathy via antioxidant activity of the herbs and provides information on core CHM treatments for further scientific investigations or therapeutic interventions.

Effect of Chinese herbal medicine on stroke patients with type 2 diabetes

ETHNOPHARMACOLOGICAL RELEVANCE

Complications of type 2 diabetes (T2D) include stroke, which is a cerebrovascular disturbance characterized by reduced blood flow in the brain, leading to death or physical disability. Chinese herbal medicine (CHM) has been widely used in ancient China for the treatment of diabetes and stroke by supplementing Qi and activating blood circulation.

AIM OF THE STUDY

This study aimed to investigate the frequencies and patterns of CHM treatment for stroke patients with T2D and the outcomes of long-term use in Taiwan.

MATERIALS AND METHODS

We identified 3079 stroke patients (ICD-9-CM: 430-438) with T2D. We allocated 618 stroke patients, matched for age, gender, and T2D-to-stroke duration, to both CHM and non-CHM groups. Chi-square test, conditional multivariable logistic regression, Kaplan-Meier method, and the log-rank test were used in this study.

RESULTS

The CHM group was characterized by more cases of chronic obstructive pulmonary disease, ulcer disease, hyperlipidemia, tobacco use, and higher income. The cumulative survival probability was higher in the CHM group (P<0.001, log rank test); after adjusting for comorbidities, income, and urbanization level, this group also exhibited a lower mortality hazard ratio (0.37, 95% confidence interval [0.25-0.55]). Shu-Jing-Huo-Xue-Tang, Xue-Fu-Zhu-Yu-Tang, and Du-Huo-Ji-Sheng-Tang; and Dan-Shen, Niu-Xi, and Yan-Hu-Suo represented the top three formulas and herbs, respectively.

CONCLUSION

The use of CHM as adjunctive therapy may improve the overall survival (OS) of stroke patients with T2D. The list of the comprehensive herbal medicines that they used might be useful in future large-scale, randomized clinical investigations of agent effectiveness, safety, and potential interactions with conventional treatments in stroke patients with T2D.

Characteristics of traditional Chinese medicine usage in patients with stroke in Taiwan: A nationwide population-based study

ETHNOPHARMACOLOGICAL RELEVANCE

Stroke has been the leading causes of death worldwide. Traditional Chinese medicine (TCM) has been used for stoke patients for thousands of years. This study aimed to investigate TCM usage and prescription patterns in stroke patients in Taiwan.

MATERIALS AND METHODS

We analyzed a random sample of one million individuals representing the 23 million enrollees selected from the National Health Insurance Research Database in Taiwan. Demographic characteristics, TCM usage, prescription patterns and mortality rate among stroke patients were analyzed.

RESULTS

We identified 23,816 patients who were newly diagnosed with stroke between 2001 and 2009 by their diagnostic codes (ICD-9-CM 430-438). Among them, 4302 patients had hemorrhagic stroke while 19,514 patients had ischemic stroke. Overall, 12% of the stroke patients (n=2862) were TCM users. The median interval between stroke onset to the first TCM consultation is 12.2 months. Among the TCM users, more than half (52.7%) of the patients received both Chinese herbal remedies and acupuncture/traumatology treatment. Bu-yang-huan-wu-tang and Dan-shen (Radix Salviae Miltiorrhizae; Salvia miltiorrhiza Bunge) was the most commonly prescribed Chinese herbal formula and single herb, respectively. TCM users had a higher incidence rate ratio in myalgia, myositis, fasciitis and insomnia than non-TCM users. Mental disorders such as anxiety and depression are common in both TCM and non-TCM users. Comparing with the non-TCM users, the TCM users had a lower mortality rate (adjusted hazard ratios were 0.44 in overall stroke, 0.50 in ischemic stroke and 0.25 in hemorrhagic stroke).

CONCLUSION

Adjunctive TCM use may reduce the risk of mortality rate among stroke patients. Bu-yang-huan-wu-tang and Dan-shen are the most common prescribed Chinese herbal formula and single herb for stroke patients, respectively. Future study investigating the anti-inflammatory and neuroprotective efficacy of Bu-yang-huan-wu-tang and Dan-shen in stroke is warranted.

Prescription patterns of Chinese herbal products for patients with fractures in Taiwan: A nationwide population-based study

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional Chinese medicine (TCM) has been used in the treatment of fracture for thousands of years. However, large-scale surveys examing the utilization of Chinese herbal products (CHPs) for treating fractures and their related symptoms are lacking. This study aimed to investigate the prescription patterns of CHPs among patients with fractures in Taiwan.

MATERIALS AND METHODS

The TCM usage in patients with fractures was analyzed using a sample of one million individuals randomly selected from the National Health Insurance Research Database who were newly diagnosis with fractures in 2001-2008, with a followed-up period through 2010.

RESULTS

We identified 115,327 patients who were newly diagnosed with fractures in the study population. Among them, 4.97% (n=5731) adjunctively utilized TCM for fracture treatment. TCM users were mostly young or middle-aged, female, and resided in highly urbanized areas. With regard to the comorbidities of fractures, TCM users had a lower prevalence of coronary artery disease, chronic obstructive lung disease, diabetes mellitus, hypertension and stroke than non-TCM users, except for osteoporosis. Shu-jing-huo-xue-tang was the most frequently prescribed Chinese herbal formula, while Rhizoma Drynariae (Gu-sui-bu) was the most common single herb for patients with fractures. The CHPs were found to cover not only bone healing but also fracture-related symptoms. TCM users had lower medical expenditure for hospitalization for the first six months after incident fractures than non-TCM users (1749±2650 versus 2274±3159 US dollars, p<0.0001).

CONCLUSIONS

Our study identified the TCM utilization for patients with fractures in Taiwan. Integration of TCM treatment reduced the medical costs for hospitalization. Further basic research and clinical studies to investigate the mechanism and clinical efficacies of CHPs are warranted.

Icariin promotes angiogenic differentiation and prevents oxidative stress-induced autophagy in endothelial progenitor cells

Reduced tissue levels of endothelial progenitor cells (EPCs) and functional impairment of endothelium are frequently observed in patients with diabetes and cardiovascular disease. The vascular endothelium is specifically sensitive to oxidative stress, and this is one of the mechanisms that causes widespread endothelial dysfunction in most cardiovascular diseases and disorders. Hence attention has increasingly been paid to enhance mobilization and differentiation of EPCs for therapeutic purposes. The aim of this study was to investigate whether Icariin, a natural bioactive component known from traditional Chinese Medicine, can induce angiogenic differentiation and inhibit oxidative stress-induced cell dysfunction in bone marrow-derived EPCs (BM-EPCs), and, if so, through what mechanisms. We observed that treatment of BM-EPCs with Icariin significantly promoted cell migration and capillary tube formation, substantially abrogated hydrogen peroxide (H2 O2 )-induced apoptotic and autophagic programmed cell death that was linked to the reduced intracellular reactive oxygen species levels and restored mitochondrial membrane potential. Icariin downregulated endothelial nitric oxide synthase 3, as well as nicotinamide-adenine dinucleotide phosphate-oxidase expression upon H2 O2 induction. These antiapoptotic and antiautophagic effects of Icariin are possibly mediated by restoring the loss of mammalian target of rapamycin /p70S6K/4EBP1 phosphorylation as well as attenuation of ATF2 and ERK1/2 protein levels after H2 O2 treatment. In summary, favorable modulation of the angiogenesis and redox states in BM-EPCs make Icariin a promising proangiogenic agent both enhancing vasculogenesis and protecting against endothelial dysfunction.

Salidroside exerts angiogenic and cytoprotective effects on human bone marrow-derived endothelial progenitor cells via Akt/mTOR/p70S6K and MAPK signalling pathways

BACKGROUND AND PURPOSE

With the increase of age, increased susceptibility to apoptosis and senescence may contribute to proliferative and functional impairment of endothelial progenitor cells (EPCs). The aim of this study was to investigate whether salidroside (SAL) can induce angiogenic differentiation and inhibit oxidative stress-induced apoptosis in bone marrow-derived EPCs (BM-EPCs), and if so, through what mechanism.

EXPERIMENTAL APPROACH

BM-EPCs were isolated and treated with different concentrations of SAL for up to 4 days. Cell proliferation, migration and tube formation ability were detected by DNA content quantification, transwell assay and Matrigel-based angiogenesis assay. Gene and protein expression were assessed by qRT-PCR and Western blot respectively.

KEY RESULTS

Treatment with SAL promoted cellular proliferation and angiogenic differentiation of BM-EPCs, and increased VEGF and NO secretion, which in turn mediated the enhanced angiogenic differentiation of BM-EPCs. Furthermore, SAL significantly attenuated hydrogen peroxide (H₂O₂)-induced cell apoptosis, reduced the intracellular level of reactive oxygen species and restored the mitochondrial membrane potential of BM-EPCs. Moreover, SAL stimulated the phosphorylation of Akt, mammalian target of rapamycin and p70 S6 kinase, as well as ERK1/2, which is associated with cell migration and capillary tube formation. Additionally, SAL reversed the phosphorylation of JNK and p38 MAPK induced by H₂O₂ and suppressed the changes in the Bax/Bcl-xL ratio observed after stimulation with H₂O₂.

CONCLUSIONS AND IMPLICATIONS

These findings identify novel mechanisms that regulate EPC function and suggest that SAL has therapeutic potential as a new agent to enhance vasculogenesis as well as protect against oxidative endothelial injury.

Ethanol extract of Peperomia pellucida (Piperaceae) promotes fracture healing by an anabolic effect on osteoblasts

ETHNOPHARMACOLOGICAL RELEVANCE

The whole plant or some part of Peperomia pellucida (L.) HBK is used in some parts of Cameroon as a treatment for fracture healing.

AIM OF THE STUDY

To evaluate the effect of ethanolic extracts of Peperomia pellucida (L.), a Cameroonian medicinal plant on bone regeneration following bone and marrow injury, and determine the mode of action.

MATERIALS AND METHODS

Ethanol extract of Peperomia pellucida was administered at 100 and 200mg/kg doses orally to adult female Sprague-Dawley rats having a drill hole injury (0.8mm) in the femur diaphysis. Vehicle (gum-acacia in distilled water) was given to the control group. After 12 days of treatment, animals were euthanized and femur bones collected. Confocal microscopy of calcein labeling at the drill hole site was performed to evaluate bone regeneration. 3-D microarchitecture of drill hole site was analyzed by micorocomputed tomography. Osteogenic effects of the extract were evaluated by assessing mineralized nodule formation of bone marrow stromal cells and expression of osteogenic genes (mRNA level of type-1 collagen, bone morphogenetic protein-2 and osteocalcin genes) in the femur.

RESULTS

Ethanol extract from Peperomia Pellucida (L.) dose-dependently induced bone regeneration at the fracture site. At 200mg/kg dose, the extract significantly increased mineral deposition compared to controls. The extract also improved microarchitecture of the regenerating bone evident from increased bone volume fraction, trabecular thickness, trabecular number, and decreased trabecular separation and structure model index. In addition, the extract increased the formation of mineralized nodules from the bone marrow stromal cells. Furthermore, the extract induced the expression of osteogenic genes in the femur including type 1 collagen, osteocalcin and BMP-2, compared to control.

CONCLUSION

Ethanolic extract of P. pellucid (L.) accelerates fracture repair in rats via stimulatory effects on osteoblast differentiation and mineralization, thereby justifying its traditional use.

Synergistic interaction between total glucosides and total flavonoids on chronic constriction injury induced neuropathic pain in rats

CONTEXT

Shaoyao Gancao Decoction (SGD), a famous herbal medicine, consists of two herbs (Paeoniae Radix and Glycyrrhizae Radix) and is traditionally used for the treatment of pain.

OBJECTIVE

To investigate the synergistic potential of total glucosides of Paeoniae Radix (TGP) and total flavonoids of Glycyrrhizae Radix (TFL).

MATERIALS AND METHODS

Oral administration of TGP and TFL alone at the doses of 60,120 and 240 mg/kg or in combination were given only one time to the neuropathic pain rat induced by chronic constriction injury. Paw pressure and heat immersion tests were performed to assess degrees of mechanical allodynia and thermal hyperalgesia, respectively. Synergistic interactions between TGP and TFL were characterized using isobolographic analysis. Expressions of Sirt1 protein were detected by immunohistochemistry.

RESULTS AND DISCUSSION

On day 14 after surgery, single oral administration of TGP and TFL both produced significant anti-allodynic and anti-hyperalgesic effects in dose-dependent and time-dependent manners. The ED(50) value of TGP was 249.4 ± 10.8 mg/kg while TFL was 871.4 ± 30.5 mg/kg. Isobolographic analysis revealed that the combination of TGP with TFL at the fixed ratios of 3:1 exerted the highest sub-additive (synergistic) interaction, of which the experimental ED(50) value was 95.1 ± 9.0 mg/kg. SGD could also downregulate Sirt1 protein expression, which was 4.2-fold higher than that of model rats in dorsal root ganglion.

CONCLUSION

Analgesic effects of SGD may contribute to simultaneous inhibition of Sirt1 overexpression and could warrant further evaluation as a possible agent for the treatment of neuropathic pain.

Comparative effectiveness in pain-related outcomes and health care utilizations between veterans with major depressive disorder treated with duloxetine and other antidepressants: a retrospective propensity score-matched comparison

OBJECTIVES

This study aimed to compare pain-related outcomes and health care utilization among patients with major depressive disorder (MDD) treated with duloxetine versus other antidepressants in the Veterans Health Administration (VHA).

METHODS

Patients initiating duloxetine or other antidepressants between October 1, 2005, and October 1, 2008 were extracted from the Veterans Integrated Service Network (VISN) 16 data warehouse. All patients included had at least 1 MDD diagnosis (ICD-9-CM: 296.2 or 296.3) and continuous eligibility in the 12 months prior to the initiation. Patients with prior diabetes (ICD-9-CM: 250.xx), schizophrenia (295.xx), or bipolar disorder (ICD-9-CM: 296.4x-296.8x) diagnosis were excluded. Duloxetine and nonduloxetine patients were matched via propensity scoring (1:1 ratio). Opioid use patterns, diagnosed substance abuse, self-reported pain score, and health care utilization over the 12-month postindex period were compared between cohorts.

RESULTS

Compared with duloxetine-treated patients (N = 439), nonduloxetine-treated patients (N = 439) during the postindex period had more opioid scripts (4.8 vs. 3.6, P = 0.002), longer use of opioid (133 vs. 100 days, P = 0.004), and a higher prevalence of substance abuse (41.00% vs. 23.69%, P < 0.001). Nonduloxetine-treated group had 12.0 more outpatient visits (41.8 vs. 29.8, P < 0.0001), 0.16 more hospital admissions (0.32 vs. 0.16, P = 0.001), and 2.36 more hospital days (3.37 vs. 1.01, P= 0.005). Additionally, nonduloxetine-treated patients were more likely to be hospitalized (17.8% vs. 10.9%, P = 0.004) over the postindex period.

CONCLUSION

Controlling for cross-cohort differences, veterans with MDD treated with duloxetine were associated with lower risks of opioid use and substance abuse and lower health care utilization than those treated with other antidepressants. ▪