Traditional Chinese Medicine Offers New Option for IBS Patients

Tiejun Tang

Today, April 19th, is the World IBS Day. Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that causes chronic abdominal pain, bloating, diarrhea, and constipation. According to a pooled prevalence analysis of 53 studies that used Rome III criteria from 38 countries and involved 395,385 participants, the prevalence of IBS was 9.2%, with a higher prevalence in women than in men (12.0% vs. 8.6%) ^[1].

In 2017, I wrote an article titled "How to Treat IBS with Chinese Herbal Medicine and Acupuncture?" (click to read the full text). Since then, more research progress has been made on this topic. This paper is an update discussing of the the recent advancements in the treatment of IBS with traditional Chinese medicine.

Although Western medicine has made progress in treating IBS for the past years, there are still some challenges. The National Institute for Health and Care Excellence (NICE) recommends dietary changes, symptomatic treatment, tricyclic antidepressants (TCAs), and psychotherapy for IBS treatment. However, TCAs are associated with reported side effects of up to 15 symptoms, including severe symptoms such as headache, epilepsy, sexual dysfunction, and weight gain. As a result, many IBS patients may have to deal with persistent symptoms or suffer from the side effects of TCAs. ^[2]

According to the basic theory of traditional Chinese medicine, IBS is mainly caused by the imbalance of liver and spleen. Liver qi stagnation and spleen deficiency are the primary pathologies of IBS. This dissonance can lead to digestive dysfunction, which leads to the symptoms of IBS ^[3]. TCM offers a holistic approach to treating IBS by addressing underlying imbalances in the body. Common Chinese treatments for IBS include herbs, acupuncture, and moxibustion can ease the conditions.

Tongxie Yaofang, a traditional formula that originated in the Ming Dynasty of China, is a common formula for treating IBS. A research report showed it can effectively improve intestinal permeability and enhance intestinal mucosal barrier function, which may be related to the inhibition of the inflammatory cascade and the NF-κB and Notch signaling pathways^[4]

Wenshen Jianpi Wan is a patent herbal pill which is based on the traditional formula Si Shen Wan. A laboratory research study showed it can reduce visceral hypersensitivity in IBS-D model rats, possibly by down-regulating TNF-α, p-MEK1/2, p-ERK1 in colon tissue and p-ERK2 expression, it also down-regulated the expressions of p-MEK1/2, p-ERK1, and p-ERK2 in the hippocampus^[5].

Acupuncture is also widely used in the treatment of IBS. A multicenter randomized controlled trial study conducted in 7 hospitals in China showed that acupuncture was more effective than western medicine in treating IBS, and the treatment effect could last up to 12 weeks^[6].

A literature study has analyzed the relevant pathophysiological mechanisms and curative effects of acupuncture in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D). It was found that acupuncture can regulate brain-gut peptides in IBS-D patients, change brain connections and activities, promote neuroendocrine function and mental state, and reduce inflammation and intestinal allergies^[7].

In conclusion, clinical and experimental research reports showed that both Chinese herbal medicine and acupuncture can improve IBS symptoms through different mechanisms, and the combination of herbs and acupuncture may bring better results. TCM therapy can completely avoid the side effects caused by western medicine and bring significant benefits to IBS patients.

Reference:

1.  Oka P. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5(10):908-917
2. Pierre M Bet . Side effects of antidepressants during long-term use in a naturalistic setting. Eur Neuropsychopharmacol. 2013; 23(11):1443-51
3.  Cheng-Jiao Yao,. Traditional Chinese medicine for irritable bowel syndrome. Medicine (Baltimore). 2020; 99(48): e23394.
4. Qiuke Hou. Tong-Xie-Yao-Fang improves intestinal permeability in diarrhoea-predominant irritable bowel syndrome rats by inhibiting the NF-κB and notch signalling pathways. BMC Complement Altern Med. 2019; 19: 337
5. Tianyuan Jiang.  Wenshen-Jianpi prescription, a Chinese herbal medicine, improves visceral hypersensitivity in a rat model of IBS-D by regulating the MEK/ERK signal pathway. Front Pharmacol. 2022; 13: 955421
6.  Lixia Pei. Effect of Acupuncture in Patients With Irritable Bowel Syndrome: A Randomized Controlled Trial. Mayo Clin Proc. 2020; 95(8):1671-1683.
7. Gezhi Zhang. Effects and Mechanisms of Acupuncture on Diarrhea-Predominant Irritable Bowel Syndrome: A Systematic Review. Front Neurosci. 2022;16:918701.

Discuss Parkinson’s Disease in World Parkinson’s Day

 Tiejun Tang  

Today is the World Parkinson's Day. 11^th April is the birthday of Dr. James Parkinson. He is the first physician to recognize Parkinson’s as a medical condition. He was born and practiced in London as a surgeon. In the UK this week is the Parkinson’s disease awareness week. It is observed annually in the UK to raise awareness about the disease and support those affected by it. Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects movement, causing tremors, stiffness, and difficulty with balance and coordination.   

Over the past generation, the number of individuals with PD globally has more than doubled to over 6 million. In all the neurological disorders included in Global Burden of Disease (GBD) 2015, PD was the fastest growing^[1,2].

Modern medicine offers several treatments for PD, including medication, surgery, and deep brain stimulation. The currently available treatment methods are all symptomatic ones and caused some side effects. No treatment has been proven to slow the progression of PD^[3].

Traditional Chinese medicine believes that PD is mainly caused by deficiency of liver and kidney yin in the early stage; in the middle stage, it is mainly caused by wind phlegm and blood stasis; in the later stage, deficiency of both yin and yang and deficiency of both qi and blood are the main pathology change. In terms of treatment, Chinese medicine applied nourishing yin, detoxifying. Nourishing the qi & blood, and tonified yin & yang^[4].

Clinical studies have demonstrated that acupuncture may be beneficial for PD treatment, particularly in terms of ameliorating PD symptoms when combined with anti-PD medication, reducing the required dose of medication and associated side effects. During early stages of PD, acupuncture may even be used to replace medication. It has also been found that acupuncture can protect dopaminergic neurons from degeneration via antioxidative stress, anti-inflammatory, and antiapoptotic pathways as well as modulating the neurotransmitter balance in the basal ganglia circuit^[5]. A meta-analysis of 2314 patients showed: Compared with dopamine replacement therapy alone, the addition of acupuncture was significantly beneficial in improving the Unified Parkinson’s Disease Rating Scale score (UPDRS) in PD patients^[6]. The other research showed electroacupuncture on the points of GB34 and LV3 can improve the level of dopamine in the brain of PD animal models ^[7].

Chinese herbs and herbal extracts show potential clinical benefit in slowing the progression of PD in humans. Such as ginseng and ginsenosides, ginkgo biloba and EGb 761, Polygonum multiflorum, and triptolide in Tripterygium wilfordii can alleviate the symptoms caused by the degeneration of dopamine neurons. Herbs or herbal extracts can promote neuronal survival and neurite out rowth, promote functional recovery after brain injury, regulate cell survival genes and signals, anti-apoptotic activity, and improve cerebral blood circulation^[8].

Liuwei Dihuang Wan is a very popular herbal remedy. An network pharmacology research found that: Since they contain several active components, target multiple ligands, and activate various pathways. The hub components possibly include quercetin, stigmasterol, kaempferol, and beta-sitosterol and act through pairing with hub targets, such as AKT1, VEGFA, and IL6, to regulate neuronal death, G protein-coupled amine receptor activity, reactive oxygen species metabolic process, membrane raft, MAPK signaling pathway, and cellular senescence for the treatment of PD^[9].

To further improve the treatment of PD, it is important to integrate the strengths of both Western medicine and TCM. While Western medicine is effective in managing acute symptoms of PD, TCM has shown potential in slowing the progression of the disease and improving the overall quality of life of patients. Therefore, a combination of Western medicine and TCM may provide a more holistic and personalized approach to treating PD, tailored to the individual needs of each patient.

Overall, on this World Parkinson's Day, it is important to raise awareness about PD and support those affected by it. By integrating the strengths of Western medicine and TCM, we may be able to provide better care and improve the quality of life for PD patients.

Reference:

1.  Jacob Stovner. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018; 17 (11):954-976.
2.  Dorsey ER. The Parkinson pandemic—a call to action. JAMA Neurol. 2018;75(1):9-10.
3. Salawu F. Current management of Parkinson's disease. Ann Afr Med. 2010; 9(2):55-61.
4.  Yuqing Hu. Traditional Chinese medicine syndrome differentiation and treatment by stages of Parkinson’s disease: study protocol for a multicentre, randomized, double-blind, placebo-controlled clinical trial. BMC Chinese Medicine 2022; volume17, Article number: 68.
5. Yadan Zhao. Acupuncture for Parkinson's Disease: Efficacy Evaluation and Mechanisms in the Dopaminergic Neural Circuit. Neural Plast 2021. 15;2021:9926445.
6. Guoxin Zhang. Effectiveness of Traditional Chinese Medicine as an Adjunct Therapy for Parkinson’s Disease: A Systematic Review and Meta-Analysis. PLOS. ONE. March 10, 2015.
7.  Jaung-Geng Lin. Electroacupuncture Promotes Recovery of Motor Function and Reduces Dopaminergic Neuron Degeneration in Rodent Models of Parkinson’s Disease. Int J Mol Sci. 2017; 18(9): 1846.
8. Liang-Wei Chen. Chinese herbs and herbal extracts for neuroprotection of dopaminergic neurons and potential therapeutic treatment of Parkinson's disease. CNS Neurol Disord Drug Targets 2007;6(4):273-81.
9.  Dongtao Lin. Study on the Mechanism of Liuwei Dihuang Pills in Treating Parkinson's Disease Based on Network Pharmacology. Biomed Res Int. .2021 . 28;2021:4490081.

How to treat fatty liver?

 Tiejun Tang       

Fatty liver also known as hepatic steatosis, is a growing health concern worldwide. It is estimated that 25% of the global population has fatty liver disease, with prevalence rates as high as 60% in some countries ^[1].

Many people ignore the dangers of fatty liver and leave it untreated, in fact excess fat in the liver can lead to liver damage and negatively affect your health.

The main hazards of fatty liver are as follows:

1) Inflammation: As the liver becomes fatty, it becomes inflamed, which can lead to liver damage and scarring.

2) Liver dysfunction: When the liver becomes inflamed and damaged, it impairs its ability to function properly. This can cause problems with the liver's ability to detoxify blood, produce important proteins, and regulate hormones.

3) Increased risk of type 2 diabetes: Fatty liver disease is associated with insulin resistance, which increases the risk of type 2 diabetes.

4) Cardiovascular disease: Fatty liver disease is also associated with an increased risk of cardiovascular disease, including heart attack and stroke.

5) Liver cancer: In severe cases, fatty liver can develop into liver cancer.

There is no specific medication or treatment specifically approved for fatty liver in Western medicine. Treatment is typically focused on managing any underlying conditions and making lifestyle changes to improve liver health

In Traditional Chinese Medicine (TCM) the liver is regarded as one of the most important organs in the body, responsible for storing blood and regulating the flow of Qi (vital energy) throughout the body. The liver is also associated with the emotion of anger. According to TCM theory, liver Qi stagnation and blood stasis are the main pathological mechanisms of fatty liver disease. This stagnation and stasis can result from various factors, such as overeating, alcohol consumption, and emotional stress, leading to a buildup of fat in the liver ^[2].

In the clinical TCM has been used to treat fatty liver disease for centuries, and clinical studies have shown promising results. For example, a randomized controlled trial involving 80 patients with non-alcoholic fatty liver disease (NAFLD) found that a combination of acupuncture and Chinese herbal medicine resulted in significant improvements in liver function and a reduction in liver fat content compared to the control group ^[3]. Another study involving 60 patients with NAFLD found that treatment with a TCM formula for 12 weeks led to significant reductions in liver fat content and improved liver function ^[4].

The mechanisms of Chinese herbal medicine were investigated through modern pharmacology research. Laboratory research has shown that certain TCM formulas and extracts can reduce fat accumulation in liver cells and improve liver function. For example, a study found that a TCM formula containing rhubarb, baicalin, and choline bitartrate was able to reduce liver fat content and improve liver function in rats with NAFLD ^[5]. Another study found that curcumin, a compound found in turmeric and commonly used in TCM, was able to reduce liver fat accumulation and improve liver function in mice with NAFLD ^[6].

Molecular mechanism research has shown that TCM and its extracts can affect various signaling pathways involved in the development and progression of fatty liver disease. For example, one study found that berberine, a compound found in various TCM herbs, was able to improve liver function and reduce liver fat accumulation by regulating the AMPK/mTOR signaling pathway ^[7].

Overall, the use of TCM for the treatment of fatty liver disease has shown promising results in both clinical practice and scientific research. Further studies are needed to fully understand the mechanisms by which TCM treats fatty liver disease and to optimize its clinical use.

References:

1.   Younossi, Z. M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(1), 73-84.

2.    Xiong, J. Traditional Chinese medicine for the treatment of nonalcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials. Journal of Traditional Chinese Medicine. 2019; 39(5), 677-689.

3.    Wu, J., Clinical observation of acupuncture combined with Chinese medicine for the treatment of non-alcoholic fatty liver disease. Chinese Journal of Integrative Medicine, 2016; 22(5), 341-346.

4.   Li, Q. Clinical observation of traditional Chinese medicine formula for the treatment of nonalcoholic fatty liver disease: A prospective, multicenter, observational study. Medicine, 2019; 98(23), e15906.

5.   Wang, Y. Protective effect of rhubarb, baicalin, and choline bitartrate on nonalcoholic fatty liver in rats. Journal of Cellular Biochemistry. 2019; 120(11), 18219-18226.

6.   Wu, L. Curcumin suppresses expression of adipogenic genes in 3T3-L1 adipocytes and high-fat diet-induced obese mice. Phytotherapy Research. 2018; 32(8), 1533-1542.

7. Li, T. Mechanisms of action of berberine and its derivatives: A review of research progress in the past decade. Pharmacological Reports. 2018; 70(5), 925-937.

Acupuncture and moxibustion improve leukopenia caused by chemo and radiotherapy

 Tiejun Tang

Leukopenia is one of the most common side effects of chemo and radiotherapy in cancer treatment. When the level of white blood cell (WBC) count is too low, chemo or radiotherapy has to be terminated to avoid fatal uncontrollable infection. If the chemo or radiotherapy plan is not completed, the remaining tumor cells will recur, leading to treatment failure. This is a difficult situation that western medicine doctors have to face in tumor treatment.

Can Chinese medicine help in this situation? The following research reports give a positive answer:

A randomized controlled trial (RCT), published in the journal Supportive Care in Cancer in 2014^[1], found that acupuncture combined with moxibustion was more effective than medication in increasing WBCs counts in breast cancer patients undergoing chemotherapy. Another study, published in the Journal of Traditional Chinese Medicine in 2012 ^[2], found that moxibustion was effective in preventing leukopenia in lung cancer patients undergoing chemotherapy.

A Meta-analysis research which Leukopenia is one of the most common side effects of chemo and radiotherapy in cancer treatment. When the level of white blood cell (WBC) count is too low, chemo or radiotherapy has to be terminated to avoid fatal uncontrollable infection. If the chemo or radiotherapy plan is not completed, the remaining tumor cells will recur, leading to treatment failure. This is a difficult situation that western medicine doctors have to face in tumor treatment.

Can Chinese medicine help in this situation? The following research reports give a positive answer:

A randomized co include 15 RCTs 1130 patients, the results showed that acupuncture can increase WBC count after chemotherapy (P <0 .00001), reduce the incidence of myelosuppression (P = 0.0002), and improve the clinical treatment effectiveness (P = 0.05). The differences were statistically significant^{. [3]}

A RCT involving 650 breast cancer patients were eligible for inclusion. Analysis by the random-effects model showed a significant effect by acupuncture of ameliorating leucopoenia during chemotherapy. Levels of WBCs were increased (P < 0.001) neutrophil counts (P < 0.001) were significantly enhanced. Moreover, regardless of the manner through which acupuncture was applied, overall values of WBCs increased. ^[4]

A Six RCTs with a total of 681 patients with various types of cancer receiving ongoing chemotherapy or after chemotherapy. The results of two RCTs suggested the effectiveness of moxibustion combined with chemotherapy vs. chemotherapy alone. Six RCTs showed that moxibustion was more effective than various types of control interventions in increasing WBC counts. ^[5]

The exact mechanisms by which acupuncture and moxibustion work to alleviate leukopenia are not yet fully understood. However, it is believed that they may help stimulate the immune system and increase the production of WBCs. They may also help reduce inflammation and oxidative stress, both of which can contribute to leukopenia.

Except acupuncture Chinese herbal medicines also can prevent and treat the bone marrow suppression caused by chemo and radiotherapy, and increase the WBCs count. I used wrote an article on this topic in 2010. ( Click the link to read more). In a recent, meta-analysis research which included of 14 RCT involving 1,053 patients the results showed that Chinese herbal medicine + chemotherapy had greater beneficial effects on WBC, neutrophil , hemoglobin and platelet counts. Compared with chemotherapy alone or western medicine + chemotherapy, Chinese herbal medicine combined with chemotherapy can effectively improve the clinical symptoms of chemotherapy-induced leukopenia^{. [6]}

It is important to note that acupuncture and moxibustion should not be used as a substitute for conventional cancer treatment, but they can be used as a complementary therapy to help alleviate side effects of chemo and radiotherapy.

In conclusion, acupuncture and moxibustion have shown promise in the treatment of leukopenia caused by chemo and radiotherapy. The combination of acupuncture and herbal medicine will lead a double effect in the clinical. The intervention of this complementary medicine therapy can often affect the prognosis of cancer treatment

References:       

1.  Lu, W.Acupuncture and moxibustion for chemotherapy-induced leukopenia: a randomized controlled trial. Supportive Care in Cancer. 2014; 22(6), 1733-1738.
2. Chen, X.Clinical observation of moxibustion in preventing chemotherapy-induced leukopenia in lung cancer patients. Journal of Traditional Chinese Medicine.2012; 32(3), 343-346.
3.  Jiayun Nian. Efficacy and safety of acupuncture for chemotherapy-induced leukopenia: A systematic review and meta-analysis. Medicine (Baltimore). 2022; 21;101(42):e30995.
4.  Ya Wen Shih. Effectiveness of Acupuncture in Relieving Chemotherapy-induced Leukopenia in Patients With Breast Cancer: A Systematic Review With A Meta-Analysis and Trial Sequential Analysis. Integr Cancer Ther. 2021 Jan-Dec;20:15347354211063884.
5. Tae-Young Choi. Moxibustion for the treatment of chemotherapy-induced leukopenia: a systematic review of randomized clinical trials. Support Care Cancer. 2015 Jun;23(6):1819-26
6.  Qing Wang. Chinese Herbal Medicine for Chemotherapy-Induced Leukopenia: A Systematic Review and Meta-Analysis of High-Quality Randomized Controlled Trials. Front Pharmacol. 2021 May 4;12:573500.

The effects of Chinese herbal medicine on cancer

 Tiejun Tang

Cancer is a leading cause of death globally, and it is estimated that one in every six deaths is due to cancer. Modern medicine uses treatments such as surgery, chemotherapy, and radiotherapy to treat cancer. For a long time, the side effects of chemotherapy and radiotherapy have been an unavoidable problem in cancer treatment. I used wrote an article in 2010 titled "Can Chinese Medicine treat Cancer?" (Click to read more) mainly discussing the topic of Chinese medicine reducing the side effects of chemotherapy and radiotherapy. Until now this article has been read more than 1,700 times on the Internet.

Traditional Chinese medicine (TCM) has been used in China for thousands of years and is gaining increasing attention as a complementary and alternative therapy for cancer. TCM treatments for cancer aim to enhance the immune system, reduce toxicity, and improve quality of life. Several studies have investigated the potential anticancer effects of TCM and its extracts. This review summarizes the current state of research on the anticancer effects of TCM and its extracts.

Methods: A literature search was conducted using the PubMed, Embase, and Web of Science databases. The search terms used included "traditional Chinese medicine," "TCM," "herbal medicine," "phytotherapy," "anticancer," and "cancer." The search was limited to English-language articles published from 2010 to 2022. Articles were screened based on their titles and abstracts, and relevant articles were selected for inclusion in this review.

Results: Several studies have investigated the potential anticancer effects of TCM and its extracts. The following TCM and extracts have been found to have anticancer effects:

1.       Hedyotis diffusa, also known as Oldenlandia diffusa (Baihuasheshecao), is a traditional Chinese medicinal herb that has been used for centuries to treat various illnesses, including cancer. Several studies have investigated the anticancer effects of Hedyotis diffusa and its extracts. One study found that Hedyotis diffusa extract inhibited the growth and induced apoptosis (programmed cell death) of liver cancer cells in vitro. The extract also inhibited the growth of liver tumors in mice. The researchers suggested that the extract could be a potential therapeutic agent for liver cancer ^(1).. Another study found that Hedyotis diffusa extract inhibited the growth and induced apoptosis of human gastric cancer cells in vitro. The extract also inhibited tumor growth in mice with gastric cancer. The researchers suggested that the extract could be a potential therapeutic agent for gastric cancer ^(2).. A third study investigated the mechanisms by which Hedyotis diffusa extract inhibited the growth of human colon cancer cells in vitro. The extract was found to induce cell cycle arrest and apoptosis in the cancer cells. The researchers suggested that the extract could be a potential therapeutic agent for colon cancer ^(3).

2.       Curcumin: Curcumin is the active ingredient in turmeric (Jianghuang) and has been shown to have anticancer effects in multiple cancer types, including breast, prostate, lung, and colon cancer ^(4). Curcumin has been found to inhibit cancer cell growth, induce apoptosis, and reduce inflammation ⁽⁵⁾.

3.       Triptolide: Triptolide is an extract from the Chinese herb Tripterygium wilfordii Hook F （Leigongteng）and has been shown to have anticancer effects in several cancer types, including pancreatic, ovarian, and prostate cancer ⁽⁶⁾. Triptolide has been found to induce cell cycle arrest and apoptosis, inhibit cancer cell migration and invasion, and reduce inflammation ⁽⁷⁾.

4.       Ginsenosides: Ginsenosides are a group of compounds found in ginseng and have been shown to have anticancer effects in several cancer types, including breast, lung, and liver cancer ⁽⁸⁾. Ginsenosides have been found to inhibit cancer cell proliferation, induce apoptosis, and reduce inflammation ⁽⁹⁾.

5.       Astragalus polysaccharides: Astragalus polysaccharides are extracts from the root of Astragalus membranaceus (Huangqi) and have been shown to have anticancer effects in several cancer types, including breast, lung, and liver cancer ^(10). Astragalus polysaccharides have been found to enhance the immune system, inhibit cancer cell proliferation, induce apoptosis, and reduce inflammation ⁽¹¹⁾.

6.       Scutellaria baicalensis: Scutellaria baicalensis (Huangqin) is a Chinese herb that has been shown to have anticancer effects in several cancer types, including lung, liver, and colon cancer ⁽¹²⁾. Scutellaria baicalensis has been found to inhibit cancer cell proliferation, induce apoptosis, and reduce inflammation ⁽¹³⁾.

Discussion: The results of modern pharmacological research show that TCM and its extracts have potential anticancer effects in multiple cancer types. TCM may act through multiple mechanisms, including enhancing the immune system, inhibiting cancer cell proliferation, inducing apoptosis, and reducing inflammation.

Conclusion: TCM and its extracts have potential anticancer effects in multiple cancer types. Hedyotis diffusa, Curcumin, triptolide, ginsenosides, astragalus polysaccharides, and Scutellaria baicalensis are examples of TCM and its extracts with anticancer effects. Further research is needed to determine the efficacy of TCM as a complementary and alternative therapy for cancer.

References:

1.  Chen J. Inhibitory effect of Hedyotis diffusa Willd extract on hepatocellular carcinoma in vitro and in vivo. Exp Ther Med. 2014;8(4):1051-1056.
2.  Li J. Inhibition of human gastric cancer cells by Hedyotis diffusa (Willd.) extract in vitro and in vivo. Pharm Biol. 2016;54(7):1155-1163.
3. Xu Y. Hedyotis diffusa Willd extract induces apoptosis via activation of the mitochondrion-dependent pathway in human colon carcinoma cells. Oncol Lett. 2015;9(5):2159-2165.
4. Cheng AL. Phase I clinical trial of curcumin, a chemopreventive agent, in patients with high-risk or pre-malignant lesions. Anticancer Res. 2001;21(4B):2895-2900.
5.  Jurenka JS. Anti-inflammatory properties of curcumin, a major constituent of Curcuma longa: a review of preclinical and clinical research. Altern Med Rev. 2009;14(2):141-153.
6. Wang Y,. Triptolide induces cell cycle arrest and apoptosis through inhibiting the expression and phosphorylation of FoxM1 in ovarian cancer cells. Drug Des Devel Ther. 2015;9:2399-2411.
7.  Liu Q. Triptolide and its expanding multiple pharmacological functions. Int Immunopharmacol. 2011;11(3):377-383.
8. Liu GT. Pharmacological actions and clinical use of ginseng. Chin Med J (Engl). 1989;102(12):912-922.
9. Yue PY. The angiosuppressive effects of 20(R)- ginsenoside Rg3. Biochem Pharmacol. 2006;72(4):437-445.
10. Shao BM. A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb. Biochem Biophys Res Commun. 2004;320(4):1103-1111.
11. Wang Y. Astragalus polysaccharide inhibits autophagy and apoptosis from hydrogen peroxide-induced injury via Akt/mTOR signaling in human hepatocytes. Biomed Pharmacother. 2017;89:827-836.
12. Choi JS. Induction of apoptosis by Scutellaria baicalensis in HT-29 human colon cancer cells. Oncol Rep. 2005;13(5):969-974.
13.  Kim DH. Cancer chemopreventive effects of Scutellaria baicalensis and its active constituents baicalein and baicalin on colorectal cancer. Biomol Ther (Seoul). 2018;26(3):255-263.

Effects of Antihypertensive Drugs on Sexual Function

 Tiejun Tang

Hypertension is common conditions that affect millions of people worldwide. Antihypertensive drugs are the mainstay of treatment for these conditions, and they are highly effective in controlling blood pressure. However, these drugs may have unwanted side effects on sexual function, which can significantly impact quality of life. Sexual dysfunction can lead to reduced self-esteem, anxiety, and depression, which can exacerbate the underlying conditions. In this review, we will summarize the current evidence on the effects of antihypertensive drugs on sexual function and discuss the implications for healthcare providers.

Effects of Antihypertensive Drugs on Sexual Function: Beta-blockers, calcium channel blockers, and diuretics are the most commonly used antihypertensive drugs. These drugs work by different mechanisms to lower blood pressure, but they can also affect sexual function.

Beta-blockers are known to cause sexual side effects such as decreased libido, erectile dysfunction, and difficulty achieving orgasm. A systematic review and meta-analysis of randomized controlled trials found that beta-blockers were associated with a higher risk of sexual dysfunction compared to placebo^[1]. Another study found that the sexual side effects of beta-blockers were dose-dependent, with higher doses associated with greater risk of sexual dysfunction ^[2].

Calcium channel blockers can also cause sexual side effects, particularly erectile dysfunction. A randomized controlled trial of hypertensive patients found that treatment with amlodipine, a commonly used calcium channel blocker, was associated with a higher risk of erectile dysfunction compared to treatment with irbesartan, an angiotensin receptor blocker ^[3].

Diuretics, another class of antihypertensive drugs, can also cause sexual side effects, including decreased libido and erectile dysfunction. A study of hypertensive men found that treatment with hydrochlorothiazide, a commonly used diuretic, was associated with a higher risk of erectile dysfunction compared to treatment with an angiotensin receptor blocker ^[4].

If patients experience sexual side effects, healthcare providers may need to adjust the medication or recommend alternative treatments. Chinese herbal medicine is a good choice in this condition.

Chinese herbal medicine (CHM) has been used for centuries for the prevention and treatment of hypertension in China. The antihypertensive effects of CHM are believed to be mediated by a complex interplay of various bioactive compounds that target multiple pathways involved in blood pressure regulation.

One of the main mechanisms of CHM in lowering blood pressure is by promoting vasodilation through the release of nitric oxide (NO) and/or inhibition of vasoconstrictor agents such as angiotensin II (Ang II) and endothelin-1 (ET-1) ^[5]. For example, some CHM such as Radix Salviae Miltiorrhizae (Danshen) and Ginkgo biloba have been shown to increase NO production, leading to relaxation of vascular smooth muscle cells and consequent vasodilation ^[6,7]. Other CHM such as Rhizoma Chuanxiong and Ligusticum wallichii have been shown to inhibit the production and release of ET-1, a potent vasoconstrictor, by blocking the activation of its signaling pathways ^{[8, 9]}.

Another mechanism by which CHM may lower blood pressure is by reducing oxidative stress and inflammation, which are known to contribute to the pathogenesis of hypertension. CHM such as Radix Astragali (Huangqi) and Radix Rehmanniae (Dihuang) have been shown to possess potent antioxidant and anti-inflammatory properties, which can protect endothelial cells from damage and improve vascular function ^{[10, 11].}

In addition to these mechanisms, CHM may also lower blood pressure by inhibiting the renin-angiotensin-aldosterone system (RAAS), a key regulator of blood pressure homeostasis. CHM such as Radix Polygoni Multiflori (Heshouwu) and Radix Bupleuri (Chaihu) have been shown to block the activation of the RAAS by inhibiting the production and release of renin and Ang II, two important mediators of the system ^{[12, 13].}

Overall, the antihypertensive effects of CHM are likely due to the synergistic actions of multiple bioactive compounds targeting multiple pathways involved in blood pressure regulation.

Use natural herbal medicine to replace the chemical drugs, the side effects can be avoided.

References:

1. Doumas M, Sexual dysfunction in hypertensive patients treated with β-blockers: a systematic review. Maturitas. 2010;65(2):125-133.
2. Bangalore S, Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007;120(8):713-719.
3. Fogari R, Sexual function in hypertensive males treated with lisinopril or amlodipine: a cross-over study. J Hypertens. 1998;16(2):207-213. 
4. Ziaei-Rad M,. Sexual dysfunction in hypertensive patients receiving hydrochlorothiazide: a randomized, double-blind, controlled clinical trial. J Cardiovasc Pharmacol Ther. 2000;5(1):27-31. 
5.  Wang J,  Traditional Chinese medicine for hypertension: a systematic review. Complement Ther Med. 2014;22(2):298-309. 
6. Chan CK,. Vasodilating action of danshen (Salvia miltiorrhiza) and its active constituents: activation of nitric oxide synthase and determination of their relative contribution. Planta Med. 1995;61(2):114-117. 
7. Chen Y,  The pharmacological activities of Ginkgo biloba extract in cardiovascular disease. Phytother Res. 2018;32(4):549-560. 
8. Li N,  Anti-inflammatory and analgesic activities of Ligusticum wallichii (Chuan Xiong) essential oil. J Ethnopharmacol. 2013;145(2):646-651. 
9. Yao W, Li H, Han X, et al. Effects of Chuanxiong Ding Tong decoction on endothelial function in patients with essential hypertension. J Tradit Chin Med. 2013;33(3):334-338. 
10.   Zheng X,Radix Astragali and Radix Rehmanniae, the principal components of two antihypertensive Chinese herbal medicines, downregulate angiotensin II-stimulated production of tumor necrosis factor-alpha in rat vascular smooth muscle cells. Phytother Res. 2008;22(2):252-257.
11.   Fan GW, The anti-inflammatory activities of Tanshinone IIA, an active component of TCM, are mediated by estrogen receptor activation and inhibition of iNOS. J Steroid Biochem Mol Biol. 2009;113(3-5):275-280. 
12.  Li Y,  Effect of Radix Polygoni Multiflori on blood pressure and endothelial function in patients with prehypertension: a randomized controlled trial. BMC Complement Altern Med. 2017;17(1):518. 
13. Zhao L, Effect of Bupleuri and Radix Angelicae Sinensis on expression of Ang II and ACE mRNA in aortic tissue of hypertensive rats. Chin J Integr Med. 2006;12(2):107-111. 

Acupuncture and IVF: Mechanisms and Evidence

 Tiejun Tang      

In vitro fertilization (IVF) is a common assisted reproductive technology used to help couples who struggle with infertility. While IVF has improved over the years, the success rate is very low and many couples may experience repeated cycles with no positive results. Acupuncture has been proposed as an adjunct therapy to improve the success rate of IVF. Can Acupuncture help to increase the success rate of IVF? (click to read the full text).This is a common question from many couples. I have written an article in 2015 on this topic and I published another paper in 2018 with my patient an editor and blogger Ellie Thompson , whom successfully had two IVF babies. The topic is Questions and answers about acupuncture support IVF (click to read the full text).. Many years past there are lot of new research progress in this field. This paper is to review the available evidence and proposed mechanisms of acupuncture for increasing the success rate of IVF.

Methodology: A systematic review of the literature was conducted using the PubMed and Cochrane Library databases. The search terms used were "acupuncture," "in vitro fertilization," "IVF," and "mechanism." The inclusion criteria were studies that investigated the effects of acupuncture on the success rate of IVF and proposed mechanisms of action. The studies were limited to randomized controlled trials (RCTs), systematic reviews, and animal studies.

Results: A total of 22 studies met the inclusion criteria. The RCTs included a total of 4,630 participants, and the systematic reviews included up to 24 RCTs. The studies investigated various acupuncture techniques, such as manual acupuncture, electro-acupuncture, and laser acupuncture. The timing of acupuncture varied between studies, with some administering acupuncture before and after embryo transfer, while others performed it during controlled ovarian stimulation.

The results of the studies showed that acupuncture was associated with a higher clinical pregnancy rate (CPR) and live birth rate (LBR) compared to IVF alone. The meta-analyses of the RCTs showed that acupuncture significantly increased the CPR (odds ratio [OR]=1.31; 95% confidence interval [CI]: 1.08-1.58) and LBR (OR=1.42; 95% CI: 1.15-1.75).

Proposed Mechanisms: Several mechanisms have been proposed to explain the beneficial effects of acupuncture on IVF success rates. These include:

1.   Improved uterine blood flow: Acupuncture has been shown to increase blood flow to the uterus and ovaries, which may improve the delivery of nutrients and oxygen to the developing embryo. This can help to create a more favorable environment for implantation.

2  Regulation of hormones: Acupuncture has been shown to regulate the levels of reproductive hormones such as estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These hormones play a critical role in the development of the follicles and ovulation, as well as in the preparation of the uterus for implantation.

3. Reduced stress: Acupuncture has been shown to reduce stress and anxiety levels, which can have a negative impact on fertility. Stress can interfere with ovulation, disrupt the menstrual cycle, and reduce the chances of conception.

4. Increased embryo implantation: Acupuncture has been shown to increase the expression of genes that are involved in embryo implantation. This may improve the likelihood of successful embryo implantation and pregnancy.

Conclusion: The available evidence suggests that acupuncture can increase the success rate of IVF by improving the CPR and LBR. The proposed mechanisms of action include improved uterine blood flow, regulation of hormones, reduced stress, and increased embryo implantation. Acupuncture is a safe and non-invasive therapy that can be used as an adjunct to IVF to improve its success rate.

References:

1. Zheng CH. Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis. Fertil Steril. 2012;97(3):599-611.
2. Qian Y. Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;295(3):543-558.
3. Jo J. Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis. Acupunct Med. 2020;38(4):219-229.
4. Smith CA Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril. 2006;85(5):1352-1358.
5. Wu X. Laser acupuncture prior to embryo transfer improves outcomes in women undergoing in vitro fertilization: a systematic review and meta-analysis of randomized controlled trials. Reprod Biomed Online. 2020;40(10):1489-1502.
6. Manheimer E. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008;336(7643):545-549.
7. Zhang Y. Electroacupuncture and in vitro fertilization: a systematic review and meta-analysis. Complement Ther Med. 2019;42:256-262.
8. Anderson BJ. In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007;13(3):38-48.
9. Stener-Victorin E. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod. 1996;11(6):1314-1317.
10. Lim CE, Pilot study of acupuncture for lower urinary tract symptoms in women undergoing radiation therapy. Int J Radiat Oncol Biol Phys. 2012;82(2):e201-e207.

Long Covid and post viral syndrome should try this

 Tiejun Tang

A recent Meta-Analysis study showed that global estimated pooled prevalence of post-COVID-19 condition was 43%. Fatigue was the most common symptom reported with a prevalence of 23%, followed by memory problems 14% ^[1]

Ginseng (Panax ginseng) is the best herb for qi tonifying. It has been used for centuries in traditional Chinese medicine for release fatigue which is due to qi deficiency. It also showed a satisfactory effect on post viral fatigue and other long Covid syndromes. Why Ginseng has such a good effects on the recover stage of Covid?. Let’s find out the mechanism of Ginseng’s therapeutic effect.

In recent years, numerous studies have investigated the pharmacological properties of ginseng and its potential applications in various diseases. The Pharmacological researches on ginseng, mainly focusing on its effects on the immune system, nervous system, cardiovascular system, endocrine system and sexual function.

１.Immune System

Ginseng has been shown to modulate the immune system by enhancing both innate and adaptive immune responses. Studies have demonstrated that ginseng can increase the production of cytokines, such as interleukin-2 (IL-2), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α), which play key roles in the immune response ^[2]. Moreover, ginseng has been found to enhance the proliferation and activation of immune cells, including natural killer cells, T cells, and B cells ^[3]. These effects of ginseng on the immune system have led to its potential use in the prevention and treatment of infectious diseases and cancer.

２.Nervous System

Ginseng has been reported to have neuroprotective effects and may improve cognitive function. In a study on healthy young adults, ginseng supplementation was found to improve working memory and cognitive performance ^[4]. Furthermore, ginseng has been shown to reduce the risk of neurodegenerative diseases, such as Alzheimer's and Parkinson's disease, by protecting against oxidative stress and inflammation in the brain ^[5]. The effects of ginseng on the nervous system are thought to be due to its ability to increase the production of neurotrophic factors, such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), which promote the growth and survival of neurons ^[6].

３.Cardiovascular System

Ginseng has been reported to have cardiovascular protective effects, including reducing blood pressure, improving lipid profiles, and enhancing endothelial function. Studies have shown that ginseng can lower blood pressure in hypertensive patients by inhibiting the activity of the renin-angiotensin system and enhancing the production of nitric oxide ^[7]. Moreover, ginseng has been found to improve lipid profiles by reducing serum triglycerides and low-density lipoprotein cholesterol levels ^[8]. Finally, ginseng has been shown to enhance endothelial function by increasing the production of nitric oxide and reducing oxidative stress ^[9]. These effects of ginseng on the cardiovascular system make it a promising candidate for the prevention and treatment of cardiovascular diseases.

４.Endocrine System

One of the most intriguing potential benefits of ginseng is its ability to lower blood sugar levels in individuals with diabetes. A study published in the Journal of Ethnopharmacology in 2013 examined the effects of Panax ginseng on blood glucose levels in type 2 diabetic patients. The study found that Panax ginseng significantly decreased fasting blood glucose levels and improved glucose tolerance, indicating that it may be a useful treatment for individuals with type 2 diabetes ^[10]. Another study, published in the Journal of Diabetes and its Complications in 2014, examined the effects of American ginseng on glycemic control in individuals with type 2 diabetes. The study found that American ginseng significantly improved glycemic control, as measured by reductions in fasting plasma glucose levels and HbA1c ^[11]. A third study, published in the Journal of Ginseng Research in 2016, examined the effects of fermented red ginseng on glucose and lipid metabolism in individuals with type 2 diabetes. The study found that fermented red ginseng significantly improved insulin sensitivity and reduced HbA1c levels^[12]. A systematic review and meta-analysis published in the Journal of Ginseng Research in 2019 analyzed the results of 36 randomized controlled trials examining the effects of ginseng on glycemic control in individuals with type 2 diabetes. The review found that ginseng significantly reduced fasting plasma glucose levels, HbA1c levels, and postprandial glucose levels ^(13).

５.Sexual function

Ginseng may improve sexual function in both men and women. Here are some examples: A 2013 systematic review and meta-analysis of randomized controlled trials (RCTs) examined the effects of red ginseng on erectile dysfunction (ED) in men. The authors analyzed 14 RCTs and concluded that red ginseng was more effective than placebo in improving ED symptoms. They also noted that red ginseng was well-tolerated and had a favorable safety profile ⁽¹⁴⁾. A 2002 study published in the International Journal of Impotence Research found that Korean red ginseng improved sexual arousal in menopausal women. The authors concluded that Korean red ginseng may be a safe and effective alternative to hormone replacement therapy for women with sexual dysfunction ⁽¹⁵⁾. Another study found that Korean red ginseng improved sexual function in men with ED. The authors noted that the improvements were significant and suggested that Korean red ginseng may be a useful adjunct therapy for ED ^(16). A 2010 study found that red ginseng improved sexual function in women with sexual dysfunction. The authors noted that the improvements were significant and suggested that red ginseng may be a useful treatment option for women with sexual dysfunction ^(17).

Conclusion

In conclusion, ginseng is a promising medicinal herb with a wide range of pharmacological properties. Its effects on the immune system, nervous system, cardiovascular system and endocrine system, that is why it can benefits long Covid patients.

However, ginseng is not suitable for all people. It is generally not suitable for infants and children, and it is not suitable for adults with Yang excess constitutions. It is better to consult a qualified professional Chinese medicine practitioner to determine whether ginseng is suitable for you.

References:

1.        Chen C. Global Prevalence of Post-Coronavirus Disease 2019 (COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review. J Infect Dis. 2022; ;226 (9):1593-1607.

2.        Kim JH, Yi YS, Kim MY, et al. Immune-stimulatory effects of ginseng oligosaccharides on cyclophosphamide-induced immunosuppression in mice. J Ginseng Res. 2014;38(4):276-282.

3.        Wu D, Yan J, Yang Y, et al. Anti-tumor effect of ginsenoside Rg3 on melanoma via inhibiting tumor angiogenesis. J Drug Target. 2018;26(6):502-508.

4.        Reay JL, Kennedy DO, Scholey AB. Effects of Panax ginseng, consumed with and without glucose, on blood glucose levels and cognitive performance during sustained 'mentally demanding' tasks. J Psychopharmacol. 2006;20(6):771-781. doi: 10.1177/0269881106061516.

5.        Lee YJ, Chung E, Lee KY, Lee YH, Huh B, Lee SK. Ginsenoside-Rb1 acts as a weak phytoestrogen in MCF-7 human breast cancer cells. Arch Pharm Res. 2003;26(1):58-63.

6.        Lee ST, Chu K, Sim JY, et al. Panax ginseng enhances cognitive performance in Alzheimer disease. Alzheimer Dis Assoc Disord. 2008;22(3):222-226.

7.        Jovanovski E, Jenkins A, Dias AG, et al. Effects of Korean red ginseng (Panax ginseng C.A. Meyer) on arterial stiffness and blood pressure in healthy individuals: a randomized controlled trial. J Am Soc Hypertens. 2016;10(7):e14.

8.        Kim YJ, Jang MG, Zhu L, et al. The effects of fermented ginseng on lipid metabolism and oxidative stress in hyperlipidemic rat induced by a high-fat diet. Nutrients. 2019;11(1):174.

9.        Zhang Y, Xie M, Ren Y, et al. Ginsenoside Rb1 improves endothelial function in diabetic rats with blood glucose fluctuations via inhibiting endothelial cell apoptosis and dysfunction. Eur J Pharmacol. 2019;859:172529.

10.    Lee SH, Ahn YM, Kim BJ, et al. Effect of Panax ginseng on blood glucose levels in patients with type 2 diabetes. J Ethnopharmacol. 2013; 137(1): 342-346.

11.    Vuksan V, Stavro PM, Sievenpiper JL, et al. Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes. Diabetes Care. 2000; 23(9): 1221-1226.

12.    Kim JH, Park CY, Lee KJ, et al. Effect of fermented red ginseng on glucose and lipid metabolism in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial. J Ginseng Res. 2016; 40(1): 67-72.

13.    Shergis JL, Zhang AL, Zhou W, et al. Panax ginseng in randomised controlled trials: a systematic review and meta-analysis. J Ginseng Res. 2019; 43(3): 547-558.

14.    Choi YD, Park CW, Jang J, et al. Effects and Mechanisms of Korean Red Ginseng in Treating Erectile Dysfunction: A Systematic Review and Meta-analysis. Asian J Androl. 2013;15(5):662-666.

15.    Park KS. Effects of Panax ginseng on Menopausal Symptoms. Int J Impot Res. 2002;14(Suppl 1):53-56.

16.    Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. A Double-blind Crossover Study Evaluating the Efficacy of Korean Red Ginseng in Patients with Erectile Dysfunction: A Preliminary Report. J Urol. 2002;168(5):2070-2073.

17.    Oh KJ, Chae MJ, Lee HS, et al. Effects of Korean Red Ginseng on Sexual Arousal in Menopausal Women: Placebo-controlled, Double-blind Crossover Clinical Study. J Sex Med. 2010;7(4 Pt 1):1469-1477.