Wendan Decoction Research Articles

Progress in the Clinical Application of Huanglian Wendan Decoction in the Treatment of Cerebrovascular Disease

Huanglian Wendan decoction, as a widely used formula in clinical practice, is characterized by phlegm-fire originating from phlegm-fire, although the names and signs of the diseases it treats are different and the symptoms are complex. Therefore, for such diseases, Huanglian Wendan decoction can be used as the basis, with appropriate adjustments and additions, aiming at clearing heat and resolving phlegm, and strengthening the treatment strategy to enhance the clinical effect. Now, its clinical application in cerebrovascular diseases is summarized.

Systematic pharmacology and experimental validation to elucidate the inflammation-associated mechanism of Huanglian Wendan (HLWD) decoction in the treatment of MAFLD associated with atherosclerosis

Ethnopharmacological relevanceMetabolic-associated fatty liver disease (MAFLD) and atherosclerosis are very common disorders that frequently coexist. The therapeutic efficacy of Huanglian Wendan (HLWD) decoction, a traditional Chinese medicine (TCM) prescription, is satisfactory in treating MAFLD associated with atherosclerosis. However, the underlying mechanisms through which HLWD exerts its effects need to be elucidated. Given the complex composition of HLWD and its multiple therapeutic targets, pharmacological investigation is challenging. Aim of this studyThis study aimed to identify the effective compounds in HLWD and elucidate the mechanisms involved in its therapeutic effect on MAFLD associated with atherosclerosis. Materials and methodsWe used a systematic pharmacology method to identify effective compounds present in HLWD and determine the mechanism by which it affects MAFLD associated with atherosclerosis. The effective components of HLWD were identified through ultrahigh-performance liquid chromatography-q exactive-orbitrap high resolution mass spectrometry (UHPLC-Q-Orbitrap HRMS). Next, a comprehensive in silico method was used to predict potential related targets and disease targets for these compounds to establish corresponding pathways. The accuracy of our assumed systemic pharmacology results was determined by conducting follow-up experiments. ResultsBy conducting UHPLC-Q-Orbitrap HRMS combined with network analysis, we identified 18 potentially active components of HLWD and assessed the inflammatory regulatory mechanism by which it affects MAFLD associated with atherosclerosis on the basis of 52 key targets. We used a high-fat, high-cholesterol (HFHC)-induced mice model of MAFLD associated with atherosclerosis to confirm our results. We found that administering HLWD significantly improved the appearance of their liver and reduced their body weight, liver weight, blood lipids, hepatic damage, and hepatic pathology. HLWD also decreased atherosclerotic lesion areas, foam cells, and inflammatory cells in the aorta. HLWD showed anti-inflammatory effects, suppressed M1 polarization, and promoted M2 polarization in the liver and aorta. HLWD might also regulate peroxisome proliferator-activated receptor-γ (PPARγ)/nuclear factor kappa-B (NF-κB) signaling to influence macrophage polarization and inflammation. ConclusionsOur results showed that HLWD protected against HFHC diet-induced MAFLD associated with atherosclerosis by regulating PPARγ/NF-κB signaling, thus adjusting macrophage polarization and inflammation. Additionally, pharmacochemistry research, network pharmacology analysis, and experimental verification can be combined to form a comprehensive model used in studies on TCM.

Integrated Network Pharmacology and Molecular Docking to Explore the Mechanisms of Ningshen Wendan Decoction in the Treatment of Schizophrenia.

Schizophrenia (SCZ) is a prevalent chronic mental disorder characterized by a high recurrence rate and significant disability. Currently, no satisfactory pharmacological treatments have been identified. Although Ningshen Wendan decoction (NSWDD) has shown promising results in improving cognitive function in patients with schizophrenia, its underlying mechanism of action remains unclear. This study systematically investigated the mechanisms of NSWDD in SCZ treatment using network pharmacology and molecular docking approaches. Analysis of the interaction genes revealed 307 common targets of NSWDD and SCZ. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses indicated the involvement of multiple signaling pathways including interleukin 17 signaling pathway, multiple virus infections, Advanced glycosylation end products (AGEs) - receptor of AGEs (AGEs-RAGE) signaling pathway, tumor necrosis factor signaling pathway, and Hypoxia-inducible factor-1 (HIF-1) signaling pathway as key pathways influenced by NSWDD in treating SCZ. These pathways are associated with various biological processes such as transcriptional regulation, apoptosis regulation, gene expression regulation, and external stimulus-response. Molecular docking simulations indicated favorable binding interactions between components of NSWDD and target proteins via intermolecular forces. The study provided initial insights into the internal molecular mechanisms underlying the beneficial effect of NSWDD on SCZ through multi-target modulation across multiple pathways.

Huanglian Wendan Decoction Improves Insomnia in Rats by Regulating BDNF/TrkB Signaling Pathway Through Gut Microbiota-Mediated SCFAs and Affecting Microglia Polarization.

Insomnia is a typical type of sleep disorder. Huanglian Wendan Decoction (HWD) is a traditional Chinese medicine (TCM) with the effects of regulating Qi, drying dampness and resolving phlegm, calming the mind, and relieving irritation. This study aims to investigate the effect of HWD on insomnia in rats and its mechanism. Para-chlorophenylalanine (PCPA)-induced insomnia in rats was used for in vivo experiments and then treated with HWD. Behavioral tests, Western blot, real-time PCR, immunofluorescent staining, 16S rRNA sequencing were conducted. The content of SCFAs was determined by GC-MS. Acetic acid-pretreated rat hippocampal nerve cells were used for in vitro experiments. The results showed that HWD significantly improved the learning memory ability, decreased sleep latency, and prolonged sleep duration in insomniac rats. HWD reduced TNF-α and IL-6 levels and increased IL-10 and Foxp3 levels. HWD also promoted the polarization of macrophages from M1 pro-inflammatory phenotype to M2 anti-inflammatory phenotype. In addition, HWD increased the expression levels of BDNF and TrkB in the hippocampus. Administration of the TrkB receptor agonist 7,8-dihydroxyflavone (7,8-DHF) confirmed the mechanism by which HWD activates BDNF/TrkB signaling to ameliorate insomnia. Furthermore, HWD restored gut microbiota richness and diversity and promoted short-chain fatty acid (SCFA) production in insomniac rats. In vitro experiments confirmed that the acetic acid-treated SCFA group could activate the BDNF/TrkB signaling pathway in neuronal cells, further promoting neuronal cell growth. In conclusion, HWD alleviated insomnia by maintaining gut microbiota homeostasis, promoting SCFA production, reducing neuroinflammatory response and microglia activation, and activating BDNF/TrkB signaling pathway.

A Network Pharmacology Approach and Validation Experiments to Investigate the Mechanism of Wen-Dan Decoction in the Treatment of SINFH.

Steroid-induced necrosis of the femoral head (SINFH) is a femoral head necrotic disease caused by prolonged use of hormones. Wen-Dan decoction is used in Chinese clinical practice for the treatment of steroid-induced necrosis of the femoral head (SINFH). However, the mechanism and active compounds of Wen-Dan decoction used to treat SINFH are not well understood. We studied the mechanism of action of Wen-Dan decoction in treating steroidinduced necrosis of the femoral head (SINFH) via network pharmacology and in vivo experiments. The active compounds of Wen-Dan decoction and SINFH-related target genes were identified through public databases. Then, network pharmacological analysis was conducted to explore the potential key active compounds, core targets and biological processes of Wen-Dan decoction in SINFH. The potential mechanisms of Wen-Dan decoction in SINFH obtained by network pharmacology were validated through in vivo experiments. We identified 608 DEGs (differentially expressed genes) (230 upregulated, 378 downregulated) in SINFH. GO analysis revealed that the SINFH-related genes were mainly involved in neutrophil activation and the immune response. KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analysis showed that the SINFH-related genes were mainly associated with cytokine receptor interactions, lipids, atherosclerosis, and tuberculosis. We identified 147 active ingredients of Wen-Dan decoction; the core ingredient was quercetin, and licorice was an active ingredient. Moreover, 277 target genes in the treatment of SINFH with Wen-Dan decoction were identified, and NCF1, PTGS2, and RUNX2 were selected as core target genes. QRT-PCR of peripheral blood from SINFH patients showed higher levels of PGTS2 and NCF1 and showed lower levels of RUNX2 compared to controls. QRT-PCR analysis of peripheral blood and femoral bone tissue from a mouse model of SINFH showed higher levels of PGTS2 and NCF1 and lower levels of RUNX2 in the experimental animals than the controls, which was consistent with the bioinformatics results. HE, immunohistochemistry, and TUNEL staining confirmed a significant reduction in hormone-induced femoral head necrosis in the quercetintreated mice. HE, immunohistochemistry, and TUNEL staining confirmed significant improvement in hormone-induced femoral head necrosis in the quercetin-treated mice. We provide new insights into the genes and related pathways involved in SINFH and report that PTGS2, RUNX2, and NCF1 are potential drug targets. Quercetin improved SINFH by promoting osteogenesis and inhibiting apoptosis.

Coronary heart disease: innovative understanding from traditional Chinese medicine and treatment by classic formulas

Coronary heart disease is a common cardiovascular disease, attacking about 11.4 million patients in China. With increasing prevalence and mortality year by year, coronary heart disease has become a major factor threatening human health and public health. Although primary and secondary prevention, intervention, coronary artery bypass grafting and other interventions have reduced the death rate, there are drug(aspirin) resistance, secondary nitroglycerin failure, post-intervention fatigue, chest tightness, and an-xiety, and complication with a high risk of bleeding, which have become the key clinical and scientific issues needed to be resolved. Coronary heart disease belongs to the category of chest impediment and heart pain in traditional Chinese medicine(TCM). The TCM etiology of this disease includes external contraction of cold, emotional disorders, constitutional insufficiency, physical weakness, and labor injury, which are closely related to sympathetic nerve activity, state of cardiac and psychological diseases, family history, and cardiovascular metabolic disorders in modern medicine. The TCM causes of coronary heart disease include Qi depression, phlegm turbidity, blood stasis, fire-heat, cold congealing, and healthy Qi deficiency, which are associated with emotional factors such as anxiety and depression, abnormal lipid metabolism, abnormalities in blood circulation and coagulation, inflammatory responses, hyperactive immune responses, and heart failure, chronic wasting disease, or aging, respectively. Accordingly, the patients with Qi depression should be treated with Chaihu Longgu Muli Decoction, and those with phlegm turbidity should be treated with Wendan Decoction and Gualou Xiebai Banxia Decoction. Xuefu Zhuyu Decoction and Guizhi Fuling Pills are recommended for blood stasis, Xiaoxianxiong Decoction and Sanhuang Xiexin Decoction for fire-heat, Zhishi Xiebai Guizhi Decoction for cold congealing, and Renshen Decoction for healthy Qi deficiency. Due to the changes in the spectrum of diseases from ancient to modern times as well as the differences in physical constitution, the key cause of coronary heart disease has evolved from the chest Yang deficiency and cold congealing to Qi depression, phlegm turbidity, phlegm combined with stasis, and fire-heat, showing a shift from cold to heat and from deficiency to excess. The combination of classic formulas presents a pattern. That is, the core formula-syndrome correspondence of a disease often fixedly appears with other formula-syndrome correspondence, which may be related to the development of the pathophysiological mechanism of the disease. In the clinical application of modern pharmacological results, the research team has formulated the clinical principle of pathogenesis corresponding to pathological changes and medicinal nature corresponding pharmacological effects. The modern pharmacological research on classic formulas is conducive to targeted treatment. Moreover, classic formulas help to ameliorate aspirin resistance, clopidogrel resistance, post-intervention anxiety, and high risk of bleeding and address the lack of effective blockade of critical lesions in the coronary artery and the progression of post-infarction heart failure. The innovative understanding of the etiology and pathogenesis of co-ronary heart disease helps to improve the clinical efficacy of TCM and the clinical system for treating coronary heart disease with classic formulas.

Investigating the role of miR-26b-5p and PTGS2 in schizophrenia treatment using Wendan decoction: Network pharmacology and experimental validation

IntroductionThis study aimed to identify the target of action of Wendan decoction, a classical Chinese herbal formula used for the treatment of psychiatric disorders, specifically schizophrenia, using network pharmacology. MethodsTraditional Chinese Medicine (TCM) bioinformatics and network pharmacology were employed to predict the genes regulated by miR-26b-5p and identify the active ingredients and related targets of the Wendan decoction from public databases. Key components and targets were screened by constructing a "TCM-component-target" network, followed by pathway enrichment analysis of the related targets. The expression levels of miR-26b-5p and prostaglandin-endoperoxide synthase 2 (PTGS2) in the peripheral blood of patients with schizophrenia patients and healthy individuals were determined using RT-qPCR. Molecular docking was performed to explore the interaction between the active ingredients of the Wendan decoction and key differentially expressed molecules, investigating the role of miR-26b-5p in the treatment of schizophrenia with the Wendan decoction. ResultsA total of 135 active constituents were extracted from the Wendan decoction, and 144 molecules, including PTGS2 and other derivatives, were screened for drug-target and disease-target inter-mapping. Compared to peripheral blood samples from healthy controls and patients with depression, peripheral blood samples from patients with schizophrenia patients showed low miR-26b-5p expression and elevated PTGS2 expression, with no significant difference observed in the expression between healthy controls and patients with depression. Molecular docking revealed that several active compounds were found in five of the six constituents of the Wendan decoction bound with PTGS2. Pathway enrichment analysis suggested that the Wendan decoction may have a potential therapeutic role in treating schizophrenia by regulating the circadian rhythm, N-methyl-d-aspartate glutamate receptor activity, inflammatory mediator regulation of transient receptor potential channels, and other pathways implicated in schizophrenia. ConclusionWendan decoction may treat schizophrenia via the miR-26b-5p targeting factor PTGS2 and inflammation-related pathways. miR-26b-5p, combined with PTSG2, holds the potential as a differential diagnostic marker for schizophrenia.

Activation of GABA type A receptor is involved in the anti-insomnia effect of Huanglian Wendan Decoction

Huanglian Wendan Decoction (HWD) is a traditional Chinese medicine (TCM) prescribed to patients diagnosed with insomnia, which can achieve excellent therapeutic outcomes. As positively modulating the γ-aminobutyric acid (GABA) type A receptors (GABAARs) is the most effective strategy to manage insomnia, this study aimed to investigate whether the activation of GABAARs is involved in the anti-insomnia effect of HWD. We assessed the metabolites of HWD using LC/MS and the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database and tested the pharmacological activity in vitro and in vivo using whole-cell patch clamp and insomnia zebrafish model. In HEK293 cells expressing α1β3γ2L GABAARs, HWD effectively increased the GABA-induced currents and could induce GABAAR-mediated currents independent of the application of GABA. In the LC-MS (QToF) assay, 31 metabolites were discovered in negative ion modes and 37 metabolites were found in positive ion modes, but neither three selected active metabolites, Danshensu, Coptisine, or Dihydromyricetin, showed potentiating effects on GABA currents. 62 active metabolites of the seven botanical drugs were collected based on the TCMSP database and 19 of them were selected for patch-clamp verification according to the virtual docking simulations and other parameters. At a concentration of 100 μM, GABA-induced currents were increased by (+)-Cuparene (278.80% ± 19.13%), Ethyl glucoside (225.40% ± 21.77%), and β-Caryophyllene (290.11% ± 17.71%). In addition, (+)-Cuparene, Ethyl glucoside, and β-Caryophyllene could also serve as positive allosteric modulators (PAMs) and shifted the GABA dose-response curve (DRC) leftward significantly. In the PCPA-induced zebrafish model, Ethyl glucoside showed anti-insomnia effects at concentrations of 100 μM. In this research, we demonstrated that the activation of GABAARs was involved in the anti-insomnia effect of HWD, and Ethyl glucoside might be a key metabolite in treating insomnia.

A Review of a Traditional Chinese Medicine Formula for Treating Insomnia with Depression: Wendan Decoction

Background: The relationship between insomnia and depression is complex and two-way. Long-term insomnia may cause, maintain, and aggravate depression, and with the development of the disease, depression patients will also experience insomnia symptoms. Oral medication is currently the main treatment for insomnia with depression (ID). Drugs such as Estazolam have good anti-anxiety and insomnia effects, high safety, and relatively small side effects. They are widely used in the treatment of ID in clinics, but some patients still have adverse reactions or low efficacy when taking Estazolam and other drugs. In recent years, Chinese herbal medicine and TCM prescriptions for the treatment of mental illness have been more and more accepted and studied by international scholars. The efficacy of Wendan Decoction (WDD) has been tested by ancient China for nearly 1,400 years, and with the development of modern pharmacological research, it is widely used in the treatment of insomnia and depression. Purpose: Therefore, based on the understanding of ID in TCM, this article discusses the pharmacodynamic effect of WDD, and based on existing clinical and experimental studies, comprehensively analyzes the clinical observation, mechanism of action, and pharmacological effect of WDD in the treatment of ID, to provide more clinical experience and experimental theoretical support for WDD in the treatment of ID. Methods: Retrieve Chinese and English literature on the treatment of ID with WDD from databases such as Web of Science, etc. Conclusion: WDD has good therapeutic effects on ID.

Therapeutic effect of Wendan Decoction combined with mosapride on gastroesophageal reflux disease after esophageal cancer surgery.

Gastroesophageal reflux disease (GERD) is a common complication of esophageal cancer surgery that can affect quality of life and increase the risk of esophageal stricture and anastomotic leakage. Wendan Decoction (WDD) is a traditional Chinese herbal formula used to treat various gastrointestinal disorders, such as gastritis, functional dyspepsia, and irritable bowel syndrome. Mosapride, a prokinetic agent, functions as a selective 5-hydroxytryptamine 4 agonist, enhancing gastrointestinal motility. To evaluate the therapeutic effects of WDD combined with mosapride on GERD after esophageal cancer surgery. Eighty patients with GERD were randomly divided into treatment (receiving WDD combined with mosapride) and control (receiving mosapride alone) groups. The treatment was conducted from January 2021 to January 2023. The primary outcome was improved GERD symptoms as measured using the reflux disease questionnaire (RDQ). The secondary outcomes were improved esophageal motility (measured using esophageal manometry), gastric emptying (measured using gastric scintigraphy), and quality of life [measured via the Short Form-36 (SF-36) Health Survey]. The treatment group showed a notably reduced RDQ score and improved esophageal motility parameters, such as lower esophageal sphincter pressure, peristaltic amplitude, and peristaltic velocity compared to the control group. The treatment group showed significantly higher gastric emptying rates and SF-36 scores (in both physical and mental domains) compared to the control group. No serious adverse effects were observed in either group. WDD combined with mosapride is an effective and safe therapy for GERD after esophageal cancer surgery. It can improve GERD symptoms, esophageal motility, gastric emptying, and the quality of life of patients. Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.

The in vivo study on antioxidant activity of wendan decoction in treating hyperlipidemia: a pharmacokinetic-pharmacodynamic (PK-PD) model.

Background: Wendan Decoction (WDD) is a six-herb Chinese medicine recipe that was first mentioned in about 652 AD. It is frequently used to treat hyperlipidemic patients' clinical complaints. According to reports, oxidative stress has a significant role in hyperlipidemia. Purpose: There has not yet been a thorough pharmacokinetic-pharmacodynamic (PK-PD) examination of the clinical efficacy of WDD in the context of hyperlipemia-related oxidative stress. Therefore, the goal of this research is to explore the antioxidant essence of WDD by developing a PK-PD model, ordering to assure its implication in treating hyperlipidemia in medical practice. Methods: The model rats of foodborne hyperlipidemia were established by feeding with high-fat feed, and the lipid-lowering effect of WDD was explored. The plasma drug concentration of rats at different doses were measured by UPL-MS/MS technology, and PK parameters were calculated using Phoenix WinNonlin 8.1 software. The level of lipid peroxide (LPO) in plasma at different time points was measured by enzyme labeling instrument. Finally, the PK-PD model was established by using Phoenix WinNonlin 8.1 software, to explore the lipid-lowering effect of WDD and the relation between the dynamic changes of chemical components and antioxidant effect. Results: The findings suggested that, WDD can reduce the levels of triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) in plasma, and high-density lipoprotein cholesterol (HDL-C) was related to the dosage. Between the peak drug levels and the WDD's maximal therapeutic response, there existed a hysteresis. WDD's effect-concentration curves displayed a counterclockwise delaying loop. Alternatively, among the ten components of WDD, hesperetin, quercetin, naringenin and tangeretin might exert more significant effects in regulating the LPO levels in hyperlipidemic rats. Conclusion: This study can be helpful for other investigators to study the lipid-lowering effect of WDD.

Effect of Modified Wendan Decoction on Serological Indices and Safety Analysis in Elderly with Chronic Cholecystitis of Damp-Heat Syndrome in Liver and Gallbladder

Effect of Modified Wendan Decoction on Serological Indices and Safety Analysis in Elderly with Chronic Cholecystitis of Damp-Heat Syndrome in Liver and Gallbladder

Mechanism of Wendan decoction in preventing obesity by regulating multiple signal pathway networks based on gene promoter methylation

ObjectiveTo investigate the potential mechanism of Wendan decoction in obesity by screening target genes with promoter region methylation changes and constructing a multiple signaling pathways network based on promoter methylation. MethodsThe methylation degree of Itgad, Col8a1, Adra2b, Jund, Rab2a, Wnt8b, Fzd9, B4galt7, Pik3cd, Creb1, Stard8, and Mmp1 in the abdominal adipose tissue of obese rats was determined using the Agena MassARRAY system. Western blot was performed to assess protein expression levels. Target genes were identified based on the methylation degree in the promoter region and protein expression. Enrichment analysis of signaling pathways was conducted to identify relevant target genes and obtain a multiple signaling pathway network associated with obesity. Core and terminal effector molecules in the pathway networks were selected as research targets for reverse transcription-polymerase chain reaction (RT-PCR) analysis. ResultsFour genes (Adra2b, Creb1, Itgad, and Pik3cd) showed a degree of promoter methylation consistent with their respective protein expression levels. Among them, Adra2b, Creb1, and Pik3cd expression increased, while that of Itgad decreased. Enrichment analysis revealed that Creb1 and Pik3cd were involved in 6 signaling pathways related to obesity: tumor necrosis factor (TNF) signaling pathway, growth hormone synthesis/secretion and action, adenosine 5′-monophosphate-activated protein kinase (AMPK) signaling pathway, relaxin signaling pathway, cyclic nucleotide (cAMP) signaling pathway, and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway. Subsequently, a multiple signaling pathways network was constructed based on promoter methylation. Key molecules including protein kinase B (AKT), mechanistic target of rapamycin complex 1 (mTORC1), and unc-51 like autophagy activating kinase 1 (ULK1), as well as terminal effector molecules interleukin-1β (IL-1β), interleukin-6 (IL-6), and chemokine (C-X-C motif) ligand 2 (CXCL2) were selected as research targets. Wendan decoction decreased the expressions of AKT, mTORC1, IL-1β, IL-6, and CXCL2 while up-regulating ULK1 expression. ConclusionThe mechanism of Wendan decoction in preventing obesity involves the regulation of multiple signaling pathways through the control of Creb1 and Pik3cd gene promoter methylation. However, the associated multi-path gene regulation mechanism in preventing obesity is complex. Thus, further exploration is needed to elucidate the role of methylation changes in this mechanism.

Clinical efficacy of Huanglian Wendan decoction in treating type 2 diabetes mellitus: A systematic review and meta-analysis.

Huanglian Wendan decoction (HLWDD) is a traditional Chinese prescription, which has been used to treat type 2 diabetes mellitus (T2DM) in recent years. However, no studies have evaluated its underlying clinical efficacy. Therefore, we used systematic review and meta-analysis to explore the clinical efficacy of HLWDD in treating T2DM. The randomized controlled trials of HLWDD on T2DM were retrieved from Chinese and foreign databases. The primary outcomes included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), and glycosylated hemoglobin, type A1c (HbA1c). The secondary outcomes included fasting serum insulin, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c). Statistical analyses were performed using Review Manager and Stata software. Mean difference (MD) with 95% confidence intervals (CI) were used to describe results. The grades of recommendation assessment, development and evaluation approach was used to rate the quality of the evidence; and trial sequential analysis was used to evaluate the required information size and treatment benefits. Twenty-three randomized controlled trials were included in this study. We showed that HLWDD can improve FBG (MD = -0.99, 95% CI: -1.10 to -0.88), 2hPG (MD = -1.57, 95% CI: -1.97 to -1.17), HbA1c (MD = -1.11, 95% CI: -1.42 to -0.80), HOMA-IR (MD = -0.80, 95% CI: -1.80 to -0.51), TC (MD = -0.65, 95% CI: -0.88 to -0.42), TG (MD = -0.32, 95% CI: -0.38 to -0.27), LDL-c (MD = -0.54, 95% CI: -0.66 to -0.41), and HDL-c (MD = 0.08, 95% CI: 0.02-0.15) levels in T2DM patients. Trial sequential analysis suggested that the eficacy of HLWDD in improving FBG, 2hPG, HbA1c, HOMA-IR, TC, TG, LDL-c, and HDL-c was sufficient to draw a firm conclusion. Grades of recommendation assessment showed that HLWDD only has high or moderate quality of evidence in improving FBG, and TG. HLWDD can improve blood glucose and blood lipid levels in T2DM patients, and may be a potential drug to treat T2DM.

Scoping review of clinical studies on Chinese herbal medicine against Helicobacter pylori and an exploration of its usage pattern

Helicobacter pylori (H. pylori) is a highly infectious bacterium that can aggravate upper gastrointestinal diseases. With the increasingly serious problem of H. pylori drug resistance, it is more important to seek new treatment methods. In recent years, there has been an increasing number of studies on the treatment of H. pylori infection and related diseases with Chinese herbal medicine (CHM). The effectiveness of CHM has also emerged. Therefore, the aim of this scoping review was to systematically identify and summarize the characteristics of randomized controlled trails (RCTs) evaluating CHM for treating H. pylori infection. Three Chinese and two English language databases were comprehensively searched. Included studies were RCTs of H. pylori-positive patients evaluating oral CHM with or without Western Medicine (WM) compared to WM alone. A descriptive analysis of study characteristics and association rule mining in R Studio software were used to identify frequent herbal combinations. The Cochrane Collaboration Risk of Bias tool was used to assess study quality. Included were 165 RCTs, with 168 comparisons, involving 16,817 participants. All the RCTs were conducted in China and 68% were published after 2012. The quality of included studies was moderate. The RCTs evaluated 187 herbs that were used in various combinations in 91 types of CHM formulas. Most RCTs compared CHM plus WM to WM only (n=103 comparisons). Only 68% of the RCTs evaluated a recommended WM triple or quadruple therapy. Results showed that Banxia Xiexin Decoction, Huangqi Jianzhong Decoction, Huanglian Wendan Decoction and Jinghua Weikang Capsule were commonly used. The association rules showed that golden thread (Coptis chinensis Franch.), debark peony root (Paeonia lactiflora Pall.), milkvetch root (Astragalus mongholicus Bunge), dandelion (Taraxacum mongolicum Hand.-Mazz.), dried tangerine peel (Citrus reticulata Blanco), tangshen (Codonopsis pilosula (Franch.) Nannf.), largehead atractylodes rhizome (Atractylodes macrocephala Koidz.), processing liquorice root (Glycyrrhiza glabra L.), pinellia tuber (Pinellia ternata (Thunb.) Makino) were commonly used clinically. The findings from this review highlight the potential role of CHM formulas for treating H. Pylori and can be used to inform further clinical trials and systematic reviews.

Meta-analysis of the effectiveness of <i>Euodia rutaecarpa</i> Benth acupressure and Wendan decoction in the treatment of vertigo

Purpose: To systematically assess the efficacy and safety of combining Euodia rutaecarpa Benth acupressure with Wendan decoction for the treatment of vertigo, thereby establishing a theoretical framework for informed clinical practice.Methods: Computer-based search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane databases to identify randomized controlled literature pertaining to efficacy and safety of Euodia rutaecarpa Benth acupressure in combination with Wendan decoction for management of vertigo. The experimental group received an intervention of Euodia rutaecarpa Benth acupressure combined with Wendan decoction. Articles that met set inclusion and exclusion criteria were screened and evaluated for quality based on Cochrane Quality Rating Scale. Baseline data, intervention data and outcome indicators of included studies were also extracted. Meta-analysis was performed using RevMan 5.4 software.Results: The difference in symptom scores between groups was statistically significant (RR = -0.04, 95 % CI (-0.3, 0.23), p = 0.78). Meta-analysis of the outcome indicators showed heterogeneity at p < 0.0001, I2 = 91 %. I2 = 91 > 50 %. There was a statistically significant difference (p < 0.05) between groups in terms of total treatment efficiency (RR = 0.31, 95 % CI (-0.25, 0.88), p = 0.28). Heterogeneity of vertigo degree score showed p < 0.0001, I2 = 98 %. I2 = 98 % > 50 %, SMD = 2.34, 95 % CI (0.69, 3.99), p = 0.53.Conclusion: The combination of clinical Euodia rutaecarpa Upright acupressure and Wendan decoction demonstrates significant clinical effectiveness in treating vertigo as evidenced by improvement of all indicators. Moreover, this treatment approach exhibits a high level of safety.

Effect of Traditional Chinese Medicine combined with Western Medicine on blood lipid levels and inflammatory factors in patients with angina pectoris in coronary heart disease identified as intermingled phlegm and blood stasis syndrome: a network Meta-analysis.

To evaluate the clinical efficacy of Traditional Chinese Medicine prescriptions for resolving phlegm in the treatment of angina pectoris of phlegm-stasis coronary heart disease by a network Meta-analysis. Randomized controlled trials (RCTs) on clinical efficacy of CHD angina pectoris with interaction of phlegm and blood stasis were searched in PubMed, Springer, the Cochrane Library and Chinese-language databases China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Data from their inception to December 2021. Literature was screened and literature bias risk was assessed by RevMan5.4 software. The overall response rate, the duration of angina attack, the levels of serum lipids such as total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C), and expression of hypersensitive C-reactive protein (hs-CRP) were selected as outcome indicators for network Meta-analysis and mapped using Stata15.1 software. Totally, 26 RCTs were included, involving 2098 participants. There were 6 TCM formulas with the effects of dispelling phlegm and removing blood stasis. Taking conventional Western Medicine as the common intervention measures, the results showed that the overall response improvement rate from high to low was displayed as modified Xiaoxianxiong decoction (, MXD), Danlou tablet (, DT), modified Gualou Xiebai Banxia decoction (, MGXBD), modified Wendan decoction (, MWD), modified Zhishi Xiebai Guizhi decoction (, MZXGD), and modified Erchen decoction (, MED). The sequence of angina attack duration improvement from high to low was MZXGD, MGXBD, DT, MWD, MXD. The sequence of TC improvement from high to low was MZXGD, MED, DT, and MGXBD. Sequence of improving TG from high to low was MED, MZXGD, MGXBD, and DT. For LDL-C improvement, the effect from good to poor was MZXGD, MGXBD, DT, and MED. With regard to HDL-C improvement, the effect was ranked as MED, MZXGD, MGXBD, and DT from good to poor. hs-CRP expression from high to low was MZXGD, MXD, MED, MWD, and MGXBD. TCM formula with the effects of dispelling phlegm and removing blood stasis combined with conventional Western Medicine has obvious advantages in treating CHD angina pectoris with interaction of phlegm and blood stasis. MZXGD has great potential in increasing the overall response rate, reducing Duration of angina attack improving blood lipids, and reducing inflammatory factors. However, due to the limitations of extant studies, the conclusions of this study need to be confirmed by numerous reasonably-designed RCTs.

Investigating the multitarget pharmacological mechanism of Wendan decoction in the treatment of schizophrenia

Investigating the multitarget pharmacological mechanism of Wendan decoction in the treatment of schizophrenia

A Synthetic External Control Study Comparing the Clinical Efficacy of Wendan Decoction and 19 Antidepressants.

Wendan decoction (WDD) has been used as a treatment for depression in China since the Tang Dynasty. However, high-quality evidence for this is lacking. This study proposed a novel synthetic external control method to evaluate its clinical efficacy. We searched public databases for clinical trials of WDD for major depression. The rate of change of the Hamilton Depression Scale score from baseline was used as an efficacy indicator, and a model-based meta-analysis was performed to analyze the clinical efficacy of WDD. To establish a reference standard for efficacy, the antidepressant efficacy distributions of a placebo and 19 antidepressants were virtually synthesized based on the same conditions as the clinical trial characteristics of WDD. This study included 5 clinical trials with 177 participants. WDD showed a slow onset, with a time to reach the maximum effect of 9.71 weeks. At 8 weeks, the rate of change in the Hamilton Depression Scale score from baseline was 66.4% (95% CI = 62.3%-70.3%) in the WDD group. The pure effect value of WDD, after deducting the placebo effect, was 26.9% (95%CI = 23.0%-30.9%), which was comparable with 5 types of antidepressants and significantly higher than the others. The proposed external synthetic control method provides a solution to the bottleneck problem of clinical efficacy evaluation in real-world research on traditional Chinese medicine. WDD has high clinical development value for the treatment of depression, and large-scale randomized controlled trials are recommended to confirm its antidepressant effect.

Clinical efficacy and metabolomics study of Wendan Decoction in the treatment of phlegm-dampness obstructive sleep apnea-hypopnea syndrome with type 2 diabetes mellitus

Ethnopharmacological relevanceWendan Decoction (WDD) is one of the classic traditional Chinese prescriptions that has been used in the treatment of type 2 diabetes mellitus (T2DM), metabolic syndrome, obstructive sleep apnea-hypopnea syndrome (OSAHS) and so on. The therapeutic effects and mechanism of WDD remain to be explored, especially from the perspective of metabolomics, oxidative stress and inflammation. Aim of the studyTo investigate the therapeutic and metabolic regulatory effects and the underlying mechanism of WDD in OSAHS with T2DM patients. Materials and methodsAll included patients were from Rudong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu Province, China. Both groups received lifestyle interventions; at the same time, all of them were administered metformin (1500 mg/day) and dapagliflozin (10 mg/day), and the treatment group was administered WDD orally. All patients were treated for two months. Before and after treatment, the changes in clinical symptoms and signs of the two groups of patients were evaluated, and the detection indicators such as body mass index (BMI), apnea-hypopnea index (AHI), lowest arterial oxygen saturation (LSaO2), Epworth sleepiness scale (ESS), percentage of total sleep time with oxygen saturation <90% (TST90), fasting plasma glucose (FPG), 2-h post-load glucose(2h-PG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR)，hemoglobin A1c (HbA1c), blood lipid levels, as well as the adverse reactions and compliance of the patients were observed and detection of serum metabolites in patients to screen out specific biomarkers. The serum metabolic profile of WDD in OSAHS with T2DM patients was explored using ultra-high-performance liquid chromatography-quadrupole/electrostatic field orbitrap high-resolution mass spectrometry (UPLC-Q Orbitrap HRMS). ResultsAfter treatment with WDD for 8 weeks, biochemical indicators, including BMI, FPG, 2h-PG, blood lipid, FINS, HbA1c, AHI, ESS, LSaO2, TST90, and HOMA-IR, were significantly improved. Serum metabolomic analysis showed that metabolites were differentially expressed before and after WDD-treated patients. Metabolomics results revealed that WDD regulated the biomarkers, such as DL-arginine, guaiacol sulfate, azelaic acid, phloroglucinol, uracil, L-tyrosine, cascarillin, Cortisol and L-alpha-lysophosphatidylcholine. Pathway enrichment analysis showed that the metabolites were associated with oxidative stress and inflammation. ConclusionThe study based on clinical research and metabolomics indicated that WDD can improve OSAHS with T2DM through multiple targets and pathways, and it may be a useful alternative therapy for the treatment of OSAHS with T2DM patients.