| Objective:Profession Li Guixian believe the ulcerative colitis belong to diarrhea cause its clinical manifestation such as sloppy, diarrhoea, and mucobloody stool. The mechanism includes poor spleen-stomach qi, liver-spleen imbalance, damp-heat as well as qi-stagnation and blood stasis. Stagnation of liver qi and spleen deficiency is a clinical common in UC manifestation. Hence profession Li treat UC by Jia Wei Chai Shao Liu Jun decoction which combines with Si Ni decoction and Liu Jun decoction to sooth liver and strengthen spleen. The decoction adding oldenlandia and bracken is to clean the damp-heat as well as pseudo-ginseng and orange peel to promote qi to activate blood. All above are bass on "If activating the blood, the mucobloody will be heal and if promoting the qi, the tenesmus will be cured" to sooth liver-qi stagnation, regulate qi-flowing for strengthening spleen, clear heat and promote diuresis as well as activate blood circulation to dissipate stasis.This subject, base on previous studies, systematically sorting the academic thoughts of professor Li Gui xian and the clinical experience in the treatment of UC,uses experiment randomized and controlled trial to explore the mechanism of modified Chaishao Liujunzi Decoction in treating ulcerative colitis through observing the mucosal healing quality under colonoscopy, the traditional Chinese medicine syndrome index, survival quality and the changed-expression of serum NF-KBp50, CRP before and after treatment. In addition to probe into the effect and mechanism of modified Chai Shao Liu Jun Zi Decoction in treating ulcerative colitis by observing colon morphologyand the index of TLR-4/NF-kappa B signal pathway.Method:This topic is divided into three parts:systematically sorting the academic thoughts of professor Li Guixian and the clinical experience in the treatment of UC,clinical and experimental research.Clinical research methods:According to the prospective and non inferiority design,60 cases of ulcer colitis patients who met the diagnostic criteria, inclusion criteria and exclusion criteria were randomly divided into two groups according to treatment sequence. The intervention group was treated with modified Chaishao liujunzi Decoction for 12 weeks, while the control group was treated with mesalazine for 12 weeks. Detailedly recorded the TCM syndrome score, the changes of colonoscopy and the quality of life before and after treatment, and the expression of NF-KBp50, CRP were measured by ELISA. We can multi-anglely evaluate the Jiawei Chaishao Liujunzi Decoction in treating ulcerative colitis based on the observation of mucosal healing quality, main symptom score and quality of life (via the Hamilton Anxiety and Depression Scale score).Experimental research methods:180 SPF SD rats were randomly divided into 6 groups by weight,such as normal group, blank group, control group and intervention group (low dosage, middle dosage and high dosage).Except normal group, the UC model were administrated by TNBS enema preparation in rats. After 4 days, the blank group were given isodose of normal saline, while the control group was treated with mesalazine hydrochloride, the intervention group received different doses of modified Chaishao Liujunzi Decoction respectively for 1 week. All rats were sacrificed at the end of last dosage. The intestinal histopathology in UC rats were detected by light microscopy. The application of Real-time PCR, detection of the expression of TLR-4, NF-k Bp65 in UC were assayed by Real-time PCR and immunohistochemical stains.Results:Clinical research results:The curative effect was determined by the changes under colonoscopy.In the intervention group, we find that 5 cases was in the clinical complete remission,8 cases was effective,10 cases was improvement,7 cases were ineffective, and the total efficiency was 76.66%.In the control group, we find that 3 cases was in the clinical complete remission,7 cases was effective,11 cases was improvement,9 cases were ineffective, and the total efficiency was 70%. After the statistical analysis, the effect of two groups was similar (P>0.05). The curative effect was determined by symptom score. In the intervention group, we find that 6 cases was in the clinical complete remission,7 cases was effective,12 cases was improvement,5 cases were ineffective, and the total efficiency was 83.33%.In the control group, we find that 4 cases was in the clinical complete remission,6 cases was effective,10 cases was improvement,10 cases were ineffective, and the total efficiency was 66.66%. After the statistical analysis, the curative effect in the intervention group was better than that in the control group (P<0.05). The curative effect was determined by Hamilton for the quality of life.In the intervention group, we find that 7 cases was in the clinical complete remission,8 cases was effective,11 cases was improvement,4 cases were ineffective, and the total efficiency was 86.66%.In the control group, we find that 4 cases was in the clinical complete remission,5 cases was effective,12 cases was improvement,9 cases were ineffective, and the total efficiency was 70%. After the statistical analysis, the curative effect in the intervention group was better than that in the control group (P<0.05). Before treatment, there is no statistical significance of clinical symptoms in two groups. After 4 weeks treatment, there is no obvious remission of patients with hematochezia, abdominal pain, diarrhea and other symptoms compared in two groups. After 8 weeks treatment, the patients with hematochezia, abdominal pain, diarrhea and other symptoms have different degrees of improvement in two groups.There was statistically significant difference(P<0.05). After 12weeks treatment, the patients with the above symptom were significantly improved in two groups than that before treatment. There was statistical significance (P<0.05). After 12weeks treatment, the symptom score in intervention group was better than that in control group. After treatment, the levels of NF-kB p50 and CRP were decreased compared with those before treatment. The difference is statistically significant (P<0.05), and" the differences between two groups have no statistical significance (P>0.05). Before treatment, the patients in two groups have different degree of anxiety plus depression. There was no significant difference (P>0.05). After treatment, the clinical symptoms of patients with anxiety plus depression were improved. The improvement in two groups was better than that before the treatment (P<0.05). The anxiety/depression improvement in intervention group was significantly better than that in control group (P<0.05).Experimental research results:It is characterize by hyperemia, swelling, erosion, partially visible necrosis and white fur like attachment, many large ulcers in blank groups by naked eyes. However,In intervention group, the colon mucosa congestion and swelling were reduced, the erosion was little, and no white coating was attached, no obvious ulcer was found.Meanwhile, Under the light microscope, we can see a larger ulcer in mucosal layer, ulcer surface with exudative necrosis layer, the visible small amount of immature granulation tissue, glandular expansion around the ulcer, mild hyperplasia of the glandular epithelial cells and intestinal wall layers with the infiltration of inflammatory cells in blank group.But, mucosa hyperemia and little inflammatory cell infltrated and fibroblast cell increased was seen in intervention group. The differnce between blank group and intervention group in pathological score is obvious(P<0.05). The positive experessin area of TLR-4, NF kappa bp65 protein in blank group was in the increment. Compared with blank group, those indexes which we have mentioned are just on the contrary in high dosage intervention group (P< 0.05). Compared with the blank group, the expression of TLR-4, NF kappa bp65 in low and middle dosage intervention group was not significantly different (P> 0.05).Conclusion:1. Modified Chaishao Liujunzi Decoction can down-regulation the levels of NF-kBp50, CRP in order to reduce the degree of inflammation of colonic lesions and improve the symptoms such as hemafecia, abdominal pain and diarrhea. Its clinical efficacy was similar to the mesalazine with safety and no obvious toxic side effects. In addition, Jiawei Chaishao Liujunzi Decoction can superiorly improve the life quality of UC patients.And it is worth to promote the application.2.The modified Jian wei Chai shao Liu jun zi Decoction exerts multi targets effect in improving UC by down-regulating the expression of TLR-4, NF kappa B p65, alleviating intestinal inflammation,promoting the secretion of mucoprotein, promoting reparation of intestinal mucosa. |
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