| BackgroundTraditional Chinese medicine enema is the aquosity or oily solution or suspension. Traditional Chinese medicine enema is made of herbal or Chinese patent medicine. It is manufactured to meet the requirements of perfusion in the rectum in order to achieve therapeutic, diagnostic or nutritional purposes. China has a lot of ancient medical books on traditional Chinese medicine enema treatment of disease documented. As early as more than a thousand years ago, "Treatise on Febrile Diseases" and had "a pig bile, diarrhea juice, and a touch of vinegar to irrigation within the anus," the record is indeed the oldest traditional Chinese medicine enema. The current study shows that traditional Chinese medicine enema has the following characteristics:①High bioavailability:compared with oral medication, drugs can be directly absorbed through the rectal mucosa, so the active component of drugs can be directly into the liver without going through the systemic circulation. It avoid the liver first-pass effect.It is the prevention or reduction of drug in the liver is damaged. It prevents the destruction of gastrointestinal digestive juice of drugs. It makes the bioavailability of drugs given full play.②It absorbs quickly, excellence quickly, maintain a long time.③It meets the requirements of traditional Chinese medicine dialectical treatment and the experiences of traditional Chinese medication. Traditional Chinese medicine enema maintains the characteristics of traditional Chinese medicine decoction. The prescription can be changed for drugs addition and subtraction according to the condition and needs.④It is suitable for a wide range. As long as the treatment effect achieved through oral diseases can be treated with the method of enema.⑤It is not subject to restrictions on drugs and dosage forms. As long as they are able to oral, such as broth, composition, syrup, soft extract, extract, powder, drug granules, pills, pellet, etc, can be dissolved or diluted for enema according to the drug property and the dosage. Otherwise, Traditional Chinese medicine enema preparation process is simple, easy, without any limitations, and therefore the primary hospital can made the enema by itself. The use is more convenient.Guangdong authentic medicinal herbs centella asiatica, the other name is Centalla asiatica, lianqiancao, diqiancao, maticao, laogonggeng, kuipengcai, bengkouwan, tiaopowan, leigongwan, etc. It is the Umbelliferae Centella asiatica in the whole plant. It is widely distributed throughout the south of the Yangtze River basin. It is commonly used in Chinese herbal medicine in Guangdong folk. It uses the entire plants as a medicine. It is beneficial to the damp elimination, promoting blood flow, haemostasis and detumescence by detoxification. Cantonese has long been the application of Centella asiatica apozem clysterin the treatment of chronic renal failure (CRF) usage. Zhongshan City, Guangdong Province Chinese Medicine Hospital of Nephrology, according to local application of methods and experiences, the trial Centella asiatica decoction enema therapy in CRF patients with more than 20 cases to obtain better effect. Compound Centella asiatica in the long-term clinical practice shown to improve symptoms in patients with CRF, lower serum creatinine, blood urea nitrogen and 24h urinary protein. The subject of the basis of modern medicine and Chinese medicine, the cause of the CRF and the pathogenesis of the comprehensive analysis and research, using the traditional Chinese medicine enema treatment, with the Guangdong native herbs Centella asiatica as the primary drug made from compound preparation, using modern scientific research methods to study and evaluation of traditional Chinese medicine compound Centella asiatica Enema pharmacological effects of CRF for the clinical application of the drug to provide more favorable scientific basis.ObjectiveCentella asiatica of compound enema rats with chronic renal failure urine biochemical indicators, blood biochemistry, kidney coefficient and kidney tissue.Methods1. SPF-grade SD rats were 70 male and female in half, weighing 220-280g, edible SPF grade feed, drinking water, sterile water for the daily feeding and water free. Week after the normal feeding adaptation of each rat were weighed, weight 200±10g in the context of selection of coat color, body similar to the normal 10 rats (male and female of all five) as the black control group, the other rats fed 0.5% adenine feed modeling experiments. During modeling, we have to observe the changes of body weight, urine volume, body hair and activities of the state. Modeling the first 30d, rats were obtained from the metabolic cages 24h urine, and used the way the tail cut blood; were used dry-chemical analysis model rats urine routine, double-reduction urine colorimetry urine protein (PRO), enzyme-coupled-rate determination of blood urea nitrogen (BUN), sarcosine oxidase enzymatic determination of creatinine (Cr) levels were observed level of modeling.2. After 30d modeling, we began administration. Except during the administration of the blank control group, the model rats continued to feed adenine feed. The model rats were randomly divided into five groups of 12 rats:model control group, compound Centella asiatica enema high-dose group(22.5g·g-1), compound Centella asiatica enema middle-dose group(15.0g·kg-1),compound Centella asiatica enema low-dose group(7.5g·kg-1), positive control group (3.68g·kg-1) and blank control group and model control group drench with sterile distilled water(10g·kg-1). In addition to Niaoduqing group method using oral administration, the remaining groups were administered enema. More than 1 dose daily administration, continuous administration of 30d.3.30d after the administration of the sample collection and testing:Take 24h rat urine, the rats were anesthetized and blood from the abdominal aorta cannulation. Test items:①24h. urine protein quantity (UTP);②blood urea nitrogen (BUN), creatinine (Cr) level.4. Purchase another 70 SD rats, male and female in half, weighing 180～220g, the same method modeling 30d.5. After 30d modeling, we began administration. Except during the administration of the blank control group, the model rats continued to feed adenine feed. The model rats were randomly divided into five groups of 12 rats:model control group, compound Centella asiatica enema high-dose group(19.56g·kg-1), compound Centella asiatica enema middle-dose group(9.78g·kg-1), compound Centella asiatica enema low-dose group(4.89g·kg-1), positive control group (3.68g·kg-1) and blank control group and model control group drench with sterile distilled water(10ml·kg-1). All animals administered by gavage method. More than 1 dose daily administration, continuous administration of 30d.6. Samples collected after administration of 30d and test:The rats were anesthetized, blood from the abdominal aorta cannulation. Test items:①potassium (K), sodium (Na), calcium (Ca), phosphorus (P) content detection;②red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT) test;③rats were killed after the removal of the kidney, weighed, with 10% formaldehyde for pathological observation.7. Statistical methods:the experimental data with mean±standard deviation (x±s) that the statistical method of variance analysis, the results using SPSS13.0 statistical software package, analysis of variance using One-Way ANOVA. Homogeneity of variance between each group using LSD multiple comparison test; variance incomplete analysis of variance used the Welch approximate experimental methods. The above test to P<0.05 for the difference was statistically significant.Results1. For UTP levels in rats:comparison with the blank control group, model control group rats UTP levels were markedly elevated in urine (P<0.05).Compared with the model control group, compound Centella asiatica enema three dose groups and the positive control group UTP in rat urine were markedly lower (P<0.05).2. On rat serum BUN, Cr impact:compared with the blank control group, model control group rats blood BUN and Cr levels were markedly elevated (P< 0.05). Centella asiatica compound enema three dose groups and the positive control group blood BUN, Cr level was markedly lower than model group (P<0.05).3. The impact on the electrolytes in rats:CRF rats with metabolic abnormalities, resulting in osmotic diuresis, and thus the body's water-electrolyte balance disorders, appears high potassium, high phosphorus, sodium, calcium, and low chlorine. After the compound Centella asiatica enema treatment, we can see that relative to the model group electrolytes have changed markedly, especially for high-dose group and the positive control group had significant changes (P<0.05).4. For the blood of rats:CRF rats fed with adenine due to the long feed, could result in decreased food intake, inadequate intake of raw materials erythropoietin, which led to hematocrit (HCT), red blood cell count (RBC) and hemoglobin (HGB) levels decreased markedly. After treatment, we can see that the positive control group and the compound Centella asiatica enema high-dose group was markedly elevated CRF rats, HCT, RBC and HGB levels (P<0.05). The Centella asiatica enema middle-dose group and low-dose group of the RBC also has a significant role in increased (P<0.05).5. Coefficients of rat kidney:kidney coefficient is the ratio of kidney weight and body weight.It can be a direct reflection of the kidney lesions. In CRF rats kidney tissue, there are a large number of adenine metabolites crystal deposition, it was "white kidneys" state. So the kidney coefficient of model control group of rats was markedly higher than the blank control group (P<0.05). After administration treatment, the compound of Centella asiatica enema high-dose group and the positive control group kidneys coefficient was markedly lower than model control group (P <0.05), but the middle-dose group and low-dose group both are not significant.6. On rat kidney tissue effects:In addition to the naked eye can see beyond the blank control group, other groups all showing "white kidneys" state, positive control group and the compound Centella asiatica enema high-dose group compared with model group, the kidney surface, smooth, granular sense is not strong. Pathological picture shows the model group can see that there are a large number of renal cortical tubular golden-yellow crystals, reducing the number of glomeruli, a larger number of glomerular degeneration, the majority of glomerular mesangial cells (MC) proliferation, extracellular matrix (ECM) increase in glomerular cysts expand, balloon adhesions, glomerular lumen expansion, some cavity protein casts, interstitial connective tissue proliferation. The positive control group and the compound of Centella asiatica enema high-dose group compared with model group, there are a larger number of glomerular, and glomerular more than a small number of MC proliferation and ECM increased, occasionally balloon adhesion, but some still have protein in renal tubular cavity tube type, inter-the quality is still proliferation of connective tissue. The compound of Centella asiatica enema middle-dose group and low-dose group compared with the model control group, the difference was not significant.ConclusionHigh-doses of the compound of Centella asiatica enema can significantly improve symptoms of rats with CRF, so that the activities of rats, body weight, mental status, appearance closer to normal rats. According to the kidney coefficient index, we can see, high-doses of the compound of Centella asiatica enema can make crystal deposits in renal tissue decreased to reduce fibrous tissue proliferation. Visual observation of the kidneys can also be clear that "white kidneys" surface of the granular model significantly better than the model control group. Through the test of blood biochemical parameters of rats can be drawn:high-dose compound Centella asiatica enema can regulate CRF rats electrolyte levels, to high potassium, high phosphorus, sodium, calcium, and low chlorine significantly alleviate the state. At the same time, high-doses of the compound of Centella asiatica enema can also be significantly increased CRF rats hematocrit (HCT), red blood cell count (RBC) and hemoglobin (HGB), improvement of anemia in CRF rats trends. Therefore, we can conclude that:High-doses of compound Centella asiatica enema on adenine-induced CRF rats had a significant therapeutic effect.
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