Study On The Therapeutic Effect And Mechanism Of Modified Shaoyao Gancao Decoction In The Treatment Of Chronic Tension-type Headache

Objective: To observe the clinical efficacy of modified Shaoyao Gancao decoction in the treatment of chronic tension-type headache(CTTH)and evaluate its efficacy and safety.To explore the effect of Jiawei Shaoyao Gancao decoction on the abnormal expression of adenosine triphosphate(ATP)gated purine receptor(P2X7R)in spinal cord of rats with tensiontype headache(TTH)and the mechanism of P2X7 R regulating TTH,so as to provide scientific research basis and theoretical support for the clinical application of Jiawei Shaoyao Gancao decoction.Methods: Clinical observation: A total of 66 patients who met thediagnostic criteria of CTTH and TCM "Toufeng disease" and the diagnostic criteria of Yingxue deficiency combined with qi stagnation and blood stasis syndrome were randomly divided into control group(n=33)and experimental group(n=33).The two groups were treated with Eperisone Hydrochloride Tablets and modified Shaoyao Glycyrrhiza decoction respectively for 4 weeks.The headache numerical pain score(NPRS score),duration,attack frequency and headache index of the two groups before and after treatment were recorded to evaluate the effects of the twotreatment methods on the primary symptoms of TTH,the TCM syndrome scores of the two groups were counted to evaluate the efficacy of TCM syndrome,the results of headache effect test questionnaire(HIT-6)were counted to evaluate the quality of life,and the safety and adverse reactions of the two treatments were observed.Experimental study: SD rats were divided into six groups: sham operation group,model group,negative control group,traditional Chinese medicine intervention group,inhibitor control group and positive control group.The rat model of tension-type headache was established by pumping ATP into bilateral semi-spinous muscles of rats.The mechanical hyperalgesia induced by ATP was detected by mechanical pain measurement with von-Frey fiber guide wire.The rats were treated with Chinese herbal medicine Jiawei Shaoyao Gancao decoction for 14 days or intervention of P2X7 R inhibitor half an hour before the establishment of the model,respectively.The pain threshold of rats in each group was measured by von-Frey method after ATP modeling.The expression levels of P2X7 R and Janus kinase 2 / signal transducer and activator of transcription 3(JAK2/STAT3)in cervical spinal cord were detected by Western blotting and real-time fluorescence quantitative PCR reaction(q-PCR).Results: Clinical observation: a total of 66 CTTH patients were randomly divided into control group(n=33)and experimental group(n=33).1.After 4 weeks of treatment,there was no significant difference in headache NPRS score and duration between the control group and the experimental group,but the headache attack frequency score of the experimental group was lower.After treatment,the headache index of the two groups decreased significantly(P<0.01),and the headache index of the experimental group decreased more significantly(P < 0.05).After treatment,the TCM syndrome scores of the two groups decreasedsignificantly(P <0.01),and the TCM syndrome scores of the experimental group decreased more significantly(P<0.01).HIT-6 scores decreased significantly in both groups after treatment,especially in the experimental group(P < 0.05).The comprehensive curative effect of the test group was better than that of the control group(p<0.05),and the probability of adverse reactions was lower(P < 0.05).Experimental research:1.ATP modeling can lead to mechanical hyperalgesia in rats(p<0.05),and at the same time up-regulate the expression of P2X7 R protein and m RNA in rat cervical spinal cord(p<0.05);2.Traditional Chinese medicine intervention or P2X7 R inhibitor intervention model Rats can effectively reverse the ATP-induced upregulation of P2X7 R expression(p<0.05)and improve rat mechanical hyperalgesia(p<0.05);3.ATP modeling can induce an increase in the phosphorylation level of JAK2 and STAT3,while traditional Chinese medicine intervention or P2X7 R inhibition Drug intervention can improve the mechanical hyperalgesia of model rats(p<0.05)and at the same time reverse the increase of JAK2 and STAT3 phosphorylation levels(p<0.05)Conclusion: The results of clinical and experimental studies show that Modified Shaoyao Gancao Decoction is safe and effective in the treatment of CTTH,and can comprehensively improve the quality of life and TCM syndromes of CTTH patients,and no obvious adverse reactions have been found.The therapeutic mechanism may be realized by regulating the expression of P2X7 R in the cervical spinal cord.And P2X7 R is likely to mediate the pathogenesis of TTH by regulating the phosphorylation of the inflammatory pathway JAK2/STAT3 pathway and the therapeutic effect of Modified Shaoyao Gancao Decoction on TTH.