Dissertation
Dissertation > Medicine, health > Chinese Medicine > TCM Internal Medicine > Modern medicine, internal diseases

The Experimental Study of Taorenchengqi Decoction in the Treatment of Acute Lung Injury/Acute Respiratory Distress Syndrome(ALI/ARDS)

Author HuYuJie
Tutor JinHongWei
School Hebei Medical University
Course Clinical basis for TCM
Keywords Taorenchengqi Decoction Acute Lung Injury AcuteRespiratory Distress Syndrome tumor necrosis factor-α interleukin-1β superoxide dismutase thromboxane B2 6-keto-prostaglandin F1α lungcoefficient
CLC R259
Type Master's thesis
Year 2014
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Objective: Through the method of the tail vein injection of oleic acid tomake an ALI/ARDS model of rat, this paper aims to observe the changes ofthe lung tissue, tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β),superoxide dismutase(SOD), thromboxane B2(TXB2),6-keto-prostaglandinF1α(6-keto-PGF1α) and lung coefficient (LI) of rats, we investigate the effect ofTaorenchengqi Decoction on ALI/ARDS and its action mechanism to provideexperimental basis for clinical application and teaching of traditional Chinesemedicine.Acute Lung Injury/Acute Respiratory Distress Syndrome(ALI/ARDS) isthe acute, ongoing and hypoxic respiratory failure caused by intrapulmonaryand extrapulmonary factors besides cardiogenic factors. Serious ALI or thefinally serious phase of ALI is defined as ARDS by most of the experts andscholars. The clinical manifestations of ALI/ARDS includes cough, chesttightness, asthma, breathing fast, even purple lips, along with less bowelsounds, abdominal distension constipation and so on. The basic pathologicalcharacteristics is that pulmonary capillary endothelial cells and alveolarepithelial cells are damaged widely, pulmonary interstitial and alveolar edemacaused by vascular permeability increasing, the formation of micro thrombuscaused by the reduce of opened blood vessels in pulmonary, leading tointrapulmonary microcirculation disorder. Although there is no record of thename of disease of ALI and ARDS in literature of traditional Chinesemedicine, according to the clinical manifestations of respiratory distress,purple lips, abdominal distension, constipation and so on, they can beattributable to the category of “Baochuan”“Jiexiong”“Fushi” and so on. Inview of the clinical manifestations of ALI/ARDS, traditional Chinese medicine starts from the theory of “the exterior-interior relationship betweenthe lung and the large intestine” which reflects the integration concept ofviscera related, the pathogenesis characteristics can be summarized as the lungand the large intestine both sick.The study according to the traditional Chinese medicine pathogenesischaracteristics of ALI/ARDS, the theory of “the exterior-interior relationshipbetween the lung and the large intestine” and the modern pharmacologicalresearch of traditional Chinese medicine, choosing Taorenchengqi Decoctionfor the treatment of ALI/ARDS rats. As early as Taorenchengqi Decoctioncan be found in Wenyi Lun of Wu Youke, on the basis of TaohechengqiDecoction which comes from Shanghan Lun, he removed Cassia twig andLicorice, added angelica, Peony and Cortex moutan to group this prescription.Wu Jutong contained this prescription in Wenbing Tiaobian, and made a littlechange on the dosage. Article21of Wenbing Tiaobian-Xiajiao article:“Lowerabdomen is hard and full, urinate is normal, people fever in the evening andfeel cool in the morning, constipation, pulse condition is heavy and strong, thisis blood gets together.It can be treated with Taorenchengqi Decoction.” Thisprescription is good at purging heat and purgation, activating blood circulationto dissipate blood stasis. Therefore, the disease can be treated withTaorenchengqi Decoction which can purge and remove blood stasissimultaneously, tongfu gas to good for lung gas, be good for lung gas to helpblood run, restore the function of administering and regulating of lung.Through observing the changes of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β), superoxide dismutase(SOD), thromboxane B2(TXB2),6-keto-prostaglandin F1α(6-keto-PGF1α) and lung coefficient (LI) of rats, wedetermine the mechanism of the treatment of ALI/ARDS with TaorenchengqiDecoction to provide experimental basis for the clinical treatment ofALI/ARDS and teaching of traditional Chinese medicine.Method:1Select32female Wistar rats of healthy and clean grade at weight of250±10g, feeded adaptively a week, after measuring body temperature, weighed and labeled by weight one by one, divided into4groups of8inaccordance with the principle of random allocation: normal group(Normalcontrol group,N), model group(Model group,M), Taorenchengqi Decoctiongroup(Taorenchengqi Decoction group,T), Dexamethasonegroup(Dexamethasone group,D). Except the normal group, the other groupsare used the method of the tail vein injection of oleic acid(0.12ml·kg-1) tomake an ALI/ARDS model of rat.2Experimental drug delivery: According to the the conversion formulabetween human and experimental animals dosage, calculate the dosage of rats.The four groups are fed with normal diet, T group is given TaorenchengqiDecoction(5.13g·kg-1·d-1), D group is given Dexamethasone(2mg·kg-1·d-1), Ngroup and M group are given distilled water(10ml·kg-1·d-1). The four groupsare treated after making model one hour and three hours separately.3Detection of indicators: From the beginning of breeding to the end ofthe experiment, measure the body temperature of rats two times in themorning and evening, drinking and eating normally, observe the situation ofthe defecate and urinate of rats closely; use the blood of femoral artery todetect the changes of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β),superoxide dismutase(SOD), thromboxane B2(TXB2),6-keto-prostaglandinF1α(6-keto-PGF1α); take out and weigh the whole lung, to calculate lungcoefficient (LI); take the right part of the lung tissue quickly placed fixed in4%paraformaldehyde, dehydrated, embedded in paraffin, HE staining,observe the structures and changes of lung under light microscope.Results:1General observationNormal control group rats activity flexibly, breath smoothly, coat glossy,eating, drinking, defecate and urinate have no obvious changes; model grouprats activity dully, curled up and frightened, coat glossy missing, breathdifficultly, frequency faster obviously, even limbs purple, the situation ofeating and drinking poor, stool dry, defecation quantity less obviously;compared with the model group, the situation of activity, diet, defecate and urinate of Taorenchengqi Decoction group and Dexamethasone group rats allimprove.2The results of indicators in the blood of ratsThe results of TNF-α, compared with the normal control group, the levelof TNF-α in the model group rats increased significantly(P<0.01). Comparedwith the model group, the level of TNF-α in Taorenchengqi Decoction groupand Dexamethasone group rats decreased significantly(P<0.01). There are noobvious differences between Taorenchengqi Decoction group andDexamethasone group(P>0.05).The results of IL-1β, compared with the normal control group, the levelof IL-1β in the model group rats increased significantly(P<0.01). Comparedwith the model group, the level of IL-1β in Taorenchengqi Decoction groupand Dexamethasone group rats decreased (P<0.05). There are no obviousdifferences between Taorenchengqi Decoction group and Dexamethasonegroup(P>0.05).The results of SOD, compared with the normal control group, the level ofSOD in the model group rats decreased significantly(P<0.01). Compared withthe model group, the level of SOD in Taorenchengqi Decoction group andDexamethasone group rats increased (P<0.05). There are no obviousdifferences between Taorenchengqi Decoction group and Dexamethasonegroup(P>0.05).The results of TXB2, compared with the normal control group, the levelof TXB2in the model group rats increased significantly(P<0.01). Comparedwith the model group, the level of TXB2in Taorenchengqi Decoction groupand Dexamethasone group rats decreased (P<0.05). There are no obviousdifferences between Taorenchengqi Decoction group and Dexamethasonegroup(P>0.05).The results of6-keto-PGF1α, compared with the normal control group, thelevel of6-keto-PGF1αin the model group rats decreased (P<0.05). But thereare no obvious differences among the model group, Taorenchengqi Decoctiongroup and Dexamethasone group(P>0.05). 3The calculation results of LICompared with the normal control group, the LI in the model group ratsincreased significantly(P<0.01), but there are no obvious differences amongthe model group, Taorenchengqi Decoction group and Dexamethasonegroup(P>0.05).4Pathology morphological observation of lung tissue under the lightmicroscopeThe structure of lung tissue of the normal control group rats is complete,there are no pathological changes; the alveolar interval of the model group ratsis widened significantly, the capillaries are expansive and congestive, there isa large number of inflammatory cells infiltration, the structure of alveolar isdamaged widely, the alveolar walls become thicker, there are edema andbleeding in the alveolar cavity, there is some hyaline membrane in part of thelung tissue; compared with the model group, the pathological changes ofTaorenchengqi Decoction group and Dexamethasone group improvesignificantly, the alveolar interval narrowing, there is a little seepage andinflammatory cells infiltration, the capillaries are expansive and congestivemildly, the edema in the alveolar cavity is reduced, there is no obvious hyalinemembrane.Conclusion:1Taorenchengqi Decoction could increase the level of superoxidedismutase(SOD), lower the level of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β), thromboxane B2(TXB2), and reduce inflammatorycells infiltration, seepage and accumulation, improve the pulmonary edemaand pulmonary congestion, it has certain effect of pertecting the lung, there areno obvious differences between Taorenchengqi Decoction andDexamethasone (P>0.05) in the short-term therapeutic effect. It proves thatTaorenchengqi Decoction has certain therapeutic effect on ALI/ARDS.2The mechanism of action of Taorenchengqi Decoction on ALI/ARDSmay relate to that it can inhibit the inflammatory response, improveantioxidant capacity and the microcirculation. 3It proves the correctness and practicability that TaorenchengqiDecoction can treat the lung and the intestine simultaneously, let the gas moveand remove blood stasis from the point of view of experimental research. Atthe same time it shows that Taorenchengqi Decoction through purging andremoving blood stasis simultaneously, namely it can tongfu gas, be good forlung gas, help blood run, remove blood stasis, it can not only treat xiajiaoxuxuezheng, but also restore the function of administering and regulating oflung, treat shangjiao and even the accumulation of the qi and blood of thewhole body, thus it extends the scope of treatment of TaorenchengqiDecoction, provides theoretical and experimental basis for traditional Chinesemedicine theory and clinic and the teaching of traditional Chinese medicine.

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