Chinese Natural Medicines and Tuberculosis WENHONG ZHANG YING ZHANG
Outline Introduction to Chinese natural medicine Chinese natural medicine and tuberculosis Chinese natural medicine and HDT of tuberculosis
Traditional Chinese Medicine Traditional Chinese Medicine is based on Yin-Yang and the five element theory (metal, wood, water, fire and earth). Explain human body s physiology, pathology, diagnosis, prevention and cure Herbal medicine, acupuncture, Tui Na, Qigong ---Regulate Yin- Yang ---> balance
Chinese Natural Herbs Herbs are a vital part of Chinese healing. Each ingredient has unique characteristics (pathogen or host). The ingredients work in harmony to help a person s body Drug combo Herbs can help boost Qi and balance Yin/Yang. Some Chinese herbs can be purchased in the US.
Modernization of TCM Traditional Chinese Medicine has been to some degree modernized by transforming the plants and ingredients to soluble granules and tablets. Modern formulations in pills and sachets Investigation of the active ingredients in TCM has produced: Artemisinin ( 青蒿素 ), which is now widely used in treatment of malaria ( 疟疾 ).
Out line Chinese natural medicine Chinese natural medicine and tuberculosis Chinese natural medicine and HDT of tuberculosis
Tong, Y., Jia, Q., & Sun, Y. (2009). A renal tuberculosis case: could Chinese medicine play a role?. The Journal of Alternative and Complementary Medicine, 15(8), 939 941.
Compound preparations of Chinese herbs used in TB treatment Medication 肺泰胶囊肺痨宁合剂抗痨胶囊肺痨康 Ingredient 苦荬菜 黄芩 百部 枇杷叶 栝楼 川贝母 北沙参 太子参 南沙参 生地黄 熟地黄 玄参 麦冬 黄精 五昧子 当归 白芍 牡丹皮 女贞子 茯苓 黄芪 陈皮 甘草 矮地茶 百部 穿破石 五指毛桃 白及 桑白皮 蒸百部 白及 天冬 川贝 紫河车 [1] 郭晓燕, 张惠勇. 中医药治疗耐药肺结核的研究进展 [J]. 时珍国医国药,2010,21(8):2028-2029.
Clinical trials of Chinese traditional medicine regimens in the treatment of TB Medication Combined replenishing qi to nourish yin methods, eliminating blood stasis method[1] Year Sample size 2012 72 Control group 3DThLAZ/ 15DTh Treated group Chinese herbs added Followup time (month) Sputum negative conversion rate 18 73.5% vs 56.3% Effective rate of chest X ray 73.5% vs 53.1% Ingredient 太子参, 玄参, 南沙参, 黄芪, 车前草, 胡颓叶, 海蛤壳, 款冬花, 黄芩, 丹参, 百部 二冬琼玉汤 [2] 2008 100 2HREZ/4 HR Chinese herbs added 3 56% vs 38% 72% vs 48% 天门冬 麦门冬 南沙参 生地黄 太子参 黄芪 五昧子 百合 山萸肉 阿胶 山药 蜂蜜 茯苓 甘草 加减保真汤 [3] 2007 37 2H 3 R 3 Z 3 E 3 Chinese herbs added 2 94.6% vs.75.0% 86.5% vs 50.0% 鱼腥草 山药 茯苓, 生地黄 丹参 知母 百部, 麦冬 党参 黄芪 白术赤芍 柴胡 黄柏, 甘草 五味子 Xiaoshui Powder[4] 2007 60 HREZ Xiaoshui Powder added 2 Hydrothorax disappearance time (26.0±3.8) vs (42.0±1.2) day 76.0% vs 20.9% 生黄芪 丹参 茯苓 党参 枸杞子 夏枯草 甘草 泽泻 车前子 桃仁 生白术 北沙参 葶苈子 生薏苡仁百部 桂枝 猪苓 当归 [1] 张晔敏, 鹿振辉, 郭晓燕等. 益气滋阴 行瘀抗痨法联合化疗长疗程治疗耐多药肺结核的随机对照临床研究 [J]. 上海中医药杂志,2012,46(9):44-46 [2] 逄金岐, 李同霞. 二冬琼玉汤加减辅助治疗初期肺结核的临床观察 [J]. 中国中西医结合杂志,2008,28(9):854-855. [3] 郝小萍, 杜雨华, 杜正新等. 加减保真汤配合抗痨强化期治疗复治菌阳肺结核 37 例临床观察 [J]. 中国中西医结合杂志,2007,27(5):448-448 [4] 荣学东, 刘伟娟, 郭新美. 消水散辅助治疗结核性胸腔残余积液疗效观察. 中国中西医结合杂志,2007,27(10);922-924
Outline Chinese natural medicine Chinese natural medicine and tuberculosis Chinese natural medicine and HDT of tuberculosis
COMMONLY USED HERBS Ranunculus ternatus 猫抓草 Prunella vulgaris 夏枯草 Stemona sessilifolia 百部 Euphorbia fischeriana 狼毒 Allium sativum 大蒜 Sophora flavescens 苦参
Astragala 黄芪 Liquorice 甘草 Curcuma 姜科植物与姜黄 Anemarrhena asphodeloides 知母花与知母
Herb Effective component Effect on bacteria Effect on human body Ternatolide Induction of GLS expression and bactericidal activity Ranunculus ternatus Sophora flavescens Allium sativum Matrine Allicin Bactericidal activity Inhibition of DNA replication and protein synthesis of M. tuberculosis to exert bactericidal effect Coptidis Rhizoma Berberine Bacteriostasis Euphorbia fischeriana Fischeriana A and B Bacteriostasis Ottelia alismoides Humulus lupulus Anemone chinensis Herbs with antibacterial and immune regulatory effect Hunmulone and lupulone Bacteriostasis or bactericidal effect Bacteriostasis Bacteriostasis Enhanced function of cytotoxic T lymphocyte Immunity enhancement, anti inflammation and hepatoprotective effect Hepatoprotective effect Immunity enhancement and hepatoprotective effect Cordyceps sinensis Adenosine, aspartic acid et al and multivitamins Immunity enhancement and symptom alleviation Astragala Salvia miltiorrhiza [1] 刘秋琼, 高玉桥. 中药治疗肺结核的研究进展 [J]. 中药材,2007,30(11):1478-1481 [2] 邓郡, 曾建国, 欧艳. 中成药治疗结核病概况 [J]. 湖南中医杂志,2011,27(3):146-147. Promotion of T cell proliferation and regulation of the immunity Decrease of the level of endothelium 1(ET 1) and nitric oxide(no)
extracts of Radix Ranunculi Ternati( 猫爪草 ), Radix Sophorae Flavescentis( 苦参 ), Prunella Vulgaris L.( 夏枯草 )and Stellera Chamaejasme L( 狼毒 )are capable of enhancing cell mediated immunity in rats by upregulating gene transcription Lu, J., Ye, S., Qin, R., Deng, Y., & Li, C. P. (2013). Effect of Chinese herbal medicine extracts on cell mediated immunity in a rat model of tuberculosis induced by multiple drug resistant bacilli. Molecular medicine reports, 8(1), 227 232.
Lu, J., Ye, S., Qin, R., Deng, Y., & Li, C. P. (2013). Effect of Chinese herbal medicine extracts on cell mediated immunity in a rat model of tuberculosis induced by multiple drug resistant bacilli. Molecular medicine reports, 8(1), 227 232.
Xu, H. D., You, C. G., Zhang, R. L., Gao, P., & Wang, Z. R. (2007). Effects of Astragalus polysaccharides and astragalosides on the phagocytosis of Mycobacterium tuberculosis by macrophages. Journal of international medical research, 35(1), 84 90.
Autophagy: Therapeutic Target for Tuberculosis Autophagy is initiated by the nucleation of an isolation membrane (phagophore). The phagophore elongates and closes on itself to form an autophagosome. Fusionofanautophagosome with a lysosome forms an autolysosome and, where the acid hydrolases in the lysosome, breaks down the inner membrane and cytoplasmic contents. During Mycobacterium tuberculosis infection, autophagy represents not only an antimicrobial mechanism for the clearance of the intracellular pathogen, but also prevents excessive inflammation, avoiding the adverse effects on host. Li W, He J, Xie L, Chen T, Xie J. Cell Physiol Biochem. 2013;31(1):1 13 19
Curcumin, a natural compound derived from the curry spice with low toxicity in normal cells, could efficiently reduce the accumulation of A53T α synuclein through downregulation of the mtor/p70s6k signaling and recovery of autophagy which was suppressed. J Neuroimmune Pharmacol (2013) 8:356 369
Curcumin plus ADM led to mitochondrial fragmentation, reduction of mitochondrial membrane potential, as well as activation of autophagy. These findings suggest the combined treatment of curcumin with ADM might be an optional chemotherapeutic method for HCC. European Journal of Pharmaceutical Sciences 43 (2011) 125 131
Real time quantitative RT PCR revealed that the expression levels of Bax gene, an apoptosis related molecule, and Beclin 1 gene which plays a key role in autophagy were higher in matrine treatment group than in control group, indicating that Beclin 1 is involved in matrine induced autophagy and the pro apoptotic mechanism. World J Gastroenterol 2010 September 14; 16(34): 4281-4290
Bactericidal Effect of Chinese Natural Medicine
Friis Møller, A., Chen, M., Fuursted, K., Christensen, S. B., & Kharazmi, A. (2002). In vitro antimycobacterial and antilegionella activity of licochalcone A from Chinese licorice roots. Planta medica, 68(05), 416 419.
CONCLUSIONS /FUTURE DIRECTIONS Efforts are underway to eradicate TB from both Drugs (Yang) and Host (Yin): Chinese Natural Medicine as a potential source for developing new agents against TB Some herbal regimens appear to work alone or improve TB therapy, further evaluation needed Mechanisms of HDT against TB complex, some herbs determined; More HDT mechanisms associated with Chinese Natural Medicine remains to be uncovered. Insights may help develop effective treatment against TB.