维普资讯 http://www.cqvip.com Jour nal of Tr adi t i ona l Chi nes e Medi ci ne 2006;26( 2) :157—160 157 Revi 。 ew A Survey of TCM St udi es on System i c Scl eroderm a Hu Dongl i u胡 东流 ,Chen Daca n 陈 达灿 & Xua n Guowe i榻 国维 Gu angdong Pr ovi nci al Hos pi t al o f Tr adi t i onal Chi ne s e Me di ci ne,Guangz hou 51012&Chi a n Sys t emi c s c l er ode r ma ( SSc) i s a pr ogr es s i ve Her ba Pt er i di s Sem i pi nna t ae)a n d f ound t hat 5F i n derm at osi s wi t h s ym m et ri c ski n scl erosi s and Ba n Bi n a Qi c n a s hor t e n he t pr oc es s of ibr f obl a s t s , is chem i a of t he f ingers or t oes.accompani ed wi m shri nk t he cel l bodi es, reduce cyt opl asma a n d l es i ons of t he j ti nt s ,mus c l es a n d ma n y i nt e r na l decr eas e h e number t of cel ls,induce apopt osi s,a n d or gans,a n d i t may cl i ni cal l y r esul t i n funct i onal i nhi bi t growt h a n d prol i f erat ion of cel l s s o as t o di sabl em ent due to scl erosi s,r igidi t y a n d at rophy of i nhi bi t t he synt h esi s of col l agens i n f ibr obl asts. t he s i n .The k fol l owi ng i s a survey oft h e bas i c a n d cl i ni cal s t udi es of TCM on SSc. T0t aJ gl ycosi de of cent el la.a n ext ract of Ji Xue Cat ( 积 雪草 Her ba Cent e l l ae ) ,ca n i n hi bi t act i vi t y of ibr f obl as ts, i nt ervene i n DNA synt hesi s i n Basi c St udi es SSc i s a col l agen di sease charact er ized by f ibrosis and scl eros is of t he sk i n, t i ssues and or gans.Over synt hesi s and l ess decomposi t i on of col l agens,and sedi ment at i on of a l ot of col l agenous f ibers i n t he sk i n.t he l ung.t he di gest i ve t ract and ot her t issues and organs a r e one of t he mai n pat hol ogi cal ibr f obl as ts,a n d act i vat e epi h el t i al cel l s,l eadi ng t o act i vat i ng of t h e germi nat i ve l ayer of cel l s.T h e exper im ent i n anim a ls proves t hat t hi s m edi ci ne ca n si gni icant f l y decrease cont ents of aci d mucopol ysacchari de and col l agens,i nhi bi t act i vi t y of t ransam i dase,a n d i h i n bi t synt hesi s of mat ri xes, fber i component s and aci d mucopol ys acchari de t o sof t en t he connect ive t iss ue. 6 process es of t his disease. Ther ef ore, st udi es on eff ect s of medi ci nes for pr ol i fer at i on of f ibr obl as ts In or der to expl ore t he mechani sm of Chi nese her bs and synt hesi s of col l agens, and f indi ng saf e, i n prom oti ng bl ood ci rcul ati on a n d r em ovi ng bl ood eff ect ive medi ci nes whi ch can i nhi bi t synt hesi s of st asi s for t r eat ment of SSc.Li .et a1 . used t he M TT col l agens and/or prom ot e decom pos i t i on of col l agens ar e one of i mport ant t asks f or t he basi c r esea r ch of SSc.Some speci al i st s have made a l ot of s t udi e s.I n s t udi es of Dan Shen( 丹 参 Ra di x Sa l vi ae Mi l t i or r hi z ae) 、Li ’ Gat and ot her s f ound t hat t anshi none. vi t ami ns and ot hers cont ai ned i n Danshen coul d i nhi bi t t he growt h of ibr f oblasts and t he expr essi ons of pr ecol l agens I and II t uRN A . decr eas e t ranscr ipt i on of col l agen genes i n t he ibr f obl ast t o i nhi bi t s ynt hesi s of col l agens,a n d at t he same t i me, obvi ousl y pr om ot e col l agenase mRNA expr essi on, i ncrease t ranscr ipt i on of col l agenase gene i n t he f ibrobl ast ,l eadi ng t o an i ncr ease of col l agenase s o as t o pr om ot e met hod t o i nvest i gat e t he eff ects of wat er sol ubl e ext ract s of 2 l Chi nese her bs wi h t t h e f unct i on of pr omot i ng bl ood ci r cul at i on a n d r emovi ng bl oo d st asi s f or prol i f er at ion of t he cul t ur ed f ibrobl ast s i n vi t r o of t he sk i n fr om SSc t he pat ients,a n d f o und t hat, of t he 2 1 Chi nese her bs, l 7 had obvi ous i hi n bi t or y act i on on t h e f i br obl ast.Among t hem , Chi Shao( 赤 勺 Radi x Pa eoni ae Rubr a ) ,Da n Shen ( 丹 参 Radi x Sal vi ae Mi l t i or r hi zae) ,Hong Hua( 红 花 Fl os Car t ha mi ) ,Mu Dan Pi( 牡 丹 皮 Codex Mout an) ,Qi n a Cat( 茜 草 Ra di x Rubi ae) ,Ru Xi ang ( 乳香 Ol i ba num) ,Su Mu ( 苏 木 Li gnum Sappa n) , Mo Ya p (没 药 My r r ha) ,Ni u Xi(牛 膝 Radi x degradat i on of s edi ment at i on coll agens i n vi vo, Achyr nt a hi s Bi dent at a e)a n d Ze La J 1( 泽兰 Her ba prevent scl er osi s of t he t i ssues.X i ao,et a1. st udi ed Lycopi Hi r t i )had n a obvi ous i hi n bi t i ng ac t i on.wi t h t he compounds of di t eroenes 5F ext ract ed fr om Chi nes e me di c i na l her b Ba n Bi n Qi(半 边 旗 a dos e—efect a n d t i me—eff ect rel at i ons. Li , et a1. 。 f ound h at t ,12 of h e 16 t det ect ed Ch i nes e her bs wi t h 维普资讯 http://www.cqvip.com 158 J our na l ofTr adi iona t l Chi nese Medi ci ne 2006;26( 2) :157・1 60 t he f unct i on of wanning Yang and t oni fyi ng t he yea r .The r esul t u rned out t t o be h at t 3l cases were ki dney,i ncl udi ng Rou Cong Rong(肉苁 蓉 Her ba ma r kedl y r el i eved a n d 15 impr oved.Zhou adopt ed Ci s t anc hi s ) ,Du Zhong ( 杜 仲 Cor t ex Euc ommi ae) , t he modi ied f Zhu yang Wen ing Tongbi f De coct i on Xu Dua n( 续 断 Ra di x Di ps a ci ) ,Yi n Yang Huo(淫 羊 藿 Her ba Epi medi i ) ,Wu Zhu Yu( 吴茱 萸 Fr uct us Evodi ae) ,Lu J i ao(鹿 角 Cor nu Cer vi ) ,Yi Zhi Re n ( 益智仁 Fr uct us Al pi ni ae Oxyphyl l a e) ,et c.ha d a n ( 助 阳温 经通 痹 汤) ,c ompos e d of Ma Hua ng( 麻 黄 He r ba Ephe rae d ) , Gui Zhi (桂 枝 Ra m ul us Ci nna m omi ) ,XiⅪ n( 细辛 He r ba As a r i ) ,Hua ng Qi i n pat i ent s wi h t SSc. ( 黄 芪 Ra di x As t r agal i ) ,Lu J i ao( 鹿 角 Ca r nu Cer vi ) , Yi n Yang Huo( 淫羊 藿 Her ba Epi medi i ) ,Da n g Gui (当归 Radi x Angel i ca e Si ne ns i s ) ,a nd Hong Hua( 红 Li . et a 1. found t h at t h e pat h ol ogi cal cha n ge of appl i cat i on wi h a t l cohol i m m ersi on sol ut i on of bl ood vessel s i n SSc pat i ent s was i mm unologi c Da n g Gui,Hong Hua,Xi Xi n,et c.t o t reat 36 cases i n j ur y i mmunocompl exes. of SSc.a n d found t h at l8 cas es wer e ma r kedl y unocompl exs on t he rel i eved,a n d 1 6 impr oved,t he t ot al efect i ve r at e obvi ous i nhi bi t or y act ion on f ibrobl st a s of h e sk t i n 花 Fl os Car t ha mi ) , combi ne d wi h e t xt ema l medi a t ed by Sedi ment at i on of bl ood i m vas cul ar wa ll ac ivat t ed compl eme nt s ,and i n j ur ed bei ng 94. 4% . vascul r endot a h el i ocyt es thr ough a ser ies of pat h ways, maki ng t hem sca li ng of t h e vas cul r a wa ll ,l eadi ng t o i ncrease of endot hel i l cel a ls i n ci rcul at ory bl ood.Cai .et 1. a st udi ed h e t r el at i on of Lai , reat t ed 30 cases of SSc by i nt ravenous dr ippi ng of 0. 5U pi t vi per nt a i— t hr ombos i sase added t o 250ml s li a ne sol ut ion,once a day,f o r 1 0—60 days, SSc wi t h def ici ency of h e k t i dney— yang,a n d found and f ound t hat 7 cases w ere ma r kedl y r el i eved,2 1 h at t t he i nci dence rat e of def ici ency of t he ca s es i mproved,t he t ota l efect ive rat e bei ng 97% . i dney- k yang,such as cool sk i n wi t h col d l i mbs, The ani ma l exper iment s a n d cl in i ca l dat a have l assi u de i t n t h e l oi ns and knees a n d so on,i n SSc i ndi cat ed t hat pi t vi per ant i —t hr ombosi sae ca n pat i ents was hi gher ,a n d t h e pl asma l evel s of decrease pl asma f ibr i nogen, bl ood l i pi ds, bl ood cor t i sol a n d cort i cot r opi n l ower as compa r ed wi t h vi scosi t y and pl at el et aggregat i ng u nct f i on,di ssol ve t hose i n normal persons,i ndi cat ing h at t SSc pat ient s t r ombus h had def ici ency of t he i dney—yang k n d a hypofunct i on mi cr oci rcul at i on of SSc.Su,et 1. a t reat ed 50 cases 0f t he l obus nt a er i or n d a adrena l cor t ex. of SSc by ora l admin i st rat i on of Lei gongt eng Cl i ni eal Studi es . , di l at e bl ood ves sel s, i mprQve Duot ai Ta bl et(雷 公 藤 多 苷 片 ) f or one yea r. Resul t s showed t hat i t could si gn if icant l y i mpr ove Li .et a1. “ di vi ded 50 cas es of SSc i nt o 3 t ypes: s cl er os i s of t he s in,r k el i eve he t s ympt oms of joi nt s , col d—dampness a n d bl ood st asi s t ype,qi — st agnat i on but i t had no efect on ibrosi f s oft h e i nt er n al orga ns and bl ood st a si s t yp e , and yang— def ici ency and and t he negat i ve r et ur ni ng of aut o—a nt i bodi es.Rao, blood s t asi s t ype, whi ch were t reat ed wi t h et a1 . 。t reat ed 33 cases of SSc ora ll y wi t h Hua Xi an i nt r a ve nous dr ippi ng of Da ns he n I nj e ct i o or Mai l uoni ng( 脉络 宁 )I ni e ct i o.As a r es ul t ,2 l c as es Zi Ca ps ul es( 花仙 子胶 囊) ,c ompos e d of Ya ng J i n Hua( 洋金 花 Fl os Dat ur a e) ,Yi nyanghuo( 淫羊 藿 Her ba Epi medi i ) , Zhi Ma Qi an zi( 制 马钱子 Semen w ere m a r kedl y r el i eved,22 i m pr oved,wi t h a t ot al efect i ve r at e of 86% .Hua n g.et a1 . empl oyed t he bas i c r e ci pe f or SSc c ompos e d of Hai Ma ( 海 马 Hi ppoca m pus ) ,Gui J i a( 龟 甲 Pl as t r um Tes t udi ni s ) , Bi e J i a( 鳖 甲 Ca rapa x Tr i onyc i s ) ,Da n Shen( 丹参 Radi x Sal vi a e Mi l t i or r hi z ae)et c.wi h t modi icat f i ons accor di ng t o di fer ent syndromes,a n d at t he same t i me i nt ravenous dr i ppi ng of Mai l uoni ng I n j e ct i o t o reat t 46 cases of SSC f or a p er iod of 3 mont h s—l St r yc hni Pr e pa ra t i on)a n d Xi Ya ng Shen (西洋参 Radi x Pana ci s Qui quef ol i i) ,combi ne d wi t h e xt er nal appl i ca t i on wi t h Y angma Ti nct ur e (洋 马 酊 ) compos ed of Yang Ji n Hua,Zhi Ma Qi an zi ,gl a ci al acet i c aci d,gl ycer in,m yr cenone,a lcohol ,et c. ,a n d found t hat 15 cases were m a r kedl y r el i eved, 16 improved.t he t ol t al efect i ve rat e bei ng 93. 9%. 维普资讯 http://www.cqvip.com J o ̄31 al of f ra di t i onal Chi nes e Medi ci ne 2006;26( 2) :157—160 159 t reat ed 16 cas es of SSc t he s i n,pa k le a n d cor p ul ent t ongue,a n d wi h such t comprehensi vel y wi t h h e t basi c r eci pe consi s t i ng of si gns of bl ood st a si s as scl eros i s of sk i n,r igi di t y of Huang Qi( 黄 芪 Ra di x As raga t li ) ,Dang She n( 党参 Radi x Co d onops i s ) , Da n g Gui (当 归 Ra di x he t f inger s a nd j oi nt s ,ba ldnes s a nd dr ynes s of he t Ange l i ca e Si nens i s ) , Chi Shao (赤 勺 Radi x and di fer enti at i ng pat h ol ogi ca l cond it ions i n Paeoni ae Rubr a) ,Shu Di Hua ng ( 熟 地 黄 Radi x Re hma n ni ae Pr apar at i on) ,J i Xue Teng (鸡 血 藤 Caul i s Spa hol t obi ) ,Fu Li ng( 茯苓 Por i a) ,Da n Shen ( 丹 参 Radi x Sa lvi ae Mi l t i or r iz h ae) ,Hong Hua(红 花 Fl os Car t ha mi ) ,Wu Sha o She( 乌梢 蛇 Zaocys ) , Rou Gui(肉桂 Cor t ex Ci nnamomi )a n d Yi n Ya n g Huo( 淫羊 藿 Her ba Epi medi i )wh ich was modi ied f accorda n ce w i h t t h e ei ght pr inci pa l s ynd r om es, Long. et a 1. accordi ng t o di ferent syndromes,i n combi nat i on wi h bat t h i n mi ner al wat er a n d m ass age; ora l adm i ni st rat i on of vi t am i ns a n d M aodongqi ng Tabl et s ;a nd i nt ra mus c ul a r i n j e ct ion or i nt ravenous dr ippi ng of Da ns hen I n j e ct i o, l ow mol ec ul r a hai r,sl ow a n d uneven pul se.Based on a na lyzi ng mos t SSc pat ient s a r e ofyi n a n d col d i n nat ure,a n d t he di sease i s superf ici ll a y l ocat ed i n sk i n,but i n essence i t i s n i a nt erna l s ynd r ome,a n d most pat i ent s shoul d be reat t ed wi h t h e drugs t o r f warmi ng yang, r emovi ng st a si s,a n d acti vat ing bl ood ci r cul at ion so as t o rem ove st a gnat ion, cons ol i dat e t h e f unda m ent al as pect s, a n d t reat t h e sym pt om s a n d t he cause at h e t sam e im e.For t h e t reat t m ent of SSc, i t i s necessary t o use drugs of l r ge a doses,w h i ch r e a pungent i n f lavor a n d hot i n pr oper ty t o st rengt hen t he k i dney- yang, a n d i nvi gorat e t h e f ire of l i fe gat e. 2 dext ran i n s come pat i ent s; ker ot h erapy or audi of requency physi ot her apy f or pat i ent s acc ompani ed wi t h igi r di t y of j oi nt s n d a s cl er os i s of ski n.H i s t reat m ent res ul t ed i n a t ot al efect i ve rat e Fi brobl ast s ca n synt h esi ze t he f ibers a n d m at ixes r i nvol ved i n t he r e pa i r of i n j ur d t e i s s ues .T he capbi l it y of synt hesi zi ng col l agen i ncreases obvi ousl y i n f ibr obl ast s of SSc pat i ent s,even t he of96% . capi bi l i ay i n t he 15t h gener at ion i s st i l l h i gher t ha n norm a1 .It i s t h e m a i n cel l i nvol ved i n f ibrosi s a n d Com m ent s scl erosi s of t he SSc t i ssue.Som e schol rs a have used SSc bel ongs t o t he cat egor y of ”numbness a n d i ni ur y of t he s in” k ,a nd” a s yndr ome r es ul t i ng f r om wi nd— col d evi l i nvol vi ng t he s i n”.and so on.The k TC M physi ci ans i n m odem t i m es hol d t hat t he pat hogenesi s of SSc i s yang— def ici ency of t he s pl een and k i dney, col d st agnat i on,obst r ucti on i n m er idi n s a and col l erals,st agnat i on of wi nd—col d and da m pness.I n recent yea r s,peopl e i nt end t o have t he vi ew t hat yang— def ici ency and bl ood s a si t s is t he ibr f obl as t s as t he s ubi e ct i n bas i c s t udi es of TCM, wi t h Da ns he n I nj e ct i on(丹参 注射 液 ), Mai l uoni ng I n j ect i on (脉 络 宁 注 射 液 ) ,t ot al gl yc os i de of cent el l a,and pi t vi per a nt i — t hrom bosi s enzym e as t he r out i ne cl i ni ca l drugs f or t reat m ent of SSc. St udi es on t he efect s of Chi nese drugs f o r act i vat i ng bl ood ci rcul at i on,r emovi ng bl ood st asi s, warmi ng yang a n d t oni f yi ng t h e k i dney on hyperl i f erat i on of f ibr obl ast s i n t h e sk i n of SSc m ost com m onl y—s een s yndrom e a n d t he basis on pat i ent s pr ovi de a n obi ect i ve bas i s f or cl i ni ca l whi ch t he cl i ni ca l di fer ent i al t r eat m ent i s gi ven. prescr ipt i ons.In f ut ure,not onl y shoul d efect i ve The t heor y of bl ood st asis i nduci ng st agnat i on—syndrom e has been w el l r ecei ved i n com ponent s of si ngle dr ug,but a l so m onom ers and compl ex pr es cr ipt i ons be st udi ed, pa rti cul rl a y, di agnosi s and t reat m ent of SSc. C l i ni cal l y, m ost cl i ni cal exper ience be sum m ari zed, efect i ve SSc pati ent s ma ni fest t o have a i nsuf i ci ent com pl ex prescr ipti ons n d a m onom er prepa r auons ot w arm i ng act i on of t he i dney- k yang n d a a decl i ne of TCM be s creened.a n d t he m echa ni sm s of TC: M i n t he product i on funct i on, w i t h s uch sym pt om s as cont rol of f ibrobl ast i c aversi on t o col d wi t h col d l i m bs.1 assi t ude i n t he m echa ni sm s of TC: M i n reat t m ent of SSc be probed. hyperl i f er at i on n d a l oi n and knees, noct ur ia, i m pot ence, prem at ure e j a cul at i on, i r r egul r mens a t r uat i on, pal e a nd SSc iS a di sease of t h e connect i ve t iss ues, purpl i sh f ingers a n d t oes,scl erosi s and at rophy of cha r act er ized by f iber s cl erosi s of t h e s i n a k n d 维普资讯 http://www.cqvip.com 1 60 J our na l ofTr adi t i onal Chi nese M edi ci ne 2006;26( 2) :157 1 60 var i ous sys t ems,at pres ent,many peopl e t end t 0 病 人 皮肤 成 纤维 细 胞增 殖 的影 响 .临床 皮 肤 科杂 bel i eve i t i s rel at ed t o i mmunol ogy, abnor m al 志 , 1998,27 (2):77~79. col l agen synt hesi s,a n d abnor m al bl ood vessel s,et c. 8 李明,王强,胡东艳,等.温阳补’ 肾中药对系统性 Gl ucocrt i coi d hor m ones, i mm unos uppressant s, 硬 皮 病 患 者 皮 肤 成 纤 维 细 胞 增 殖 的影 响 .中 国麻 风 vaso—act i vat i ve agent s, i nhi bi t ors of connect i ve 皮肤 病 杂 志 2 0 00; 1 6( 2) :1 0 6~1 07. t i ssue f or m at i on are us ual l y used t o t reat SSc.Some 9 李 尚珠 ,刘 春华 ,黄平 平,等.川芎 素对 系统性硬 Of t h e medi ci nes have i nhi bi t or y act i on on t he 皮 病 患者 循 环 内皮 细胞 的 影 响.中华 皮肤 科 杂志 hemat opoi et i c sys t em a n d bone m arr ow,a n d have 2001:34 (1): 34~35. good t herapeut ic ef f l ect i n some cases. Gl ucocort i coi d hor m ones have act i ons of nt a i — i nf lam mat i on. i nhi bi t i ng bi osynt h esi s of col l agens a n d aci d mucopol ysacchari des t o mai nl y i mpr ove t he s ympt oms of t he j oi nt s ,a n d a re efect i ve f or f ever ,myal gi a,serosi t i s a n d int erst i t i al pneumoni a, but t hey can nei t her delay t he progressi on of SSc,nor cha n ge t he prognosi s of t he di sease,l et al one t hat t hey a r e f or bi den i n pat i ent s of lat e st age,part i cul rl a y i n pat i ent s wi t h azot emia becaus e t hey can pr om ot e obl i t erat i ng changes of t he renal vessel s. Now,bl eomyci n has been us ed f or a successf ul devel opment of t h e a n imal model s of SSc ,t hus provi di ng US a combi nat ion t o assess t h e t h erapeut i c efect s a n d st udy t he mechanisms of Chi nese drugs cl i nical l y and exper iment al l y. 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