1.Staged Efficacy of Qijia Rougan Prescription Combined with Entecavir for Chronic Hepatitis B-related Hepatic Fibrosis with Qi Deficiency and Collateral Stasis Syndrome Based on "Zhu Ke Jiao" Theory
Baixue LI ; Xin WANG ; Jibin LIU ; Li WEN ; Cen JIANG ; Wenjun WU ; Dong WANG ; Shuwan LIU ; Huabao LIU ; Yongli ZHENG ; Liang HUANG ; Yue SU ; Song ZHANG ; Yanan SHANG ; Hang ZHOU ; Quansheng FENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(9):180-188
ObjectiveThis paper aims to investigate and evaluate the staged efficacy and safety of the representative empirical prescription of the “Zhu Ke Jiao” theory, Qijia Rougan prescription, combined with entecavir in the treatment of hepatic fibrosis in chronic hepatitis B. MethodsA multicenter randomized controlled clinical study was conducted, and 101 patients diagnosed with chronic hepatitis B-related hepatic fibrosis (CHB-HF) who met the diagnosis and inclusion criteria were randomly assigned to an observation group (Qijia Rougan prescription + entecavir) and a control group (entecavir). The treatment duration was 24 weeks. Liver stiffness measurement (LSM), fibrosis-4 index (FIB-4), portal vein diameter, hepatitis B serology, biochemical indicators, hepatic fibrosis markers in serum [hyaluronic acid (HA), laminin (LN), procollagen Ⅲ peptide (PⅢP), and type Ⅳ collagen (Ⅳ-C)], and traditional Chinese medicine syndrome scores were used as efficacy evaluation indicators. Efficacy assessments and explorations of different staged subgroups of Qijia Rougan prescription were conducted according to LSM values based on the Metavir pathological staging standard. ResultsA total of 98 cases were included for statistical analysis, with 49 cases in the observation group and 49 in the control group. The general data of the patients in both groups were comparable. Compared with the same group before treatment, the observation group showed a significant reduction in LSM and FIB-4 (P<0.01), as well as notable improvements in LN, Ⅳ-C, and various TCM syndrome scores (P<0.05, P<0.01). When compared to the control group after treatment, the observation group demonstrated significant improvements in LSM, FIB-4, and various TCM syndrome score indicators (P<0.05, P<0.01), indicating that the observation group performed better than the control group. Subgroup analysis of the regression of hepatic fibrosis stages showed that compared to the same group before treatment, the observation group had better improvement in regression of stages F2 and F3 (P<0.05). When compared to the control group after treatment, the observation group exhibited superior improvement in regression of stage F3 (P<0.05). No adverse events occurred in either group during the treatment period. ConclusionCompared with entecavir alone, the combination of Qijia Rougan prescription and entecavir significantly improves the degree of hepatic fibrosis and clinical TCM symptoms in patients. The optimal intervention period is primarily during stage F3, which is a potential “interception” point of the “Zhu Ke Jiao” theory.
2.Discussion on Construction of a Multi-Agent "Cross-scale" Collective Decision-making Model for Superior Disease Entities in Sichuan-style Traditional Chinese Medicine
Qiuping CHEN ; Hang ZHOU ; Dan ZHENG ; Baixue LI ; Chenhao LIU ; Ju CHEN ; Jibin LIU ; Quansheng FENG ; JIANGYUMING ; Cen JIANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):1-13
At present, the systematic excavation of the clinical experience and academic thought of the Sichuan school of Chinese medicine vis-à-vis its dominant disease entities remains fragmentary, and replicable paradigms are scarce. Confronted with empirical fragmentation, data heterogeneity and decision-making subjectivity, the standardised distillation, inheritance and clinical translation of these distinctive experiences has become a critical bottleneck constraining the development of the Sichuan school. The integration of artificial-intelligence technologies in data processing, pattern recognition and intelligent decision-making has rendered deep mining of traditional Chinese medicine(TCM) clinical knowledge and patterns imperative. Constructing an intelligent modern TCM diagnostic-therapeutic-evaluative system is now the obligatory route for inheritance and innovation in Chinese medicine, and simultaneously provides a technological breakthrough for intelligent decision paradigms in the dominant diseases of the Sichuan school. Accordingly, this study adopts the regional academic school as its point of entry, focuses on the dominant diseases of the Sichuan school, and proposes an innovative pathway of "four-dimensional data-multi-modal fusion-multi-agent decision-making". Specifically, four data dimensions are defined and instantiated: (Ⅰ) knowledge from classical medical literature and historical case records. (Ⅱ) objective four-diagnosis phenotypic data. (Ⅲ) master physicians' prescribing regularities. (Ⅳ) characteristic mechanisms of renowned formulae. Leveraging multi-modal data fusion and generative artificial intelligence, the entire causal chain of Famous Physicians and Renowned Formulas is explicated to reconstruct the diagnostic-therapeutic cognitive logic of the regional school. Finally, a multi-agent collective-decision model is established and refined for the dominant diseases of the Sichuan school, capable of generating precise, individualised treatment regimens and thereby advancing an intelligent diagnostic-therapeutic paradigm that delivers more efficient and accurate clinical decision support.
3.Wisdom Inheritance of Distinguished Physicians' Experience Through Integration of Multimodal Data and AIGC: A Case Study on Experience in Diagnosis and Treatment of Lung Cancer with Phlegm-dampness and Blood Stasis Syndrome by Distinguished Traditional Chinese Medicine Physicians of Sichuan School
Yang YU ; Yadong MU ; Wenping LIU ; Chongcheng XI ; Li ZHANG ; Yan GAO ; Cen JIANG ; Quansheng FENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):14-25
Lung cancer, with persistently high incidence and mortality rates, remains a significant global health challenge. By taking the study on the experience in diagnosis and treatment of lung cancer with phlegm-dampness and blood stasis syndrome by distinguished traditional Chinese medicine physicians of the Sichuan School as an example, the diagnosis and treatment system for lung cancer with phlegm-dampness and blood stasis syndrome, which was formed in response to the humid and foggy environment of the Sichuan Basin, possesses unique value. However, traditional inheritance modes face challenges such as fragmentation, lack of standardization, and insufficient quantification, which hinder the promotion and application of this experience. This research focused on how to leverage multimodal data and artificial intelligence-generated content (AIGC) to achieve precise analysis, intelligent inheritance, and clinical innovation of the experience in diagnosis and treatment of lung cancer with phlegm-dampness and blood stasis syndrome by distinguished traditional Chinese medicine physicians of the Sichuan School. By integrating multimodal data (encompassing four diagnostic methods of traditional Chinese medicine, modern medical imaging, clinical laboratory tests, molecular biology, and regional environmental information), a precise diagnosis and treatment system integrating macro and micro perspectives for the "disease, syndrome, and pathogenesis" was constructed. The research yielded the following results: (1) In precise syndrome differentiation, the objective quantification of the phlegm-dampness and blood stasis syndrome was achieved. By constructing a "four diagnostic methods, imaging, and molecule" correlation model, the study revealed intrinsic links between tongue and pulse parameters and the tumor microenvironment, as well as between regional climatic factors and syndrome characteristics, enabling real-time dynamic monitoring of efficacy. (2) In elucidating patterns, the study systematically explored the syndrome differentiation thoughts of Sichuan School physicians, such as the timing of purgation and tonification. A "pathogenesis, syndrome complex, and prescriptions and herb" network model was constructed, which accurately elucidated the synergistic action mechanisms of core herb pairs and quantified the dynamic compatibility patterns of reinforcing healthy Qi and eliminating pathogenic factors. (3) In intelligent empowerment, an auxiliary system integrating intelligent syndrome differentiation, treatment plan generation, and efficacy evaluation was built. This system can fuse regional characteristics with individual data, dynamically generate and optimize personalized prescriptions aligned with the experience of Sichuan School, and predict efficacy trends and potential adverse reactions. The integration of multimodal data and AIGC can effectively facilitate the structured inheritance and clinical translation of distinguished physicians' experience. The established intelligent diagnosis and treatment model integrating traditional Chinese medicine and Western medicine demonstrates clear potential in prolonging patients' progression-free survival, alleviating symptoms, and reducing adverse reactions to treatment. This study provides a referential methodological framework for the traditional Chinese medicine experience in diagnosis and treatment of lung cancer, especially the empirical inheritance and modernized development of regional academic schools. It contributes to advancing clinical diagnosis and treatment toward greater precision and personalization.
4.Technologies and Research Applications of Large Language Models in Traditional Chinese Medicine
Yuxiu ZENG ; Qiong ZHAO ; Chongcheng XI ; Quansheng FENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):50-59
The integration of large language model (LLM) and traditional Chinese medicine (TCM) promotes the informatization of TCM,and also provides a new direction for the inheritance and innovation of TCM in the new era. Based on the research background of LLM,the development process of LLM based on the Transformer architecture is summarized,and the research progress of LLM in TCM is reviewed. The main process of constructing TCM LLMs and the key techniques used by researchers during model development are summarized. Based on the related literature, the main application scenarios of TCM LLMs and the research explorations conducted by TCM researchers using LLMs are outlined. Meanwhile,the current challenges faced in the development of TCM LLMs are analyzed. Further improvements are urgently needed in the construction of high-quality data,the evaluation methodology of TCM LLMs,the interpretability of the model, multimodal fusion of TCM LLMs, and the development of TCM prescription recommendation models. Looking forward to the future development of LLM in TCM,it is expected to provide a reference for the deeper integration of LLMs and TCM,and facilitate the modernization of TCM.
5.Mechanisms on Chronicity of Infectious Diseases from Warm Disease Theory of Pathogen Invading Nutrient and Blood Aspects: Integrating Classical Wisdom with Innovative Perspectives
Baixue LI ; Hang ZHOU ; Jibin LIU ; Xia LI ; Xiyang LIU ; Haihui LIU ; Peijie WU ; Dong WANG ; Cen JIANG ; Wenjun WU ; Quansheng FENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):60-69
The chronicity of infectious diseases is an important field in the collaborative research of traditional Chinese and Western medicine. The warm disease theory of pathogen invading nutrient and blood aspects in traditional Chinese medicine (TCM) takes the struggle between healthy Qi and pathogenic Qi and cementation of Yin as the core pathogenesis, providing a unique theoretical framework for explaining the common pathology of infectious chronic diseases. This theory originated from Yin-Yang interaction in the Internal Classic and was enriched with WU Youke's theory of intruding pathogen interacting and lingering in blood vessels and YE Tianshi's theory of long-term illness entering collaterals. Combining the theory with modern medical knowledge, our team has condensed the dynamic pathogenesis model of deficiency (nutrient and blood aspects) and excess (pathogen) interacting in the blood collaterals of Yin aspect, the core feature of which is the four-dimensional interactions of cause (pathogen characteristics), location (three Yin locations of diseases), nature (deficiency and excess), and potential (transmission trend). The common pathology of infectious chronic diseases is reflected in interactions. That is, the interactions between nutrient and blood deficiency (immune exhaustion and metabolic disorder) and pathogen excess (pathogen persistence and fibrous hyperplasia) in the liver collaterals (Jueyin), kidney collaterals (Shaoyin), lung collaterals (Taiyin) and other blood collaterals of Yin aspect form the pathological damage characterized by immune inflammatory response-continuous tissue damage with excessive repair. Taking the inheritance and innovative development of classics as the main line, this paper systematically discusses the scientific connotation of the theory of pathogen invading nutrient and blood aspects and the paths of inheritance and innovation and clarifies the original significance of this theory in the chronic development of infectious diseases. Furthermore, taking clinical diseases as an example, this paper reflects the guiding value of this classical theory in the modern diagnosis and treatment of infectious diseases with integrated traditional Chinese and Western medicine and the application potential of this theory in solving complex medical problems through the construction of the innovative paradigm of precise diagnosis and treatment with integrated traditional Chinese and Western medicine.
6.Action of Immune Microenvironment and Metabolic Reprogramming in Hepatocellular Carcinoma Based on "Deficiency of Healthy Qi and Stasis Toxins"
Xia LI ; Jiexiong YANG ; Xiyang LIU ; Wenjun WU ; Cen JIANG ; Quansheng FENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):100-109
Hepatocellular carcinoma (HCC), a malignancy with high mortality, exhibits poor survival rates and prognosis. The profound suppression of the tumor immune microenvironment (TIME) and the abnormal hyperactivity of metabolic reprogramming (MR) are the two primary factors driving HCC progression. Traditional Chinese medicine has demonstrated significant efficacy in HCC treatment. The team proposed that "deficiency of healthy Qi and stasis toxins" was the core pathogenesis of HCC, closely associated with TIME suppression and MR hyperactivity. This paper proposed that a suppressed state of the TIME was the biological manifestation of "deficiency of healthy Qi", where the functional exhaustion of effector T lymphocytes and natural killer cells reflected the decline of "healthy Qi" in eliminating pathogens. Conversely, the expansion and activation of immunosuppressive cells, such as regulatory T cells (Tregs), M2-like tumor-associated macrophages (TAM-M2), and myeloid-derived suppressor cells (MDSCs) , represent the dysfunction of "healthy Qi" in maintaining homeostasis. MR serves as the material basis of "stasis toxins". Stasis toxins exhibit heat stagnation, manifested by abnormal hyperactivity of glycolysis and lipid synthesis. They demonstrate migratory propensity, as toxic metabolites like lactic acid and prostaglandin E2 promote tumor invasion and metastasis. They display a consumptive nature, reflected in the functional suppression of immune cells. The vicious cycle between TIME and MR is the biopathological reflection of "deficiency of healthy Qi intertwined with stasis toxins". Immunosuppression exacerbates MR, while toxic metabolites further impair immune function, establishing a pathogenic chain of "deficiency leading to stasis, and stasis toxins damaging healthy Qi". The primary therapeutic approach is reinforcing healthy Qi, resolving stasis, and removing toxins, which can reinforce and tonify healthy Qi to regulate pathways, such as phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt), C-X-C chemokine receptor type 4/ C-X-C chemokine ligand 12 (CXCR4/CXCL12), and toll-like receptor 4/ nuclear factor-kappa B/ signal transducer and activator of transcription 3 (TLR4/NF-κB/STAT3), adjust T lymphocyte ratios, inhibit Tregs/TAM-M2 function, and downregulate immune checkpoints, including programmed death ligand 1/programmed death 1(PD-L1/PD-1), and reshape TIME. It is also involved in resolving stasis and removing toxins to modulate phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) and hypoxia-inducible factor-1α (HIF-1α) signaling pathways, suppress key enzymes in glycolysis and lipid synthesis, and block toxic metabolite production. Thus, this therapy synergistically regulates the immune and metabolic network, breaks the vicious cycle of "deficiency in healthy Qi and stasis toxins", and offers a novel strategy for integrating traditional Chinese medicine and Western medicine in HCC treatment.
7.Staged Treatment of Hepatic Fibrosis Based on Correlation Between "Collaterals and Vascular System" and Theory of "Hepatic Collateral Disease"
Jing ZHANG ; Qiuping CHEN ; Yu LIANG ; Wenping LIU ; Quansheng FENG ; Jibin LIU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):110-118
Hepatic fibrosis(HF) is a common pathological link of a variety of chronic hepatic diseases, and its complex pathological mechanism and prolonged clinical course pose a major challenge to modern medicine. Modern conventional therapies for HF cannot reverse the pathological vascular remodeling of the liver, and targeted vascular treatment for HF is a current research hotspot. There is a contradiction between the inhibition of pathological repair and the promotion of physiological regeneration with a single targeted therapy. The dynamic equilibrium concept of "achieving equilibrium of Yin and Yang" of traditional Chinese medicine can provide a new treatment strategy, and multi-target traditional Chinese medicine compounds can achieve two-way regulation of pathological mechanisms. According to the research on the modernization of traditional Chinese medicine, the "collaterals and vascular system" are highly compatible in structure and function, and they can guide the treatment of HF at different stages by identifying their common pathological links in HF. The intrahepatic collaterals are an important component of the hepatic collaterals, and the theory of "hepatic collateral disease" based on this physiology has important guiding significance for the clinical diagnosis and treatment of HF. Hepatic sinusoidal obstruction caused by endothelial dysfunction in the early stage of HF is a pathological manifestation of stagnant nutrient Yin in collateral passages. It can be treated by diffusing Qi to resolve stagnation and promoting circulation to unblock collaterals. Repeated stimulation of angiogenesis by hypoxia and inflammation in the medium stage is the pathological manifestation of lingering stagnation of damp and heat in collateral passages. It can be treated by clearing and draining damp and heat, eliminating turbidity, and unblocking collaterals. Pathological vascular remodeling induced by hemodynamic abnormalities in the later stage is a pathological manifestation of the consumption of collateral passages by pathogenic toxins. At this stage with excessive pathogenic factors and deficient healthy Qi, combined therapy of dredging and nourishing is adopted to eliminate toxins, resolve blood stasis, nourish Yin, and supplement Qi simultaneously. Moreover, the holistic concept of harmony between human and nature in traditional Chinese medicine emphasizes the time, place, and treatment based on individual conditions, so the practical application of the theory should consider the specific regional characteristics. This paper aims to discuss the characteristics of pathogenesis, treatment principles, prescriptions, and medicines in different stages of HF based on the correlation between "collaterals and vascular system" as well as the theory of "hepatic collateral disease". It was proposed that Qi deficiency and collateral obstruction were the core pathogenesis of HF, and that hepatic collateral damage was the core pathological basis for the deterioration and prognosis of HF. The scientific connotation and pathogenesis evolution of collateral damage and mass generation in HF were discussed. Sichuan was taken as an example to investigate the treatment of HF according to local conditions, providing new ideas for the treatment of HF.
8.DIA Proteomic Profiling on Staged Regulatory Effect of Tonifying Deficiency and Dredging Collaterals Method on Liver Fibrosis in Rats Based on Theory of "Zhu Ke Jiao"
Xin WANG ; Pengyu ZHU ; Li WEN ; Jibin LIU ; Aochun YUE ; Ziyi CHEN ; Jing ZHANG ; Li ZHU ; Quansheng FENG ; Cen JIANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):119-132
ObjectiveThis paper aims to investigate the differential mechanisms underlying the staged therapeutic effects of Qijia Rougan formula on liver fibrosis using proteomic technology. MethodsThe staged rat model of liver fibrosis was established by subcutaneous injection of carbon tetrachloride (CCl4) and olive oil. One hundred and four SD rats were randomized into thirteen groups:a normal group,a two-week model group,a four-week model group,a six-week model group,an eight-week model group,a two-week Qijia Rougan formula group,a four-week Qijia Rougan formula group,a six-week Qijia Rougan formula group,an eight-week Qijia Rougan formula group,a two-week compound Biejia Ruangan tablet group,a four-week Compound Biejia Ruangan Tablet group,a six-week Compound Biejia Ruangan Tablet group,and an eight-week compound Biejia Ruangan tablet group. After two weeks of drug intervention,liver tissue and abdominal aortic blood samples were collected from the rats for testing. Hematoxylin-eosin (HE) staining,Masson staining,and Picro Sirius red staining were used to observe pathological damage and collagen fiber deposition in liver tissues. Immunohistochemistry (IHC) was employed to detect the contents of fibrosis markers in liver tissues. The contents of liver function indicators in the serum were measured using a fully automated biochemical analyzer,and the levels of liver fibrosis indicators in the serum were assessed by enzyme-linked immunosorbent assay (ELISA). Liver tissues from the normal group,each model group,and each Qijia Rougan formula group were subjected to label-free quantitative proteomic analysis to identify differential proteins among the groups,with key proteins validated by Western blot. Finally,bioinformatics analysis was performed on the differential proteins. Results(1) The staged rat model of liver fibrosis constructed with CCl4 and olive oil showed pathological results at the 2nd,4th,6th,and 8th weeks of modeling that were consistent with the Metavir standards for the F1,F2,F3,and F4 stages. Compared with those in the normal control group,the protein expressions of α-smooth muscle actin (α-SMA) and Collagen Ⅰ were significantly increased in each stage (P<0.05). The levels of liver function indicators in the serum,including alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP),direct bilirubin (DBIL),and total bilirubin (TBil) in each model group,were significantly elevated in each stage (P<0.01). The levels of liver fibrosis indicators in the serum,including procollagen Ⅲ peptide (PⅢP),type Ⅳ collagen(Ⅳ-C),hyaluronic acid (HA),and laminin (LN) in each model group,were significantly increased in each stage (P<0.05,P<0.01). This study successfully established a staged rat model of liver fibrosis. (2) Compared with the model groups at each stage,the administration groups showed a reduction in hepatocyte ballooning degeneration,a more orderly arrangement of hepatocytes,and a decrease of inflammatory cell infiltration. The blue-stained collagen fibers became significantly thinner and finer,with reduced and narrowed fibrous septa. The areas of collagen fibers and Picro Sirius red staining were reduced (P<0.05). The positive areas of α-SMA and Collagen Ⅰ expression were significantly decreased (P<0.05). The levels of ALT,AST,ALP,DBIL,and TBil in the rats of the model groups at each stage were significantly reduced (P<0.05,P<0.01). The levels of PⅢP,Ⅳ-C,HA,and LN in the rats of the model groups at each stage were significantly decreased (P<0.05). Among these,the improvements in all indicators were most significant in the F3 stage (P<0.01).(3) The proteomic results show that a total of 165 differential proteins exhibit a callback trend when comparing the model groups at four stages with the normal group,and when comparing the Qijia Rougan formula group with the model group. Western blot analysis reveals that the levels of NAD(P)H:quinone oxidoreductase 1 (NQO1),mitogen-activated protein kinase 1 (MAPK1),arginase 1 (Arg1),and glutathione S-transferase α1 (GSTA1) were consistent with the proteomic results. Bioinformatics results reveal that 165 differentially expressed proteins are enriched in multiple signaling pathways. Notably,signaling pathways such as drug metabolism-cytochrome P450,arginine biosynthesis,and the peroxisome proliferator-activated receptor (PPAR) signaling pathway were found to be closely associated with liver fibrosis,suggesting that the Qijia Rougan formula may exert its staged regulatory effects on liver fibrosis by regulating these pathways. ConclusionThe Qijia Rougan formula may achieve staged regulation of liver fibrosis by regulating drug metabolism-cytochrome P450,arginine biosynthesis,and the PPAR signaling pathway.
9.Characteristics of Traditional Chinese Medicine Syndromes and Their Correlation with Ocular Manifestations in Chronic Hepatitis B Complicated by Metabolic Dysfunction-associated Fatty Liver Disease
Jingdong CUI ; Dingqi LI ; Yichen PENG ; Xiaoxiao DENG ; Zhenglong ZHENG ; Zilin XIONG ; Haiyang HU ; Peijie WU ; Yuelian WANG ; Liang HUANG ; Quansheng FENG ; Baixue LI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):144-154
ObjectiveThis paper aims to investigate the traditional Chinese medicine syndrome types in patients with chronic hepatitis B (CHB) complicated by metabolic dysfunction-associated fatty liver disease (MAFLD) and explore the correlations between these syndrome types and clinical indicators, as well as ocular manifestation characteristics, thereby providing a reference for syndrome differentiation and treatment strategies in traditional Chinese medicine. MethodsGeneral data, information from the four diagnostic methods of traditional Chinese medicine, clinical indicators, and ocular manifestation data were collected from 506 patients with CHB complicated by MAFLD enrolled at the Public Health Clinical Center of Chengdu between June 2024 and December 2024. Cluster analysis, principal component analysis, and complex network models were employed to identify the distribution patterns of traditional Chinese medicine syndromes. Correlations between different syndrome types and clinical indicators, as well as ocular manifestation characteristics, were further analyzed. ResultsThe predominant syndromes identified in patients with CHB complicated by MAFLD were dampness and heat accumulation (51.58%), liver depression with spleen deficiency (31.62%), blood stasis obstructing collaterals (8.89%), and Qi-Yin deficiency (7.91%). No statistically significant differences were found among the four syndrome types in routine blood tests and liver function indicators. However, patients with the dampness and heat accumulation type exhibited significantly higher levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and alpha-fetoprotein (AFP), along with lower levels of high-density lipoprotein cholesterol (HDL-C), compared with those with other syndrome types. Regarding ocular manifestations, the incidence of moon halo signs was significantly higher in patients with the blood stasis obstructing collaterals type than in those with other syndrome types. Additionally, the incidence in scleral zone 3 (corresponding to the large intestine) was higher in patients with the damp and heat accumulation type. ConclusionDampness and heat accumulation is the core syndrome type in patients with CHB complicated by MAFLD, commonly accompanied by spleen deficiency, liver depression, blood stasis, and Yin deficiency. A complex syndrome pattern characterized by a predominance of dampness and heat, along with a mixture of deficiency and excess, is formed. Different traditional Chinese medicine syndrome types are associated with distinct clinical indicators and ocular manifestation characteristics. Among them, patients with the dampness and heat accumulation type exhibit more pronounced metabolic disturbances and liver injury, whereas those with the blood stasis type show a higher incidence of moon halo signs. Abnormalities in scleral zone 3 are also more prevalent in patients with dampness and heat type.
10.Investigating Molecular Mechanisms of Qijia Rougan Prescription and Its Key Effect or Ingredients Against Hepatic Fibrosis Based on Macrophage M2 Polarization
Li WEN ; Quansheng FENG ; Cen JIANG ; Baixue LI ; Dong WANG ; Jike LI ; Xia LI ; Fei WAN ; Yanfeng ZHENG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(14):155-165
ObjectiveBased on the regulation of macrophage M2 polarization, this study aims to explore the molecular mechanism and action targets of the Qijia Rougan prescription and its key effector ingredients in anti-fibrosis, thereby providing a basis and reference for the development of new drugs for hepatic fibrosis. MethodsA rat model of hepatic fibrosis was established by subcutaneous injection of 40%CCl4, followed by oral administration of Qijia Rougan granules. The volume of collagen fibers was detected using Masson staining, the fibrosis markers Collagen Ⅰ and α-SMA were detected using immunohistochemistry, the proportion of M2 macrophages was detected by flow cytometry. The expression levels of M2 macrophage phenotype markers CD163 and CD206 were detected using immunofluorescence double staining. Western blot was used to detect the levels of the transforming growth factor-β (TGF-β), platelet derived growth factor subunit B (PDGFB), interleukin-10 (IL-10), phosphorylated Janus kinase 1 (p-JAK1), and phosphorylated signal transducer and activator of transcription 6 (p-STAT6). Real-time fluorescent quantitative PCR was used to detect the relative expression levels of JAK1, STAT6, Arginase 1(Arg1), and Fizz1. Based on the theory of serum pharmacology, liquid chromatography-mass spectrometry and WENN analysis were used to obtain the active ingredients of Qijia Rougan prescription. Molecular docking and molecular dynamics simulation were performed to analyze the effector ingredients and their targets. The identified effector ingredients were interfered with IL-4-induced M2 polarization of RAW264.7 macrophage in vitro to validate the targets. ResultsQijia Rougan prescription significantly reduced the content of fibrosis markers α-SMA and Collagen Ⅰ, as well as collagen fiber content (P<0.05). It decreased the proportion of M2 macrophages and the levels of related cytokines IL-10, TGF-β and PDGFB, and up-regulated the levels of p-JAK1 and p-STAT6 (P<0.05). A total of 1 214 compounds were identified from Qijia Rougan prescription, medicated serum and blank serum, and 29 ingredients were finalized by Venn analysis, including 15 blood-entry prototypes and 14 drug metabolites. Molecular docking showed that enoxolone and berberine bound more strongly to JAK1, with binding free energies of -9.6 kcal·mol-1(1 cal≈4.184 J) and -9.1 kcal·mol-1, respectively. Molecular dynamics simulations showed that JAK1-enoxolone and JAK1-berberine exhibited stable simulation trajectories within 100 ns, with essentially identical conformations and high protein overlap before and after simulation. Their binding free energies were -25.18 5.0.81 kcal·mol-1 and -27.39 7.0.85 kcal·mol-1, respectively. The number of hydrogen bonds formed between JAK1 and enoxolone ranges from 0 to 5, and most of the time can be maintained at 2-3. In vitro intervention with enoxolone or berberine significantly reduced p-JAK1 and p-STAT6 levels (P<0.05). ConclusionQijia Rougan prescription inhibits M2 macrophage polarization in hepatic fibrosis. Enoxolone and berberine are the key effector ingredients of Qijia Rougan prescription to inhibit macrophage M2 polarization through targeting JAK1 and modulating the JAK1/STAT6 signaling pathway, thereby ameliorating hepatic fibrosis. This study provides a basis for prescription optimization, clinical application and new drug development, as well as a reference for monolithic anti-hepatic fibrosis research.

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