1.Staged Characteristics of Mitochondrial Energy Metabolism in Chronic Heart Failure with Heart-Yang Deficiency Syndrome and Prescription Intervention from Theory of Reinforcing Yang
Zizheng WU ; Xing CHEN ; Lichong MENG ; Yao ZHANG ; Peng LUO ; Jiahao YE ; Kun LIAN ; Siyuan HU ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):129-138
Chronic heart failure (CHF) is a complex clinical syndrome caused by ventricular dysfunction, with mitochondrial energy metabolism disorder being a critical factor in disease progression. Heart-Yang deficiency syndrome, as the core pathogenesis of CHF, persists throughout the disease course. Insufficiency of heart-Yang leads to weakened warming and propelling functions, resulting in the accumulation of phlegm-fluid, blood stasis, and dampness. This eventually causes Qi stagnation with phlegm obstruction and blood stasis with water retention, forming a vicious cycle that exacerbates disease progression. According to the theory of reinforcing Yang, the clinical experience of the traditional Chinese medicine (TCM) master Tang Zuxuan in treating CHF with heart-Yang deficiency syndrome, and achievements from molecular biological studies, this study innovatively proposes an integrated research framework of "TCM syndrome differentiation and staging-mitochondrial metabolism mechanisms-intervention with Yang-reinforcing prescriptions" which is characterized by the integration of traditional Chinese and Western medicine. Heart-Yang deficiency syndrome is classified into mild (Stage Ⅰ-Ⅱ), severe (Stage Ⅲ), and critical (Stage Ⅳ) stages. The study elucidates the precise correlations between the pathogenesis of each stage and mitochondrial metabolism disorders from theoretical, pathophysiological, and therapeutic perspectives. The mild stage is characterized by impaired biogenesis and substrate-utilization imbalance, corresponding to heart-Yang deficiency and phlegm-fluid aggregation. Linggui Zhugantang and similar prescriptions can significantly improve the expression of peroxisome proliferator-activated receptor gamma co-activator-1α(PGC-1α)/silent information regulator 2 homolog 1 (SIRT1) and ATPase activity. The severe stage centers on oxidative stress and structural damage, reflecting Yang deficiency with water overflow and phlegm-blood stasis intermingling. At this stage, Zhenwu Tang and Qiangxin Tang can effectively mitigate oxidative stress damage, increase adenosine triphosphate (ATP) content, and repair mitochondrial structure. The critical stage arises from calcium overload and mitochondrial disintegration, leading to the collapse of Yin-Yang equilibrium. At this stage, Yang-restoring and crisis-resolving prescriptions such as Fuling Sini Tang and Qili Qiangxin capsules can inhibit abnormal opening of the mitochondrial permeability transition pore (MPTP), reduce cardiomyocyte apoptosis rate, and protect mitochondrial function. By summarizing the characteristics of mitochondrial energy metabolism disorders at different stages of CHF, this study explores the application of the theory of reinforcing Yang in treating heart-Yang deficiency syndrome and provides new insights for the clinical diagnosis and treatment of CHF.
2.Traditional Chinese Medicine Treatment of Chronic Heart Failure Based on AMPK Signaling Pathway
Kun LIAN ; Lichong MENG ; Xueqin WANG ; Yubin ZHANG ; Lin LI ; Xuhui TANG ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):139-148
Chronic heart failure (CHF) is a group of complex clinical syndromes caused by abnormal changes in the structure and/or function of the heart due to various reasons, resulting in disorders of ventricular contraction and/or diastole. CHF is a condition where primary diseases such as coronary heart disease, hypertension and pulmonary heart disease recur frequently and persist for a long time, presenting blood stasis in meridians and collaterals, stagnation of water and dampness, and accumulation of Qi in collaterals. Its pathogenesis is complex and may involve myocardial energy metabolism disorders, oxidative stress responses, myocardial cell apoptosis, autophagy, inflammatory responses, etc. According to the theory of restraining hyperactivity to acquire harmony, we believe that under normal circumstances, the adenosine monophosphate-activated protein kinase (AMPK) signaling pathway functions normally, maintaining human physiological activities and energy metabolism. Under pathological conditions, the AMPK signaling pathway is abnormal, causing energy metabolism disorders, inflammatory responses, and myocardial fibrosis. Traditional Chinese medicine (TCM) can regulate the AMPK signaling pathway through multiple mechanisms, targets, and effects, effectively curbing the occurrence and development of CHF. It has gradually become a research hotspot in the prevention and treatment of this disease. Guided by the theory of TCM, our research group, through literature review, summarized the relationship between the AMPK pathway and CHF and reviewed the research progress in the prevention and control of CHF with TCM active ingredients, TCM compound prescriptions, and Chinese patent medicines via regulating the AMPK pathway. The review aims to clarify the mechanism and targets of TCM in the treatment of CHF by regulating the AMPK pathway and guide the clinical treatment and drug development for CHF.
3.Danhong Injection Regulates Ventricular Remodeling in Rat Model of Chronic Heart Failure with Heart-Blood Stasis Syndrome via p38 MAPK/NF-κB Signaling Pathway
Zizheng WU ; Xing CHEN ; Jiahao YE ; Lichong MENG ; Yao ZHANG ; Junyu ZHANG ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):149-159
ObjectiveTo explore the mechanism of ventricular remodeling mediated by the p38 mitogen-activated protein kinase (MAPK)/nuclear factor kappa B (NF-κB) signaling pathway in the rat model of chronic heart failure (CHF) with heart-blood stasis syndrome, as well as the intervention effect of Danhong injection. MethodsIn vivo experiment: SPF-grade male SD rats were assigned via the random number table method into 4 groups: Sham operation, model, captopril (8.8 mg·kg-1), and Danhong injection (6.0 mL·kg-1). The model of CHF with heart-blood stasis syndrome was established by abdominal aortic constriction, and the sham operation group only underwent laparotomy without constriction. All the groups were treated continuously for 15 days. The tongue color of rats was observed. Echocardiography, hemorheology, heart mass index (HMI), and left ventricular mass index (LVMI) were measured. Hematoxylin-eosin (HE) staining and Masson staining were performed to observe the pathological and fibrotic changes of the myocardial tissue. Enzyme-linked immunosorbent assay (ELISA) was employed to quantify the levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), angiotensin Ⅱ (AngⅡ), tumor necrosis factor-α (TNF-α), and Creactive protein (CRP) in the serum, as well as the levels of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) in the myocardial tissue. Western blot was used to quantify the protein levels of p-p38 MAPK/p38 MAPK and p-NF-κB p65/NF-κB p65 in the myocardial tissue. In vitro experiment: H9C2 cardiomyocytes were treated with 1×10-6 mol·L-1 AngⅡ to establish a model of myocardial hypertrophy. H9C2 cardiomyocytes were allocated into normal, model, inhibitor + Danhong injection, Danhong injection (20 mL·L-1), and inhibitor (SB203580, 5 μmol·L-1) groups. CCK-8 assay was used to detect the viability of H9C2 cardiomyocytes. Rhodamine-labeled phalloidin staining was used to reveal the area of cardiomyocytes. Real-time PCR was performed to determine the mRNA levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). Western blot was used to assess the protein levels of p-p38 MAPK/p38 MAPK and p-NF-κB p65/NF-κB p65. ResultsIn vivo experiment: Compared with the sham operation group, the model group showed purplish-dark tongue with decreased R, G, B values of the tongue surface (P<0.01), increased whole blood viscosity (at low, medium, and high shear rates) (P<0.01), decreased left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) (P<0.01), increased left ventricular end-diastolic diameter (LVIDd), left ventricular end-systolic diameter (LVIDs), and left ventricular posterior wall thickness at end-diastole (LVPWd) (P<0.01), raised LVMI and HMI (P<0.01), and elevated levels of NT-proBNP, TNF-α, IL-6, and CRP in the serum and MMP-2 and MMP-9 in the myocardial tissue (P<0.01). The HE and Masson staining of the myocardial tissue showed compensatory myocardial hypertrophy, fibrosis, and massive inflammatory cell infiltration in the model group. Additionally, the model group presented up-regulated protein levels of p-p38 MAPK/p38 MAPK and p-NF-κB p65/NF-κB p65 in the myocardial tissue (P<0.01). Compared with the model group, each administration group showed increased R, G, B values of the tongue surface (P<0.05, P<0.01), decreased whole blood viscosity (at low, medium, and high shear rates) (P<0.05, P<0.01), increased LVEF and LVFS (P<0.01), decreased LVIDd, LVIDs, and LVPWd (P<0.05, P<0.01), declined LVMI and HMI (P<0.05, P<0.01), and lowered levels of NT-proBNP, TNF-α, IL-6, and CRP in the serum and MMP-2 and MMP-9 in the myocardial tissue (P<0.01). HE and Masson staining showed alleviated compensatory myocardial hypertrophy, reduced fibrosis, and decreased expression of p-p38 MAPK/p38 MAPK and p-NF-κB p65/NF-κB p65 in the myocardial tissue (P<0.01). In vitro experiment: When the concentration of Danhong injection reached 20 mL·L-1, the survival rate of H9C2 cardiomyocytes was the highest (P<0.01). Compared with the normal group, the model group showed up-regulated mRNA levels of ANP and BNP (P<0.01), increased relative cell surface area (P<0.01), and raised protein levels of p-p38 MAPK/p38 MAPK and p-NF-κB p65/NF-κB p65 (P<0.01). Compared with the model group, each administration group showed down-regulated mRNA levels of ANP and BNP (P<0.01), reduced relative cell surface area (P<0.05, P<0.01), and down-regulated protein levels of p-p38 MAPK/p38 MAPK and p-NF-κB p65/NF-κB p65 (P<0.05, P<0.01). ConclusionDanhong injection can regulate ventricular remodeling through the p38 MAPK/NF-κB pathway, thereby exerting a protective effect on the rat model of CHF with heart-blood stasis syndrome.
4.Diagnosis and Treatment of Chronic Heart Failure Based on Thinking of Five Differentiation
Kun LIAN ; Lichong MENG ; Manting YI ; Lin LI ; Fei WANG ; Siyuan HU ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(5):160-168
Chronic heart failure (CHF) refers to a clinical syndrome in which the function or structure of the heart is changed due to damage to the original myocardium, resulting in reduced pumping and/or filling functions of the heart. In recent years, the mechanisms, pathways, and targets of traditional Chinese medicine (TCM) in the treatment of CHF have been continuously confirmed, and the application of TCM theories in guiding the syndrome differentiation and precise treatment of CHF is currently a research hotspot. On the basis of the syndrome differentiation and treatment in TCM, Professor LI Candong innovatively proposed the thinking of five differentiation: Disease differentiation, syndrome differentiation, pathogenesis differentiation, symptom differentiation, and individual differentiation. This article explores the clinical diagnosis and treatment of CHF from this thinking, emphasizing comprehensive syndrome differentiation, objective analysis, dynamic assessment, and individualized treatment. In terms of diagnosis, the first is to identify the disease name, cause, location, severity, and type of CHF, determine the type and its evolution, and clarify the process of transmission and transformation between deficiency and excess. Secondly, it is necessary to distinguish the authenticity, severity, primary and secondary, urgency and complexity of CHF syndromes, providing scientific guidance for syndrome differentiation and treatment. Thirdly, according to the symptoms and the principles of deficiency and excess, the physician should identify the core pathogenesis of CHF from the perspectives of Qi, blood, Yin, Yang, deficiency, stasis, phlegm, water, and toxins. Fourthly, from the macro, meso and micro levels, the physician should carefully distinguish the presence or absence, severity, authenticity, and completeness of the symptoms to guide the diagnosis and treatment process of CHF. Finally, personalized medication for CHF should be promoted based on the patient's gender, age, constitution, and living habits. In terms of treatment, based on the thinking of five differentiation, we propose that the treatment of CHF should integrate the disease and syndrome, clarify the pathogenesis, and apply precise treatment. The treatment should be people-oriented, staged, and typed, and the medication should be adjusted according to symptoms. This diagnostic and therapeutic approach is based on the holistic concept and syndrome differentiation and treatment, and combines the three causes for appropriate treatment, providing new ideas and insights for the diagnosis and treatment of CHF.
5.Danhong Injection Regulates Mitochondrial Dynamics in Rat Model of Chronic Heart Failure via AMPK/Drp1 Pathway
Jiahao YE ; Zizheng WU ; Yao ZHANG ; Lichong MENG ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(16):126-135
ObjectiveTo investigate the effects of Danhong injection on mitochondrial dynamics, morphology, and function in the rat model of chronic heart failure by mediating the adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)/dynamin-related protein 1 (Drp1) pathway. MethodsFrom 75 SD rats, 15 rats were randomly selected as the sham group, and the remaining 60 rats were used to prepare a rat model of chronic heart failure by abdominal aortic constriction (AAC). The modeled rats were randomly allocated into model, Danhong Injection (6 mL·kg-1), and captopril (8.8 mg·kg-1) groups and administrated with corresponding agents for 15 consecutive days. The levels of N-terminal pro-brain natriuretic peptide (NT-pro BNP), adenosine diphosphate (ADP), adenosine triphosphate (ATP), interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α and the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ were determined by enzyme-linked immunosorbent assay. The changes in cardiac function were detected by echocardiography. The ultrastructural changes of myocardial mitochondria were observed by transmission electron microscopy. Western blot was employed to assess the protein levels of AMPK, p-AMPK, Drp1, p-Drp1, optic atrophy 1 (Opa1), mitofusin (Mfn2), and fission l (Fis1) in the myocardial tissue. Real-time PCR was performed to determine the mRNA levels of Opa1, Mfn2, and Fis1, and immunohistochemistry to detect the expression of p-AMPK. ResultsCompared with the sham group, the model group showed elevated levels of NT-pro BNP, ADP, TNF-α, IL-6, and IL-1β (P<0.01), declined ATP level (P<0.01), weakened activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ (P<0.01), decreased left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) (P<0.01), and increased left ventricular internal diameter at end-diastole (LVDd) and leaf ventricular internal diameter at end-systole (LVIDs) (P<0.01). Electron microscopy results showed that the model group presented heavily abnormal myocardial structure, with large areas of myofilament structure destroyed and dissolved, significantly enlarged residual structural gaps, and fragmented mitochondria. Western blot results showed that the model group demonstrated down-regulated protein levels of p-AMPK, Mfn2, and Opa1 (P<0.01) and up-regulated protein levels of p-Drp1 and Fis1 (P<0.01) in the myocardial tissue. Real-time PCR results showed that the model group presented up-regulated mRNA level of Fis1 (P<0.01) and down-regulated mRNA levels of Mfn2 and Opa1 (P<0.01). Immunohistochemistry results showed reduced expression of p-AMPK in the model group compared with sham group (P<0.01). Compared with the model group, Danhong injection lowered the levels of NT-pro BNP, ADP, TNF-α, IL-6, and IL-1β (P<0.01), raised the level of ATP (P<0.01), increased the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ (P<0.05, P<0.01), increased the LVEF and LVFS (P<0.01), decreased the LVDd and LVIDs (P<0.05, P<0.01), alleviated mitochondrial damage, up-regulated the protein levels of p-AMPK, Mfn2, and Opa1 (P<0.05, P<0.01), down-regulated the protein levels of p-Drp1 and Fis1 (P<0.01), reduced the mRNA level of Fis1 (P<0.01), elevated the mRNA levels of Mfn2 and Opa1 (P<0.05, P<0.01), and promoted the expression of p-AMPK (P<0.05). ConclusionDanhong injection repairs the imbalance of mitochondrial dynamics, restores the mitochondrial function, improves the myocardial energy metabolism, and reduces the inflammatory response by regulating the AMPK/Drp1 pathway, thus improving the cardiac function.
6.Shenfu Injection Improve Chronic Heart Failure by Regulates Glycolytic Pathway Mediated by HIF-1α/PFKFB3 Pathway
Ji OUYANG ; Kun LIAN ; Xiaoqian LIAO ; Lichong MENG ; Lin LI ; Zhenyu ZHAO ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(16):136-145
ObjectiveThis study aims to explore the mechanism and targets of Shenfu Injection in regulating glycolysis to intervene in myocardial fibrosis in chronic heart failure based on the hypoxia-inducible factor-1α (HIF-1α)/ 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB3) signaling pathway. MethodsA rat model of chronic heart failure was established by subcutaneous injection of isoproterenol (ISO). After successful modeling, the rats were randomly divided into the Sham group, Model group, Shenfu injection (SFI, 6 mL·kg-1) group, and inhibitor (3PO, 35 mg·kg-1) group, according to a random number table, and they were treated for 15 days. Cardiac function was evaluated by echocardiography, and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were detected by enzyme-linked immunosorbent assay (ELISA). Fasting body weight and heart weight were measured, and the heart index (HI) was calculated. Pathological changes in myocardial tissue were observed by hematoxylin-eosin (HE) and Masson staining, and the fibrosis rate was calculated. Biochemical assays were used to determine serum levels of glucose (GLU), lactic acid (LA), and pyruvic acid (PA). Western blot was used to analyze the expression of proteins related to the HIF-1α/PFKFB3 signaling pathway (HIF-1α and PFKFB3), glycolysis-related proteins (HK1, HK2, PKM2, and LDHA), and fibrosis-related proteins [transforming growth factor (TGF)-β1, α-smooth muscle actin (α-SMA), and Collagen type Ⅰ α1 (ColⅠA1)]. Real-time PCR was used to detect the mRNA expression of HIF-1α and PFKFB3 in myocardial tissue. ResultsCompared with the Sham group, the Model group showed significantly decreased left ventricular ejection fraction (LVEF), left ventricular shortening fraction (LVFS), interventricular septal thickness (IVSd), and interventricular septal strain (IVSs) (P<0.05), while left ventricular internal dimension at end-diastole (LVDd) and end-systole (LVIDs) were increased (P<0.05). Serum NT-proBNP levels were significantly increased (P<0.01), and body weight was decreased. Heart weight was increased, and the HIT index was increased (P<0.05). Myocardial tissue exhibited inflammatory cell infiltration and collagen fiber deposition, and the fibrosis rate was significantly increased (P<0.05). Serum GLU was decreased (P<0.05), while LA and PA levels were increased (P<0.05). Protein expressions of HIF-1α, PFKFB3, HK1, HK2, PKM2, LDHA, TGF-β1, α-SMA, and ColⅠA1, as well as the mRNA expression of HIF-1α and PFKFB3 were increased (P<0.05). Compared with the Model group, both the SFI group and 3PO groups showed significant improvements in LVEF, LVFS, IVSd, and IVSs (P<0.05) and decreases in LVDd, LVIDs, and NT-proBNP levels (P<0.05). Body weight was significantly increased. Heart weight was significantly decreased, and the HIT index was significantly decreased (P<0.05). Inflammatory cell infiltration, collagen fiber deposition, and the fibrosis rate were significantly decreased (P<0.05). Serum GLU levels were significantly increased (P<0.05), while LA and PA levels were decreased (P<0.05). Expressions of glycolysis-related proteins, fibrosis-related proteins, and HIF-1α/PFKFB3 pathway-related proteins and mRNAs were significantly suppressed (P<0.05). ConclusionSFI improves cardiac function in chronic heart failure by downregulating the expression of HIF-1α/PFKFB3 signaling pathway-related proteins, regulating glycolysis, and inhibiting myocardial fibrosis.
7.Pathogenesis of Chronic Heart Failure with Anxiety and Depression and Therapeutic Mechanisms of Bupleuri Radix-based Formulas from Theory of Shaoyang Pivot
Duoting TAN ; Kun LIAN ; Hao LIANG ; Lichong MENG ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(16):156-164
Chronic heart failure (CHF), as the terminal stage of various cardiovascular diseases, is characterized by a prolonged clinical course and recurrent exacerbations. The coexistence of CHF with anxiety and depression falls under the category of psycho-cardiological diseases. Studies have demonstrated that anxiety and depression are closely associated with adverse outcomes including elevated risks of cardiovascular events and increased mortality in CHF patients. The complex pathogenesis poses challenges to modern medical treatments, which often face limited efficacy and concurrent side effects. According to the theory of Shaoyang Pivot in traditional Chinese medicine (TCM), this paper elucidates that obstructed Shaoyang Pivot—manifested as Qi transformation disorder, dysregulated fluid metabolism, and abnormal distribution of ministerial fire-serves as a critical pathological basis for CHF with anxiety and depression. Bupleuri Radix-based Formulas, such as Xiao Chaihu Tang, Chaihu Guizhi Tang, and Chaihu Jia Longgu Muli Tang, aim to harmonize lesser Yang to restore the Qi transformation, activate Yang to promote water excretion, and redistribute ministerial fire, thus effectively alleviating pathological states such as Qi stagnation, blood stasis, water retention, and phlegm-fire disturbing the heart in CHF patients with anxiety and depression. Consequently, they mitigate symptoms of this psycho-cardiological disease. Mechanism studies have revealed that Bupleuri Radix-based formulas exhibit multi-target effects, including modulation of neurotransmitters, suppression of inflammatory responses, regulation of lipid metabolism, protection of cardiomyocytes, and improvement of the endothelial function. By interpreting the TCM pathogenesis of CHF with anxiety and depression from the theory of Shaoyang Pivot, this paper delves into the therapeutic principles and mechanisms of Bupleuri Radix-based formulas, providing a theoretical foundation for optimizing TCM diagnosis and treatment strategies for psycho-cardiological diseases.
8.To explore the rule of diagnosis and treatment of chronic heart failure from "disease - syndrome - symptom - stage - molecular phenotype"
Kun LIAN ; Lichong MENG ; Ying DENG ; Zhenyu ZHAO ; Lin LI ; Zhixi HU
International Journal of Traditional Chinese Medicine 2025;47(2):150-156
It is of great significance to study the diagnosis, prevention and treatment of chronic heart failure. This study took the name of Western medicine disease as the main line, took TCM syndromes as the aim, combined the symptoms, signs, stages and molecular phenotype, and explored the diagnosis and treatment law of the disease. It is believed that chronic heart failure includes the syndrome of qi deficiency and blood stasis, yang deficiency and blood stasis, qi-yin deficiency, heart-kidney yang deficiency and yang deficiency water syndrome. There were many clinical manifestations such as chest tightness, shortness of breath, fatigue, limb edema and pulse knot. It involved many pathological mechanisms and molecular phenotype such as myocardial fibrosis, inflammatory response and myocardial cell injury. Treatment should be divided into early, middle and late stages according to the characteristics of "disease - syndrome - symptom- stage- molecular phenotype".
9.Exploration on the effects of Shenfu Injection on apoptosis and improvement of chronic heart failure based on Fas/FasL pathway
Kun LIAN ; Xin LI ; Fei WANG ; Peng LUO ; Lichong MENG ; Lin LI ; Zhixi HU
International Journal of Traditional Chinese Medicine 2025;47(3):327-335
Objective:To explore the mechanism of Shenfu Injection in treating chronic heart failure (CHF) based on Fas/FasL apoptosis signaling pathway.Methods:A total of 70 SPF male C57BL/6 mice were divided into blank group (15 mice) and model group (55 mice) according to random number table. The CHF model was prepared by intraperitoneal injection of isoproterenol. After 4 weeks, the successfully modeled mice were randomly divided intoa model group, Shenfu Injection group, and Western medicine group using a random number table method. After adfministration for 15 d, the left ventricular ejection fraction (LVEF) and left ventricular shortening fraction (LVFS) of each group of mice were measured by heart color ultrasound 1; serum NT-proBNP was detected by enzyme-linked immunosorbent assay (ELISA); Hematoxylin-eosin staining (HE) was used to observe the changes of myocardial tissue morphology; TUNEL pod method was used to detect apoptosis; the mRNA transcription levels of tumor necrosis factor-α (TNF-α), Fas, Fas ligand (FasL), Caspase-3 and Caspase-8 were detected by RT-PCR; protein expression levels of TNF-α, Fas, FasL, Caspase-3 and Caspase-8 in myocardial tissue were detected by Western blot. The logarithmically grown H9c2 cells were divided into blank group, model group and Shenfu Injection group. The cells in blank group were cultured for 48 hours; cells in the model group were exposed to 80 μmol/L isoproterenol for 48 hours; cells in Shenfu Injection group were pretreated with 5 μl/ml Shenfu injection for 3 hours and exposed to 80 μmol/L isoproterenol for 48 h. The cell growth was observed under microscope. Western blot and RT-PCR were used to detect the expression of related proteins and mRNA transcription. TUNEL pod and flow cytometry were used to detect apoptosis.Results:Compared with the model group, the cardiac function improved in the model group and Shenfu Injection group, serum NT ProBNP levels decreased ( P<0.01 or P<0.05), myocardial cell injury and apoptosis were reduced ( P<0.01 or P<0.05), and the mRNA and protein expression of TNF-α, Fas, FasL, Caspase-3, Caspase-8 in myocardial tissue decreased ( P<0.01 or P<0.05). The H9c2 cells in the blank group were spindle shaped with clear structure; the myocardial cells in the model group shrank and became shorter, with blurred cell boundaries and exhibiting apoptotic and necrotic morphology; Most H9c2 cells in the reference group were spindle shaped, with reduced cell death and increased density. Compared with the model group, the levels of TNF-α, Fas, FasL, Caspase-3, Caspase-8 protein and mRNA in H9c2 cells of the Shenfu Injection group decreased ( P<0.01 or P<0.05), and the apoptosis rate decreased ( P<0.01). Conclusion:Shenfu Injection may improve cardiac function and cardiomyocyte apoptosis of CHF mice through Fas/FasL signaling pathway.
10.Syndrome Treatment of Chronic Heart Failure and Diabetes Mellitus omorbidity Based on "Syndrome-based Treatment of Disease"
Lichong MENG ; Kun LIAN ; Xinchun LI ; Cong LU ; Zhixi HU
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(24):233-242
Chronic heart failure (CHF) and diabetes mellitus (DM) comorbidity presents a myriad of symptoms and a complex pathogenesis, making the traditional diagnostic and treatment model of "using disease to treat syndrome" often inadequate in clinical practice. The concept of "syndrome-based treatment of disease" is rooted in the core thinking of traditional Chinese medicine (TCM) syndrome differentiation and treatment, emphasizing the importance of syndrome as the guiding principle. This approach categorizes various diseases according to their corresponding syndrome categories for exploration, adhering to the principle of starting from the syndrome and addressing the disease thereafter, which highlights the advantages of TCM holistic view and syndrome differentiation and treatment. The pathogenesis of CHF is characterized by deficiency of both Qi and Yin, along with blood stasis, affecting organs such as the lung, spleen, and kidney, which in turn impacts the distribution and metabolism of body fluids. Dysfunction in body fluid regulation leads to stagnation, resulting in pathological products like phlegm and turbidity, which exacerbates syndromes of Yin deficiency and excessive heat. As the conditions of Yin deficiency and dryness-heat intensify, and as body fluid depletion continues, the patient's DM symptoms worsen, contributing to or aggravating the comorbidity. Following the diagnostic approach of "syndrome-based treatment of disease", TCM diagnosis and treatment of CHF and DM comorbidity should focus on the core pathogenesis of "deficient Qi retention". This study categorized CHF and DM comorbidity into four stages: A (comorbid risk period), B (precomorbid period), C (intermediate stage of comorbidity), and D (advanced comorbidity), proposing corresponding TCM syndrome types for each stage. In terms of treatment, adhering to the principle of "tonifying deficiency and relieving stagnation", the specific methods included invigorating Qi and strengthening the body, nourishing Yin and generating body fluids, activating blood circulation and Qi, and promoting diuresis and removing toxins. This study reviewed recent research progress on Chinese medicine compound prescriptions for CHF combined with DM, aiming to achieve precise treatment for both diseases and provide a scientific basis for the application of TCM in the prevention and treatment of CHF and DM comorbidity.

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