Pharmacodynamical study on sinus lavage with traditional Chinese medicine
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《中华医药杂志》英文版
[Abstact] Objective This study is to assess the pharmacodynamical effect of a solution,composed of chuanlian wild chrysanthemum dahurian angelica root,angelica and Indian dendranthema,which serves to cure sinusitis.Methods Acute local toxicity test was performed by dripping the concentrated solution of this concoction into the nasocavities of Guinea pigs repeatedly for 4 hours.Seven days later they were sacrificed under anesthesia,and the mucosa of their nasal cavities checked immediately.Test of the effect to inhibit the proliferation of granuloma was performed by injecting 2% agar solution 2 ml,and then applying high-dose solution,low-dose solution,control group and group of fluocinolone acetonide acetate respectively,for 7 successive days.Twenty-four hours after the last administration,we removed the agar pieces and measured the wet weight.Resulte The acute local toxicity test showed all the animals had survived normal in their activies,and the nasal mucosa was reddish,free from irritation.The nasal test indicated that this concoction of traditional Chinese medicine in high dosage was capable of checking the formation of granuloma,nearly as effective as fluocinolone acetonide acetate.Conclusions Along with sinus operation using the functional endoscope,the application of this concoction during the postoperative period will arouse more and more attertion from the medical wcircles.
[Key words] sinusitis;therapy;drugs,Chinese herbal;medicine,traditional Chinese;pharmacodynamics
INTRODUCTION Chronic nasosinusitis is easy to recur after treatment,among those causes,an important factor is the incomplete recovery of the immunologic function of the mucous membrane of the nasal sinuses and the barrier function of the mucous membrane system in addition to the factor of the operation itself.After the operative treatment,the key task for a successful treatment and reduction of recurrence is to prevent the growth of granulation,stop the recurrence of the polypus,and promote the regeneration of the mucous membrane of nasal sinuses and the recovery of its physiological function.It is also the purpose of the medication.So far,there is no very reliable medicine that can control effectively the dropsy of the mucous membrane and the growth of the granulation after the operation of the nasal sinuses and can promote the regeneration of the mucous membrane.Since 1996,we have been using the washing solution of nasosinusitis clinically and have got good clinic effect.Now we report the pharmacodynamic results of the animal experiment of the washing solution and its toxicity test as follows.
MATERIALS AND METHODS
Experimental Animals and Model Building
Ten white Guinea pigs,half being male or female,with a body weight of 200 gram,provided by the Experimental Animal Center of the First Military Medical University (with the animal conformity certificate No.98A0681).In the local toxicity test,we set a high-dose group,and condensed the washing solution by 35 times in the test.50 SD white rats,all being male,with a body weight of 80~100 g,provided by the Experimental Animal Center of Guangdong Province (with the animal conformity certificate No.99A032).In the test of proliferation of chronic granuloma,we divided the 50 SD white rats randomly into a model blank control group,a fluocinolone acetonide acetate group and a group of high-dose washing solution.
Medicine and Reagent
The washing solution for nasosinusitis was composed of Coptis chinensis,dahurian angelica root,angelica and
The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510120,Guangdong Province,China
Indian chrysanthemum flower.It was prepared by Pharmaceutic Center of Hospital of Traditional Chinese Medicine of Guangdong Province (the lot number is 971015),250 ml each bottle,with a content of crude drugs being 20.4%.The fluocinolone acetonide acetate was provided by Tianjin Pharmaceutical Industry Company.
Laboratory Procedures
In the acute local toxicity test,the concentrated washing solution of nasosinusitis was applied to the Guinea pigs many times,making them exposed to the medicine for 4 hours.Seven days after the application,the pigs were sacrificed them by anesthesia,and then checked the mucous membrane condition in the nasal cavity immediately.
Test of the Control of Chronic Proliferation of Granuloma
Put the white rats in shallow anesthesia and did the following operation in a sterile environment:hypodermic injection of 2% agar solution 2 ml at the dorsal mid-line of rats,medicines applied where the injection was done (including high-dose nasosinusitis washing solution,low-dose nasosinusitis washing solution,normal saline,fluocinolone acetonide acetate);on the same day when they contracted nasosinusitis and for 7 days running once a day.24 hours after the last administration,we killed them by exess anesthesia and took out the granuloma agar pieces and measured their wet weights.
Observation Parameters
The acute local toxicity tested included the general condition of the body including the animals' daily activity,such as eating and drinking,and local condition including the symptom of irritation of nose,the color of the nasal membrane,dropsy condition,hyperaemia,bleeding,or ulcer.In the test of the efficacy against chronic granuloma proliferation,the wet weights of the granulation agar were observed.
Statistical Method
We did statistical analysis with t test.
RESULTS
Acute Local Toxicity Test
Four hours after application to the animals,there was no abnormal reaction.After continuous observation for 7 days,all the animals survived and were normal in daily activity including eating and drinking.Their nasal mucosa were reddish,without dropsy,bleeding or ulcer,or symptoms of irritation of the nasal mucosa such as sternutation,rhinorrhea.
Effect against Granuloma Proliferation
DISSCUSION
The recurrence of chronic nasosinusitis is very hard to cure,even by surgical treatment,especially the conglutination and mucous membrane hypoplasia after the operation impedes the full recovery of the disease to a great extent.At present,there is no efficient way to prevent granulation growing and promote mucous membrane regeneration,except repeated clearing to prevent the growth of granulation.In terms of traditional Chinese medicine,chronic nasosinusitis belongs to the category biyuan (rhinorrhea with turbid discharge),whose pathogenesis is chiefly that the moist heat and evil toxin go up along the channel,burning the nasal sinuses and eroding the sarcolemma.Moreover,owing to lack of vital qi and deerment in treatment,the toxin stays there,so the disease occurs repeatedly and is hard to cure.Hence,in treatment,drugs that can reduce fever,diminish inflammation,promote blood flow,drain pus and smooth the channel are chosen.The nasosinusitis washing solution is composed of Coptis chinensis,wild chrysanthemum flower,dahurian angelica root,Radix Angelicae Sinensis and so on,being a pure traditional Chinese medicine,and prepared by a special technological process.Our clinical experience showed,it had the functions to drain pus,stimulate the regeneration of mucous membrane,and prevent granulation;after administration of this medicine for chronic nasosinusitis,it has got a very good curative effect.Angelica is the best drug for promoting blood flow,and it is fragrant and able to smooth the channel,so it can improve the ventilatory function of the nasal cavity.Moreover,modern pharmacological study has also proved that,Coptis chinensis and wild chrysanthemum flower are characterized by a general bacteriostatic action.Hence,local treatment by the nasosinusitis washing solution can not only play the role of mechanical washing and drainage,but also improve the local blood circulation and smooth the way for the air circulation in the nose,so as to provide a good environment for the nasal cavity and nasal sinuses.The result of this experimental study has proven that,in a high dose the nasosinusitis washing solution may have the same effect as fluocinolone acetonide acetate,able to check the formation of granuloma obviously,but in a low dose its effect is not obvious,which may result from the lack of the drug concentration of unit volume.If the drug concentration of unit volume is too high,it will certainly irritate the nasal mucosa,affecting the motion of the pilus of the mucous membrane,so,this problem is also one of the issues for further study in the future.The acute local toxicity experiment in this study showed that the said washing solution has no stimulatory effects on the nasal cavity.The result indicated that,this washing solution can help the regeneration and repair of the mucous membrane after the operation to nasosinusitis,can restrain the recurrence of rhinopolypus,and provide a good treatment means for nasosinusitis[3].Along with the wide application of the nasal sinuses operation using the functional endoscope,the use of the nasosinusitis washing solution of Traditional Chinese Medicine in the period around the operation,might arouse more and more attention from the medical circles.
REFERENCES
1. Xiao Jianxin,Li Yuan,Zhang Gehua,et al.Correlative factors of conglutination after the endoscope-based nasal sinuses operation and their prevention and Treatment.China Journal of Otorhinolaryngology,1999,36 (6):356.
2. Wang Dejian.Otorhinolaryngology,Fifth edition.Shanghai:Shanghai Press of Science and Technology,1999,49.
3. Lin Yanfeng.Recent development of treatment of chronic maxillary sinusitis by combination of Chinese traditional medicine and Western medicine.China Journal of Joint Study of Chinese Traditional Medicine and Western Medicine on Otorhinolaryngology,1997,5 (1):45.
(Editor Emilia)(XIA Ji-yan)
[Key words] sinusitis;therapy;drugs,Chinese herbal;medicine,traditional Chinese;pharmacodynamics
INTRODUCTION Chronic nasosinusitis is easy to recur after treatment,among those causes,an important factor is the incomplete recovery of the immunologic function of the mucous membrane of the nasal sinuses and the barrier function of the mucous membrane system in addition to the factor of the operation itself.After the operative treatment,the key task for a successful treatment and reduction of recurrence is to prevent the growth of granulation,stop the recurrence of the polypus,and promote the regeneration of the mucous membrane of nasal sinuses and the recovery of its physiological function.It is also the purpose of the medication.So far,there is no very reliable medicine that can control effectively the dropsy of the mucous membrane and the growth of the granulation after the operation of the nasal sinuses and can promote the regeneration of the mucous membrane.Since 1996,we have been using the washing solution of nasosinusitis clinically and have got good clinic effect.Now we report the pharmacodynamic results of the animal experiment of the washing solution and its toxicity test as follows.
MATERIALS AND METHODS
Experimental Animals and Model Building
Ten white Guinea pigs,half being male or female,with a body weight of 200 gram,provided by the Experimental Animal Center of the First Military Medical University (with the animal conformity certificate No.98A0681).In the local toxicity test,we set a high-dose group,and condensed the washing solution by 35 times in the test.50 SD white rats,all being male,with a body weight of 80~100 g,provided by the Experimental Animal Center of Guangdong Province (with the animal conformity certificate No.99A032).In the test of proliferation of chronic granuloma,we divided the 50 SD white rats randomly into a model blank control group,a fluocinolone acetonide acetate group and a group of high-dose washing solution.
Medicine and Reagent
The washing solution for nasosinusitis was composed of Coptis chinensis,dahurian angelica root,angelica and
The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,Guangzhou 510120,Guangdong Province,China
Indian chrysanthemum flower.It was prepared by Pharmaceutic Center of Hospital of Traditional Chinese Medicine of Guangdong Province (the lot number is 971015),250 ml each bottle,with a content of crude drugs being 20.4%.The fluocinolone acetonide acetate was provided by Tianjin Pharmaceutical Industry Company.
Laboratory Procedures
In the acute local toxicity test,the concentrated washing solution of nasosinusitis was applied to the Guinea pigs many times,making them exposed to the medicine for 4 hours.Seven days after the application,the pigs were sacrificed them by anesthesia,and then checked the mucous membrane condition in the nasal cavity immediately.
Test of the Control of Chronic Proliferation of Granuloma
Put the white rats in shallow anesthesia and did the following operation in a sterile environment:hypodermic injection of 2% agar solution 2 ml at the dorsal mid-line of rats,medicines applied where the injection was done (including high-dose nasosinusitis washing solution,low-dose nasosinusitis washing solution,normal saline,fluocinolone acetonide acetate);on the same day when they contracted nasosinusitis and for 7 days running once a day.24 hours after the last administration,we killed them by exess anesthesia and took out the granuloma agar pieces and measured their wet weights.
Observation Parameters
The acute local toxicity tested included the general condition of the body including the animals' daily activity,such as eating and drinking,and local condition including the symptom of irritation of nose,the color of the nasal membrane,dropsy condition,hyperaemia,bleeding,or ulcer.In the test of the efficacy against chronic granuloma proliferation,the wet weights of the granulation agar were observed.
Statistical Method
We did statistical analysis with t test.
RESULTS
Acute Local Toxicity Test
Four hours after application to the animals,there was no abnormal reaction.After continuous observation for 7 days,all the animals survived and were normal in daily activity including eating and drinking.Their nasal mucosa were reddish,without dropsy,bleeding or ulcer,or symptoms of irritation of the nasal mucosa such as sternutation,rhinorrhea.
Effect against Granuloma Proliferation
DISSCUSION
The recurrence of chronic nasosinusitis is very hard to cure,even by surgical treatment,especially the conglutination and mucous membrane hypoplasia after the operation impedes the full recovery of the disease to a great extent.At present,there is no efficient way to prevent granulation growing and promote mucous membrane regeneration,except repeated clearing to prevent the growth of granulation.In terms of traditional Chinese medicine,chronic nasosinusitis belongs to the category biyuan (rhinorrhea with turbid discharge),whose pathogenesis is chiefly that the moist heat and evil toxin go up along the channel,burning the nasal sinuses and eroding the sarcolemma.Moreover,owing to lack of vital qi and deerment in treatment,the toxin stays there,so the disease occurs repeatedly and is hard to cure.Hence,in treatment,drugs that can reduce fever,diminish inflammation,promote blood flow,drain pus and smooth the channel are chosen.The nasosinusitis washing solution is composed of Coptis chinensis,wild chrysanthemum flower,dahurian angelica root,Radix Angelicae Sinensis and so on,being a pure traditional Chinese medicine,and prepared by a special technological process.Our clinical experience showed,it had the functions to drain pus,stimulate the regeneration of mucous membrane,and prevent granulation;after administration of this medicine for chronic nasosinusitis,it has got a very good curative effect.Angelica is the best drug for promoting blood flow,and it is fragrant and able to smooth the channel,so it can improve the ventilatory function of the nasal cavity.Moreover,modern pharmacological study has also proved that,Coptis chinensis and wild chrysanthemum flower are characterized by a general bacteriostatic action.Hence,local treatment by the nasosinusitis washing solution can not only play the role of mechanical washing and drainage,but also improve the local blood circulation and smooth the way for the air circulation in the nose,so as to provide a good environment for the nasal cavity and nasal sinuses.The result of this experimental study has proven that,in a high dose the nasosinusitis washing solution may have the same effect as fluocinolone acetonide acetate,able to check the formation of granuloma obviously,but in a low dose its effect is not obvious,which may result from the lack of the drug concentration of unit volume.If the drug concentration of unit volume is too high,it will certainly irritate the nasal mucosa,affecting the motion of the pilus of the mucous membrane,so,this problem is also one of the issues for further study in the future.The acute local toxicity experiment in this study showed that the said washing solution has no stimulatory effects on the nasal cavity.The result indicated that,this washing solution can help the regeneration and repair of the mucous membrane after the operation to nasosinusitis,can restrain the recurrence of rhinopolypus,and provide a good treatment means for nasosinusitis[3].Along with the wide application of the nasal sinuses operation using the functional endoscope,the use of the nasosinusitis washing solution of Traditional Chinese Medicine in the period around the operation,might arouse more and more attention from the medical circles.
REFERENCES
1. Xiao Jianxin,Li Yuan,Zhang Gehua,et al.Correlative factors of conglutination after the endoscope-based nasal sinuses operation and their prevention and Treatment.China Journal of Otorhinolaryngology,1999,36 (6):356.
2. Wang Dejian.Otorhinolaryngology,Fifth edition.Shanghai:Shanghai Press of Science and Technology,1999,49.
3. Lin Yanfeng.Recent development of treatment of chronic maxillary sinusitis by combination of Chinese traditional medicine and Western medicine.China Journal of Joint Study of Chinese Traditional Medicine and Western Medicine on Otorhinolaryngology,1997,5 (1):45.
(Editor Emilia)(XIA Ji-yan)