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      Chinese herbal Pulian ointment in treating psoriasis vulgaris of blood-heat syndrome: a multi-center, double-blind, randomized, placebo-controlled trial

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          Abstract

          Background

          Traditional Chinese medicine (TCM) has a long history in the treatment of psoriasis vulgaris. We aimed to evaluate the clinical efficacy and safety of Chinese herbal Pulian ointment in treating psoriasis vulgaris of blood-heat syndrome.

          Methods

          A multicenter, randomized, double-blind, placebo-controlled trial was conducted. Participants with psoriasis vulgaris of blood-heat syndrome were blinded and randomized to receive Pulian ointment or placebo ointment twice daily for 4 weeks, with follow-up 8 weeks after treatment. Psoriasis Area Severity Index (PASI) scores, severity of each symptom and area of skin lesion and quality of life were assessed at baseline, 2 weeks, and 4 weeks. Adverse events were recorded during the study. SAS 9.4 software and SPSS 17.0 software was applied for data analysis.

          Results

          A total of 300 participants with psoriasis vulgaris of blood-heat syndrome were assessed for eligibility, and 294 were randomly assigned to the Pulian ointment and placebo group from six study centers. Full analysis set (FAS): after 4 weeks of treatment, there were significant differences between groups in PASI score and the separate score of skin lesion area, favoring Pulian ointment group ( P < 0.05). However, no significant differences were observed in scores of scaling, erythema and induration/thickness ( P > 0.05). Per protocol set (PPS): There was no statistically significant difference in PASI score and separate score of each symptom and area of skin lesion between two groups ( P > 0.05). Quality of life measured by Hamilton Anxiety Rating Scale (HAMA) and 36-Item Short Form Health Survey (SF-36) improved after treatment in both groups, but there was no significant difference between the two groups ( P > 0.05). After being followed up for 8 weeks, the total relapse rates of the Pulian Ointment group and placebo group were 5.88 and 8.45%, respectively, and the difference was not statistically significant between the two groups ( P > 0.05). No adverse event was observed in both groups throughout the study.

          Conclusions

          Pulian Ointment seems effective and well tolerated in improving the PASI score and separate score of skin lesion area for patients with psoriasis vulgaris of blood-heat syndrome. Further research could build on the current study to explore whether other preparation forms and greater intervention intensity are necessary for better therapeutic effects.

          Trial registration

          Chictr.org.cn Identifier ChiCTR-TRC-12002054.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12906-017-1631-5) contains supplementary material, which is available to authorized users.

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          Most cited references16

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          Psoriasis.

          Psoriasis is a common relapsing and remitting immune-mediated inflammatory disease that affects the skin and joints. This review focuses on current immunogenetic concepts, key cellular players, and axes of cytokines that are thought to contribute to disease pathogenesis. We highlight potential therapeutic targets and give an overview of the currently used immune-targeted therapies.
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            The anti-inflammatory potential of Cortex Phellodendron in vivo and in vitro: down-regulation of NO and iNOS through suppression of NF-κB and MAPK activation.

            Cortex Phellodendri amurensis (CPA), derived from the dried bark of Phellodendron amurense Rupr., is a traditional medicine widely used to treat various inflammation-related diseases. The aim of this study was to investigate the anti-inflammatory activity and molecular mechanism of CPA in vivo and in vitro. Mice were pretreated with CPA (200 mg/kg, p.o.) for three consecutive days; 2h after the last CPA treatment, mice were intraperitoneally injected with lipopolysaccharide (LPS) to induce endotoxemia (35 mg/kg). After treatment, we assessed survival rate, protein levels and cytokine expression. In addition, we confirmed the molecular mechanism of anti-inflammatory effects of CPA in LPS-stimulated macrophage RAW 264.7 cells. The results showed that CPA significantly increased mice survival rates and down-regulated LPS-induced interleukin (IL)-6, IL-1β and macrophage chemo-attractant protein (MCP)-1 in serum. In addition, CPA inhibited inducible nitric oxide synthase (iNOS), activation of nuclear factor (NF)-κB by degradation and phosphorylation of IκBα, and attenuated phosphorylation of mitogen-activated protein kinases (MAPKs; ERK 1/2, p38 and JNK) from mice challenged with LPS. Moreover, in RAW 264.7 cells, CPA dose-dependently down-regulated LPS-stimulated NO, iNOS expression, as well as inflammatory cytokines and protein expression, consistent with the results in vivo. The anti-inflammatory properties of CPA in vitro and in vivo suggest its utility for attenuating inflammation-related diseases.
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              Baicalin attenuates lipopolysaccharide induced inflammation and apoptosis of cow mammary epithelial cells by regulating NF-κB and HSP72.

              Baicalin is the main ingredient of traditional Chinese herbal medicine, Scutellaria baicalensis, which has been widely used clinically as an anti-inflammatory agent. However, molecular mechanism of action of this drug is not yet clear. In the present study, the protective mechanism of baicalin against lipopolysaccharide (LPS) induced inflammatory injury in cow mammary epithelial cells (CMECs) was explored. For this purpose, in vitro cultured CMECs were treated with baicalin (10μg/mL) and LPS (10μg/mL) for 24 and 12h, respectively, and the cell viability was measured by using cell counting kit-8 (CCK-8). The results revealed that LPS induced inflammatory responses, as p-p65/p65 and p-IκBα/IκBα ratios and TNF-α and IL-1β production was increased in the CMECs. Both Bcl-2/Bax ratio and cell viability were decreased and caspase-3 cleaved following LPS treatment, indicating apoptosis of CMECs. Moreover, both LPS and baicalin increased HSP72 expression of the CMECs. However, cellular inflammatory responses and apoptosis were significantly reduced in baicalin treated CMECs. In conclusion, baicalin ameliorated inflammation and apoptosis of the CMECs induced by LPS via inhibiting NF-κB activation and up regulation of HSP72.
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                Author and article information

                Contributors
                nola8316@sina.com
                zhaowenbin7@126.com
                13811181935@163.com
                jianping_l@hotmail.com
                zhgzh62000@126.com
                dzmpfkz@yeah.net
                Yuan-wen@sohu.com
                yawlsw@163.com
                Chineseherb@sohu.com
                zhi@tsinghua.edu.cn
                Journal
                BMC Complement Altern Med
                BMC Complement Altern Med
                BMC Complementary and Alternative Medicine
                BioMed Central (London )
                1472-6882
                15 May 2017
                15 May 2017
                2017
                : 17
                : 264
                Affiliations
                [1 ]ISNI 0000 0004 1771 3349, GRID grid.415954.8, Department of Dermatology, , China-Japan Friendship Hospital, ; Beijing, 100029 China
                [2 ]Department of Dermatology, Beijing Pinggu Hospital, Beijing, 101200 China
                [3 ]Beijing Sinocro Pharma Science Co., Ltd., Beijing, 100024 China
                [4 ]ISNI 0000 0001 1431 9176, GRID grid.24695.3c, Center for Evidence-Based Chinese Medicine, , Beijing University of Chinese Medicine, ; Beijing, 100029 China
                [5 ]GRID grid.459365.8, Department of Dermatology, , Beijing Hospital of Traditional Chinese Medicine, ; Beijing, 100010 China
                [6 ]GRID grid.412073.3, Department of Dermatology, , Dongzhimen Hospital, ; Beijing, 100007 China
                [7 ]Department of Dermatology, Dongfang Hospital, Beijing, 100078 China
                [8 ]GRID grid.464297.a, Department of Dermatology, , Guang’anmen Hospital, ; Beijing, 100053 China
                [9 ]GRID grid.413440.6, Department of Dermatology, , Air Force General Hospital, PLA, ; Beijing, 100036 China
                Article
                1631
                10.1186/s12906-017-1631-5
                5432985
                28506228
                616ccbc1-8018-4c7f-a9d6-b9d8ac168ffc
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 February 2016
                : 8 February 2017
                Funding
                Funded by: Eleventh Five year Plan for Sci and Tech Research of China
                Award ID: 2008BAI53B044
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Complementary & Alternative medicine
                pulian ointment,chinese herbal medicine,blood-heat syndrome,psoriasis vulgaris,efficacy,randomized controlled trial

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