| This paper discusses the understanding of CHOLM in preventing and treating atherosclerosis through theoretical discussion,clinical research,animal experiment research and cell experiment research.1 To explore the theoretical origin and research progress of intestinal flora metabolite TMAO and atherosclerosis from the relationship between heart and small intestine.Since ancient times,traditional medicine has said that the heart and small intestine sharing a paired relationship."The Heart and the Small Intestine Sharing a Paired Relationship" from the theoretical formation in the Qin and Han dynasties to the theoretical development in the Sui,Tang,Song,Jin and Yuan dynasties,and finally to the theoretical maturity in the Ming and Qing dynastie.It has gradually formed the characteristics of heart and small intestine meridians,which are closely related to physiology and affected by pathology.At the same time,contemporary physicians found that the metabolism of intestinal flora has a great impact on atherosclerosis that causes coronary heart disease,which is also consistent with the theoretical understanding of " The Heart and the Small Intestine Sharing a Paired Relationship".This article discusses the theoretical significance and historical evolution of "The Heart and the Small Intestine Sharing a Paired Relationship" from the theoretical discussion,and then discusses the current research on intestinal flora and its impact on atherosclerosis.Professor Zheng Qiongli,a famous cardiovascular doctor in our hospital,has accumulated rich experience in the prevention and treatment of atherosclerosis.She pays attention to the overall concept,and actively applies the theories of "heart and spleen are related"," The Heart and the Small Intestine Sharing a Paired Relationship" to clinical practice.She believes that the prevention and treatment of atherosclerosis should not be limited to blood vessels,but should start from the whole,which is closely related to digestion.Therefore,her self prepared Huanglian Jiangzhi Recipe can regulate the metabolism of blood lipids,control the metabolism of intestinal flora,thus affecting the inflammatory reaction of the body,and then preventing atherosclerosis.It has sufficient research basis and value in the study of intestinal flora and atherosclerosis.2 Clinical study on Huanglian Jiangzhi Recipe in preventing and treating atherosclerosis of Phlegm and Stasis Type.Objective: To observe the clinical efficacy of Huanglian Jiangzhi Recipe in preventing and treating atherosclerosis of phlegm and stasis type.Methods: From the aspect of clinical observation,82 cases of atherosclerosis of phlegm and stasis type in the cardiovascular department of Wuhan Integrated Traditional and Western Medicine Hospital from May 2020 to October 2021 were selected and divided into the test group and the control group according to the random number table.In the control group,Simvastatin(trade name: Shujiangzhi)was given orally 20 mg each time,once a night.The test group was given Huanglian Jiangzhi Recipe orally,100 ml each time,twice a day;Simvastatin is 20 mg orally once a night.Huanglian Jiangzhi Recipe and Simvastatin should be taken every half an hour.The course of treatment was 8 weeks.After treatment,the basic situation and safety analysis of the two groups of patients were evaluated respectively,and the differences between the two groups of patients in the Seattle Angina Pectoris Scale,CHOLM Symptom Score Scale,TMAO level,blood lipids(CHOL,TG,HDL-C,LDL-C)and inflammatory level(TNF-α、IL-6)were compared.Then evaluate the clinical efficacy and analyze the relationship between TMAO and atherosclerosis.Results: There was no statistical difference in age,sex and body mass index among the groups(P>0.05).In terms of intra-group comparison,compared with before treatment,the Seattle Angina Pectoris Scale,CHOLM Syndrome Score Scale,TMAO level,blood lipid and inflammation level of patients in the two groups decreased after treatment(P<0.01).The comparison between groups showed that compared with the control group,the test group was lower in the Seattle Angina Pectoris Scale and the CHOLM Syndrome Score Scale than the control group(P<0.05);At the same time,the efficacy of the test group was better than that of the control group in terms of TMAO level,blood lipid and inflammation level(P<0.05).Conclusion: Huanglian Jiangzhi Recipe combined with Simvastatin can not only significantly improve the clinical symptoms and CHOLM syndrome scores of atherosclerosis patients of phlegm and stasis type,but also reduce the levels of TMAO,blood lipids and inflammation of patients.The efficacy is better than that of Simvastatin alone.The patient has no obvious adverse reactions,and Huanglian Jiangzhi Recipe combined with Simvastatin are safe and effective.3 Study on the effect of Huanglian Jiangzhi Recipe on atherosclerosis inflammation and intestinal flora from animal experiments.Objective: To observe the effects of Huanglian Jiangzhi Recipe on serum lipid index,inflammatory index,intestinal flora index TMAO,aortic pathological changes and related factors in aortic tissue in atherosclerosis animal models.Methods: The atherosclerotic mice were fed with a high-fat and high choline diet for 12 weeks to prepare the atherosclerosis model,and then the western medicine group was given Simvastatin intragastric intervention for 8weeks,the Chinese and Western medicine group was given Huanglian Jiangzhi Recipe and Simvastatin intragastric intervention for 8 weeks,and the model group and the blank group were given physiological saline intervention for 8 weeks.Observe the differences of body weight and blood lipids among the blank group,the model group,the Chinese and Western medicine group and Western medicine group.The content of TMAO in serum was determined by HPLC tandem mass spectrometry.The pathological injury of aorta was observed by HE staining.The changes of inflammatory factors in mice were detected by enzyme immunosorbent assay(ELISA).The expression of TLR4,My D88 and NF-κB related factors in aortic tissue was detected by q RT-PCR and WB methods.Results: After animal modeling and drug intervention,there was no obvious abnormality in hair,spirit,appetite and activity of all mice.In terms of body weight,the mice in the model group increased significantly compared with the blank control group;Compared with the model group,the Chinese and western medicine group and the Western medicine group both showed different degrees of weight loss.In terms of blood lipids,compared with the blank group,the contents of CHOL,TG and LDL-C in the group of model mice were significantly increased,while the contents of HDL-C were significantly decreased,with a statistically significant difference(P<0.01);Both the Western medicine group and the Chinese and Western medicine group can significantly reduce the levels of serum CHOL,TG and LDL-C in mice,and increase the level of serum HDL-C,which is significantly different from the model group(P<0.05);Compared with the Western medicine group,the serum fat level of the Chinese and Western medicine group was lower,and the difference was statistically significant(P<0.05).In terms of TMAO,compared with the blank group,the content of serum TMAO in the model group was significantly higher(P<0.01);Both the Western medicine group and the Chinese and Western medicine group can significantly reduce the level of TMAO in the serum of mice,and the difference is statistically significant compared with the model group(P<0.01);Compared with the Western medicine group,the TMAO level of the Chinese and Western medicine group was lower,and the difference was statistically significant(P<0.05).From the HE staining of mouse aorta,the endothelium in the aorta of normal mice was continuous and complete,with clear structure,no stenosis of vascular lumen,no formation of atherosclerotic plaque,and no obvious inflammatory cell infiltration.In the model group,the aorta endothelium of mice was locally proliferating,and obvious plaque formation,lumen stenosis,and a large number of cholesterol crystals and inflammatory cell infiltration were observed in the plaque.Compared with the model group,the vascular endothelium of the Western medicine group and the Chinese and Western medicine group can be improved to different degrees,and the improvement degree of the Chinese and Western medicine group is slightly better than that of the Western medicine group.In terms of inflammatory factors,compared with the blank group,the content of IL-6 and TNF-α in the serum of model mice was significantly higher(P<0.01);Both the Western medicine group and the Chinese and Western medicine group can significantly reduce the levels of IL-6 and TNF-α in the serum of mice,and the difference is statistically significant compared with the model control group(P<0.01);Compared with the Western medicine group,the level of serum IL-6 and TNF-α in the Chinese and Western medicine group was significantly lower(P<0.05).From the m RNA and protein levels of related factors in the aortic tissue,compared with the blank group,the m RNA and protein levels of TLR4,My D88 and NF-κB in the aortic tissue of model mice were significantly higher,with significant statistical significance(P<0.01);However,the m RNA and protein levels of TLR4,My D88 and NF-κB in the aorta of mice in the Western medicine group and the Chinese and Western medicine group decreased significantly compared with the model control group(P<0.01);Compared with the Western medicine group,the m RNA and protein levels of TLR4,My D88 and NF-κB in the Chinese and Western medicine group were significantly lower(P<0.05).Conclusion: Huanglian Jiangzhi Recipe combined with Simvastatin can significantly reduce the levels of blood lipids,inflammatory indicators and TMAO in atherosclerosis mice,improve the pathological changes of aorta in atherosclerosis mice,and reduce the expression of TLR4,My D88,NF-κB m RNA and protein level in atherosclerosis mice.Compared with Simvastatin alone,Huanglian Jiangzhi Recipe combined with Simvastatin can significantly improve the relevant indicators of atherosclerosis in mice.4 Study on the mechanism of Huanglian Jiangzhi Recipe in preventing and treating atherosclerosis based on TMAO-TLR4-NF-κB pathway.Objective: To observe the effects of different concentrations of Huanglian Jiangzhi Recipe on the HUVECs stimulated by TMAO in cell experiments,and to explore the mechanism of Huanglian Jiangzhi Recipe in preventing and treating atherosclerosis.Methods: From the aspect of cell experiment,CCK8 method was used to screen the serum concentration of Huanglian Jiangzhi Recipe,The stimulation concentration of TMAO on HUVECs was measured by CCK-8 method.According to the results of CCK8,the cells were divided into blank group,TMAO stimulation group,traditional Chinese medicine 10% serum group and traditional Chinese medicine 20% serum group.Use TMAO to stimulate human umbilical vein endothelial cells(HUVECs),and then add different doses of Huanglian Jiangzhi Recipe medicated serum for intervention.The expression of TLR4,My D88 and NF-κB in cells was detected by q RT-PCR and Western Blot.Results: CCK8 detection showed that there was statistical difference in the activity of HUVECs in the serum groups with different concentrations of Huanglian Jiangzhi Recipe(P<0.01).CCK8 detection found that the stimulation of TMAO to HUVECs increased with the increase of TMAO concentration.From the results of q RT-PCR and WB,the m RNA and protein expressions of TLR4,My D88 and NF-κB in TMAO group increased significantly(P<0.01),The m RNA and protein expression of TLR4,My D88 and NF-κB decreased after treatment with different doses of Huanglian Jiangzhi Recipe,which was significantly different from that of TMAO group(P<0.01),There was significant difference between different dose groups(P<0.05).Conclusion: Huanglian Jiangzhi Recipe can reduce the expression of TLR4,My D88 and NF-κB in HUVECs stimulated by TMAO,and delay the process of atherosclerosis by regulating the TMAO-TLR4-NF-κB pathway. |
