Central Laboratory, Hospital of Chengdu University of Traditional Chinese Medicine, NO. 39 Shi-er-qiao Road, Chengdu, 610072, Sichuan Province, PR China.
J Ethnopharmacol. 2020 Apr 6;251:112442. doi: 10.1016/j.jep.2019.112442. Epub 2019 Dec 28.
ETHNOPHARMACOLOGICAL RELEVANCE: The process of liver fibrogenesis includes a number of common and etiology-dependent or independent mechanisms and events. Up to now, there are still insufficient approved biological or chemical therapies directly targeting and reversing advanced fibrosis. The key is that once liver fibrosis is triggered, it presents a complex network control model with the activation of HSCs as the core, resulting in poor efficacy of treatment. Traditional Chinese medicine (TCM) has unique advantages in treating hepatic fibrosis because of its syndrome differentiation and treatment and comprehensive pharmacological effects of multi-channel, multi-level and multi-target. However, TCM's advantages were rarely discussed as previous reviews focused on the active ingredients of TCM and single Chinese Medicine. Therefore, this paper focuses on TCM herbal formulae's pharmacological role, target and related mechanisms in the treatment of liver fibrosis. AIM OF THE STUDY: This paper will focus on the pharmacological role, target and related mechanisms of TCM herbal formulae in the treatment of liver fibrosis. MATERIALS AND METHODS: We collect English literatures or Chinese literatures with English Abstract on the treatment of liver fibrosis with TCM herbal formulae from databases including PubMed, Wiley InterScience, Science Direct OnSite/Elsevier, Ovid, Excerpta Medica Database, SpringLink, CNKI and China Biomedical Literature Database. Based on previous literatures, we summarize the TCM herbal formulae with definite anti-hepatic fibrosis effects. RESULTS: To some extent, classical or modern TCM herbal formulae including Yinchenhao Decoction (YCHD), Xiayuxue Decoction (XYXD), Xiaochaihutang (XCHT), Yiguanjian Decoction (YGJ), Huangqi Decoction (HQD), Dahuang Zhechong Pills (DHZC), Fuzheng Huayu Formula (FZHY), Fufang Biejia Ruangan Tablets (FFBJRG), Anluo Huaxian Pills (ALHX) and Compound 861 (Cpd861) have anti-hepatic fibrosis effect both on patients with liver fibrosis and animal models with liver fibrosis. CONCLUSION: According to the principle of syndrome differentiation and treatment, Liver fibrosis patients with different syndromes are treated with different herbal formula, which increases the difficulty of clinical efficacy research. YCHD and XYXD research lack randomized and controlled clinical trials. XCHT, YGJ and HQD research has small sample sizes despite randomized and controlled clinical trials. In contrast, most modern herbal formulae have randomized and controlled clinical trials. For instance, FZHY and ALHX recently published the research results of the combination of entecavir in the treatment of patients with chronic hepatitis B liver fibrosis or cirrhosis. Compared to anti-viral treatment with entecavir alone, this method has improved the reversion rate of liver fibrosis but still needs syndrome classification therapy of TCM. TCM Herbal formulae have a good prospect in treating liver fibrosis, but its composition of multiple drugs and a wide range of targets intensify the difficulty of studying their anti-hepatic fibrosis mechanisms. Future research needs to further study the anti-hepatic fibrosis mechanisms and select corresponding TCM herbal formula to treat patients with different syndromes of liver fibrosis or the same patient with different syndromes at different stages to achieve better curative results.
民族药理学相关性:肝纤维化的发生过程包括一些共同的、病因依赖的或独立的机制和事件。到目前为止,仍然没有足够的被批准的生物或化学疗法可以直接针对和逆转晚期纤维化。关键是,一旦肝纤维化被触发,它就呈现出一个以 HSCs 激活为核心的复杂网络控制模型,导致治疗效果不佳。中药(TCM)在治疗肝纤维化方面具有独特的优势,因为它具有辨证施治和综合药理学作用,具有多通道、多层次和多靶点的特点。然而,由于之前的综述主要关注 TCM 的活性成分和单味中药,因此 TCM 的优势很少被讨论。因此,本文重点介绍 TCM 复方在治疗肝纤维化中的药理作用、靶点和相关机制。
研究目的:本文将重点介绍 TCM 复方在治疗肝纤维化中的药理作用、靶点和相关机制。
材料和方法:我们从包括 PubMed、Wiley InterScience、Science Direct OnSite/Elsevier、Ovid、Excerpta Medica Database、SpringLink、CNKI 和中国生物医学文献数据库在内的数据库中收集了关于 TCM 复方治疗肝纤维化的英文文献或带有英文摘要的中文文献。基于之前的文献,我们总结了具有明确抗肝纤维化作用的 TCM 复方。
结果:在某种程度上,经典或现代的 TCM 复方,包括茵陈蒿汤(YCHD)、下瘀血汤(XYXD)、小柴胡汤(XCHT)、一贯煎(YGJ)、黄芪汤(HQD)、大黄䗪虫丸(DHZC)、扶正化瘀方(FZHY)、复方鳖甲软肝片(FFBJRG)、安络化纤丸(ALHX)和 Cpd861,对肝纤维化患者和肝纤维化动物模型都具有抗肝纤维化作用。
结论:根据辨证施治的原则,不同证型的肝纤维化患者采用不同的复方进行治疗,这增加了临床疗效研究的难度。YCHD 和 XYXD 的研究缺乏随机对照临床试验。XCHT、YGJ 和 HQD 的研究尽管进行了随机对照临床试验,但样本量较小。相比之下,大多数现代复方都进行了随机对照临床试验。例如,FZHY 和 ALHX 最近公布了恩替卡韦联合治疗慢性乙型肝炎肝纤维化或肝硬化患者的研究结果。与单独使用恩替卡韦抗病毒治疗相比,这种方法提高了肝纤维化的逆转率,但仍需要 TCM 的辨证论治。TCM 复方在治疗肝纤维化方面具有良好的前景,但由于其多种药物组成和广泛的靶点,增加了研究其抗肝纤维化机制的难度。未来的研究需要进一步研究抗肝纤维化机制,并选择相应的 TCM 复方来治疗不同证型的肝纤维化患者或同一患者在不同阶段的不同证型,以达到更好的治疗效果。
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