title: Clinical research on navel application of Shehuang Paste combined with Chinese herbal colon dialysis in treatment of refractory cirrhotic ascites complicated with azotemia.
abstract: OBJECTIVE
  To explore the efficacy and mechanism of a novel therapeutic method of traditional Chinese medicine in patients with refractory cirrhotic ascites complicated with azotemia.
  
  
  METHODS
  Seventy-five cases of refractory cirrhotic ascites complicated with azotemia were randomly divided into 3 groups: comprehensive treatment (n = 29), simple treatment (n = 24), and control (n = 22). The basic treatment methods were the same in all groups, including liver protecting medicines, diuretics and supportive drugs. The control group underwent only the basic treatment. Shehuang Paste (SHP) was applied to the navels of the two treatment groups once a day for 30 d. Colon dialysis with Chinese herbs was administered to the comprehensive treatment group once every two days. Before and after treatment, we measured abdominal circumference, BUN, Cr, serum Na+, urine Na+/K+, liver function, endotoxin content, NO, and ET-1. Color Doppler ultrasonography was conducted to measure the portal vein blood flow.
  
  
  RESULTS
  The total effective rate for ascites was 72.4% in the comprehensive treatment group, 45.8% in the simple treatment, contrasting with 18.2% in the controls. Between the two treatment groups and the controls, there were significant differences in the effective rates (P < 0.01, and P < 0.05). There was also a significant difference (P < 0.05) between the two treatment groups. Measurements of Cr and BUN showed higher values for the treatment groups, with the comprehensive better than the simple group (P < 0.05). Sera Na, urine Na/K were different, P < 0.01 between pre- and post-treatment in the comprehensive group, and P < 0.05 in the simple group. The treatment groups' endotoxin content was also significantly reduced (P < 0.01, and P < 0.05), with the comprehensive group better than the simple group (P < 0.05). Portal vein blood flow and NO content significantly reduced (P < 0.05), as did ET-1 content (P < 0.01). There were no significant changes in the control group (P > 0.05). The comprehensive treatment group's pre- and post-treatment portal vein and splenic vein blood flows showed a positive correlation to NO, ET-1 and endotoxin contents.
  
  
  CONCLUSIONS
  When treating refractory cirrhotic ascites complicated with azotemia, Shehuang Paste combined with Chinese herbal dialysis is better than Shehuang Paste alone for ascites resolution, azotemia, and endotoxin elimination. However, both methods on their own were also effective for reducing portal and splenic vein blood flow, and lowering the contents of NO, ET-1 in the two treatment groups.
authors.affiliation: Department of Hepatology, Shenzhen Hospital of Traditional Chinese Medicine, Guangzhou University of TCM, Shenzhen 518033, Guangdong Province, China.
authors.forename: Guang-Dong
authors.initials: GD
authors.lastname: Tong
authors.forename: Da-Qiao
authors.initials: DQ
authors.lastname: Zhou
authors.forename: Jing-Song
authors.initials: JS
authors.lastname: He
authors.forename: Lai
authors.initials: L
authors.lastname: Zhang
authors.forename: Zhi-Fei
authors.initials: ZF
authors.lastname: Chen
authors.forename: Chun-Ling
authors.initials: CL
authors.lastname: Xiao
authors.forename: Li-Sheng
authors.initials: LS
authors.lastname: Peng
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D053099:Azotemia / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D001783:Blood Flow Velocity; D001806:Blood Urea Nitrogen; D003106:Colon / Q000378:metabolism*; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage / Q000627:therapeutic use*; D019332:Endothelin-1 / Q000097:blood; D004731:Endotoxins / Q000097:blood; D004733:Enema; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009824:Ointments; D011169:Portal Vein / Q000503:physiopathology; D012964:Sodium / Q000097:blood; D013162:Splenic Vein / Q000503:physiopathology; D014472:Umbilicus
chemical_list: D004365:Drugs, Chinese Herbal; D019332:Endothelin-1; D004731:Endotoxins; D009824:Ointments; D012964:Sodium