Study on the effect and mechanism of Yanghe decoction Huacai (阳和汤化裁) on tissue repair of Yin syndrome after anal fistula surgery

doi:10.19852/j.cnki.jtcm.20240515.004

Abstract

Abstract:

OBJECTIVE: To observe the clinical efficacy and safety of Yanghe decoction Huacai (阳和汤化裁) for the repair of Yin syndrome wounds with slow-healing after anal fistula surgery.

METHODS: A total of 120 patients with slow-healing negative wounds with after low-grade anal fistula surgery who met the inclusion criteria were divided into a treatment group and a control group based on a random number table method, with 60 patients in the treatment group and 60 patients in the control group. The treatment group was given Yanghe decoction Huacai in combination with routine treatment; the control group was only given routine treatment, in which the wound surface was disinfected with iodine, and then covered with sterile gauze. The course of treatment in both groups was 10 d. After treatment, the wound secretion score, wound granulation tissue score, the expression levels of basic fibroblast growth factor (bFGF), transforming growth factor β1 (TGF-β1), and epidermal growth factor (EGF) in the wound, wound healing time and clinical efficacy were compared.

RESULTS: There was no significant difference in age or gender between the two groups (P > 0.05). On the 10th and 15th days after the surgery, the wound secretion scores were higher in the treatment group than in the control group (P < 0.01). Comparing the two groups at the 10th and 15th day after surgery, the granulation tissue growth scores in the treatment group were better than the in control group (P < 0.01). On the 10th and 15th day after operation, the expression levels of bFGF, TGF-β1 and EGF factors in the treatment group were stronger than those in the control group. The healing time of the wounds in the treatment group was significantly shorter than in the control group (P < 0.01). The clinical efficacy of the two groups after treatment was compared, and the overall efficacy of the treatment group was significantly higher than that of the control group (P < 0.01).

CONCLUSIONS: Yanghe decoction Huacai have significant efficacy in the treatment of slow-healing wounds with Yin syndrome after anal fistula surgery. It improves wound secretions, promotes the growth of wound granulation tissue, and shortens wound healing time. Its mechanism of action may be related to the control of wound inflammation. It is related to increasing the expression of bFGF, TGF-β1 and EGF in wound tissue, and promoting wound angiogenesis and fibroblast proliferation.

Key words: Yanghe decoction huacai, rectal fistula, general surgery, intercellular signaling peptides and proteins, negative wound, mechanism

WU Yijuan, SUN Xinghong, GUO Haixia, ZHANG Xiangan. Study on the effect and mechanism of Yanghe decoction Huacai (阳和汤化裁) on tissue repair of Yin syndrome after anal fistula surgery[J]. Journal of Traditional Chinese Medicine, 2024, 44(4): 813-821.

Figures/Tables 7

Table 1 Comparison of secretion scores between the two groups of patients [M (P25, P75)]

Group	n	10th day after surgery	15th day after surgery
Control	60	2 (1, 2)	1 (1, 1)
Treatment	60	3 (3, 3)	2 (2, 2)
Z value		－8.86	－7.1
P value		< 0.01	< 0.01

Table 2 Comparison of traumatic granulation tissue scores between the two groups of patients [M (P25, P75)]

Group	n	10th day after surgery	15th day after surgery
Control	60	2 (2, 2)	2 (1, 2)
Treatment	60	2.5 (2, 3)	2 (2, 3)
Z value		－6.275	－6.701
P value		< 0.01	< 0.01

Figure 1 Comparison of traumatic bFGF expression after surgery in 10th and 15th after surgery A: treatment group: bFGF at 10th after surgery (× 200); B: treatment group: bFGF at 15th after surgery (× 200); C: control group: bFGF at 10th after surgery (× 200); D: control group: bFGF at 15th after surgery (× 200). Control group: the patients have routine drug changes since the first postoperative day (disinfection with iodophor, sterile gauze coverage, and tape wrapping); treatment group: based on treatment in the control group, patients in this group were given oral Yanghe decoction Huacai on the 5th post-operative day. Dyeing method of all pictures are the immunohistochemistry. bFGF: basic fibroblast growth factor.

Figure 2 Comparison of traumatic TGF-β1expression after surgery in 10th and 15th A: treatment group: TGF-β1 at 10th after surgery (× 200); B: treatment group: TGF-β1 at 15th after surgery (× 200); C: control group: TGF-β1 at 10th after surgery (× 200); D: control group: TGF-β1 at 15th after surgery (× 200). Control group: the patients have routine drug changes since the first postoperative day (disinfection with iodophor, sterile gauze coverage, and tape wrapping); treatment group: based on treatment in the control group, patients in this group were given oral Yanghe decoction Huacai on the 5th post-operative day. Dyeing method of all pictures are the immunohistochemistry. TGF-β1: transforming growth factor β1.

Figure 3 Comparison of traumatic EGF expression after surgery in 10th and 15th after surgery A: treatment group: EGF at 10th after surgery (× 200); B: treatment group: EGF at 15th after surgery (× 200); C: control group: EGF at 10th after surgery (× 200); D: control group: EGF at 15th after surgery (× 200). Control group: the patients have routine drug changes since the first postoperative day (disinfection with iodophor, sterile gauze coverage, and tape wrapping); treatment group: based on treatment in the control group, patients in this group were given oral Yanghe decoction Huacai on the 5th post-operative day. Dyeing method of all pictures are the immunohistochemistry. EGF: epidermal growth factor.

Table 3 Comparison of wound healing time between two groups of patients (d)

Group	Case	Minimum time	Longest time	$\bar{x}±s$	t value	P value
Control	60	21	33	28±3	9.124	< 0.01
Treatment	60	17	27	22±3	9.124	< 0.01

Table 4 Comparison of clinical outcomes between the two groups of patients (n)

Group	n	Heal	Effect	Improve	No effect	Z value	P value
Control group	60	33	24	3	0	－4.555	< 0.01
Treatment group	60	55	5	0	0	－4.555	< 0.01

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