First, the efficacy of Polygonum multiflorum Thunb
Raw Polygonum multiflorum Thunb has the effects of detoxifying, eliminating carbuncle, stopping malaria, moistening intestines and relaxing bowels; It can be used for treating sores, scrofula, rubella pruritus, chronic malaria, intestinal dryness and constipation.
Radix Polygoni Multiflori Preparata has the effects of nourishing liver and kidney, nourishing essence and blood, blackening hair and beard, and strengthening bones and muscles; It can be used for treating blood deficiency, sallow, dizziness, tinnitus, premature gray hair, soreness of waist and knees, numbness of limbs, metrorrhagia and leukorrhagia.
Caulis Polygoni Multiflori has the effects of nourishing heart, calming nerves, expelling wind and dredging collaterals; It is used for insomnia, dreaminess, blood deficiency, body pain, skin numbness, rheumatism, rubella and itching.
Second, the chemical constituents and pharmacological effects of Polygonum multiflorum Thunb
The chemical constituents of Polygonum multiflorum Thunb mainly contain stilbenes, anthraquinones, flavonoids, phospholipids and other components. The chemical constituents of Polygonum multiflorum Thunb are similar to those of Polygonum multiflorum Thunb, but the contents of stilbenes and anthraquinones are lower than those of Polygonum multiflorum Thunb.
Polygonum multiflorum Thunb. has the activities of reducing blood lipid, resisting atherosclerosis, resisting aging, enhancing immunity, regulating nerves, protecting liver, resisting inflammation and promoting hematopoietic cell production. Caulis Polygoni Multiflori has sedative, hypnotic, hypolipidemic and anti-atherosclerosis activities.
Iii. Liver injury induced by Polygonum multiflorum Thunb.
(1) The adverse reactions of Polygonum multiflorum Thunb and its related preparations are mainly manifested in the hepatobiliary system and gastrointestinal system, with symptoms such as fatigue, nausea, vomiting, loss of appetite, liver discomfort, dry mouth, bitter taste, itchy skin, yellow urine, yellow eyes, yellow skin, abdominal pain, diarrhea, abdominal distension, and occasionally rash, fever and eye pigmentation. Laboratory examination may lead to abnormal laboratory indexes such as transaminase and/or bilirubin increase.
(2) The dosage and incubation period of patients with liver injury caused by Polygonum multiflorum Thunb and related preparations are wide. Among them, the minimum dosage is 1~3g/d, and the maximum dosage is100g/d; The incubation period is the shortest 1~3d, the longest is more than half a year, and the median time is about 20d. The dose and time of Polygonum multiflorum Thunb have no dependence on the occurrence of liver injury, suggesting that the liver injury of Polygonum multiflorum Thunb is idiotypic and there may be susceptible population.
(3) The proportion of women is slightly higher than that of men, and the ratio of male to female is about1:1.16. The onset age of liver injury caused by Polygonum multiflorum Thunb and its preparations is quite large, ranging from 8 years old to 87 years old. Men are mostly 20~49 years old, mostly for the treatment of alopecia, eczema and other diseases; Women are mostly 40 ~ 59 years old, mostly in the treatment of white hair, palpitations and other diseases.
(4) Liver injury cases caused by Polygonum multiflorum Thunb and its related preparations are more common in seborrheic alopecia, gray hair, eczema, psoriasis, vitiligo, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and other diseases, and most of them are accompanied by immune disorder or autoimmune diseases, suggesting that immune disorder may be one of the important risk factors for liver injury caused by Polygonum multiflorum Thunb and its related preparations. In addition, the liver injury caused by Polygonum multiflorum Thunb and related preparations has a worse prognosis in people with chronic liver disease (especially alcoholic liver disease), and it is easier to progress to chronic drug-induced liver disease and even death.
(5) Polygonum multiflorum Thunb. is one of the varieties with the most reported cases of liver injury caused by a single Chinese medicine. Most patients use it by themselves, and most of them use powder, drink tea instead, soak in wine, cook porridge, etc. Most Polygonum multiflorum Thunb. products are unprocessed or the degree of processing is unclear. About 20% of the cases of liver injury caused by Polygonum multiflorum Thunb and its related preparations have taken more than the dosage specified in the instructions or pharmacopoeia, suggesting that large doses may increase the risk of liver injury of Polygonum multiflorum Thunb.
Fourth, the mechanism of liver injury induced by Polygonum multiflorum Thunb.
In the modern toxicology research, no obvious hepatotoxic reaction was found in the range of the maximum tolerated dose of experimental animals, whether it was raw or processed products or its different extracted parts, suggesting that it is safe for the body to use Polygonum multiflorum Thunb under normal conditions.
Combined with the toxicological study of the disease, it is found that Polygonum multiflorum Thunb can promote immune overactivation in the susceptible animal model mediated by immune stress, and can induce liver injury within the range equivalent to the commonly used clinical dose. Compatibility with Chinese herbs such as Poria cocos and Glycyrrhiza uralensis Fisch can reduce the risk of liver injury.
Combined with pharmacogenomics research, it is confirmed that the liver injury of Polygonum multiflorum Thunb is related to organism factors, especially immune-related genetic differences, and the susceptibility gene HLA-B * 35: 01that Polygonum multiflorum Thunb can induce specific liver injury is found, indicating that Polygonum multiflorum Thunb is only at risk of liver injury for a few specific people, but it is safe for the vast majority of people.
Combined with knock-out and knock-in screening, it was found that the specific liver injury of Polygonum multiflorum Thunb was related to the structure and content of stilbenes and anthraquinones contained in it. Cis-stilbene glucoside and emodin -8-0-? -Glucoside can induce liver injury, and trans stilbene glycoside can synergistically enhance its liver injury. Processing can reduce the liver injury of Polygonum multiflorum Thunb, suggesting that strengthening the quality and safety control of Polygonum multiflorum Thunb is helpful to reduce the risk of liver injury.
Based on various research results, some scholars have proposed that immune stress is caused by Polygonum multiflorum Thunb. Three causes of poisoning? Mechanism hypothesis: When the immunity of the body is over-activated, the immune enhancer in Polygonum multiflorum Thunb can further promote the immune response of the body, enhance the sensitivity of the liver to the susceptible components of liver injury in Polygonum multiflorum Thunb, and lead to over-expression of immune inflammatory factors, thus inducing immune-specific liver injury.
Therefore, the hepatotoxicity of Polygonum multiflorum Thunb is only obvious to a small number of people, and it is related to susceptible genes, but it is undeniable that Polygonum multiflorum Thunb is a valuable medicinal material in traditional Chinese medicine.