Therapeutic efficacy of the Qing Dai in patients with intractable ulcerative colitis

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may become intractable when treated with conventional medications such as aminosalicylates, corticosteroids, and azathioprine. The herbal medicine Qing Dai has traditionally been used in Chinese medicine to treat UC patients, but there is a lack of published data on the efficacy of Qing Dai in UC treatment. We report several cases of patients with intractable UC who take Qing Dai in a retrospective observational study. Furthermore, we explore the mechanisms of action of Qing Dai. Nine patients with active UC who received conventional medications but wished to receive Qing Dai as an alternative medication were included in our analysis. The UC severity level was determined based on the clinical activity index (CAI). Additionally, 5 of the 9 patients were endoscopically evaluated according to the Matts grading system. Each patient received 2 g/d of Qing Dai orally and continued taking other medications for UC as prescribed. Electron spin resonance was applied to explore the mechanisms of action of Qing Dai. After 4 mo of treatment with Qing Dai, the CAI score decreased from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; P < 0.001). Similarly, the endoscopic Matts grade decreased from 3.4 ± 0.5 to 2.2 ± 0.8 (P = 0.02). Six of 7 patients who were on prednisolone upon enrollment in the study were able to discontinue this corticosteroid. Electron spin resonance revealed that Qing Dai possesses strong hydroxyl radical scavenging activity. Qing Dai showed significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications. Scavenging of hydroxyl radicals appears to be a potential mechanism through which Qing Dai acts, but the significance of the scavenging ability of Qing Dai with respect to the anti-inflammatory effect in UC patients warrants further investigation.

Keywords: Electron spin resonance; Herbal medicine; Hydroxyl radical; Qing Dai; Ulcerative colitis.

Figure 1

The clinical activity index score and endoscopic Matts grade before and after Qing Dai initiation. A: The score markedly improved from 8.3 ± 2.4 to 2.4 ± 3.4 (mean ± SD; t-test, P < 0.001) after the initiation of Qing Dai. The line plotted in gray shows the average; B: The Matts grade significantly improved from 3.4 ± 0.5 to 2.2 ± 0.8 (mean ± SD; t-test, P = 0.02) after the initiation of Qing Dai treatment. The line plotted in gray shows the average.

Figure 2

Endoscopic finding before and after treatment. A: Before the initiation of Qing Dai, endoscopic examination showed severe ulcers and erosions in the rectum; B: After 3 mo of Qing Dai treatment, the mucosal damage completely disappeared.

Figure 3

Electron spin resonance of Qing Dai. Representative electron spin resonance spectra of CYPMPO-OH (for hydroxyl radical determination) obtained by the addition of solvent control or an ethanol extract of Qing Dai at a concentration of 25 μg/mL. The test was repeated in five independent trials, and a representative result is presented.