This work was supported by the Sichuan Administration of Traditional Chinese Medicine Special Research Project of Traditional Chinese Medicine (2021MS417).

The clinical protocol has been approved by the Administrative Committee of Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine (Record number: KY20221005). Experimental procedures were carried out in accordance with the guidelines of Hospital of Chengdu University of Traditional Chinese Medicine. The consent of the patients, who have signed an informed consent form, is required for the operation. The operator should understand the anatomy of the rectum before administering the enema and look at the anatomical annotations (see Figure 3).
1. Pre-therapy preparation of the operator
<ol>
	<li>Include patients with principal symptoms (i.e., persistent epigastric pain).</li>
	<li>Exclude patients with the following conditions: gastrointestinal bleeding, pregnancy, severe cardiovascular disease, arteriovenous tumor, hemiplegia, stroke, cardiopulmonary-cerebral insufficiency, severe colon ulcer or infarction, hernia, abdominal surgery, patients with intestinal adhesions, ileocectomy, megacolon disease and bleeding or perforation, patients with intestinal surgery, dialysis, patients with instinctive hypertension, catatonic heart disease, or severe hemorrhoids.</li>
	<li>Exclude patients with a breakage of the perianal skin and a history of allergy to rhubarb.</li>
	<li>Ensure that patients have no psychiatric disorders and can actively cooperate with the treatment.</li>
</ol>
2. Pre-therapy preparation of the patients
<ol>
	<li>Have the patient eliminate both stool and urine before the operation.</li>
	<li>Inform the patients that is it normal to experience localized sensations such as swelling, fullness, and mild pain.</li>
	<li>Have patients promptly notify if defecation occurs or if there is discomfort. 
	&#8203;NOTE: The enema solution should be retained for more than 1 h, as the long retention time facilitates drug absorption26.</li>
</ol>
3. Preparation of the decocted medicinal liquid
NOTE: The Hospital of Chengdu University of TCM supplied the raw rhubarb27 (Rheum officinale Baill. DaHuang) (Figure 1).
<ol>
	<li>Add 30 g of raw rhubarb and 200 mL of water to the automatic decoction and packaging machine.</li>
	<li>Boil, and then simmer for 5 min.</li>
	<li>Filter with a non-woven filter package (24 mm x 30 mm).</li>
	<li>Remove residue with the non-woven filter package and cool down the remaining liquid to 37-39 &#176;C.</li>
</ol>
4. Operational procedure
<ol>
	<li>Check the patient&#39;s basic information (name, age, hospital number), verify the patient&#39;s condition, and re-evaluate them. Explain the process and advantages of an enema to the patient, making sure that they can fully understand and relax during it.</li>
	<li>Regulate the room temperature (18-28 &#176;C).</li>
	<li>Prepare all necessary items (Figure 2 and Table of Materials). Check the expiration dates and bring them to the bedside.</li>
	<li>Close all doors and windows. Ensure that the patients are not unnecessarily exposed and are kept warm.</li>
	<li>Wash and dry hands, put on disposable gloves, and measure the temperature of the enema liquid using a thermometer beside the bed.</li>
	<li>Assist the patient in assuming the left lateral decubitus position (if necessary, choose the right lateral decubitus position based on the condition). Fully expose the anus, place the center of the treatment sheet under the buttocks, and use a pillow to elevate the buttocks by 10 cm (Figure 3).</li>
	<li>Lubricate the front end of the anal canal with paraffin oil, drain the paraffin oil from the anus, and expose the anus.</li>
	<li>Adjust the temperature of the liquid medication to be equivalent to the patient&#39;s body temperature (37-39 &#176;C) at a drip rate of 60-80 drops per minute, ensuring that the liquid level does not exceed 35 cm from the anus.</li>
	<li>Close the stopper clip (part of the disposable enema kit) and pour the liquid into the hanging bag (part of the disposable enema kit).</li>
	<li>Instruct the patient to open their mouth to breathe when inserting the anal canal, to relax the anus and facilitate the smooth insertion of the anal canal.</li>
	<li>Insert the anus canal 30-35 cm28 with the plastic hose (part of the disposable enema kit), open the stopper clip, and slowly drip the liquid (the dripping rate depends on the patient&#39;s condition) for 15 to 20 min. 
	NOTE: If the plastic hose is blocked, close the stopper clip immediately and squeeze the pressurized bladder (part of the disposable enema kit) to unblock it.</li>
	<li>During the infusion, constantly monitor and inquire about the patient&#39;s tolerance. Adjust the infusion rate in the event of discomfort or convenience and discontinue the infusion if necessary.</li>
	<li>Perform general Tui na (place fingertips on the perianal skin to gently knead back and forth in a circular motion) to relax the muscles around the anus, before extubation of the plastic hose (Figure 2A)29.</li>
	<li>After administering the medication, clamp and remove the plastic hose from the anal canal. 
	NOTE: The dosage for Chinese herbal enema should not exceed 200 mL.</li>
	<li>Assist the patient in drying the perianal skin by gently rubbing the anus with gauze. Help the patient assume a comfortable lying position and elevate the buttocks. 
	&#8203;NOTE: If the patient has a sluggish pulse, a pale face, cold perspiration, severe abdominal pain, and palpitation, stop the operation immediately and contact a doctor.</li>
</ol>
5. Post-operation care
<ol>
	<li>Have the patient lay in the left lateral position if they are still comfortable.</li>
	<li>Have the patient rest. Advise them to use clean bedsheets, keep the anus dry and clean, and change the bedsheets promptly after fluid flows.</li>
	<li>Observe fluid flow from the anus after the enema. Observethe shape, color, volume, and smell of the stool, to determine the success of the enema.</li>
	<li>Advise the patient not to use excessive force to relieve stools, and inform healthcare staff promptly of any constipation.</li>
	<li>Observe the patient&#39;s symptoms, temperature, blood pressure, pulse rate, heart rate, and respiration.</li>
</ol>

<ol>
	<li>Boxhoorn, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+pancreatitis.">Acute pancreatitis.</a> Lancet. 396 (10252), 726-734 (2020).</li><li>Xiao, A. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Global+incidence+and+mortality+of+pancreatic+diseases:+a+systematic+review,+meta-analysis,+and+meta-regression+of+population-based+cohort+studies.">Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies.</a> The Lancet. Gastroenterology &amp; Hepatology. 1 (1), 45-55 (2016).</li><li>Mederos, M. A., Reber, H. A., Girgis, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+pancreatitis:+A+review.">Acute pancreatitis: A review.</a> JAMA. 325 (4), 382-390 (2021).</li><li>Lee, P. J., Papachristou, G. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+insights+into+acute+pancreatitis.">New insights into acute pancreatitis.</a> Nature Reviews. Gastroenterology &amp; Hepatology. 16 (8), 479-496 (2019).</li><li>Pu, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+5-year+retrospective+cohort+study:+epidemiology,+etiology,+severity,+and+outcomes+of+acute+pancreatitis.">A 5-year retrospective cohort study: epidemiology, etiology, severity, and outcomes of acute pancreatitis.</a> Pancreas. 49 (9), 1161-1167 (2020).</li><li>Lankisch, P. G., Apte, M., Banks, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+pancreatitis.">Acute pancreatitis.</a> Lancet. 386 (9988), 85-96 (2015).</li><li>Garg, P. K., Singh, V. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Organ+failure+due+to+systemic+injury+in+acute+pancreatitis.">Organ failure due to systemic injury in acute pancreatitis.</a> Gastroenterology. 156 (7), 2008-2023 (2019).</li><li>Moggia, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pharmacological+interventions+for+acute+pancreatitis.">Pharmacological interventions for acute pancreatitis.</a> The Cochrane Database of Systematic Reviews. 4 (4), (2017).</li><li>Szatmary, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+pancreatitis:+Diagnosis+and+treatment.">Acute pancreatitis: Diagnosis and treatment.</a> Drugs. 82 (12), 1251-1276 (2022).</li><li>Leppaniemi, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=WSES+guidelines+for+the+management+of+severe+acute+pancreatitis.">WSES guidelines for the management of severe acute pancreatitis.</a> World Journal of Emergency Surgery. 13 (14), 27 (2019).</li><li>Zhang, J. J., Zhang, Z. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+on+the+characteristics+of+prescriptions+recorded+in+Treatise+on+febrile+diseases+in+treating+constipation.">Analysis on the characteristics of prescriptions recorded in Treatise on febrile diseases in treating constipation.</a> Clinical Journal of Chinese Medicine. 8, 279 (2016).</li><li>Yan, Z. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+and+safety+of+retention+enema+with+traditional+Chinese+medicine+for+ulcerative+colitis:+A+meta-analysis+of+randomized+controlled+trials.">Efficacy and safety of retention enema with traditional Chinese medicine for ulcerative colitis: A meta-analysis of randomized controlled trials.</a> Complementary Therapies in Clinical Practice. 42, 101278 (2021).</li><li>Chen, Q., Ma, L., Akebaier, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+study+on+treatment+of+hyperuricaemia+by+retention+enema+of+Chinese+herbal+medicine+combined+with+allopurinol.">Clinical study on treatment of hyperuricaemia by retention enema of Chinese herbal medicine combined with allopurinol.</a> Chinese Journal of Integrative Medicine. 15 (6), 431-434 (2009).</li><li>Gao, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Changrui+enema+inhibits+inflammation-induced+angiogenesis+in+acute+radiation+proctitis+by+regulating+NF-&#954;B+and+VEGF.">Changrui enema inhibits inflammation-induced angiogenesis in acute radiation proctitis by regulating NF-&#954;B and VEGF.</a> Acta Cirurgica Brasileira. 35 (5), 202000502 (2020).</li><li>Lu, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Shenshuaikang+enema,+a+Chinese+herbal+remedy,+inhibited+hypoxia+and+reoxygenation-induced+apoptosis+in+renal+tubular+epithelial+cells+by+inhibiting+oxidative+damage-dependent+JNK/Caspase-3+signaling+pathways+using+network+pharmacology.">Shenshuaikang enema, a Chinese herbal remedy, inhibited hypoxia and reoxygenation-induced apoptosis in renal tubular epithelial cells by inhibiting oxidative damage-dependent JNK/Caspase-3 signaling pathways using network pharmacology.</a> Evidence-Based Complementary and Alternative. 2020, 9457101 (2020).</li><li>Dai, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Traditional+Chinese+medicine+enema+therapy+in+a+patient+with+a+confirmed+negative+SARS-CoV-2+test+in+the+respiratory+tract+but+positive+in+the+intestinal+tract:+A+case+report.">Traditional Chinese medicine enema therapy in a patient with a confirmed negative SARS-CoV-2 test in the respiratory tract but positive in the intestinal tract: A case report.</a> Frontiers in Public Health. 9, 687283 (2021).</li><li>Wan, B., Fu, H., Yin, J., Xu, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+rhubarb+combined+with+early+enteral+nutrition+for+the+treatment+of+severe+acute+pancreatitis:+A+randomized+controlled+trial.">Efficacy of rhubarb combined with early enteral nutrition for the treatment of severe acute pancreatitis: A randomized controlled trial.</a> Scandinavian Journal of Gastroenterology. 49 (11), 1375-1384 (2014).</li><li>Yao, P., Cui, M., Li, Y., Deng, Y. Y., Wu, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+rhubarb+on+intestinal+flora+and+toll-like+receptors+of+intestinal+mucosa+in+rats+with+severe+acute+pancreatitis.">Effects of rhubarb on intestinal flora and toll-like receptors of intestinal mucosa in rats with severe acute pancreatitis.</a> Pancreas. 44 (5), 799-804 (2015).</li><li>Wang, Y., Zhang, X., Li, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Applying+hot+compresses+with+rhubarb+and+mirabilite+to+reduce+pancreatic+leakage+occurrence+in+the+treatment+of+severe+acute+pancreatitis.">Applying hot compresses with rhubarb and mirabilite to reduce pancreatic leakage occurrence in the treatment of severe acute pancreatitis.</a> Iranian Journal of Public Health. 46 (1), 136-138 (2017).</li><li>Wang, G. Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Qingyi+decoction+attenuates+intestinal+epithelial+cell+injury+via+the+calcineurin/nuclear+factor+of+activated+T-cells+pathway.">Qingyi decoction attenuates intestinal epithelial cell injury via the calcineurin/nuclear factor of activated T-cells pathway.</a> World Journal of Gastroenterology. 28 (29), 3825-3837 (2022).</li><li>Wen, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chaiqin+chengqi+decoction+alleviates+severity+of+acute+pancreatitis+via+inhibition+of+TLR4+and+NLRP3+inflammasome:+Identification+of+bioactive+ingredients+via+pharmacological+sub-network+analysis+and+experimental+validation.">Chaiqin chengqi decoction alleviates severity of acute pancreatitis via inhibition of TLR4 and NLRP3 inflammasome: Identification of bioactive ingredients via pharmacological sub-network analysis and experimental validation.</a> Phytomedicine. 79, 153328 (2020).</li><li>Li, J., Zhang, S., Zhou, R., Zhang, J., Li, Z. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perspectives+of+traditional+Chinese+medicine+in+pancreas+protection+for+acute+pancreatitis.">Perspectives of traditional Chinese medicine in pancreas protection for acute pancreatitis.</a> World Journal of Gastroenterology. 23 (20), 3615-3623 (2017).</li><li>Yang, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Traditional+Chinese+medicine+formulas+alleviate+acute+pancreatitis:+Pharmacological+activities+and+mechanisms.">Traditional Chinese medicine formulas alleviate acute pancreatitis: Pharmacological activities and mechanisms.</a> Pancreas. 50 (10), 1348-1356 (2021).</li><li>Li, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+diagnosis+and+treatment+of+acute+pancreatitis+in+China.">Guidelines for the diagnosis and treatment of acute pancreatitis in China.</a> Journal of Pancreatology. 4 (2), 67-75 (2021).</li><li>Li, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+progress+on+the+comprehensive+treatment+of+acute+pancreatitis+with+traditional+Chinese+medicine.">Research progress on the comprehensive treatment of acute pancreatitis with traditional Chinese medicine.</a> Journal of Emergency in Traditional Chinese Medicine. 31 (3), 549-551 (2022).</li><li>Liu, M., L, Z., Wang, Y., Zeng, M., Chen, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nursing+experience+of+traditional+Chinese+medicine+enema+in+patients+with+acute+pancreatitis.">Nursing experience of traditional Chinese medicine enema in patients with acute pancreatitis.</a> World Latest Medicine Information. 18 (1), 186 (2018).</li><li>Wang, Q., Yi, F., Peng, X., Li, D., Lu, Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Dahuang+(rhubarb)+retention+enema+on+inflammatory+factors+in+patients+with+severe+acute+pancreatitis.">Effects of Dahuang (rhubarb) retention enema on inflammatory factors in patients with severe acute pancreatitis.</a> Journal of Emergency in Traditional Chinese Medicine. 25 (3), 518-519 (2016).</li><li>Zhang, Y., Lv, X. Y., Li, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+modified+rhubarb+retention+enema+in+the+treatment+of+severe+acute+pancreatitis.">Application of modified rhubarb retention enema in the treatment of severe acute pancreatitis.</a> Practical Clinical Medicine. 15 (10), 86-88 (2014).</li><li>Lai, X. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nursing+of+patients+with+acute+severe+pancreatitis+undergoing+traditional+Chinese+medicine+retention+enema.">Nursing of patients with acute severe pancreatitis undergoing traditional Chinese medicine retention enema.</a> Journal of Emergency in Traditional Chinese Medicine. 21 (6), 1022 (2012).</li><li>Banks, P. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Classification+of+acute+pancreatitis-2012:+revision+of+the+Atlanta+classification+and+definitions+by+international+consensus.">Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus.</a> Gut. 62 (1), 102-111 (2013).</li><li>Zhang, S. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expert+consensus+on+TCM+diagnosis+and+treatment+of+acute+pancreatitis.">Expert consensus on TCM diagnosis and treatment of acute pancreatitis.</a> Chinese Journal of Traditional Chinese Medicine. 32 (9), 4087-4088 (2017).</li><li>Shen, J. B., Wang, Z. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+study+of+traditional+Chinese+medicine+retention+enema+in+the+treatment+of+severe+acute+pancreas.">Clinical study of traditional Chinese medicine retention enema in the treatment of severe acute pancreas.</a> The Chinese Journal of Clinical Pharmacology. 31 (18), 1831-1833 (2015).</li><li>Zerem, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+severe+acute+pancreatitis+and+its+complications.">Treatment of severe acute pancreatitis and its complications.</a> World Journal of Gastroenterology. 20 (38), 13879-13892 (2014).</li><li>Yadav, D., Lowenfels, A. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+of+pancreatitis+and+pancreatic+cancer.">The epidemiology of pancreatitis and pancreatic cancer.</a> Gastroenterology. 144 (6), 1252-1261 (2013).</li><li>Wentao, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+progress+on+the+clinical+application+of+traditional+Chinese+medicine+enema.">Research progress on the clinical application of traditional Chinese medicine enema.</a> World Journal of Integrated Traditional and Western Medicine. 15 (8), 1565-1568 (2020).</li><li>Cao, Y. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advances+in+bio-active+constituents,+pharmacology+and+clinical+applications+of+rhubarb.">Advances in bio-active constituents, pharmacology and clinical applications of rhubarb.</a> Chinese Medicine. 12, 36 (2017).</li><li>Chen, X., Valente, J. F., Alexander, J. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+sennosides+on+bacterial+translocation+and+survival+in+a+model+of+acute+hemorrhagic+pancreatitis.">The effect of sennosides on bacterial translocation and survival in a model of acute hemorrhagic pancreatitis.</a> Pancreas. 18 (1), 39-46 (1999).</li><li>Le, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pharmacology,+toxicology,+and+metabolism+of+sennoside+A,+a+medicinal+plant-derived+natural+compound.">Pharmacology, toxicology, and metabolism of sennoside A, a medicinal plant-derived natural compound.</a> Frontiers in Pharmacology. 12, 714586 (2021).</li><li>Wang, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Salidroside,+a+phenyl+ethanol+glycoside+from+Rhodiola+crenulata,+orchestrates+hypoxic+mitochondrial+dynamics+homeostasis+by+stimulating+Sirt1/p53/Drp1+signaling.">Salidroside, a phenyl ethanol glycoside from Rhodiola crenulata, orchestrates hypoxic mitochondrial dynamics homeostasis by stimulating Sirt1/p53/Drp1 signaling.</a> Journal of Ethnopharmacology. 293, 115278 (2022).</li><li>Hou, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Salidroside+intensifies+mitochondrial+function+of+CoCl2-damaged+HT22+cells+by+stimulating+PI3K-AKT-MAPK+signaling+pathway.">Salidroside intensifies mitochondrial function of CoCl2-damaged HT22 cells by stimulating PI3K-AKT-MAPK signaling pathway.</a> Phytomedicine. 109, 154568 (2023).</li></ol>

The authors have nothing to disclose.

AP is an inflammatory disease that can progress to SAP. According to numerous studies, SAP is a devastating disease linked with mortality ranging from less than 10% to as high as 85%, albeit with decreasing mortality in the recent decade33. SAP seriously impacts patients&#39; quality of life, and can even lead to death if not treated promptly and effectively. Aggressive and effective early treatment is of clinical importance34.
Chinese herbal ene...

Acute pancreatitis (AP) is an acute abdominal disease, characterized by a local pancreatic inflammatory response from an abnormal activation of pancreatic enzymes that have a digestive effect on the pancreas and surrounding organs1. As one of the most prevalent gastrointestinal reasons for hospitalization in the United States, acute pancreatitis requires increasing attention as it continues to increase worldwide2,3. In the past decade, the understanding of the pathophysiological mechanisms of acute pancreatitis has made significant strides4,5,6. About 5%-10% of cases of acute pancreatitis are associated with severe organ dysfunction; this type of pancreatitis is defined as severe acute pancreatitis (SAP)7. Early Western medical treatment of AP generally consists of fluid therapy, analgesia, nutritional support, and treatment for the cause and early complications. However, Western medical treatment still lacks specific drugs for AP at this stage8,9,10.
In traditional Chinese medicine (TCM), AP is referred to as &#34;abdominal pain&#34;, &#34;Pi Xin Tong&#34;, and &#34;pancreatic fever&#34;. TCM enema therapy is one of the most used treatments in Chinese medicine, dating back to the honey decoction method from Zhang Zhong Jing&#39;s &#34;treatise on cold pathogenic diseases&#34; in the Han Dynasty11. Its clinical efficacy is documented for the treatment of ulcerative colitis12, hyperuricaemia13, acute radiation proctitis14, acute kidney injury15, and SARS-CoV-2 in the intestinal tract16.
In recent years, an enema with TCM (rhubarb17,18, mirabilite19, and compound preparations such as Qingyi decoction20 and Dachengqi decoction21) has been widely utilized in clinical and experimental studies of SAP. It has been shown to protect pancreatic function, reduce abdominal pain and abdominal distension, and delay disease progression22,23. The 2021 Chinese guidelines for the diagnosis and treatment of AP include TCM enema24. However, it is unclear how the TCM enema should be administered to SAP patients. Therefore, we present a protocol to perform the TCM enema, providing a potent method for investigating the components and mechanisms of ethnic drugs in the treatment of SAP patients25.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Automatic decoction machine packaging machine</td>
			<td>Taizhou Guo pin Le Ji Machinery Co., Ltd</td>
			<td>GPJ13(1+1)</td>
			<td></td>
		</tr>
		<tr>
			<td>Care turning pillows</td>
			<td>Hengshui Binhu New Area Fubon Medical Equipment Factory</td>
			<td>20220902R</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable enema device</td>
			<td>Yangzhou Yuankang Medical Equipment Co., Ltd.</td>
			<td>20220502B</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable gloves</td>
			<td>Jiangxi Almei Medical Equipment Co., Ltd.</td>
			<td>AEM/ST-AZ</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable medical kit</td>
			<td>Zhende Medical Supplies Co., Ltd.</td>
			<td>20211220</td>
			<td></td>
		</tr>
		<tr>
			<td>Disposable treatment sheet</td>
			<td>Xinxiang Huakang Eisai Co., Ltd</td>
			<td>HK-38</td>
			<td></td>
		</tr>
		<tr>
			<td>Medical gauzepad</td>
			<td>Xinxiang Huakang Eisai Co., Ltd</td>
			<td>HK-02B</td>
			<td></td>
		</tr>
		<tr>
			<td>Medical nursing pad</td>
			<td>Hefei Mattel Care Products Co., Ltd</td>
			<td>CND502</td>
			<td></td>
		</tr>
		<tr>
			<td>Non-woven Filter Package</td>
			<td>Chengdu New Medical and Health Products Factory</td>
			<td>20192183#(C)</td>
			<td></td>
		</tr>
		<tr>
			<td>Paraffin oil</td>
			<td>Shandong Lierkang Medical Technology Co., Ltd.</td>
			<td>180801</td>
			<td></td>
		</tr>
		<tr>
			<td>Raw rhubarb</td>
			<td>Sichuan Guoqiang traditional Chinese Medicine&#160; Co., Ltd</td>
			<td>21120104</td>
			<td></td>
		</tr>
		<tr>
			<td>Thermometer</td>
			<td>Shenzhen Chenzhou Technology Co., Ltd.</td>
			<td>TP300</td>
			<td></td>
		</tr>
	</tbody>
</table>

enema of traditional chinese medicine for patients with severe acute pancreatitis

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional Chinese medicine (TCM) enema has been widely utilized in clinical and experimental studies of SAP. It has been demonstrated to have beneficial effects in protecting pancreatic function and delaying disease progression. The procedure of TCM enema is to perfuse the Chinese medicinal liquid of raw rhubarb (Rheum officinale Baill. DaHuang) from the anus into the rectum and colon. Basic steps of the procedure include boiling the herbal solution in advance, using a disposable enema kit to assist patients in taking a left lying position, raising the patient's hip 10 cm, and carefully inserting the enema 30-35 cm into the anus, with a drip speed of 60-80 drops/min. The medicine liquid temperature should be equivalent to the patient's body temperature, typically between 37-39 &#176;C. The end of the enema operation should be slow, and Tui na (massage therapy) should be administered before extubation. The medication liquid should be kept in the rectum for more than 1 h. After issuing an enema, it is essential to observe the patient's feces and abdomen, and to evaluate the remission of abdominal signs and symptoms.

In this study, the patient was admitted because of repeated epigastric pain. According to the diagnostic criteria30, the patient was diagnosed with SAP. After the patient was treated with this protocol, there was a noted therapeutic effect31.
Patient A, a female, 84 years old, was diagnosed for the first time on May 2, 2019. The patient complained of repeated epigastric distension and pain. The clinical tests showed that the serum amylase was 509...

Watch this Scientific Journal Video about Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis at JoVE.com

Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis

An enema is a type of traditional Chinese medicine (TCM) therapy used to treat severe acute pancreatitis (SAP). The therapy involves instilling a TCM liquid into the rectum and colon through the anus to keep the liquid in the intestine, absorbing through the intestinal mucosa. This study aims to standardize the enema procedure for SAP patients.

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional ...

enema-traditional-chinese-medicine-for-patients-with-severe-acute

Research

JoVE Journal

Medicine

20.9K Views.  Hospital of Chengdu University of Traditional Chinese Medicine. An enema is a type of traditional Chinese medicine (TCM) therapy used to treat severe acute pancreatitis (SAP). The therapy involves instilling a TCM liquid into the rectum and colon through the anus to keep the liquid in the intestine, absorbing through the intestinal mucosa. This study aims to standardize the enema procedure for SAP patients.

Video: Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

Patients with severe traumatic brain injury (sTBI) have difficulty knowing whether they are accurately expressing their thoughts and emotions because of disorders of consciousness, disrupted higher brain function, and verbal disturbances. As a consequence of an insufficient ability to communicate, objective evaluations are needed from family members, medical staff, and caregivers. One such evaluation is the assessment of functioning brain areas. Recently, multimodal brain imaging has been used to explore the function of damaged brain areas. [18F]-fluorodeoxyglucose positron emission tomography-computed tomography ([18F]FDG-PET/CT) is a successful tool for examining brain function. However, the assessment of brain glucose metabolism based on [18F]FDG-PET/CT is not standardized and depends on several varying parameters, as well as the patient&#39;s condition. Here, we describe a series of semiquantitative assessment protocols for a region-of-interest (ROI) image analysis using self-produced [18F]FDG tracers in patients with sTBI. The protocol focuses on screening the participants, preparing the [18F]FDG tracer in the hot lab, scheduling the acquisition of [18F]FDG-PET/CT brain images, and measuring glucose metabolism using the ROI analysis from a targeted brain area.

Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury

[18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography is useful for studying glucose metabolism related to brain function. Here, we present a protocol for an [18F]FDG tracer set-up and semiquantitative assessment of the region-of-interest analysis for targeted brain areas associated with clinical manifestations in patients with severe traumatic brain injury.

Patients with severe traumatic brain injury (sTBI) have difficulty knowing whether they are accurately expressing their thoughts and emotions because of ...

Sodium Taurocholate Induced Severe Acute Pancreatitis in C57BL/6 Mice

Biliary acute pancreatitis induction by sodium taurocholate infusion has been widely used by the scientific community due to the representation of the human clinical condition and reproduction of inflammatory events corresponding to the onset of clinical biliary pancreatitis. The severity of pancreatic damage can be assessed by measuring the concentration, speed, and volume of the infused bile acid. This study provides an updated checklist of the materials and methods used in the protocol reproduction and shows the main results from this acute pancreatitis (AP) model. Most of the previous publications have limited themselves to reproducing this model in rats. We have applied this method in mice, which provides additional advantages (i.e., the availability of an arsenal of reagents and antibodies for these animals along with the possibility of working with genetically modified strains of mice) that may be relevant to the study. For acute pancreatitis induction in mice, we present a systematic protocol, with a defined dose of 2.5% sodium taurocholate at an infusion speed 10 &#181;L/min for 3 min in C57BL/6 mice that reaches its maximal level of severity within 12 h of induction and highlight results with outcomes that validate the method. With practice and technique, the total estimated time, from the induction of anesthesia to the completion of the infusion, is 25 min per animal.

Animal models for severe acute pancreatitis enable the study of pathophysiological changes at the initial stage, facilitating observation of the evolution of inflammatory events. Here we provide a protocol for the induction of severe acute biliary pancreatitis by retrograde infusion of sodium taurocholate into the pancreatic duct of anesthetized C57BL/6 mice.

Biliary acute pancreatitis induction by sodium taurocholate infusion has been widely used by the scientific community due to the representation of the ...

Fertility Preservation in Patients with Severe Ovarian Dysfunction

Ovarian function progressively declines during aging and in some pathophysiological conditions including karyotype abnormality, autoimmune diseases, chemo- and radiation-therapies, as well as ovarian surgeries. In unmarried women with severe ovarian dysfunction, fertility preservation is important for future pregnancies. Although oocyte cryopreservation is an established method for fertility preservation, these patients could only preserve a limited number of oocytes even after ovarian hyperstimulation, leading to repeated stimulations to ensure sufficient oocytes to guarantee future pregnancy. To solve this issue, we have recently developed a drug-free in vitro activation (IVA) procedure, which enable us to stimulate early stages of ovarian follicles to develop to the preantral follicle stage. These preantral follicles can respond to the unique protocol of gonadotropin stimulation, resulting in increased number of retrieved oocytes per ovarian stimulation for cryopreservation. The drug-free IVA comprised from the surgical approach and ovarian stimulation. We removed a part of cortex from one or both ovaries from patients under laparoscopic surgery. The ovarian cortical tissues were cut into small cubes to disrupt the Hippo signaling pathway and stimulate the development of early stage follicles. These cubes were grafted orthotropically into remaining ovaries as well as beneath the serosa of both Fallopian tubes. We have already published the surgical procedure of the drug-free IVA and the protocol of subsequent ovarian stimulation, but herein we present the details of laboratory methods required for drug-free IVA.

We present details of laboratory procedures for drug-free in vitro activation (IVA) of ovarian follicles for patients with severe ovarian dysfunction. This method could increase the number of retrievable oocytes per ovarian hyperstimulation and benefit fertility preservation for those patients.

Ovarian function progressively declines during aging and in some pathophysiological conditions including karyotype abnormality, autoimmune diseases, ...

Establishment of a Mouse Severe Acute Pancreatitis Model using Retrograde Injection of Sodium Taurocholate into the Biliopancreatic Duct

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a lack of effective treatments in the current clinical practice. With the easy accessibility of transgenic and knockout strains and their small size, which allows minimal doses of drugs required for in vivo evaluation, a well-established experimental model in mice is preferred for AP research. Moreover, SAP induced through sodium taurocholate (TC) is currently one of the most widely used and best characterized models. This model has been investigated for novel therapies and possible molecular events during the process of AP. Here, we present the generation of an AP mouse model using sodium taurocholate and a simple homemade microsyringe. Moreover, we also provide the methodology for the subsequent histology and serological testing.

A mouse model of severe acute pancreatitis is described herein. The procedure presented here is very rapid, simple, and accessible, thereby potentially allowing the study of the molecular mechanisms and different therapeutic interventions in acute pancreatitis in a convenient way.

The prevalence of acute pancreatitis (AP), especially severe acute pancreatitis (SAP), is increasing in younger age groups annually. However, there is a ...

A Traditional Chinese Medicine Characteristic Therapy for Bronchial Asthma: Moxibustion

Bronchial asthma is a chronic inflammatory disease of the airway which can lead to symptoms such as recurrent wheezing, shortness of breath, chest tightness, or cough, as a result of increased airway reactivity. With high diurnal variation, these symptoms often occur or worsen at night or in the morning. By burning and roasting the Chinese medica above human acupoints, moxibustion is a type of treatment that stimulates the activity of the human meridians through drugs and heat stimulation to prevent and treat diseases. According to the principle of syndrome differentiation and treatment of traditional Chinese medicine, acupoints are selected on the corresponding parts, which has a definite effect. It is regarded as a characteristic traditional Chinese medicine therapy for bronchial asthma. This protocol elaborates the methods and steps of patient management, material preparation, selection of acupoints, operation, and postoperative nursing to ensure safe and effective moxibustion treatment to significantly improve the clinical symptoms and quality of life of patients with bronchial asthma.

This protocol presents a curative procedure of moxibustion in treating patients with bronchial asthma.

Bronchial asthma is a chronic inflammatory disease of the airway which can lead to symptoms such as recurrent wheezing, shortness of breath, chest ...

Tai Chi with Mindfulness Training to Manage Diabetic Peripheral Neuropathy

Effects of Mindfulness Training Combined with Tai Chi in Patients with Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. One of its crucial therapy approaches is mind-body exercise. Recently, various exercise modalities, including stepping, resistance, aerobics, balance, and whole-body vibration, were investigated to construct the most suitable form of exercise for patients with DPN. The purpose of this study is to describe a standard protocol for mindfulness training combined with Tai Chi. The convenience sampling method was used to select 90 patients with DPN who met the inclusion and exclusion criteria from three communities. The three communities were randomly divided into the control group (CG), the Tai Chi group (TCG), and the mindfulness training combined with the Tai Chi group (MTCG). The CG was given routine health education guidance once a month, a total of three times. Based on the CG, the TCG practiced Tai Chi three times; the MTCG received mindfulness training combined with Tai Chi exercise a week for a total of 12 weeks. Before the intervention and 12 weeks after the intervention, the clinical symptoms, neurological function, attention awareness level, pain, and quality of life of the subjects were evaluated by Toronto Clinical Scoring System (TCSS), Mindful Attention Awareness Scale (MAAS), Visual analog scale (VAS), Diabetes Specificity Quality of life Scale (DSQL) and tumor necrosis factor-&#945;. Overall, the addition of mindfulness training to Tai Chi effectively enhances the exercise effects of Tai Chi. Therefore, mindfulness training combined with Tai Chi is worthy of promotion and application.

Author Spotlight: Integrating Tai Chi with Mindfulness Training to Achieve an Effective Mind-Body Exercise 

When studying exercise for treating diabetic peripheral neuropathy (DPN), achieving mind-body exercise is essential. This study proposes a protocol for mindfulness training combined with Tai Chi to achieve mind-body exercise.

Diabetic peripheral neuropathy (DPN) is one of the most prevalent chronic complications of diabetes. One of its crucial therapy approaches is mind-body ...

Acupuncture Stimulation of Ears to Alleviate Sleeping Disorders in COPD Patients

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome characterized by persistent and irreversible airflow limitation and chronic respiratory symptoms. It has a wide spectrum of complications, and sleep disorders, as part of it, are common in severe cases, especially in elderly patients. Long-term lack of sleep may lead to the aggravation of the original disease, reducing patients' quality of life. Benzodiazepines are mainly used for symptomatic treatment of COPD combined with sleep disorders. However, such drugs have the side effect of respiratory central inhibition and could probably aggravate hypoxia symptoms. Auricular acupuncture is a special method of treating physical and psychosomatic dysfunctions by stimulating specific points in the ear. This article explains the specific methods of clinical operation of auricular acupuncture in detail, including assessment of patient eligibility, medical devices used, acupuncture points, course of treatment, post-treatment care, responses to emergencies, etc. The Pittsburgh sleep quality index (PSQI) and chronic obstructive pulmonary disease assessment scale (CAT) were used as the observational index of this method. So far, clinical reports have proved that auricular acupuncture has a definite curative effect in the treatment of COPD combined with sleep disorders, and its advantages of simple operation, few adverse reactions are worthy of further study and promotion, which provide a reference for the clinical treatment of such diseases.

Author Spotlight: Utilizing Traditional Chinese Acupuncture of the Ear to Improve Sleep Disorders 

This protocol introduces an effective method to improve the sleep condition of patients with chronic obstructive pulmonary disease and alleviate cough symptoms by using auricular acupuncture techniques to percutaneously stimulate specific acupoints in the patients' ears.

Chronic obstructive pulmonary disease (COPD) is a clinical syndrome characterized by persistent and irreversible airflow limitation and chronic ...

Warm Acupuncture and Moxibustion to Relieve COPD with Abdominal Distension

A Preliminary Study on Warm Acupuncture and Moxibustion for Treating Chronic Obstructive Pulmonary Disease with Abdominal Distension

Most patients with COPD have a combination of abdominal distension, which has been shown to adversely affect pulmonary symptoms, frequency of acute exacerbations, and quality of life in patients with COPD. Warm acupuncture and moxibustion have been shown to be effective in relieving symptoms in patients with COPD combined with abdominal distention. Warm acupuncture and moxibustion are highly effective, easy to perform, and inexpensive forms of traditional Chinese medicine treatments. The standardized practice of warm acupuncture and moxibustion is very important for the treatment of COPD combined with abdominal distension. The specific steps include selecting the appropriate acupoints for needling through syndrome differentiation treatment and selecting moxa sticks of appropriate length for moxibustion for about 30 min after the De-qi. The course of treatment lasts for one week. The following indicators are specifically assessed: the score of the COPD Assessment Test (CAT) and the abdominal distension visual analog scale (VAS). This article will clearly illustrate how to standardize the manipulation of warm acupuncture and moxibustion to relieve COPD combined with abdominal distention.

Author Spotlight: An Effective Traditional Chinese Medicinal Treatment for Chronic Obstructive Pulmonary Disease with Abdominal Distension 

Here, we present a protocol to properly manipulate warm acupuncture and moxibustion for treating chronic obstructive pulmonary disease (COPD) with abdominal distension.

Most patients with COPD have a combination of abdominal distension, which has been shown to adversely affect pulmonary symptoms, frequency of acute ...

Standardizing Press Needle Treatment for Myopia with Dry Eye

Press Needle: A Traditional Chinese Medicine Therapy for Myopia Patients with Dry Eye

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with myopia. Needle prickling has been shown to be effective in providing symptom relief in patients with myopia and dry eye. Press needle is a long-lasting, easy-to-operate, and inexpensive traditional Chinese medicine treatment. The standard practice of needle insertion is very important for the treatment of myopia and dry eye. The specific steps include selecting the appropriate acupoints, piercing them with appropriate needles, and fixing them in the skin or subcutaneously at the acupoints, burying them for 2 days, resting for 1 day; the course of treatment lasts for 2 weeks. Specifically, the following indicators were assessed: uncorrected visual acuity and the ocular surface disease index. This article will explain how to standardize the operation of a press needle in the treatment of myopia and dry eye.

Author Spotlight: Exploring Press Needle Efficacy and Underlying Molecular Pathways

Here, we present a protocol to standardize the operation of acupuncture in the treatment of myopia with dry eye.

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with ...

Herb Decoction Formulation and Gavage Standardization in Osteosarcoma Mice

Gavage Strategy for Decoction Formula of Traditional Chinese Medicine in Osteosarcoma Model Mice

Decoction formula is the most commonly used dosage form in traditional Chinese medicine and applied in clinical practice for thousands of years by trans-oral administration, which is characterized by quick effect, easy absorption, and individualized treatment based on the specific syndromes of patients. The quality of the decoction formula is directly responsible for the clinical efficacy of traditional Chinese medicine; therefore, the standardization process of the decoction formula is important to avoid differences in decoction quality caused by subjective factors. Meanwhile, due to the limitations of performing clinical experiments, small animals bearing human diseases, such as mice, are often used in medical research to explore the therapeutic efficacy and comprehensive mechanisms of different interventions, including the decoction formula for traditional Chinese medicine.&#160;Consequently, as an important trans-oral administration method, the skilled gavage technique is particularly important to avoid potential esophagus damage and drug spillage, which will ensure an equal amount of medicine being administered to each model animal, leading to accurate experimental results. Furthermore, the standardized method of decoction formula preparation and skilled gavage strategy are necessary to protect animal welfare and minimize the number of animals used. Here, we reported a detailed standardization process of the decoction formula and gavage technique with Yiqi Jiedu decoction in osteosarcoma mouse model as an example. The efficacy was evaluated by the tumor volume. This protocol will maximize animal protection and improve the reliability of research data, therefore providing effective strategies for future investigating therapeutic efficacy and molecular mechanisms of decoction formula for traditional Chinese medicine in vivo.

Author Spotlight: Standardized Herbal Decoction Protocol for Enhanced Animal Studies

The protocol provides a detailed standardization process of decoction formula and gavage technique with Yiqi Jiedu decoction in the osteosarcoma mouse model as an example. It describes animal protection and improves reliability of research data, providing effective strategies for investigating therapeutic efficacy and molecular mechanisms of decoction formulas in vivo.