Dampness-Heat Accumulation

Dan Wang et al. (2026) · JAMA network open

This phase 3 randomized trial of 606 adults in China explored whether Guang Jing, a capsule made from the total flavonoids (plant pigment compounds with antioxidant activity) of the traditional Chinese herb Desmodium styracifolium, helps ureteral stones pass out of the body. A ureteral stone is a mineral deposit lodged in the tube that carries urine from the kidney to the bladder. Treatment that encourages passage is called medical expulsive therapy, and the authors note that alpha-blocker drugs, the guideline option, have shown mixed results in large trials. No oral medicine is currently approved for urolithiasis, and Guang Jing is already approved in China for ureteral stones. Participants were adults aged 18 to 70 with a newly diagnosed ureteral stone of 5 to 10 mm and a traditional Chinese medicine pattern called damp-heat accumulation (urethral burning, lower back pain or blood in the urine). At 34 hospitals, three of every four received 3 capsules (0.6 g) of Guang Jing three times daily for 28 days, and the rest received identical placebo capsules. Neither participants nor investigators knew who received which. Passage was confirmed by CT scan on day 28, read by blinded investigators. By day 28, 44.6% of the Guang Jing group (204 of 457) had passed their stone versus 33.8% of the placebo group (50 of 148). That is a 10.9 percentage point difference (relative risk 1.32, so passage was about one-third more likely; P = .03). At day 14 the groups did not differ significantly (29.1% vs 22.3%; P = .14), and stone movement distance was almost identical (29.5 vs 29.7 mm). Among those with 0.6 to 1.0 cm stones, passage was 37.2% vs 24.4% (a larger gap in the bigger stones), and 66.2% of Guang Jing participants with distal stones, the lower part of the ureter near the bladder, passed them. Adverse events were similar (19.3% vs 18.2%, meaning side effects were about as common with the capsule as with placebo), with no medication-related serious events. The authors describe the absolute benefit as modest, since 55.4% of the Guang Jing group did not pass a stone by day 28. The trial enrolled a fairly uniform group, mostly from southern China, and the subgroup results were exploratory. The authors state that this homogeneous population limits how far the findings generalize, and that CT slice thickness may have missed small differences in stone movement. They plan further trials in Europe and North America and call for studies to identify who benefits most and to establish how the extract works in humans.

Qiaoyun Liu et al. (2026) · Frontiers in endocrinology

This systematic review and meta-analysis of 56 randomized controlled trials (4,605 participants) examined whether herbal formulae containing Smilax glabra, known in Chinese as Tufuling, help people with acute gout. Gout is a painful inflammatory arthritis caused by uric acid crystals depositing in joints. In traditional Chinese medicine, many acute flares are classed as dampness-heat accumulation, a pattern defined by red, swollen, hot, painful joints and dark urine, and treated by clearing heat and resolving dampness. The authors also used computer-based network pharmacology to predict which plant compounds and proteins might explain the effects. All 56 trials took place in China and enrolled adults, with ages ranging from 18 to 80 years, diagnosed with gout and the dampness-heat pattern. Participants received a Tufuling-containing herbal formula, sometimes with external applications or acupuncture, either alone or added to standard drugs such as NSAIDs, colchicine, allopurinol or benzbromarone, for 14 days or less. Comparison groups received the standard drugs alone. Pain was measured on a 10-point visual analog scale, and blood uric acid, C-reactive protein and erythrocyte sedimentation rate (inflammation markers) were also tracked. Herbal formulae added to standard drugs reduced pain by 0.94 points on the 10-point scale (a modest but statistically significant gain across 17 trials), raised the chance of a treatment response by 15% (risk ratio 1.15), and lowered blood uric acid by 57 micromoles per litre. Herbal formulae alone did not beat standard drugs for pain (a 0.33-point difference, not significant) but did lower uric acid. Adverse events, mostly stomach and intestinal complaints, totalled 73 in herbal groups versus 161 in comparison groups, all mild to moderate. Certainty of evidence was rated low to moderate, and heterogeneity was very high for pain (I² = 93.2%). Network analysis predicted 49 gout-related protein targets for Tufuling, centred on PTGS2, IL1B, PPARG and TP53 (proteins governing inflammation and metabolism), and docking suggested diosgenin binds PTGS2 strongly (-11.6 kcal/mol). The authors suggest Tufuling-based formulae may be a useful adjunct in acute gout, but the evidence carries clear limits. Most trials lacked blinding and trial registration, all came from China, treatment lasted at most 14 days, a quarter of trials did not report adverse events, and only four reported follow-up. The findings do not extend to chronic gout or other traditional patterns, and the network predictions are untested hypotheses. The authors call for larger, rigorous trials with longer follow-up and laboratory validation of the predicted targets.