Portal de Periódicos da CAPES

Bilirubin would be the indispensable component for some of the most important therapeutic effects of Calculus Bovis (Niuhuang)

2008; Lippincott Williams & Wilkins; Volume: 121; Issue: 5 Linguagem: Inglês

10.1097/00029330-200803010-00024

2542-5641

Xiaofa Qin,

Hemoglobinopathies and Related Disorders

To the Editor: As we know, Calculus Bovis (Niuhuang in Chinese, the gallstone of Bos taurus domesticus Gmelin) is one of the most precious and commonly-used medicinal materials in China.1 Its use was first recorded in "Shennong Bencao Jing" (Divine Farmer's Materia Medica Classic) more than two thousand years ago,1 and now it has been used in 650 out of the 4500 traditional Chinese medicines. The price of natural Calculus Bovis has been twice of the gold. As the natural occurrence is very rare, great efforts have been taken for some substitutes of natural Calculus Bovis. One has been the so-called cultured Calculus Bovis, which is either the induced gallstones in animals in vivo, or those produced in vitro under the conditions mimicking the gallstone formation process in vivo.1 Another is the so-called artificial Calculus Bovis, being a mixture of bile salts, bilirubin and some other gradients that have been found in and believed to have contributed to the therapeutic effects of natural Calculus Bovis.1 As natural and cultured Calculus Bovis are far behind the actual needs, it is reported that 98% of Calculus Bovis used in China in 2004 was artificial. However, there is a big difference in therapeutic effects between the artificial and natural Calculus Bovis. As a result, the artificial Calculus Bovis has been banned for use in the treatment of critical patients. Up to date, the reason for this difference, and thus the detailed mechanism of natural Calculus Bovis remains largely unknown. However, it is known that there is a big difference in bilirubin between the artificial (0.63%) and natural Calculus Bovis (up to more than 60%).2 Here I suggest that this difference in bilirubin might have caused the difference in efficacy. How could bilirubin have contributed to this difference? It has long been recognized that bilirubin may have some beneficial effects due to, for instance, its antioxidant capacity.3 However, other antioxidants do not share the same therapeutic properties as Calculus Bovis. Here I suggest some efficacy of Calculus Bovis would probably largely attribute to a unique property that bilirubin has, i.e., the inactivation of digestive proteases.3 It is believed that increased translocation of gut bacteria and infiltration of their components have played a critical role in many critical conditions like trauma, shock, burn injury, sepsis, obstructive jaundice, pancreatitis, and the development of multiple organ failure,4 while digestive proteases may have greatly contributed to these processes by the digestive damage of the compromised gut barrier.5 It is found that unconjugated but not conjugated bilirubin can inactivate the pancreatic proteases such as trypsin and chymotrypsin.3 As most bilirubin in Calculus Bovis is in the unconjugated form,2 it would be capable to protect the gut by inactivate these digestive proteases. Regulations on cultured Calculus Bovis require that only those with 35% or higher of bilirubin can be used for the treatment of critical patients, while those with 18%-34% of bilirubin can be used for regular patients, but those with bilirubin lower than 18%> can not be used medically.6 Here bilirubin is used as a reference parameter for Calculus Bovis quality.6 I suggest that bilirubin itself would be the indispensable component that has actually contributed to some of the most important therapeutic effects of Calculus Bovis. This is also in accordance with the fact that Calculus Bovis needs to be dried down in dark to keep its efficacy, while bilirubin is just the component that is highly sensitive to light. Further study in this area would be worthwhile. It will help us to realize and make a good use of the great treasures of Chinese traditional medicine. Xiao-fa QIN Department of Surgery New Jersey Medical School University of Medicine & Dentistry of New Jersey Newark, New Jersey, NJ 07103, USA Tel: 973–972–2896 Fax: 973–972–6803 Email: [email protected]