Can Sha

Thirty-one randomised controlled trials in 2,372 patients with renal anaemia. Shengxuening raised haemoglobin by 7.15 g/L against placebo (GRADE high certainty) and by 6.49 g/L against active comparators (GRADE very low), and improved serum ferritin and transferrin saturation, with fewer adverse drug reactions than comparator drugs. The intervention is a purified sodium iron chlorophyllin preparation extracted from silkworm excrement, not the crude drug Can Sha, and the result should not be read as evidence for decocted Can Sha.

Thirty-nine trials in 4,562 patients with iron deficiency anaemia. Shengxuening improved red cell count, haemoglobin, mean corpuscular volume, serum iron and transferrin saturation, with effects on mean corpuscular haemoglobin, haematocrit and ferritin comparable to conventional iron supplementation, and fewer adverse events. Again the intervention is the purified chlorophyllin product derived from silkworm excrement rather than the crude drug.

Multicentre, open-label, randomised dose-comparison across 31 Chinese hospitals in adults and children with iron deficiency anaemia. Haemoglobin rose in all three dose groups in adults and in the medium and high dose groups in children; total effective rate 84.8 per cent; adverse events 4.07 per cent, mainly nausea, diarrhoea and rash. There was no untreated or placebo arm, so it establishes dose response and tolerability rather than efficacy against no treatment. The product is the sodium iron chlorophyllin extract of silkworm excrement.

Silkworm excrement extract inhibited alpha-glucosidase in a cell-free assay, and in insulin-resistant HepG2 cells increased glucose consumption, reduced lipogenesis and raised phosphorylation of AMPK, PI3K and Akt. This is the crude drug material rather than a purified derivative, but the evidence is entirely in vitro and combined with network-pharmacology prediction.

In a myelosuppressed mouse model the silkworm excrement chlorophyllin extract raised peripheral blood counts, improved bone marrow morphology and increased serum erythropoietin and granulocyte-macrophage colony-stimulating factor, with upregulation of stem cell factor and the JAK2 and STAT3 pathway in liver. Mechanistic animal evidence for the purified derivative.

Extract of the crude drug reduced lipid accumulation in differentiating 3T3-L1 adipocytes, downregulated PPAR-gamma, C/EBP-alpha and aP2, raised Sirt1 and Sirt6 and lowered Parp1, and shifted energy production toward branched-chain amino acid catabolism. Cell-culture evidence only, with no dosing implication for patients.

Fed a 20:1 silkworm excrement concentrate or sodium copper chlorophyllin to common carp. The concentrate was safe at 0.5 per cent of the diet but impaired growth, feed efficiency and digestive enzyme activity at 1.0 per cent. Both additives improved lipid handling and antioxidant capacity by different routes. The value for a practitioner is the demonstration of a dose ceiling for concentrated extracts of this material, not the aquaculture outcome.