目的:对大柴胡汤及其"方剂要素"对NAFLD模型大鼠"肠-肝轴"作用机制进行相关分析,揭示大柴胡汤的配伍规律.方法:105只大鼠分为正常组、模型组、盐酸吡格列酮组、疏肝利胆组、健脾化痰组、通腑泄浊组、大柴胡汤组,按照方法造模及给药,检测"肝轴"及"肠轴"相关指标,采用Critic法进行综合评价.结果:与正常组比较,模型组"肝轴"以及"肠轴"各个指标权重之和Z总1、Z总2差异均有统计学意义(P<0.05);与模型组比较,盐酸吡格列酮组、疏肝利胆组、通腑泄浊组以及大柴胡汤组"肝轴"各个指标权重之和Z总1差异均有统计学意义(P<0.05),盐酸吡格列酮组、健脾化痰组、通腑泄浊组以及大柴胡汤组"肠轴"各个指标权重之和Z总2差异有统计学意义(P<0.05).肠道菌群分析显示,通腑泄浊方剂要素对改善NAFLD模型大鼠肠道菌群优势显著,能提高NAFLD大鼠肠道菌群中拟杆菌属、萨特氏菌属、假丁酸弧菌属细菌和Akkermansia muciniphila等有益菌的相对丰度.结论:大柴胡汤中疏肝利胆方剂要素主要通过疏利肝胆作用显著调节肝脏脂质代谢以及肝脏免疫功能,即调节"肝轴";大柴胡汤中健脾化痰方剂要素主要通过健运脾胃、化痰作用改善肠黏膜屏障功能,即调节"肠轴";大柴胡汤中通腑泄浊方剂要素主要调节肠道菌群;大柴胡汤全方则可同时作用于"肝轴"和"肠轴",对NAFLD模型大鼠起治疗作用.

目的:采用网络药理学方法探讨健脾益肾化浊方治疗卒中后认知障碍(PSCI)的作用机制.方法:利用中药系统药理学数据库与分析平台(TCMSP)、中医药综合数据库(TCMID)及ETCM数据库筛选健脾益肾化浊方的活性成分,运用Swiss Target Prediction数据库对活性成分进行靶点预测;运用GeneCards数据库筛选PSCI相关疾病靶点;运用RStudio软件对健脾益肾化浊方及PSCI共同靶点绘制韦恩图;将二者共同靶点通过STRING及Metascape数据库分别进行PPI分析,基因本体(GO)富集分析和京都基因和基因组百科全书(KEGG)富集分析;运用Cytoscape 3.6.0绘制"健脾益肾化浊方-靶点-PSCI-通路"网络图;采用AutoDock对核心成分及核心靶点进行分子对接验证.结果:筛选出健脾益肾化浊方39种活性成分和553个靶点,筛选出PSCI潜在靶点2305个,二者共同靶点为254个.通过GO及KEGG富集分析,发现健脾益肾化浊方可能通过突触可塑性、抗细胞凋亡、抗炎等多靶点、多途径发挥对PSCI的治疗作用.分子对接结果提示活性成分Stigmasterol与核心靶点(MAPK1、SRC、MAPK3、TP53、HSP90AA1),Palmatine与核心靶点(AKT1)具有较好的结合活性.结论:健脾益肾化浊方治疗PSCI可能通过调节突触可塑性、抗细胞凋亡、抗炎等生物学过程发挥作用.

目的:探讨小儿珠珀散治疗感冒的药物效应,为临床应用提供参考.方法:针对感冒过程中儿童可能出现的发热、咳嗽、痰多、消化不良等症状,分别利用脂多糖(LPS)致热家兔,氨水诱发小鼠咳嗽,酚红排泌法、半固体营养糊小鼠肠推进实验探讨小儿珠珀散对症治疗的作用.结果:小儿珠珀散可降低小鼠耳肿胀程度、家兔体温上升幅度;延长小鼠咳嗽潜伏期,减少咳嗽次数,减少小鼠气管酚红排出量;促进小鼠胃排空,增加小鼠小肠推进率(P均＜0.05).结论:小儿珠珀散可缓解感冒过程中的多种症状.

当前临床对痴呆症的研究主要集中在阿尔茨海默病(Alzheimer's disease,AD)上,而对血管性认知障碍(vascular cognitive impairment,VCI)的研究较少,近年来,VCI的防治研究虽有一定的成果,但仍没有突破性进展,缺乏特效药.VCI属于中医学"痴呆""呆病""善忘"等范畴,中医治疗VCI具有一定的优势.本文基于"肾通于脑"的理论,通过文献研究,分析探究从肾论治VCI的可行性与科学性,为补肾类中药治疗肾虚型VCI提供依据.

The study aims to analyze the outcome indicators of randomized controlled trial(RCT) of traditional Chinese medicine(TCM) in the treatment of hypertensive intracerebral hemorrhage(HICH) in recent three years, and thus provide suggestions for the future studies in this field. Four English databases, four Chinese databases and two online registration websites of clinical trials were searched. The RCTs published between January 2018 and September 2020 were screened. The risk of bias was assessed and outcome measures were classified. A total of 151 839 articles were retrieved, of which 44 RCTs were included for analysis after screening. The outcome measures of the included RCTs were classified into 7 categories, among which the symptoms/signs category showed the highest reporting rate. National Institute of Health stroke scale(72.73%) was the most frequently reported outcome indicator, while the vo-lume of intracerebral hemorrhage determined by computerized tomography(36.36%) was the most frequently reported lab test outcome. Most studies collect the outcomes at the end of treatment, while 9 studies reported long-term outcomes 3 months or more after onset. Compared with those of international clinical trials, the application of some of the outcomes was reasonable, focusing on patients' symptoms, quality of life and objective outcomes. However, there were still several problems: unclear primary and secondary outcome measures, insufficient attention to long-term prognosis, insufficient attention to social function, few TCM outcomes, lack of measurement blindness and the use of unreasonable composite outcomes. It is recommended that researchers should rationally design the outcome indicators of clinical trials and develop the core outcome set.

目的 评价针刺治疗卒中后认知障碍(post-stroke cognitive impairment,PSCI)的疗效.方法 检索从建库至2020年7月30日中国知网数据库(CNKI)、中文维普数据库(VIP)、万方数据库(WanFang)、CBM、PubMed、Embase、Cochrane Library Database7个数据库和ClinicalTrials.gov.纳入所有针刺治疗PSCI的临床随机对照试验(RCT).对纳入的研究逐个进行质量评价和描述性分析,而后采用RevMan 5.4软件进行Meta分析.结果 共纳入15个RCT,共1 301例受试者符合纳入标准,干预组652例,对照组649例.研究结果显示针刺干预在改善患者蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)、Barthel指数评定量表(BI)、日常生活能力量表(ADL)、美国国立卫生研究院卒中量表(NIHSS)的评分方面均优于对照组,且未见严重的不良反应.结论 现有临床证据表明,针灸可减轻脑卒中后神经功能缺损的程度,并可以提高患者的自我生活能力,但鉴于目前评价针灸疗效的临床试验及病例数较少,尚不能作出其是否有效的确切结论,有必要进一步开展高质量、大样本RCT研究评价其疗效.

目的 探讨急性缺血性脑卒中后认知障碍的中医证候要素,为临床早期干预提供辨证论治依据.方法 纳入多中心协作收集的急性缺血性脑卒中后认知障碍患者331例,采用“中医症状、舌脉象观察表”进行四诊信息采集,内容含40项临床症状、20项舌象及10种脉象.对受试者的70项四诊信息采用因子分析方法进行证候要素提取,并统计证候要素分布特点.结果 40项临床症状中出现频率位于前5位的为乏力(44.71％)、言语謇涩(41.99％)、失眠(41.39％)、夜尿频多(35.95％)、神疲(35.35％).舌色以舌暗出现频率最高,占53.47％;苔色以苔白最为常见,占66.77％;苔质以苔薄最多,占48.94％.脉弦出现频率最高,占65.86％,其次为脉滑、脉沉.经因子分析后共得出6个证候要素,其中气虚比例最高(43.20％),其次为痰(23.56％)、血瘀(16.31％)、火(8.46％)、阴虚(5.44％)、阳虚(3.02％),病位以肾、脾、肝多为常见.结论 急性缺血性脑卒中后认知障碍中医证候要素以气虚为主,肾脾亏虚、痰瘀互结可能是脑卒中急性期出现认知障碍的重要病理因素.

缺血性脑卒中是以运动、认知等神经功能损伤为主的缺血性脑病,恢复患者神经功能对预后极其重要.脑功能网络用于描述脑网络各节点或各脑区之间的连接关系,反应人的运动、认知功能等.脑默认网络属于功能网络,是指大脑静息态下存在一系列自发的、有组织的脑功能活动,该网络被认为与人的认知过程密切相关.脑功能网络在功能核磁共振上的突出观察指标定义为功能连接,部分脑区的功能连接异常就表征着该功能网络出现异常,可能与疾病的发生发展有密切关系.中医药治疗缺血性脑卒中患者,可有效调节大脑功能网络的功能连接,从而在治疗中发挥重要作用.本文以大脑功能网络为基本点,阐述中医药对缺血性脑卒中患者静息态神经功能网络及其功能连接影响的研究进展.

目的:通过对卒中后非痴呆患者的5年随访,分析其认知功能变化特点及其与中医证候要素的关系.方法:2011年10月至2013年9月在北京中医药大学东方医院纳入卒中后非痴呆患者233例,5年后随访,66例完成面对面访视.根据认知水平是否较入组时下降分为认知下降组(39例)和认知无下降组(27例),分析5年认知功能变化与中医证候要素之间的关系.结果:认知下降组气虚、痰浊证候要素较基线显著增加(P＜0.05,P＜0.01),证候虚实夹杂、多个证候要素组合的比例明显增加(P＜0.05).下降显著的认知域为视空间与执行功能、语言、延迟回忆.视空间与执行功能下降组,5年后气虚明显增加,但差异无统计学意义;在语言、延迟回忆下降组,5年后痰浊显著增加(P＜0.01).结论:在卒中后认知功能下降的长期病程中,证候要素倾向于虚实夹杂、相兼组合,证候及病机更加复杂;气虚、痰浊与卒中后认知障碍进展相关,气虚与视空间与执行功能下降之间存在关联,痰浊与语言、记忆功能下降之间存在关联.

目的:观察康力康呆灵对老年性痴呆模型小鼠行为学及血清、脑内MDA、SOD含量的影响,探讨其改善老年性痴呆病理机制.方法:将SAMP8小鼠按体质量随机分组,分别给予阳性药安理申(55 mg/kg)、康力康呆灵低、中、高剂量.以ICR小鼠为正常对照组,每日1次,连续给药4周后观察小鼠行为学及血清与脑组织MDA、SOD含量变化.结果:与模型组比较,低剂量组康力康呆灵对小鼠学习记忆有改善作用,中、高剂量组能显著提高小鼠学习能力,中剂量组小鼠脑组织中SOD含量升高,各剂量组小鼠血清中MDA含量均降低,低剂量组小鼠脑组织中MDA含量明显降低.结论:康力康呆灵对老年性痴呆模型小鼠行为学具有改善作用,其作用机理可能与调节SOD、MDA的含量有关.

目的 比较中风后痴呆与非痴呆患者二便的差异,尝试从二便角度分析中风后痴呆中医证候特点.方法 将2 996例中风患者根据认知功能障碍程度分为非痴呆组2 348例、痴呆组648例,采用项目统一制定的《中医周边症状、舌脉象观察表》采集2组患者二便信息并作比较,分析差异条目所蕴含的证候特点.结果 与非痴呆组比较,痴呆组小便清长、小便短赤、夜尿频多、尿后余沥、咳笑时遗尿、尿急、排便无力、便秘发生率高,2组差异有统计学意义(P＜0.01);其中,夜尿频多、便秘的发生率最高.在校正年龄、NIHSS评分因素后,发现尿急(OR=1.519,P＜0.05)、排便无力(OR=1.353,P＜0.05)与中风后痴呆具有相关性.结论 二便异常在中风后痴呆患者中发生率更高.尿急、排便无力与中风后痴呆具有相关性,提示在疾病复杂病机中脾肾气虚的重要性.

目的:探究药对“茵陈—郁金”抗肝纤维化的疗效.方法:采用CCl4皮下注射建立大鼠肝纤维化模型,使用不同配比的“茵陈—郁金”溶液进行灌胃治疗,通过组织病理学及测定肝组织羟脯氨酸(Hydroxyproline,Hyp)的方法进行疗效评估.结果:“茵陈—郁金”配伍对肝纤维化模型大鼠有—定治疗作用,且在3个实验组中,茵陈∶郁金=1∶2时疗效最佳,其纤维化程度最轻,血清Hyp含量最低.结论:清热利湿与活血化瘀的中医治法联合运用具有一定抗肝纤维化效果,临床采用活血化瘀为主,清热利湿为辅的治法或可取得较好疗效.

苓芍术甘汤见于《伤寒论》第28条,原名桂枝去桂加茯苓白术汤,刘渡舟教授提出,本方与苓桂术甘汤相对应,示人“和阴利水”之法.文章结合《金匮要略》“血不利则为水”、叶天士《外感温热篇》提出“通阳不在温,而在利小便”等相关论述,深入阐述张仲景和阴利水法的临床意义,并根据中医阴阳对立统一理论,以《伤寒论十四讲》“苓桂剂”所载方剂为模板,推演化裁出“苓芍剂”之苓芍茜红汤、苓芍杏苡汤等具有“和阴利水”功效的新方,旨在启迪中医创新思路,更好地继承和发扬仲景学术,指导临床实践.

目的:观察桑叶降糖作用,分析桑叶对2型糖尿病(T2DM)大鼠肝脏Toll样受体及其下游信号元件基因表达的影响,初步探讨其降糖机制.方法:选取SPF级雄性Wistar大鼠46只,高脂饲料饲喂8周后,腹腔注射链脲佐菌素(STZ),以制备T2DM模型.根据血糖值将模型大鼠随机分成模型组、阳性药二甲双胍(0.2 g/kg)组和桑叶高、低剂量(3 g/kg,1 g/kg)组,每组12只,另取10只大鼠为正常对照组.灌胃给药,持续12周,每周测其空腹血糖,并于第11周时进行OGTT和ITT实验.以上实验结束后免疫吸附试验(ELISA)试剂盒测定血清中胰岛素、IL-6、肿瘤坏死因子-(TNF-)和C反应蛋白(CRP)水平,实时PCR法测定大鼠肝脏TLRs及MyD88、TRAF-6、核因子-B mRNA水平.结果:大鼠给药桑叶后,血糖值降低,饮水量明显减少,差异有统计学意义(P<0.05),糖耐量得到显著改善,血清中IL-6、CRP水平明显降低,差异有统计学意义(P<0.05),TLR7、TLR8、TLR9以及其下游信号元件TRAF-6、MyD88、核因子-B mRNA相对表达均较模型组明显降低,差异有统计学意义(P<0.05).结论:桑叶降糖可能与其抑制肝脏组织TLRs及其下游信号表达,降低炎性反应有关.

“以知为度”一词出自《伤寒论》,是以用药见效为尺度来控制总体给药量的一种方法.临证所见,病情有轻重、药物有厚薄、人体耐受度也有差异,所以用药剂量不能一概而论,而应该以患者服药后确切反应为基础,从宏观把握用药剂量,达到个体化治疗的目的.仲景十分重视对患者服药后出现不同反应的观察,笔者全面梳理《伤寒论》《金匮要略》中的相关论述,以作为不同经方疗效评价及临床药量把握的依据,意在举一反三,启迪临床用药思路,从而更好地继承和发扬仲景学术.

五脏皆体阴而用阳,但具体到各个脏器及用药则各有偏颇,临床中心阴、肺阳、脾阴并不少见.心阴具有滋养、润泽之作用,不足则虚火上炎或邪气易侵,可见心悸怔忡或神昏蒙昧等,治以滋阴养营、清心开窍;肺阳具有温煦、防御之作用,不足则易感外邪或宣布不畅,可见感冒频发或咳喘痰嗽等,治以温肺补气、祛邪固表;脾阴具有濡润、滋养百骸之作用,不足则脾运不健或润燥失养,可见乏力神疲、腹胀腹泻等,治以养脾运脾、养津生液.应予以重视,有利于临床实际.

Objective:To optimize the water extraction process of Shenlian formula.Method:Rats were randomized into control group,extract Ⅰ group (water extraction),extract Ⅱ group (water extraction and ethanol precipitation),extract Ⅲ group (water extraction and ethanol precipitation of some herbs,ethanol extraction of others),extract Ⅳ group (water extraction of some herbs,ethanol extraction of others),and the numbers of premature ventricular contraction,the total time of ventricular tachycardia and ventricular fibrillation were used to evaluate the arrhythmia induced by myocardial ischemia reperfusion arrhythmia.Orthogonal design was used to optimize the process conditions by taking solvent volume,extraction time and times as factors after investigating pharmacodynamics index of different extraction process routes.Paeoniflorin,liquiritin and glycyrrhizic acid,as examining parameters,were evaluated by HPLC with a mobile phase of acetonitrile-0.1％ phosphoric acid solution for gradient elution.Result:Optimal extraction process was as follows:extracted thrice with 10,8,8 times the amount of water,decocted for 1.5 h per time.Extracting amounts of paeoniflorin,liquiritin and glycyrrhizic acid were 22.88,15.17,13.54 mg· g-i Conclusion:This optimized extraction process is stable and feasible,which can provide reference value for the actual production of Shenlian granules.

The main causes of IgA nephropathy of internal and external causes,involving organs except common kidney,heart,still involve the lungs,liver;pathological factors mainly heat evil,it is divided into excess heat and deficiency heat,and the pathological factors throughout the pathogenesis of the disease.Therefore,the pathogenesis of IgA nephropathy can be summed up as "two aspects,four viscera,a mainline".Through the study of this theoretical framework,we can understand the disease more comprehensively,and provide reference for clinical diagnosis and treatment.

Ganmai Dazao Tang is a famous formula for hysteria in Jinguiyaolue(Synopsis of the Golden Chamber).The connotation of hysteria has been explored in the paper through summing up relative knowledge of medical practitioners in the successive dynasties.The pathogenesis of hysteria lies in function disorder of five viscera resulting in that five viscera fail to restrain their spirits, viscera spirits float and heart spirit is uneasy.Hysteria reflects the clinical pathological features of estrangement among qi, blood, yin and yang, and viscera spirits failing to be restrained and floating in the exterior.The combining and medicating laws of Ganmai Dazao Tang, and pathological features hysteria have been further analyzed according to principle of correspondence between formula-syndrome factors.The pharmacodynamic material basis of Ganmai Dazao Tang has been analyzed and the opinion of placebo efficacy has been negated according to the progresses in modern pharmacological research and clinical research.The combination of Ganmai Dazao Tang is rigorous, and similar to Guizhi Tang, the first one of all TCM formulas.These two formulas both are based on regulating yin and yang and widely applied in the clinic with significant curative effects.

By consulting ancient and modem literature,combining with clinical practice,it is believed that recurrent oral ulcer (ROU) is closely related to the theory of"latent pathogen",the cause and the pathogenesis of "latent pathogen" are linked to the formation of ROU,and the disease is treated by the method of nourishing Yin and suppressing the excessive Yang with SanJia FuMai Tang and Da Ding,FengZhu in clinic,which could obtain better effects.