目的:观察滋肾平肝法联合耳穴贴压对抽动症患儿智力言语智商(VIQ)、操作智商(PIQ)和总智商(FIQ)及血清多巴胺(DA)、5-羟色胺(5-HT)、γ-氨基丁酸(GABA)水平的影响.方法:选取我院2018年5月—2019年9月门诊收治的抽动症患儿120例,采用随机数字表法分为对照组和治疗组各60例,对照组给予氟哌啶醇片治疗,治疗组在对照组基础上给予滋肾平肝中药联合耳穴贴压法治疗.两组均治疗3月,比较两组患儿治疗前后运动性抽动、语言性抽动、耶鲁综合抽动严重程度量表(YGTSS)评分及中医证候积分改善情况,患儿智力发育(VIQ、PIQ、FIQ)、血清DA、5-HT、GABA水平,两组临床总有效率及不良反应发生情况.结果:经治后,两组患儿运动性抽动、语言性抽动、YGTSS积分、中医证候积分较治疗前均降低(P＜0.05),且治疗组均显著低于对照组(P＜0.05);VIQ、PIQ、FIQ评分均较治疗前升高(P＜0.05),且治疗组高于对照组(P＜0.05);血清DA、5-HT水平均较治疗前降低(P＜0.05),且治疗组低于对照组(P＜0.05),GABA水平较治疗前升高,且治疗组高于对照组(P＜0.05);治疗组临床总有效率为93.33％(56/60),高于对照组的80.0％(48/60)(P＜0.05);治疗组不良反应发生率为8.33％(5/60),显著低于对照组的33.33％(20/60)(P＜0.05).结论:滋肾平肝法联合耳穴贴压能显著改善患儿抽动症状,降低血清DA、5-HT含量,提高GABA水平,有效调节神经递质失衡,改善患儿智力,且不良反应小,值得临床推广应用.

1 黄龙止咳方 组? 成:炙麻黄6?g,杏仁9?g,紫苏子9?g,桑白皮9?g,前胡9?g,地龙6?g,蝉蜕5?g,旋覆花6?g(包). 功? 效:祛风解痉,宣肺化痰,清气降逆. 主? 治:小儿咳嗽变异性哮喘(风痰痹阻、肺热气逆证). 用? 法:每日1剂,水煎,分2～3次服. 方? 解:方中炙麻黄味苦辛性温,宣肺降气、祛风平喘;地龙味咸性寒,清肺和络、解痉平喘.两药相合宣降并举、平喘解痉,使肺气宣达通畅,则咳自止而喘自平,皆为君药.

<正>南京市名中医1956年生,安徽桐城人,医学硕士,南京市中医院副院长,主任中医师,教授,博士生导师。曾先后兼任中华中医药学会理事,江苏中医药学会常务理事,南京中医药学会副理事长、理事长,江苏省中医药学会儿科专业委员会主任委员、名誉主任委员等。

从病因病机、具体临床表现及脑髓的生理特性反推小儿多发性抽动症的病理特点,在此基础上,再从已有的研究成果等方面论述"脑髓神机失调致病"的合理性,以期阐明小儿多发性抽动症之关键病机。此关键病机的确立将提高本病尤其是重症病例治疗的针对性和靶向性,并且将对一大类儿童神经精神系统疾病如多动症、自闭症、忧郁症等中医诊治的理论与实践上的突破产生启发和指导作用。

Objective:To study TCM research progress of Cough variant asthma.Methods:Summary the recent TCM research progress of Cough variant asthma from name,etiological factor and pathogenesis,therapeutic method and other aspects.Results:Early diagnosis and treatment have considerable clinical significance to prevent and delay the further development of the cough variant asthma.Conclusion:TCM for cough variant asthma has certain curative effect and a good clinical advantage.

<正>小儿多动症是目前临床常见的儿童行为问题,主要表现为与年龄不相称的注意力易分散,不分场合的过度活动和情绪冲动[1]。张骠教授系南京中医药大学儿科博士研究生导师,长期从事中医儿科临床、教学、科研工作,临证经验丰富,尤精于诊治小儿精神神经系统疾病。笔者有幸随师侍诊,感悟一二,现仅

OBJECTIVE:To study the effects of Jing'an Oral Liquid (JOL) on the central neurotransmitters of multiple tics (MT) children. METHODS:Sixty MT children patients were randomly assigned to the treatment group and the control group, 30 cases in each group. Another 30 healthy children were recruited as the health group. JOL and Tiapride Tablet (TT) was respectively given to patients in the treatment group and the control group. The treatment course was 2 months. The levels of central neurotransmitters [dopamine (DA), homovanillic acid (HVA), 5-hydroxytryptamine (5-HT), norepinephrine (NE), glutamic acid (GLU), aspartate (ASP), gamma-aminobutyric acid (GABA)] were measured using high performance liquid chromatography (HPLC) before and after treatment, and compared with the health group. RESULTS:Compared with the health group, the levels of 5-HT, HVA, GLU, and ASP significantly increased in the treatment group and the control group before treatment (P < 0.05), GABA significantly decreased (P < 0.05). Compared with before treatment in the same group, the levels 5-HT, HVA, and GLU significantly decreased in the treatment group (P < 0.05), while the levels of NE and GABA significantly increased (P < 0.05). The levels of DA, 5-HT, GLU, and ASP significantly decreased, while the levels of NE ang GABA significantly increased in the control group, showing statistical difference (P < 0.05). There was no statistical difference in each index between the treatment group and the control group before and after treatment (P > 0.05). CONCLUSIONS:(1) The imbalance of a variety of monoamines and amino acid neurotransmitters can lead to MT, especially in the changes of 5-HT, HVA, GLU, ASP, and GABA. (2) JOL can significantly reduce the levels of 5-HT, HVA, and GLU, and significantly increase the levels of NE and GABA, which might be its pharmacodynamic mechanisms for treating MT.

<正>发热为儿童最常见的症状之一,也是最常见的急诊与住院原因[1]。小儿外感发热是小儿时期最常见的疾病,多由外感风邪所致,以发热、恶寒、鼻塞流涕、喷嚏、头痛、咽部刺激症状为主要临床表现,一年四季均可发病。本文就小儿外感发热的中西医治疗进展综述如下。

感染后咳嗽(post-infectious cough,PIC)病因分布随年龄、性别、病程、地域等存在差异,中医根据其病程、咳嗽、地域特点并结合患者具体情况,因时、因地、因人治宜,辨证施治,治疗上注重顾护脾胃,用药轻扬,扶正与祛邪并举。

Objective:To Explore the relationship between pathogenesis of Tourette syndrome(TS) and dominant with presynaptic dopamine nerve fibers.At the same time to observe the effect of Jing'an oral liquid on distribution of dopamine transporter of TS model rats.Method: The model of TS was established by peritoneal injection of 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane(DOI) 1 mg·g-1 for 21 days.SD rats were randomly divided into 4 groups,the control group,the model group,Jing'an oral liquid group(11 g·kg-1) and tiapride group(0.025 g·kg-1),and drugs were orally administered for 21 days.In each group with 99 Tc-TRODAT-1 as a ligand,the distribution of dopamine transporter in rat brain was measured by γ-radiation immunity Counter.Result: In model group,three sites'(striatum,cerebral cortex and hippocampus) radioactive uptake ratio(CMP / GB) was significantly higher than that in control group(P0.05).In Jing'an oral liquid group three sites' radioactive uptake ratio(CMP/GB) was lower than that in model group(P0.05) with a statistically significant difference.Conclusion: Compared with normal group,the distribution of dopamine transporter(DAT) in model group brain significantly is increased,which may cause the dopamine hyperfunction and lead to TS,.Jing'an oral liquid may be play a therapeutic role by reducing the distribution of DAT,thereby reducing the presynaptic dopamine neurons over-dominance.

目的:观察静安口服液对小儿多发性抽动症(Tourette综合征,TS)模型大鼠抽动行为的改善、脑组织及血浆5-羟色胺(5-HT)含量的影响及其相互关系.方法:Tourette综合征模型用腹腔注射DOI(连续20d)的方法制作,分为空白对照组、模型组、静安口服液组、硫必利组4组,5-HT用HPLC法测定.结果:静安口服液能明显减少模型动物的抽动和刻板动作次数,具有良好的对抗抽动及刻板行为效用(P<0.01);能降低脑组织及血浆中5-HT含量(P<0.05,P<0.01);脑组织及血浆中5-HT含量变化呈正相关.结论:静安口服液能减轻Tourette综合征动物模型的抽动及刻板运动等症状,降低脑组织及血浆5-HT水平,推测其作用机理主要与拮抗5-HT受体、减少脑及外周血中5-HT神经递质的异常释放,从而降低突触前5-HT神经元的过度支配和靶器官活动亢进有关.

目的:观察静安口服液对小儿多发性抽动症(Tourette综合征)模型大鼠脑组织、血浆多巴胺(DA)和高香草酸(HVA)含量的影响.方法:Tourette综合征模型用ip DOI(连续20d)的方法,分为空白对照组、模型组、静安口服液组、硫必利组4组.多巴胺(DA)和高香草酸(HVA)用HPLC法测定.结果:静安口服液能降低脑组织中DA和HVA含量(P<0.01),作用与硫必利相似.血浆中DA含量极微量,血浆中HVA未检出.结论:静安口服液模型组大鼠脑组织DA和HVA含量较空白对照组明显升高,而静安口服液、硫必利二组含量较模型组明显降低,因此,推测静安口服液作用机理与调整脑内DA和HVA神经递质,减少DA和HVA的异常释放,从而降低突触前多巴胺神经元的过度支配有关.

张骠教授则根据小儿独特的生理病理特点,提出食滞的重要性,并根据多年临证经验,总结出治疗此病的有效验方银葛清解汤,临床疗效显著,充分发挥了中医药的治疗优势。

目的:观察静安口服液对小儿多发性抽动症(Tourette综合征,TS)模型大鼠脑组织、血浆兴奋性氨基酸(EAA)谷氨酸(GLU)、天冬氨酸(ASP)及抑制性氨基酸(IAA)γ-氨基丁酸(GABA)含量的影响。方法:Tourette综合征模型用腹腔注射DOI(连续20天)的方法制造。分为正常组、模型组、静安口服液组、硫必利组4组。氨基酸用高效液相色谱法(HPLC)测定。结果:静安组、硫必利组脑组织GABA含量比模型组明显升高(P<0.05、0.001),静安组脑组织GABA含量明显低于硫必利组(P<0.05)。模型组血清GLU含量较正常组升高,有显著性差异(P<0.05)。血清中ASP、GABA未检出。结论:Tourette综合征模型大鼠存在氨基酸递质含量的变化,主要表现为以GLU为代表的EAA的升高和以GABA为代表的IAA的降低。静安口服液治疗Tourette综合征的机理与其对脑组织中GABA含量的提升效应有关。

Objective To study the effect on the monoamines neurotransmitters and their metabolites in mouse's brain by Jing'an Oral Liquid.Methods To determine the content of monoamine neurotransmitters and their metabolites in mouse's brain by HPLC-ED.Results Three dose groups all could decrease significantly the content of DA in mouse's brain,at the same time could increase significantly the content of 5-HIAA which is 5-HT's metabolites in mouse's brain.Conclusion The role that Jingan Oral Liquid can adjust the content of the above neurotransmitters may be the one of its effective mechanisms of treating multiple tics.

Objective:To study the effects of Jing'an oral liquid on the the levels of dopamine(DA),homovanillic acid(HVA),norepinephrine(NE) and the expression of COMT mRNA in brain tissue of rat models with Tourette Syndrome.Methods:The rat models with Tourette Syndrome were established by peritoneal injection of DOI for 20 days.SD rats were randomly divided into few groups,namely,the control group,the model group,Jing'an oral liquid group and Tiapride group.The levels of DA,HVA and NE were measured by HPLC;COMT mRNA was measured by PT-PCR.Results:The levels of DA,HVA and NE in the model group were significantly higher than that of the control group(P<0.01) and were decreased by Jing'an oral liquid which was similar to tiapride.The average optical density ratio of COMT mRNA in the model group were significantly lower than that of the control group(P<0.05).The remaining groups were no significant difference(p﹥0.05).Conclusion:The pathogenesis of TS involved with that the catecholamine released excessively,and its degeneration enzyme,COMT'activity reduced which caused the catecholamine not to exterminate,and to hypermetabolize.Jing'an oral liquid may play a therapeutic action by adjusting the imbalances of DA,HVA and NE,and reducing their excessive release,therefore lowering the excessive control function of the presynaptic neuron dopamine and norepinephrine neuron.Jing'an oral liquid has not been able to affect the expression level of COMTmRNA.

张骠教授系南京市中医院主任医师,南京中医药大学教授、博士生导师,从事中医及中西医结合儿科医、教、研工作20余载,中医功底深厚,临证经验丰富.其对小儿咳嗽变异型哮喘(cough variant asthma,CVA)的中医治疗颇有心得,疗效显著.

<正>小儿乃稚阴稚阳之体,肺常不足,固表御邪功能尚弱,加之冷暖不知自调,故易为外邪所犯,导致感冒、咳嗽等肺系疾病,使肺系疾病成为儿科发病率最高的一类疾病。张骠教授系南京中医药大学儿科博

<正>咳嗽变异性哮喘(caugh variant asthma,简称CVA)又名咳型哮喘、隐匿型哮喘,是以慢性咳嗽为主要或唯一临床表现的一种特殊类型的哮喘,曾被称为"过敏性咳嗽",现已将二者明确为两种不同的疾病。国内有研究认为34%的儿童慢性咳嗽是由于CVA所致。流行病学资料显示,大约5%～6%的

简要回顾运脾学说的渊源与沿革,总结其确立与发展的历程,系统阐述该学说的理论基础和临床应用范围。在此基础上,就该学说对儿科临床的指导意义与价值、运脾方药的现代作用机制和运脾学说研究的发展趋势进行了较为深入的探讨。