目的 观察中药丹栀逍遥散对广泛性焦虑(GAD)大鼠脑Papez环路上神经营养因子[脑源性神经营养因子(BDNF)、碱性成纤维生长因子(bFGF)、神经生长因子(NGF)]及脑源性神经营养因子受体(TrkB)、碱性成纤维生长因子受体(bFGFR)表达的影响.方法 将雄性Wistar大鼠随机分为正常组、模型组、中药组(丹栀逍遥散组)和西药组(盐酸丁螺环酮组),每组8只.模型组、中药组、西药组采用天敌暴露饮水冲突刺激法建立GAD大鼠模型.中药组和西药组分别以丹栀逍遥散和盐酸丁螺环酮水溶液灌胃,每天1次,连续21 d.正常组和模型组蒸馏水灌胃21 d.造模成功后,取脑组织,行石蜡切片,免疫组织化学SP法检测Papez环路内海马(CA1、CA2、CA3、DG区)和杏仁核、丘脑前核的BDNF、TrkB、bFGF、bFGFR及NGF的表达.结果 与正常组比较,模型组海马各区和杏仁核区TrkB、NGF的表达水平明显降低(P<0.05或P<0.01);模型组海马各区bFGF、bFGFR的表达水平明显升高,杏仁核区的表达水平明显下降(P<0.05或P<0.01);模型组海马各区及杏仁核区、丘脑前核区的BDNF表达与其他3组间比较,差异均无统计学意义(P>0.05),但海马CA1区模型组与正常组有下降趋势.与模型组比较,中药组海马各区和杏仁核区bFGF、TrkB、NGF的表达水平明显升高(P<0.05或P<0.01);中药组海马各区和杏仁核区bFGFR的表达水平明显升高,西药组海马各区和bFGFR的表达水平明显降低(P<0.05);丘脑前核区的表达在模型组与正常组以及中药组与西药组之间的比较,差异均无统计学意义(P>0.05).结论 经过中药丹栀逍遥散干预的GAD大鼠,海马和杏仁核区内bFGF与其受体bFGFR,BDNF的受体TrkB和NGF的表达水平明显回升,有利于bFGF、BDNF、NGF更好地发挥其生理功能,促进损伤脑区局部微环境的恢复,增强神经可塑性,保护神经元,抑制凋亡与坏死,促进神经的修复以及神经干细胞的增殖与分化.提示疏肝清热健脾法能够通过刺激神经营养因子在海马及杏仁核内的表达来发挥其促神经修复功能.

Background:Guillain-Barre syndrome（GBS） is an acute demyelinating polyneuritis in which the immune system attacks part of the peripheral nervous system.About two-thirds of GBS patients have a history of acute infection before developing GBS.Immunotherapy and supportive therapies are widely used to treat GBS;however,one in three patients experiences neurologic sequelae.In China,acupuncture-moxibustion has shown unique benefits for the treatment of neurological diseases and has a wide range of applications in neurology.Case presentation:We treated an elderly Russian female patient diagnosed with GBS.The chief complaints were upper limb weakness,lower limb paralysis,and inability to self-care.The traditional Chinese medicine diagnosis was flaccidity syndrome（Wei Zheng）.After 5 weeks of acupuncture and moxibustion combined with Chinese patent medicine treatment,the patient’s limb muscle strength was significantly improved and her ability to self-care was largely restored.Conclusion:The present findings demonstrated that acupuncture and moxibustion combined with Chinese patent medicine can alleviate muscle weakness caused by GBS.However,clinical randomized controlled trials are warranted to verify the precise clinical efficacy.

Objective:To explore acupuncture and moxibustion acupoints for the treatment of dysmenorrhea and provide the data for acupoint selection.Methods:The clinical research data for treatment of primary dysmenorrhea in recent 20 years was reviewed and the results were sorted out,analyzed and summarized.Results:A total of 179 clinical cases on primary dysmenorrhea were treated with acupuncture and moxibustion,76 acupoints were involved,970 times.Conclusion:The basic rule of treating primary dysmenorrhea with acupuncture involves applying treatment to foot meridian and Yin meridian,the application to three Foot meridians is considered especially effective.Amongst meridians,the key ones are Ren meridian and three Foot meridians.The most important acupoints are:Sanyinjiao (SP6),Guanyuan (RN4),Qihai (RN6),Diji (SP8),Zusanli (ST36),Zhongji (RN3),Taichong(LR3).Treatment involves checking out meridians and applying to the correspondent acupoints.

目的:观察基于肩部经络循行指导的温针灸治疗肩周炎的临床疗效.方法:检索22部古籍和11种期刊中针灸治疗肩周炎的文献并进行整理,统计穴位和使用频率,总结出研究肩周炎的经脉、诊察部位、精确的诊察定位.收集近2年共82例肩周炎患者,随机分为2组,分别使用肩部经络循行指导下温针灸治疗和局部温针灸治疗肩周炎,治疗结束时比较2组肩关节功能综合评分和治疗有效率.结果:和局部温针灸组相比,肩部经络循行指导下温针灸治疗组疼痛评分及总有效率均显著改善,差异均具有统计学意义(P＜0.05).结论:肩部经络循行指导下温针灸治疗肩周炎优势明显,疗效肯定,值得临床推广.

Background: Stress urinary incontinence（SUI）, is the most common type of urinary incontinence affecting women. SUI has a significant impact on psychosocial functioning and quality of life. Biomedical treatments, such as surgery, often result in post-operative complications. In China, traditional Chinese medicine tends to be the treatment of choice for SUI.Case presentation: We present a 35-year-old patient who developed SUI following forceps delivery and was treated successfully with acupuncture and Chinese herbs. Traditional Chinese diagnosis, including channel and acupoint palpation revealed the patient had a syndrome pattern of liver/kidney deficiency, disordered bladder qi transformation, all of which lead to enuresis. Acupuncture, both body and scalp needling, were performed. Herbs were prescribed adjunctively.Conclusion: Traditional Chinese medicine modalities may be considered for treatment of SUI based on appropriate syndrome pattern assessment.

Introduction: Standard treatments are often unsatisfactory on chronic urticaria (CU). Acupoint stimulation, including acupuncture, electroacupuncture, acupoint catgut embedding, acupoint injection, has shown benefit about alleviating itching, reducing amount and range of the lesions. However, the methodological quality of these trials is unknown. Thus, the objective of this review is to evaluate the quality and effectiveness of acupoint stimulation for chronic urticaria.Methods: We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, CNKI, CBM, VIP, Wanfang databases from January 1966 to June 2015. Randomized controlled trials (RCTs) on acupoint stimulation for CU were included. The Cochrane risk of bias tool was used to evaluate methodological quality.Results: Eight RCTs met the inclusion criteria, which were all low quality. Acupuncture plus other treatment was significantly superior to western medicine alone and autologous blood injection plus herbal medicine was better than herbal medicine alone in increasing the number of cured patients.Conclusions: Acupoint stimulation may provide benefit in CU; however, more large scale, high quality studies are needed for assessing the effects before it is recommended. (C) 2015 The Authors. Published by Elsevier GmbH.

目的观察醒脑静注射液联合纳洛酮治疗急性重度酒精中毒的临床疗效。方法将58例急性重度酒精中毒患者随机分为两组,在常规治疗基础上,对照组28例单用纳洛酮治疗,治疗组30例予以醒脑静注射液联合纳洛酮治疗;比较两组意识恢复正常时间和运动功能恢复正常时间。结果治疗组意识和运动功能恢复正常时间均显著短于对照组。结论醒脑静注射液与纳洛酮联合治疗急性重度酒精中毒,其疗效显著优于单纯使用纳洛酮。

我们采用益气活血涤痰解郁法,用自拟醒脑解郁汤治疗中风后抑郁,取得满意疗效,现报道如下. 一般资料 病例诊断标准:依据中国精神疾病的分类和诊断标准和第2版修订(CCMD222R)对脑卒中后抑郁障碍的诊断标准.

我们采用益气活血涤痰解郁法自拟醒脑解郁汤治疗中风后抑郁症,取得满意疗效,现报道如下. 一般资料 入组标准:①首发脑卒中,经CT或MRI证实为脑血管意外,病程在半年以上,并存在不同程度神经功能缺损症状者.②抑郁自评量表(SDS) > 41 分提示可能存在抑郁.③汉密尔顿抑郁量表(HAMD ,24项) 评分≥20分[1].

目的观察强心汤治疗慢性肺源性心脏病急性发作期的临床疗效。方法将72例肺源性心脏病急性发作期患者随机分为两组,均予氧疗、缓解支气管痉挛、控制肺部感染、扩张血管、强心、利尿等西医常规治疗,治疗组加服强心汤;两组均治疗14d。结果治疗组总有效率高于对照组;两组中医证候积分、动脉血气、心脏射血分数等各项指标较治疗前均明显改善,治疗组改善优于对照组。结论慢性肺源性心脏病急性发作期采用中西医结合综合治疗方案,能提高总体疗效,有效缓解心力衰竭症状及体征,改善心功能,提高生活质量。

目的观察自拟方羚茅汤联合醒脑静注射液治疗脑卒中昏迷的临床疗效。方法将符合中风中脏腑痰火闭窍证的67例脑卒中昏迷病人随机分为治疗组35例和对照组32例,对照组以醒脑静注射液和西医综合治疗,治疗组加用中药自拟方羚茅汤治疗,比较两组患者的清醒时间、中医证候积分、并发症的发生率及神经功能的改善和总有效率。结果治疗组总有效率、清醒时间和中医证候积分、神经功能缺损的改善明显优于对照组,两组差异有统计学意义;而并发症的发生率虽然低于对照组,但无统计学意义。结论羚茅汤联合醒脑静注射液具有协同之功效,能够缩短脑卒中昏迷患者的意识恢复时间,最大程度改善神经功能缺损评分和中医证候,降低死亡率。

<正>痞满证是指心下痞塞,胸膈满闷,触之无形而不痛的证候,主要见于消化系统多种疾病的发展过程中。王宝玉老师是北京市第三批师承指导专家,从医30余年,在消化系统疾病、肺系病、脑病及内科杂病等方面积累了丰富的临床经验,其中对痞满证的诊治具有自己独到的见解,

王宝玉医师在临床上应用四妙丸治疗多种疾病取得一定疗效,现举例如下. 慢性前列腺炎 患者,男,35岁,于2003年9月13日初诊.4年前无明显诱因出现排尿疼痛不利,尿色黄,尿液时有浑浊,伴腰痛和少腹疼痛不适,会阴睾丸偶有坠胀.未系统诊治,近1个月症状明显加重.伴有性功能障碍,食欲不振,舌质红,苔黄腻,脉弦滑.嗜酒史10余年.查前列腺液:白细胞15～20个/HP,磷脂小体(+).诊断:慢性前列腺炎.中医诊断:精浊.辨证:湿热蕴结.予以清热化湿通淋法.方药以四妙丸加减:苍术12g,黄柏15g,生薏苡仁30g,牛膝12g,木香6g,乌药12g,香附10g,王不留行12g,蒲公英20g,玄参15g,木通6g,车前草10g.服药期间禁饮酒及浓茶、咖啡等饮品.服用7剂后,排尿疼痛不利减轻,尿浑浊好转,仍有尿色黄,舌质淡红,苔薄黄,脉弦.上方减木通、车前草,加当归9g,紫草10g.继续服用10剂,自觉腰痛及睾丸坠胀减轻.再服7剂后症状基本消失,复查前列腺液白细胞3～5个/HP.效不更方,再服10剂以巩固疗效.随访2个月未复发.

近年来,现代医学对肺心病的研究虽有长足的进步,但在治疗方面仍无一种堪称理想的方法.作为一线药物的利尿剂、血管扩张剂、强心甙等都有较大的毒副作用,且远期疗效尚不清楚.中医药注重人体整体机能的调理,加之中药副作用少,适宜肺心病长期使用.王宝玉主任在30多年的临床实践中积累了一些经验,现将随师学习心得整理如下.

慢性肺源性心脏病(简称肺心病)的急性加重期是呼吸科应诊率较高的一种急症,患者以咳喘、气急、呼吸困难、心悸、水肿、唇甲紫绀、颈静脉怒张、腹胀等症状为主要表现,可以在几天内病情加重恶化.