乌梅丸载于《伤寒杂病论》厥阴篇,历代医家多认为其有温脏安蛔之功,临床应用范围较为局限,自清代医家柯琴提出其为厥阴病之主方后乌梅丸才被医家重视,其临床应用亦得以拓展.乌梅丸证之成因,实则归于厥阴风木气运失常,阴阳不相顺接,而非仅为蛔虫内扰所致.以《黄帝内经》"开阖枢"理论分析六经之功能,并结合《伤寒杂病论》原文可证"阴枢"实为厥阴,乌梅丸为厥阴病之主方,有顺接阴阳之功,故其可治疗厥阴枢机不利,寒热错杂之证.《辅行诀五脏用药法要》与《伤寒杂病论》二者同源,均参考了《汤液经法》所载内容,《辅行诀五脏用药法要》中补泻诸方及救逆方之组成有规律可寻,均依文中所载"汤液经法图"而成,与五行理论密切相关.该文通过探索"汤液经法图"组方规律及药物五行归属,以"汤液经法图"组方规律剖析乌梅丸,可证乌梅丸主要作用于肝、脾、心三脏,依黄帝内经五脏藏神理论,此三脏与情志调节密切相关,故以乌梅丸论治厥阴枢机不利、寒热错杂所致之情志病有据可循,文末亦列举概述近年乌梅丸治疗情志病的报道.该文为临床应用乌梅丸治疗情志病提供了思路及依据,扩展了其应用范围,古方亦能为今用.

临床研究表明卒中后出现抑郁症比无抑郁症的卒中发病率更高,且患者的精神状态较差.随着医疗水平的提升及心身医学的发展,卒中后抑郁(PSD)逐渐受到重视.PSD的病机较为复杂,但总以情志内伤,气机郁结为主,同时肾精不足、肝肾亏虚贯穿本病始终,治疗需在疏肝理气的基础上兼顾补益肝肾,其次再予以辨证论治,临床多将本病分为肝气郁结、肝郁化火、痰气交阻、虚热内扰、心脾两虚、瘀阻脑络等证型.针对其病因病机,常以柴胡配郁金疏肝、清心、解郁;熟地配陈皮补肾益髓,行气健脾;丹皮配栀子清肝泻火除烦;苏梗配半夏行气化痰;柏子仁配酸枣仁养心安神;女贞子配墨旱莲滋补肝肾;白术配太子参补气健脾;龙骨配牡蛎镇惊安神.

"肝藏血,血舍魂"源于五脏藏神理论,其核心内容是肝脏储藏血液和调节血量,肝魂在肝血提供的物质基础上进行神志活动.躯体性焦虑是以躯体症状为主要表现的焦虑症.基于"肝藏血,血舍魂"理论,躯体性焦虑的病机可概括为肝不藏血、肝失疏泄与血不养魂、魂失所舍,可治以养血柔肝、调畅气机及柔肝安魂、调和阴阳,临证可灵活选用疏肝理气解郁、清泻肝火、滋阴降火、活血化瘀等治法.

慢性主观性头晕的发病率高、病机复杂,多为虚实夹杂之证.常常涉及多个脏腑,在临床上主要表现为肝郁化火、肝血亏虚、肝阳上亢、痰浊上扰、痰饮内停等证.临床研究表明焦虑、抑郁等不良情绪可引起慢性主观性头晕,而慢性主观性头晕也会加重抑郁等不良情绪,所以慢性主观性头晕与情绪因素关系密切.因此在治疗时常将疏肝解郁之法贯穿其始终,其次根据辨证予以清肝泻火、平肝潜阳、养血活血、祛痰开窍等治法.结合辨病及辨证,临床常以香附配栀子疏肝解郁,清肝泻火;白芍配钩藤养血敛阴,平肝息风;川芎配当归养血活血;半夏配天麻燥湿祛痰,息风止晕;菖蒲配郁金祛痰开窍;泽泻配白术利水除饮,健脾制水;升麻配柴胡升举清阳;酸枣仁配珍珠母安神定志.

《黄帝内经》提出"五脏藏神"理论,即心藏神、肺藏魄、肝藏魂、脾藏意、肾藏志.基于此,失眠与焦虑共病的内在病机当为"神不得藏",其中以"心神""肝魂""脾意"为辨治重点.心不藏神则神烦,治当安心神,方选天王补心丹加减;肝不藏魂则惊悸,治当归肝魂,方选一贯煎化裁;脾不藏意则郁结,治当宁脾意,方选归脾汤出入.同时,基于五脏一体观,亦应重视肺、肾二脏的藏神功能.各脏神有所藏,则失眠与焦虑得平.附验案1则以佐证.

失眠是临床常见疾病,严重影响患者生活质量及身心健康.毛丽军教授认为,失眠的根本病因病机是阳气常满,不得入于阴,故不眠.在临床工作中毛丽军教授多从临床症状论治,经验丰富,组方灵活,用药考究,见解独特,故将毛丽军教授治疗失眠的经验进行整理.

目的:探讨补阳还五汤联合强力定眩片对后循环缺血(PCI)性眩晕患者眩晕症状、氧化应激及血流指标的影响.方法:选取中国中医科学院西苑医院于2018年12月～2019年12月间接收的80例PCI性眩晕患者,采用信封法将患者随机分为对照组(n=40,常规西医治疗)和研究组(n=40,常规西医基础上增加补阳还五汤联合强力定眩片治疗),比较两组患者临床疗效、眩晕症状、氧化应激及血流指标,记录两组治疗期间不良反应发生情况.结果:治疗2个疗程后,研究组的总有效率高于对照组(P＜0.05).两组患者治疗2个疗程后眩晕障碍量表(DHI)评分、超氧化物歧化酶(SOD)、一氧化氮(NO)水平、椎动脉平均血流速度、基底动脉平均血流速度均升高,且研究组高于对照组(P＜0.05);两组丙二醛(MDA)水平、全血黏度、血浆黏度、红细胞压积均降低,且研究组低于对照组(P＜0.05).两组不良反应发生率比较无差异(P＞0.05).结论:补阳还五汤联合强力定眩片治疗PCI性眩晕患者,可改善患者眩晕症状及血流状况,降低机体氧化应激程度,疗效确切,且用药安全性较好.

目的:系统评价华佗再造丸治疗缺血性脑卒中的疗效和安全性,旨在为临床治疗用药提供循证参考.方法:检索PubMed、Embase、Cochrane Library、中国知网等数据库,筛选华佗再造丸治疗缺血性脑卒中的临床随机对照试验,文献发表日期限定在从建库开始到2020年12月14日.2名研究者独立进行文献筛选及数据提取.采用Cochrane协作网提供的偏倚风险评估工具评估纳入研究的质量.根据异质性大小选择固定或随机效应模型汇总效应估计值.生成森林图以显示汇总结果,使用TSA0.9软件进行试验序贯分析.结果:共纳入16篇文献,包括1616名受试者,观察组827名,对照组789名.Meta分析结果显示,华佗再造丸组在提高治疗有效率(OR=3.36,95％CI为2.43～4.56,P<0.001)、降低NIHSS评分(MD=-2.72,95％CI为-3.72～-1.73,P<0.001)、提高日常生活能力(MD=8.89,95％CI为4.51～13.26,P<0.001)方面优于对照组;仅6项研究报告了安全性指标,有待更多研究以进一步明确临床用药安全性.TSA结果显示,华佗再造丸组治疗缺血性脑卒中有效率更优的证据确切.结论:当前研究表明华佗再造丸联合基础治疗可显著提高缺血性脑卒中患者的有效率,降低NIHSS评分,提高日常生活能力,但其安全性有待进一步确证.由于本研究纳入的研究方法质量偏低,且样本量小,需进一步进行大规模、高质量的研究验证其疗效和安全性.

抑郁症具有患病率高、复发率高的特点.伴随抑郁症复发次数增加,抑郁症对患者心理及社会功能造成负面影响的程度也随之增加.复发性抑郁在中医学中属于"郁证"范畴,情志异常为诱发因素,思虑过多损伤心、肝、脾乃为发病根本环节.复发性抑郁多以心脾不足为本、肝郁气滞为标,属于本虚标实,故在治疗时应从虚论治,以脾、心、肝三脏为重点,以补益心脾、扶助正气为治疗的基本原则,同时要重视滋补阴液.本文对毛教授治疗复发性抑郁的经验进行总结.

目的 探讨脑出血恢复期病人血压变异性与中医证型的相关性.方法 收集2017年1月—2019年12月于北京市海淀区马连洼社区卫生服务站就诊的脑出血恢复期病人,收集中医证素并进行24 h动态血压监测,以血压变异率值表示血压变异性.分析血压变异率与中医证型的关系.结果 54例脑出血恢复期病人中,肝肾亏虚证最多,其次为痰瘀互结证,气虚血瘀证最少.肝肾亏虚证病人年龄高于气虚血瘀证、痰瘀互结证病人.肝肾亏虚证病人病程最长.肝肾亏虚证的血压变异率最高,气虚血瘀症的血压变异率最低.结论 脑出血恢复期病人中以肝肾亏虚证的血压变异率最大,在脑出血恢复期肝肾亏虚证病人的病程最长.

目的 观察益气养阴药对卒中相关性肺炎的预防作用.方法 将80例急性脑梗死病人随机分为试验组和对照组,对照组采用常规西医治疗方法和安慰剂治疗,试验组在对照组基础上使用生脉Ⅱ号口服液治疗,监测两组治疗前后神经功能缺损评分(NIHSS)、Barthel指数、体液免疫指标,并观察卒中相关性肺炎发生情况.结果 治疗14d后,对照组卒中相关性肺炎发生率为20.0％,试验组为22.2％,两组卒中相关性肺炎发生率比较差异无统计学意义(P＞0.05).对照组与试验组NIHSS评分、Barthel指数随时间变化均呈好转趋势,但两组体液免疫指标改善情况差异无统计学意义.结论 益气养阴法对气阴两虚型中风病人卒中相关性肺炎的预防作用不明显,但可改善病人NIHSS评分、Barthel指数.

多系统萎缩(multiple system atrophy, MSA)病变部位广泛，临床表现复杂，依据主要临床表现将多系统萎缩分为黑质纹状体变性(MSA-P)、Shy-Drager 综合征(MSA-A)、橄榄体脑桥小脑萎缩(MSA-C)3个亚型[1]。根据临床表现，MSA应属于中医“痿证”“眩晕”“晕厥”“阳痿”“遗尿”范畴[2]。周绍华是中国中医科学院西苑医院专家委员会委员，博士生导师，全国著名中医专家第二、三届师带徒导师。MSA虽分型不同、病名各异，但周教授认为MSA的3种亚型之间存在着共同的发病机制，在应用中药治疗MSA、运动神经元病、帕金森氏病等方面经验丰富，现将其治疗MSA的相关经验介绍如下。

误吸是卒中相关性肺炎的常见危险因素，其中隐性误吸更应引起临床工作者关注。由于脑卒中病人气道保护性反射的减弱，使得隐性误吸的概率大大增加，而传统鼻胃管对于隐性误吸并不具有预防作用。因此，对于急性脑卒中病人，在应用鼻胃管减少误吸的同时，加强口咽部卫生的管理，进一步探究卒中后免疫抑制状态在卒中相关性肺炎中的作用机制，从根本上增强病人的抗病能力，应成为下一步研究工作的重点。

Objective] To observe the clinical effects of Tianwang Buxin decoction in the treatment of heart Yin deficiency type of Generalized Anxiety Disorder. [Methods] 63 patients with Generalized Anxiety Disorder(heart Yin deficiency type) were randomly divided into three groups: Tianwang Buxin decoction group, paroxetine group, Tianwang Buxin decoction combined paroxetine group, course of treatment for 8weeks.Contrast the scores of three groups by HAMA before and after treatment. [Results] The clinical efficacy was almost the same among the three groups without significant difference, but the decrease of HAMA scores of Tianwang Buxin decoction combined paroxetine group was obviously lower than Tianwang Buxin decoction group and paroxetine group(P<0.05), among which, TCM group and combination group of TCM and WM had less side effect than WM group. [Conclusion]The clinical efficacy of Tianwang Buxin decoction group is almost the same with the paroxetine group without significant difference. The clinical efficacy of Tianwang Buxin decoction combined paroxetine group is more significant.

Objective To investigate the effect of Jiawei Wendan decoction(JWD)in the treatment of generalized anxiety disor-der(GAD)with phlegm heat syndrome.Methods Ninety patients with GAD and phlegm heat syndrome were randomly divided into three groups:Group A treated with JWD,group B treated with paroxetine,and group C treated with JWD and paroxetine for 4 weeks. The efficacy was observed.Results The improvement of the Hamilton Anxiety Scale (HAMA)and self rating Anxiety Scale (SAS)in group C were better than those in group A and group B(P< 0.05).The adverse reaction in group C was less than that in group B(P<0.01).Conclusion JWD was effective for the treatment of GAD with phlegm heat syndrome.JWD combined with paroxetine could re-duce the side effects of western medicine.

To investigate the neuroprotective effect and underlying machanism of cysteamine on 1-methy1-4-phenylpyridinium(MPP+)induced SH-SY5Y cell model.Methods MPP+-induced SH-SY5Y cell model was established with the purpose of observation protective effect and the protection mechanism of cysteamine.The protection of cysteamine on MPP+ induced neurontoxicity was estimated by 3-[4,5-dimethylthiazol-2-yl ]-2,5-dipheryltetr azolium bromide(MTT).The underlying mechanism of neuroprotection was determined by oxidative stress indicators,such as:malondialdhyde(MDA),reaction oxygen(ROS),antioxidant antioxidant glutathione(GSH).Results①The highest cell survival rate was observed at the dose of cysteamine (CS)400μmol/L in MPP+ treated SY5Y cell model after CS pretreatment at 24 hours.② CS 400μmol/L pretreatment can effectively reduce the MPP+-induced intracellular ROS and MDA level.③CS 400 μmol/L pretreatment can significantly increase the cellular antioxidant GSH levels.Conclusion CS has neuroprotective effect in SY5Y cell models.The neuroprotective effect is likely through inhibiting the oxidative indicators,promoting synthesis of cellular GSH.

Objective To investigate the protective mechanism of cysteamine(CS) on dopaminergic neurons in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)-lesioned C57BL mice model.Methods Seventy-eight C57BL mice were randomly divided into six groups:control group,MPTP model group,CS 20 mg/kg+MPTP group,CS 75 mg/kg+MPTP group,MPTP+CS 20 mg/kg group and MPTP+CS 75 mg/kg group.MPTP 20 mg/kg,intraperitoneal injection,twice daily for two days,interval 12 hours;once daily for three days.Pretreatment of CS in 2 doses(20 mg/kg,75 mg/kg) subcutaneous injection twice daily for four days,prior to MPTP;CS treatment was used at the beginning with MPTP;the total course of treatment lasted for 14 days.The mice were decapitated after the last injection,dopamine(DA) concentration was measured in striatum by reversed phase high performance liquid chromatography-electrochemistry,and tyrosine hydroxylase(TH) was measured by immunohistochemistry in substantia nigra,oxidative stress indicators in substantia nigra were detected by chromatography.Results DA levels in striatum and the number of TH-positive neurons in substantia nigra were significantly reduced in MPTP-lesioned mice compared with those of control group(P0.01);CS(20 mg/kg),pretreatment significantly increased DA content in striatum and the number of substantia nigra dopaminergic neurons compared with MPTP group(P0.01).The protective mechanism was that CS(20 mg/kg) inhibited ROS,MDA,and promoted the synthesis of intracellular GSH.Cysteamine(75 mg/kg) pretreatment and treatment group(20 mg/kg,75 mg/kg) did not show the protective effect against MPTP damaged dopaminergic neurons and DA content in striatum(P0.05).Conclusion The protective effect of CS(20 mg/kg) on dopaminergic neurons damaged by MPTP in the PD mice model is due to its antioxidant abilities.Effect of CS on dopaminergic neurons is correlated with its dose.

目的 观察半胱胺对MPTP所致C57BL小鼠帕金森病(PD)模型多巴胺能神经元的影响.方法 取78只SPF级C57BL小鼠,随机分为6组:对照组,MPTP模型组,半胱胺预防性给药组(半胱胺20、75 mg/kg+ MPTP组),半胱胺治疗组(MPTP+半胱胺20、75 mg/kg组).半胱胺预防性给药组(20、75 mg/kg),2次/d×4 d,皮下注射,再给以MPTP;半胱胺治疗性给药与MPTP同天给药；总疗程均为14 d.高效液相谱检测纹状体多巴胺(DA)的含量；免疫组化检测黑质酪氨酸羟化酶阳性细胞.结果 半胱胺(20 mg/kg)预防组有效地减少MPTP导致的黑质DA能神经元和纹状体DA含量的降低(P＜0.01).结论 半胱胺(20 mg/kg)有效地预防MPTP引起的多巴胺能神经元损害,保护作用与剂量有关.

This article introduces Professor Zhou Shaohua's experience in treating neurological and mental disease with herbal medicine,including single medicine for multiple use,using potent herbs,paired herbs and guiding herbs,attention to the quality,process of herbs and the different effects of herbs with the same name.

Objective Explore the effect of generalized anxiety disorder by TCM treatment.Methods Inclusion criteria would be in line with the 63 cases of patients with anxiety disorder were randomly divided into three groups,chinese medicine group were treated in accordance with the differentiation of different decoction of Chinese medicine one day,and medicine with the permit change;Western medicine oral paroxetine group,taking a daily morning;The other group were given paroxetine daily agents and a daily one,determine the effect after 6 weeks.Results The overall efficiency of the three groups have similar statistical test was no significant difference,TCM and western medicine group comparison group does not keep statistics on the cure rate learning differences,in group of Chinese and Western Medicine,western medicine group and comparison group with a significant difference between the cure rate,TCM with western medicine group there is no significant difference in cure rate group.Conclusion Traditional Chinese Medicine Combined with Western Medicine in the treatment of generalized anxiety disorder,clinical cure rate is significantly better than the use of Western medicine(paroxetine),and less adverse reaction.Prompt treatment of generalized anxiety disorder by TCM has a certain advantage.