目的 通过免疫组织化学法、Western blot免疫印迹法测定脑缺血再灌注大鼠脑组织内巢蛋白的表达及其相对含量水平变化,研究脑脉通、骨髓间充质干细胞移植及其联合促进神经细胞再生的作用机制.方法 青年SD大鼠,清洁级,190只,雌雄各半;随机数字表法进行2次随机分组:第1次分为假手术组和手术组,手术组包括模型组、BMSCs移植组(简称移植组)、脑脉通组、BMSCs移植联合脑脉通组(简称联合组),假手术组为10只大鼠,其余各组45只;第2次对手术组按取材时间点各分为7d、14 d、28 d组,每组各15只.参照改良的Longa法制备局灶性脑缺血动物模型,术前4天脑脉通和联合组给予脑脉通[40.5 mg/(100 g·d),40.5 mg/mL]灌胃,假手术组、模型组和移植组以同等容积的生理盐水灌胃,1次/d;术后3h缓慢拔出线栓进行缺血后再灌注;再灌注后24 h移植组和联合组由颈内动脉给予BMSCs悬液,模型组、脑脉通组颈内动脉给予同等体积的生理盐水;每只大鼠分别于术后48 h以及术后7d、14 d、28 d评测神经功能,术后7d、14 d、28 d取材,应用免疫组织化学法、Western blot蛋白免疫印迹法从蛋白水平观察各组大鼠脑组织中巢蛋白的表达以及相对含量的变化,结合图像分析技术及统计学分析进行结果分析.结果 正常大鼠脑组织中可见巢蛋白的少量表达;缺血再灌注损伤后大鼠脑组织中巢蛋白的表达呈现先高后低再低的特点;与模型组比较,移植、脑脉通、联合组大鼠巢蛋白的表达增加显著(P＜0.05,P＜0.01,P＜0.01);与脑脉通组比较,移植7d组巢蛋白的表达显著增加(P＜0.01);与移植组比较,脑脉通14 d组、28 d组大鼠巢蛋白阳性表达显著性增加(P＜0.05);与联合组比较,其各时间点巢蛋白表达均较移植组、脑脉通组增加显著(P＜0.01);同组不同时间点比较,移植7组巢蛋白表达较其14 d组、28 d组增加显著(P＜0.01);脑脉通7d组、14 d组巢蛋白表达较其28 d组增加显著(P＜0.01);联合7d组大鼠巢蛋白阳性表达较14 d组、28 d组增加显著(P＜0.01).结论 大鼠脑缺血再灌注损伤可诱导脑组织中巢蛋白重新表达并且其表达随再灌注时间呈规律性变化,具有明显的时空表达模式;骨髓间充质干细胞移植、中药脑脉通及其联合可促进巢蛋白的表达,并且两者联合后效果明显.

目的 探讨冠心病不同阶段患者痰瘀互结证分布规律.方法 运用临床流行病学横断面调查方法,将全国6个地区48家临床研究中心的11 383例健康人群及冠心病不同阶段患者分为健康对照组、低危人群组、代谢综合征组、冠心病稳定期组、急性冠脉综合征组、介入治疗围手术期组、冠心病心力衰竭组6组,参照《冠心病痰瘀互结证宏观诊断标准》对6组人群痰瘀互结证的分布规律进行描述,并对证的量化评分进行分析.结果 1)痰湿证分布(占比)与量化评分(95％置信区间)呈现健康对照组(27.7％,3.4～3.8分)、低危人群组(43.3％,5.0～5.4分)、代谢综合征组(65.1％,7.4 ～7.9分)、冠心病稳定期组(75.1％,9.0 ～9.3分)、急性冠脉综合征组(78.5％,9.3～10.0分)、冠心病心力衰竭组(78.6％,9.5 ～10.2分)依次增高趋势.2)血瘀证分布与量化评分呈现健康对照组(6.8％,1.0～1.3分)、低危人群组(16.0％,2.2 ～2.4分)、代谢综合征组(21.9％,2.9 ～3.3分)、冠心痛稳定期组(63.5％,7.9～8.3分)、冠心病心力衰竭组(69.2％,8.8 ～9.5分)、急性冠脉综合征组(78.9％,10.0 ～ 10.8分)依次增高趋势.3)痰瘀互结证分布与量化评分呈现健康对照组(3.0％,4.5 ～5.0分)、低危人群组(8.9％,7.2 ～7.7分)、代谢综合征组(15.8％,10.3～11.0分)、冠心病稳定期组(51.2％,16.9 ～ 17.5分)、冠心病心力衰竭组(57.2％,18.3 ～ 19.5分)、急性冠脉综合征组(64.7％,19.4 ～20.6分)依次增高趋势.4)不同地区冠心病患者痰湿证、血瘀证、痰瘀互结证分布及量化评分差异均具有统计学意义(P＜0.05).华北和西北地区的冠心病患者痰瘀互结证占比及程度重于其他地区,而华东地区冠心病患者的痰湿证、血瘀证、痰瘀互结证占比及程度均为最轻.南方(含华南与西南)地区患者在冠心病前阶段(健康对照组、低危人群组、代谢综合征组)痰湿证、血瘀证、痰瘀互结证占比及程度均重于其他地区.结论 痰瘀互结证是贯穿冠心病全程的主要证候,并且存在一定的地域差异.

目的 建立扎里奴思方的UPLC-PDA指纹图谱及多成分含量测定方法.方法 采用Waters ACQUITY UHPLC T3(2.1 mm×100 mm,1.7μm)色谱柱,流动相为乙腈(A)-0.1％甲酸水溶液(B),梯度洗脱,流速0.4 mL/min,柱温30℃,检测波长317 nm;采用UPLC-PDA对其中9种物质进行含量测定.结果 共确定扎里奴思方指纹图谱13个共有色谱峰,通过对照品比对出其中9个共有峰.10批样品指纹图谱相似度为0.923～0.983.9种物质在一定浓度范围内呈良好线性关系,r值均大于0.9990;含量测定结果表明肉桂酸、没食子酸含量较高.各物质回收率在98.82％～102.91％之间,RSD均小于2.52％;样品在24 h内稳定,重复性良好.结论 建立了扎里奴思方指纹图谱分析方法及含量测定方法,该方法简便、重复性良好,可为进一步完善扎里奴思方质量控制方法提供参考.

为归纳整理中医文献对痴呆的认知.按照历史脉络,从病名、病位、病因病机、论治之要,论治方药的顺序对痴呆进行梳理.认为痴呆隶属于中医学“善忘”、“健忘”、“呆病”、“中风后善忘”、“中风后神呆”等病证之范畴;其病位虽在脑,但辨治涉及心、肾、脾胃、肝和肺等多脏腑;痴呆的病理要素,以气、火、痰、瘀、虚为主,临床可根据患者的体质、感邪种类等差异,既可单独为患,亦可兼挟发病.临证辨识当以具体表现为依据,以四诊辨证为准绳.治疗以虚则补之、实则泻之为原则,以脑为首,从五脏分治,以心肾为主,兼及他脏.通过按历史脉络对历代医家论治痴呆名方进行归纳整理,结合现代中医文献研究分析后,中医认知、防治痴呆的思路进一步明朗清晰,即以滋肾益髓、补心健脾为主,兼安心神,疏肝气,祛痰浊、活血瘀,交心肾、清心火.且此辨治经验承上启下、澄源彻流,对后世及当今论治痴呆病证的影响甚大,其借鉴意义极强.

目的:对近年中医病证结合治疗急性缺血性中风的相关临床研究进展进行总结,为临床治疗急性缺血性中风提供参考.方法:检索中国知网、万方数据库中相关文献,检索词为“急性缺血性中风、病证结合、临床研究”,检索式为“并”,根据文献筛选标准纳入与中医病证结合治疗急性缺血性中风密切相关的研究,并排除重复的研究.结果:检索到中国期刊全文数据库(CNKI)论文287篇,剔除113篇,初读后选取56篇进行精读.结论:病证结合是现代中医诊疗发展的新思路,是治疗疾病的新方法,将使中医以其更加独特的优势指导临床治疗,为中风病的治疗和预后提供新的诊疗体系.

刘敬霞教授认为,痰瘀互结而蒙蔽脑窍是引起中风后血管性痴呆的病机关键,逐瘀化痰开窍治法对改善认知功能和促进学习记忆能力修复具有重要作用.因此在治疗中风后认知功能障碍上以化痰逐瘀开窍法为主,兼以补益肝肾、益气活血通络.再根据患者的具体兼证佐以加减,主方用补阳还五汤合半夏白术天麻汤化裁以化痰逐瘀、补气活血通络、开窍醒神治疗.

随着现代生活水平的提高,耳鸣的发病率逐年增多,刘敬霞教授以辨证通窍法治疗耳鸣,认为耳鸣辨证应当分单侧及双侧,其中单侧主要与肺及呼吸道相关,双侧主要与脉管填塞相关,治疗上注重中医辨证与西医辨病相结合,临证采用祛风散寒通窍、逐瘀通窍、升阳通窍及化浊通窍的治法,注重患者平素的饮食、情志调节,达到辨证通窍治疗耳鸣的目的.

Objective To observe the effects of Zhali Nusi Fang(ZLNSF) on recovery of neurological function in patients with acute cerebral infarction of different syndromes,and to clarify the appropriate syndrome for ZLNSF.Methods 150 patients with acute cerebral in-farction were divided into five groups according to syndrome differentiation,including syndrome of phlegm and blood stasis,syndrome of phlegm heat and bowel excess,syndrome of qi deficiency and blood stasis,syndrome of wind and fire on the disturbance card,syndrome of Yin deficiency and wind stirring.The clinical efficacy,neurological deficit(NIHSS) score and the daily living activity(ADL)score of each group were compared before and after treated.Results The NIHSS score of patients was significantly lower, ADL score was significantly higher (P<0.05),especially 7 and 14 days after treated.The patients with phlegm and blood stasis syndrome were improved more than others.Con-clusions ZLNSF could promote the recovery of defects nerve function,improve the activities of the adverse and daily living capacity decline after cerebral infarction,which is particularly evident in patients of phlegm and blood stasis syndrome,this role is consistent with the effects of phlegm and blood stasis of ZLNSF.

目的 探讨中西医结合对急性脑梗死患者TNF-α、IL-6及血液流变学的影响.方法 选择2016年3月~2017年3月我院收治的脑梗死患者70例作为研究对象,随机分为观察组、对照组,每组各35例,对照组予控制血糖、降压及调节血脂治疗,合并感染的患者给予抗感染治疗,观察组在对照组基础上加用自拟"芪蛭五藤通脉方",比较两组患者治疗前后TNF-α、IL-6水平及血液流变学指标的变化情况.结果 观察组患者治疗后的临床总有效率94.3%、显著高于对照组的77.1%,差异具有显著性(P<0.05);观察组患者治疗后的IL-6、TNF-α水平明显低于治疗前及对照组,差异具有显著性(P<0.05),观察组患者治疗后的全血黏度高低切变率、血浆黏度、红细胞压积及纤维蛋白原水平明显低于治疗前及对照组,差异具有显著性(P<0.05).结论 在常规西医治疗的基础上联合芪蛭五藤通脉方中西医结合治疗脑梗死可以显著提高临床疗效,抑制炎症反应,同时通过降低血液黏滞度及血浆纤维蛋白原水平而有利于预防脑梗死血栓形成,值得临床推广.

通过中医回医文献、临床研究等方面,对痰浊的形成及其病因病机、论治体系进行梳理.认为五脏失和与气血津液失常为痰浊基本机制,脾为生痰之源,肾为生痰之本,肺为储痰之器;肝郁气结、心之血脉瘀滞则津停凝结为痰浊;五脏皆生痰浊,其致病多属本虚标实.其次,中风多因体虚,与痰浊密切相关.回医痰浊理论与中风:四性、四液禀性衰败为痰浊病理根源;脑主脏腑,脑经主司全身脏腑经络,痰浊交阻脑经,脑元失养失用而发中风,化痰浊与通利脑经防治脑中风.为完善回医对中风的理论认知,丰富回医药治疗中风的手段与方法,提高临床疗效提供依据.

李遇春教授经过多年临床实践,自拟解郁安神汤,坚持"病症结合,宏观辩证和微观辩证相参"的学术思想,擅用解郁安神汤化裁治疗各科疾病,虽然其主症特点各异,但分析证候,始终围绕情志不舒、肝脏功能失调的病机,体现了中医"异病同治"的思想.此外,李老在临床药物治疗的同时注重配合精神治疗和心理辅导,善用药对,随症加减,疗效显著.

刘敬霞教授擅长运用化痰祛瘀方法治疗缺血性中风患者,临床取得较为良好的治疗效果.

This paper introduces professor LIU Jingxia's clinical experience of treating hypertension by drug pairs.Professor LIU suggests that the incidence of hypertension is due to emotional internal injuries,diet,deficiency of kidney.The pathological properties are both deficiency and excess.The deficiency and excess situation can tranform each other.We should pay attention to the whole concept and syndrome differentiation and treatment in clinic and keep the thought of body differentiation-disease differentiation-sydnrome differentiation.In the medication,professor LIU especially pays attention to drug pairs and drug pairs are the bridge of single herb and compound and the basis of compatibility,which can not only enhance the efficacy,but also reduce toxicity and side effects.The clinical curative effect is distinct when flexible compatibility in clinic.

刘敬霞教授治疗颈动脉斑块形成的经验,认为颈动脉斑块形成大体可分为内因和外因,内因年老体衰,肾精不足,脾失健运,气血亏虚,经脉失养,血液凝滞所致脉道闭塞不通,治以健脾益气,活血化瘀;外因风寒湿热之邪侵袭血脉,脉道闭阻不通,治以祛风散寒,清利湿热,活血化瘀.将从病因病机,选方用药,辨证论治,病案举隅四方面对刘敬霞教授治疗颈动脉斑块形成的思想进行总结,以飨同道.

Professor LIU Jingxia believes that the mutual closure of phlegm and blood stasis is the key to the pathogenesis of this disease; In clinical practice, with the combination of Chinese and western, it should pay attention to the combination of disease differentiation and syndrome differentiation and determination of etiologic factors based on differentiation.To take boosting qi and freeing vein therapy as the rule,use Huangqi Wuteng Decoction as the basic prescription, flexibly treat according to the differentiation with addition and subtraction.

Glycyrrhiza uralensis Fisch. (G. uralensis) is one of the most widely used herbal medicines. This study was designed to enrich total flavonoids (TFF) from G. uralensis. The chemical profile of TFF was identified by HPLC and colorimetric assay. The TFF mainly contained liquiritin apioside, liquiritin, isoliquiritin apioside, liquiritigenin and isoliquiritigenin without glycyrrhizic acid. To study the anti-inflammatory activity of TFF, the DMB-induced ear vasodilatation assay and carrageenan-induced rat paw edema model have been utilized. Treatment with TFF showed significant anti-inflammatory activities in the two models. The two in-vivo edema assays demonstrated that the TFF possesses significant dose-dependent anti-inflammatory activity, similar to that of indomethacin at a dose of 500 mg/kg. In rat paws with carrageenan, treatment with TFF (500 and 250 mg/kg) markedly inhibited the expression of IL-1β and iNOS. TFF at all doses noticeably decreased levels of NO and MDA at the site of inflammation, while only i.g. TFF at a dose of 500 mg/kg significantly decreased TNF-α levels in the carrageenan-injected paws. In addition, an increase in SOD activity was induced by TFF at all doses. These results revealed that TFF exhibited significant anti-inflammatory activity in acute inflammatory models.

目的:探讨芪蛭五藤通脉方对脑血栓的治疗效果.方法:将100例脑血栓患者随机分为研究组和对照组,每组50例.对照组采用常规西药治疗,给予控制血糖、降低血压及调节血脂.研究组在常规西药治疗基础上服用自拟"芪蛭五藤通脉方".两组均于治疗1个月后评价疗效及不良反应发生率.比较两组治疗前、后神经功能(NIHSS评分)、血微循环指标(全血黏度、血浆黏度、红细胞压积)变化情况.结果:研究组治疗总有效率明显高于对照组(96.0％VS 74.0％,P<0.01).两组不良反应发生率比较差异无统计学意义(2.0％VS 4.0％,P>0.05).两组治疗后全血黏度、血浆黏度、红细胞压积、NIHSS评分均明显低于治疗前,差异均有统计学意义(P<0.05).研究组治疗后全血黏度、血浆黏度、红细胞压积、NIHSS评分均明显低于对照组治疗后,差异有统计学意义(P<0.05).结论:芪蛭五藤通脉结合西医治疗能够有效缓解脑血栓的临床症状,改善神经功能和机体微循环的高凝状态,促进患者早日康复.

补中益气汤是金元四大家之一的李东垣所创的方剂,李遇春教授擅用补中益气汤化裁治疗各科疾病,体现了中医“异病同治”的思想.李教授认为临证运用补中益气汤在益气健脾、滋养胃阴的同时,要标本兼治,其中以脾胃虚弱为本,气火痰瘀等病邪为标,治疗过程中亦要重视其病机寒热错杂、虚实并见.与此同时,李遇春教授坚持“病症结合,宏观辨证和微观辨证相参”的学术思想,善用药对,随症加减,疗效显著.

缺血性脑血管病是指脑部血液供血不足引起的脑组织缺血性损害,使局部血液循环所提供的氧和其它营养物质与神经元代谢需求之间骤然供应与需求不平衡,最终导致缺血中央区的神经元坏死的一类疾病,其临床表现为肢体无力、偏瘫、感觉障碍、语言障碍、视觉障碍、共济失调等[1].脑血管疾病是造成人类死亡的三大疾病之一,具有高发病率、高病死率、高致残率的特点,严重危害人类健康并降低患者的生存质量.缺血性脑卒中是由于大脑主要动脉的血流短暂或持久阻断所引起,占脑卒中的70％ ～90％.研究表明,缺血性脑卒中的发病由多因素、多环节造成,其发病机制涉及由血管闭塞引起的缺血中心区和缺血半暗区的细胞功能衰竭、脑组织能量代谢、兴奋性氨基酸毒性、自由基损伤、神经细胞凋亡等多个环节[2].

Objective To investigate the effects of Hui Medicine Zhali Nusi Fang on expressions of ICAM1 and VCAM1 in the heat-phlegm and sthenic-fu syndrome rats after cerebral ischemia-reperfusion.Methods Sixty male SD rats were randomly divided into sham model,Nimodipine and Zhalinusi Fang groups(n=15).Except sham group,the other groups were fed with high fat diet for four weeks.Next,rat stools were administered intragastrically once a day for three days to make the heat-phlegm and sthenic-fu syndrome,then focal cerebral ischemia models were established by middle cerebral artery occlusion with nylon thread.Rats were given with nimodipine(NMDP)(10.8 mg/kg),Zhali Nusi Fang(1.54 g/0.1 kg) by ig before the model preparation.The material at 1,3,7 days were obtained respectively, to determine brain water content before bringing out the rat brain.The expressions of ICAM1 and VCAM1 were observed by immunohistochemistry and RT-PCR methods.Results Compared with that of sham group,brain water content of model group rats was increased(P<0.01),the expressions of ICAM1,ICAM1 mRNA and VCAM1,VCAM1 proteins were upregulated(P<0.01).Compared with those of model groups,brain water content of ZLNSF and NMDP groups were reduced,the expressions of ICAM1,VCAM1 proteins and ICAM1,VCAM1 mRNA were decreased(P<0.01).Compared with those of NMDP group,the expressions of ICAM1,VCAM1 proteins and ICAM1,VCAM1 mRNA were decreased(P<0.05),especially the seven-day group(P<0.05).