Objective To systematically evaluate the clinical efficacy of Xuefu Zhuyu Decoction（XFZYD） for post-stroke depression. Methods The literature related to the XFZYD treatment of post-stroke depression（randomized controlled trials） was retrieved from databases including Chinese National Knowledge Infrastructure（CNKI）, VIP Chinese Science Journals Database（VIP）, WanFang Data, Chinese Biomedical Literature Service System（SinoMed）, Embase, Pubmed, Cochrane Library and Web of Science. The collected literature was published from the establishment date of each database up to July 10, 2022. The quality of the included literature was evaluated with the Manual Cochrane 5.4.1, and RevMan 5.4.1 was used to perform meta-analysis. Results The included 19 articles in the study involved 1,352 patients, with 679 patients in the observation group and 673 patients in the control group. Meta-analysis results showed that the clinical efficiency of the observation group was higher than that of the control group [OR=4.41,95%CI（3.02,6.44）,P＜0.000 01]; After treatment, observation group had lower scores than control group in Hamilton depression scale（HAMD） [MD=-4.98,95%CI（-6.12,-3.83）], NIH stroke scale（NIHSS） [MD=-4.09,95%CI（-4.74,-3.45）], and activity of daily living scale（ADL） [MD=-4.19,95%CI（-8.16,-0.22）], P＜0.000 01; And the incidence of adverse reactions in the observation group was lower than that in the control group [OR=0.07,95%CI（0.02,0.26）,P＜0.000 01]. Conclusion The combined use of XFZYD with conventional western medicine has more satisfactory efficacy than the single use of conventional therapy for post-stroke depression, and can better improve clinical symptoms and patients’ activity of daily living with good safety; However, the relevant findings need further validation due to the quantity and quality of included literature.

目的:运用Meta分析评价血府逐瘀汤联合常规西药治疗PCI术后再发心绞痛的临床疗效.方法:检索中文(中国知网、维普、万方、中国生物医学文献服务系统)和英文(Embase、Pub Med、Cochrane Library、Web of sci-ence)数据库,收集血府逐瘀汤联合常规西药治疗PCI术后再发心绞痛的随机对照试验,采用Revman 5.4.1和Sta-ta 15.1软件进行Meta分析,对异质性采用敏感性分析,发表偏倚采用漏斗图评价.结果:共纳入13项RCTs,共1419例患者.观察组患者治疗后中医证候有效例数高于对照组[OR=4.27,95％CI(2.32,7.85),P＜0.01],心电图有效例数高于对照组[OR=3.10,95％CI(2.06,4.67),P＜0.01],心绞痛发作频率[MD=-2.09,95％CI(-2.78,-1.41),P＜0.01]和持续时间[MD=-151.20,95％CI(-210.08,-92.33),P＜0.01]均低于对照组,观察组患者治疗后血浆黏度[MD=-0.70,95％CI(-0.75,-0.65),P＜0.01]、红细胞压积[MD=-5.80,95％CI(-6.10,-5.50),P＜0.01]、全血黏度[MD=-0.90,95％CI(-1.08,-0.72),P＜0.01]和纤维蛋白原[MD=-0.70,95％CI(-0.87,-0.53),P＜0.01]均低于对照组.结论:血府逐瘀汤联合常规西药可有效提高PCI术后再发心绞痛患者的临床疗效.

柴胡加龙骨牡蛎汤为汉代张机(字仲景)所创,用于治疗伤寒误下,邪入少阳之证.古代医家多以此方治疗不寐、郁证、狂证、癫痫等精神、神经系统疾病,鲜有此方论治心悸病的记载.通过观察现代人日常生活和工作发现,生活节奏快、工作压力大是现代都市人普遍的特点,因此尤易出现焦虑、紧张、担忧等异常情绪,长此以往,首先会影响人们的气机运行.气郁首先犯于肝脏,肝气郁滞,气机不畅,则无力运行血液,心脏失于气血的濡养而发为心悸;此外肝气郁滞,日久化火,肝火上扰心神,加之气血涌盛,扰乱心神而致心神不宁,故在临床上治疗心律失常时,沈琳教授多主张心病从肝论治,心肝同治.在运用柴胡加龙骨牡蛎汤时,沈琳教授坚持方证辨证这一核心要点,领悟张机"但见一症便是,不必悉具"的核心思想,牢牢把握"胸满烦惊心悸"为关键点,临床但见因焦虑、受惊、疲累或寐差等所致心悸烦躁来诊者,以柴胡加龙骨牡蛎汤寒温并用,攻补兼施,肝胆调和,热祛魂安,使错杂之邪得以解除,其中以忧思、紧张等情志不悦为突出表现者,系气郁有热,魂神不定之象,以柴胡加龙骨牡蛎汤加减投之,取其疏肝清热,安神定悸之意,再配伍情志疏导,每每效如桴鼓.

持续性心房颤动是临床常见病,房颤虽未对患者造成生命威胁,但严重影响患者生活质量.对于药物复律失败,射频消融术后复发,具有明显症状的持续性心房颤动患者,目前尚未有很好的治疗手段.沈琳主任医师在临床上善从肝、从火论治心房颤动,应用柴胡加龙骨牡蛎汤化裁转复持续性房颤常获良效,现分享医案1则以兹为持续性房颤的转复治疗及症状控制提供新思路.

柴胡加龙骨牡蛎汤属仲景经方,出自《伤寒论》第107条.近年来,该方的临床应用已扩展至心血管、生殖、内分泌、消化等多个领域,且疗效确切,尤其在心悸病的治疗上效果显著.然而目前尚缺乏对柴胡加龙骨牡蛎汤治疗心悸病相关文献的系统性整理及归纳分析.本文对柴胡加龙骨牡蛎汤各组分的现代药理学研究以及该方治疗心悸病的研究进展进行综述.