目的 探讨大黄灵仙方减轻胆道炎症防治胆石症的可能作用机制.方法 将50只SD大鼠随机分为空白组、模型组、大黄灵仙组、大黄灵仙+空白抑制剂组、大黄灵仙+抑制剂组,每组10只.除空白组外,其余各组均采用脂多糖(LPS)诱导构建大鼠胆道炎症动物模型.大黄灵仙组、大黄灵仙+空白抑制剂组、大黄灵仙+抑制剂组三组大鼠制备胆道炎症模型前3天开始中药灌胃,给药剂量为320mg/(kg·d),空白组、模型组大鼠给予2ml/100g蒸馏水灌胃,每天2次,连续干预6天.采用HE染色观察各组胆管病理形态改变,免疫组化法检测胆管核因子κB(NF-κB)蛋白表达,ELISA法检测大鼠血清白细胞介素1β(IL-1β)和肿瘤坏死因子α(TNF-α)表达水平,实时PCR法检测胆管组织中微小核糖核酸-30b(miRNA-30b)及转化生长因子β1(TGF-β1)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)和骨形态发生蛋白2(BMP2)mRNA表达,Western blot法检测TGF-β1、NLRP3以及BMP2蛋白表达量.结果 与空白组比较,模型组大鼠胆管结构异常,汇管区内可见大量淋巴细胞、浆细胞浸润以及胆小管扩张,NF-κB蛋白阳性表达增加,出现核浸润,血清炎症因子IL-1β、TNF-α表达明显升高,胆管组织中TGF-β1、NLRP3、BMP2mRNA以及蛋白表达量显著增加,miRNA-30b表达水平明显下降(P＜0.01).与模型组比较,大黄灵仙组和大黄灵仙+空白抑制剂组胆管病理形态均改善,炎性细胞浸润减少,NF-κB阳性表达降低,同时核浸润减轻,血清炎症因子IL-1β、TNF-α表达水平下降,胆管组织中TGF-β1、NLRP3、BMP2 mRNA以及蛋白表达量均降低,miRNA-30b表达水平均明显升高(P＜0.05或P＜0.01),而大黄灵仙+抑制剂组各指标改善不明显(P＞0.05).大黄灵仙组和大黄灵仙+空白抑制剂组各指标差异亦无统计学意义(P＞O.05).结论 大黄灵仙方可能通过调控miRNA-30b及炎症-纤维化相关因子表达,起到延缓胆石症病程进展的作用.
‘Syndrome differentiation and treatment’ is the basic principle of understanding, diagnosis and treatment of diseases in traditional Chinese medicine（TCM）, and the current methods of syndrome differentiation are diverse and characteristic.For many years, the authors often used different syndrome differentiation methods to consult each other in diagnosis, but there were some shortcomings, so the authors kept searching for a simple one. This paper introduces the syndrome differentiation system of ‘twelve principles-pathology-prescription syndrome’ in detail. This syndrome differentiation system is a new opinion put forward by the author inspired by Mr. HU Xi-shu’s thinking of ‘six meridians-eight principles-prescription syndrome’.It emphasizes the importance of machine reflecting disease symptoms and pathological state in TCM syndrome differentiation thinking, adds the ‘qi, blood, water and food’ to fill the eight principles, and constructs the syndrome differentiation system of ‘twelve principles-pathology-prescription syndrome’, in order to provide a accuracy, effect and new idea in the clinical syndrome of TCM.
甘草泻心汤出自《伤寒杂病论》,为张仲景所创名方,原方可治疗寒热错杂于中、脾胃虚弱较甚、水谷不化、心下痞硬而满之证,亦用于治疗狐惑病,现代医家将该方广泛用于临床治疗口腔、咽喉、前后二阴黏膜糜烂及伴随消化系统症状的患者及失眠者.王清坚教授基于中医"十二纲—病理—方证"辨证体系,根据患者症状及病理状态,选用甘草泻心汤治疗面部皮炎伴口腔内溃疡,准确辨证、方证对应,疗效显著.通过分析王教授治疗面部皮炎的医案一则,整理其对该病的治疗经验,以飨同行.
王清坚教授基于"十二纲-病理-方证"理论,在辨治小儿功能性腹痛时,使用"十二纲-病理"与"病理-方证"相结合方法治疗该病,可发挥中医药"速、效、准"的优势.
