目的 总结半夏自东汉至今的临床用量规律,并分析原因,为该药临床合理使用提供参考.方法 汇总前人从东汉至今对半夏临床用量的研究结果,归纳其最常用量及其范围,最大用量及最小用量,并与《中华人民共和国药典》(以下简称《药典》)规定用量作比较,从中总结规律并分析原因.结果 半夏的常用量及其范围呈汉唐用量大、范围宽,宋金元用量下降、范围骤缩,明清至今用量增、范围扩大的变化规律,剂型、炮制、煎服法是主要影响因素;半夏超大剂量与极小剂量应用在历代均属少数,大剂量与所治病证有关,小剂量与用药人群有关.结论 《药典》规定半夏用量(3～9 g)与古代医家的用药用量经验有一脉相承之处,常规情况应遵循.对于失眠、恶性肿瘤、痰浊重证可适当增加用量,大剂量用药过程中需注重防控相关不良反应.对于低龄、高龄、孕妇、阴虚血燥或肝肾功异常等特殊人群,需适当减少用量.

阳气在人体生命活动中发挥主导地位,正如《黄帝内经》云"阳气者,精则养神,柔则养筋".纤维肌痛综合征(FMS)以周身弥漫性疼痛为主要症状,常伴失眠、抑郁、认知功能受损等神志异常表现,病机为阳气失调.针灸作为中医学的瑰宝,具有通调阳气、扶阳祛邪的作用,在治疗FMS上具有一定的优势.基于《黄帝内经》重阳理论探讨针刺治疗FMS的选穴,可为临床治疗提供参考.

目的 基于R软件探讨谷世喆教授针灸治疗抑郁症的取穴配伍经验.方法 选取2015年1月至2020年11月于北京中医药大学国医堂谷世喆教授门诊就诊的抑郁症患者病历资料、总结谷世喆教授经验的专著《知针知药》、谷世喆教授发表于中国知网的论文中的相关医案,应用Microsoft Office Excel 2019对谷世喆教授的针灸处方构建资料数据库,采用R软件进行描述性分析、Apriori关联规则分析和层次聚类分析.结果 谷世喆教授治疗抑郁症使用穴位86个,共计1601次,使用次数排前7位的穴位为膻中、四神聪、百会、内关、神门、印堂、天枢.使用频次最高的经脉为任脉,选穴部位多在经络的四根、三结之处,配伍时讲究根结相引、标本相应.脏腑辨证以清心安神为主,重视肝胆、脾胃的调节.关联分析得到常用穴位组合为内关-天枢-膻中、行间-侠溪-膻中、建里-中脘-天枢、建里-膻中-中脘.聚类分析结果显示,谷世喆教授对抑郁症辨证论治的思路为益气养阴、健脾宁心、清心安神、疏肝利胆.结论 谷世喆教授针灸治疗抑郁症以膻中为主穴,辨证论治以益气养阴、健脾宁心、清心安神、疏肝利胆为主要思路.

目的:探析谷世喆教授治疗颈型颈椎病的用穴特点、取穴规律和组方特色.方法:运用Excel 2019创建谷世喆教授治疗颈型颈椎病针灸处方库,使用R语言对其进行频次分析,运用Apriori算法对腧穴进行关联规则分析,应用Gephi软件对针灸处方进行社区聚类分析.结果:纳入病例共101首针灸处方,谷世喆教授治疗颈型颈椎病用穴共64个,总频次1 107次,使用最多的腧穴为颈百劳,其次是肩中俞、天柱、合谷和风池.阳经穴位使用频率高达70.37％,使用频次最多的经脉为足太阳膀胱经.关联规则分析结果显示,治疗颈型颈椎病腧穴配伍以颈百劳-天柱-肩中俞最为常见.社区聚类结果显示,形成了 3个稳定的腧穴群组,分别为:肝俞-肾俞-膈俞-大肠俞;膻中-百会-印堂-安眠;肩中俞-天柱-风池.结论:通过数据挖掘分析得出谷世喆教授针刺治疗颈型颈椎病注重阳经选穴、颈项局部选穴和腰背部选穴相结合,体现了谷教授治疗颈椎病"温阳通气,形神同调"的学术思想.

目的:采用网络药理学方法探讨泻心通腑汤治疗失眠伴抑郁的依据,预测泻心通腑汤治疗失眠伴抑郁的作用机制.方法:通过数据库检索,得到失眠、抑郁的疾病基因及泻心通腑汤中活性成分的作用靶点;并筛选出泻心通腑汤的中药活性成分在治疗失眠伴抑郁过程中所涉及的功能及通路,最终构建"中药-活性成分-靶点-通路"网络.结果:通过网络药理学方法得到泻心通腑汤中50种活性成分可与失眠伴抑郁的191个疾病靶点相关联,KEGG富集分析得到通路124条.结论:泻心通腑汤治疗失眠伴抑郁可能是通过多靶点、多成分起到作用,而其中PI3 K/AKT信号通路为泻心通腑汤治疗失眠伴抑郁最有可能起作用的通路.

本文总结了《黄帝内经》的面部分候脏腑体系,其以所阐述的以望面色分候脏腑为主要内容,分为明堂色部、五脏热病色部、五脏风色部、五官色部;并将《黄帝内经》中经络对面部影响的零散条文加以汇总、整理成面部分候经络体系,其分为经络在面部的循行、经络之气对面部的影响、经络病候在面部的反映三个部分.此后本文将两大体系的异同进行了比较、分析,脏腑为主的面部分候脏腑体系以鼻部为中心,基本遵循五脏—五色的对应关系;而在面部循行的经络以阳经为主,其病候反映在面部以面黑、面赤为主要表现,且病候一般初在经络,久则入脏腑;两个体系有着层次和分布上的差异.

目的 采用ALFF静息态磁共振分析技术探讨耳甲电针对抑郁症患者脑部神经元自发活动的调节作用.方法 纳入20例轻中度抑郁症患者,进行8周的耳甲电针治疗,并于治疗前后采集汉密尔顿抑郁量表(HAMD-17)评分及静息态功能磁共振扫描数据,评估耳甲电针抗抑郁的疗效,同时采用低频振幅算法对患者静息态功能磁共振数据进行分析,探讨耳甲电针对患者局部脑区神经元自发活动的调节作用.结果 经过8周治疗后,患者HAMD-17量表评分降低;左侧的颞叶下回ALFF值升高,而右侧海马、楔前叶、距状裂周围皮质、左侧后扣带回和右侧丘脑ALFF值降低.结论 耳甲电针可有效改善患者的抑郁症状,对脑默认网络、情绪回路、认知和视觉相关皮质的脑区的自发神经元活动的调节作用可能是其抗抑郁的重要机制.

In this study, the authors reviewed domestic and foreign literatures, conducted the textual research on origin and development of Cassia Semen, studied records in ancient books and ancient and modern literatures, clinical adverse reactions and relevant experimental studies in recent years, and summarized the clinical features and influencing factors related to the safety of Cassiae Semen. According to the findings,Cassia Semen's safety risks are mainly liver and kidney system damages, with the main clinical features of fatigue, anorexia, disgusting of oil, yellow urine and gray stool; digestive system injury, with the main clinical features of diarrhea, abdominal distension, nausea and loose stool; reproductive system damage, with the main clinical features of vaginal bleeding. Allergic reactions and clinical adverse events, with the main clinical features for numb mouth, itching skin, nausea and vomiting, diarrhea, wheezing and lip cyanosis were also reported. The toxicological studies on toxic components of Cassiae Semen obtusifolia were carried out through acute toxicity test, subacute toxicity test, subchronic toxicity test and chronic toxicity test. Risk factors might include patients, compatibility and physicians. Physicians should strictly abide by the medication requirements in the Pharmacopoeia, pay attention to rational compatibility, appropriate dosage,correct usage and appropriate processing, control the dosage below 15 g to avoid excessive intake, strictly control the course of treatment to avoid accumulated poisoning caused by long-term administration. At the same time, clinicians should pay attention to the latest research progress, update the knowledge structure, quickly find the latest and useful materials from clinical practice, scientific research and drug information and other literatures, make evaluation and judgment for the materials, establish a traditional Chinese medicine intelligence information library, and strengthen the control over adverse effects with a pre-warning consciousness. The authors suggested standardizing clinical medication of Cassiae Semen, and avoiding misuse or excessive use; clinicians should prescribe it in strict accordance with there commended usage and dosage in the Pharmacopoeia, and focus on the safety signal accumulation in clinic, while strengthening studies for toxic substance basis and toxicity mechanism, in order to give full play to Cassiae Semen's clinical efficacy and reduce its adverse reactions.

Objective:To analyze the composing experience of professor Yan Zheng-hua for chest pain by using traditional Chinese medicine(TCM)inheritance support system.Method:Collecting the prescriptions for chest pain,then the data were entered into TCM inheritance support system and composing principles were analyzed by using datamining methods such as revised mutual information,complex system entropy cluster and unsupervised hierarchical cluster.Result:Based on the analysis of 122 Prescriptions,the frequency of each herb and association rules among the herbs were computed,34 core combinations and 7 new prescriptions were mined from the database.Conclusion: Professor Yan Zhenghua is good at simulating the circulation of blood,regulating qi and nourishing the heart for tranquilize to relieve chest pain,TCM inheritance support system can be used to analyze senior TCM doctor clinical experience.

目的基于中医传承辅助系统软件,分析颜正华教授治疗眩晕的用药经验。方法收集颜教授治疗眩晕的病案,采用关联规则apriori算法、复杂系统熵聚类等无监督数据挖掘方法,确定处方中各种药物的使用频次及药物之间的关联规则,分析颜教授治疗眩晕的用药经验。结果共筛选出190首处方,分析其中药物的使用频次,药物之间的关联规则,挖掘出56个核心组合和11首新处方。结论颜正华教授治疗眩晕经验丰富,多用平肝潜阳、重镇安神和活血散瘀之品,中医传承辅助系统对于挖掘名老中医临床经验具有重要实用价值。

目的:基于中医传承辅助系统软件,分析颜正华教授治疗失眠的用药经验.方法:收集颜正华教授治疗失眠的病案,采用关联规则apriori算法、复杂系统熵聚类等无监督数据挖掘方法,确定处方中各种药物的使用频次及药物之间的关联规则,分析颜正华教授治疗失眠的用药经验.结果:对筛选出的170处方进行分析,确定处方中药物的使用频次,药物之间的关联规则,挖掘出44个核心组合和7首新处方.结论:颜正华教授治疗失眠经验丰富,多将养心安神和重镇安神之品配合使用.中医传承辅助系统对于挖掘名老中医临床经验具有重要实用价值.