此文基于传统方剂学教学模式存在的问题,探讨方剂学教学创新思路及举措.借助网络学习平台翻转课堂,实现线上与线下混合式教学;依托国家级虚拟仿真实验教学平台,实现实践教学与理论教学、实验教学的混合;以知识链理论为基础,以思维导图为呈现形式,实现前期中医基础课程知识与方剂学教学内容的融合;开展课程思政教学改革,注重思政元素的有机融入,实现思政教育与专业知识传授的混合,从而形成方剂学多维度混合式教学模式.通过一系列教学创新举措的实施,学生的自主学习、团队协作能力,辨证用方及安全用方能力,知识的融会贯通能力均得到提高,同时学生专业自信更加坚定,职业认同感得以增强.

脓毒症是由宿主对感染的反应失调而引起的严重器官功能障碍综合征,该病具有高发病率和高死亡率的特点.脓毒症会严重损害上皮组织,对肠上皮的影响最为严重.反之,肠屏障受损会导致肠菌及内毒素易位进而加剧脓毒症.鉴于目前没有系统深入的关于脓毒症肠屏障功能障碍机制的文献报道,因此,本文从肠上皮细胞、炎症、免疫状态、微循环、凝血功能、肠道酶反应、肠道菌群及短链脂肪酸(SCFAs)等角度系统深入地总结了近10年脓毒症肠屏障功能障碍的分子机制及肠屏障功能障碍在脓毒症中的作用,以期为临床及药物开发从保护肠屏障入手治疗脓毒症提供理论依据及新的治疗靶点.

目的 明确血府逐瘀胶囊对卒中后抑郁(PSD)的治疗效果,并基于网络药理学线索利用实验验证其关键作用途径.方法 利用tMCAO复合慢性不可预知应激手段复制大鼠PSD模型,实验设置假手术组(SHAM组),模型组(PSD组),血府逐瘀胶囊高(XFH,2.16 g·kg-1)、低(XFL,0.43 g·kg-1)剂量组,氟西汀(FLU,0.0018 g·kg-1)组.除 SHAM组和PSD组外其余各组每日灌胃给药,连续28d.利用神经行为学评分、糖水偏好实验、旷场实验、强迫游泳实验、HE染色技术考察血府逐瘀胶囊防治PSD的药效作用,利用网络药理学技术初步探讨其关键作用环节;基于肠屏障功能,利用FITC标记的葡聚糖肠道渗透性、HE染色技术验证血府逐瘀胶囊对肠屏障功能的影响;利用Western blot技术考察血府逐瘀胶囊对大鼠结肠组织胞质紧密连接蛋白1(ZO-1),紧密连接蛋白(Occludin),紧密连接蛋白1(claudin-1)表达的影响.结果 药效学结果显示,与SHAM组相比,PSD组大鼠神经行为学评分显著升高,糖水偏好率、自主活动显著降低,不动时间显著延长,神经元细胞数目减少、胞核固缩.与PSD组相比,XFL组相关症状逐步改善,神经行为学评分显著降低,糖水偏好率、自主活动明显增加,强迫游泳的不动时间显著减少,神经元细胞数目增多,核固缩减少.网络药理学结果显示,血府逐瘀胶囊可调节炎症,抑制MAPK信号通路的激活,继而上调紧密连接蛋白的表达来修复肠屏障,提示其防治PSD作用可能与改善肠屏障功能有关.利用整体动物实验对肠屏障功能进行验证,结果表明与SHAM组相比,PSD组肠道渗透性显著增加,肠黏膜病理损伤,病理评分明显升高,肠组织ZO-1、Occludin与claudin-1表达水平显著下降;与PSD组相比,XFL组的结肠通透性显著降低,肠黏膜病理损伤减轻,肠组织ZO-1、Occludin和claudin-1的蛋白表达水平显著升高.结论 血府逐瘀胶囊可通过上调肠组织紧密连接蛋白表达改善脑缺血导致的肠屏障功能,进而发挥防治PSD作用.

在前期开展方剂学课程思政教学的基础上,方剂学教学团队从"抗疫"主题方向深入开展课程思政教学改革.文章明确了"统一行动,学生参与,考核评定,拓展延伸"的课程思政运行机制,提出了针对"抗疫"主题修订的课程思政教学目标,并重点论述了"抗疫"主题课程思政的具体实施情况,即课程思政主渠道建设、利用"第二课堂"开展"抗疫"主题系列活动以及在对外教学中融入课程思政元素等,同时探讨了课程思政质量考核评价体系,全面介绍了方剂学"抗疫"主题课程思政教学改革情况.课程思政教学改革的实施,提高了学生的政治认同,培养了学生的家国情怀,提高了学生的文化素养和道德修养.

防治学说是关于疾病预防、治疗原则的理论,是连接中医基础理论和临床各科的中心环节,蕴含着丰富的防病治病思想和传统文化知识.以术载道、以道驭术,教师在防治学说的教学过程中以学生为中心,注重学情分析和课程教学规律,道术兼备、深化内涵,将知识传授与德育教育紧密结合起来,不仅有助于增强学生职业认同感,感悟文化和培养中医思维,对于实现"中医基础理论"课程目标和落实中医学专业人才培养方案也具有重要的意义.

针对中医药人才院校培养模式中实践教学弱化,特别是中医特色实验教学项目匮乏的问题,提出开发并应用虚拟仿真实验教学项目,探索虚拟仿真实验教学在中医药人才培养中的应用.以"基于'阳虚寒积证'的辨治及含附子方剂的安全使用和中毒诊治"项目为例,从"阳虚寒积证"的辨证论治、温脾汤煎煮、附子中毒诊治等方面介绍项目建设内容,阐释混合式教学过程,探讨中医方剂学虚拟仿真实验教学体系规划,虚拟仿真实验教学项目的应用,以有效提升中医药实践教学质量.

Background Neuroinflammation and microglia reactivity are now recognized to be features of Parkinson’s disease (PD). Thus, microglia phenotype is a potential new target for developing treatments against PD. Duzhong Fang (DZF) is a traditional Chinese medicine (TCM) prescription. The theory of TCM argues that Duzhong Fang, nourishing yin and tonifying yang, may treat PD. However, its modern pharmacological studies and the underlying mechanisms are unclear. Methods First, MPTP was used to establish a parkinsonian mouse model, and behavioral testing was used to evaluate the locomotor dysfunction. Then, HPLC, immunohistochemical staining, and Western blot assays were performed to evaluate the survival of dopaminergic neurons. Molecular biological and immunofluorescence staining were used to evaluate the neuroinflammation and microglial activation. In addition, RNA-seq transcriptomics was used to analyze differentially expressed genes and verify by RT-PCR. Results In the present study, we first confirmed that DZF can alleviate neuroinflammation and ameliorate dyskinesia in parkinsonian mice. Then, further studies found that DZF can regulate microglial morphology and reactivity and act on the POMC gene. POMC is an upstream target for regulating inflammation and proinflammatory cytokines, and DZF can directly inhibit the POMC level and restore the homeostatic signature of microglia in parkinsonian mice. Conclusion This study found that POMC may have a potential role as a therapeutic target for PD. DZF may inhibit neuroinflammation and play an anti-PD effect by down-regulating the expression of POMC.

目的:通过比较分析中西医养生价值观差异,提出相关思考和政策建议.为更进一步认识中西养生文化的根源,加强对中西养生理论及文化的理解,为促进中医与西方在养生文化上的共同发展.为踏实贯彻"健康中国2030"规划贡献力量.方法:采用文献检索方法,收集我国中医学和现代西方养生的资料,从饮食、运动、心态、道德、环境等进行了比较分析.结果:我国传统养生思想和现代西方养生观念存在部分重合也有一定差异.在饮食上西方强调卡路里、营养成分及其配比,而中医养生则注重脏腑、四季、五味的和调;在运动方面西方以"动"主,重视形体的健美,中医养生学则重视"静"对形神的塑造和道德的要求.中医养生讲究宏观对生命的调整,西医养生讲究局部和微观上的精准把控.结论:中西医在养生在推进健康中国建设的道路上各有所长,不同医学体系之间可以相互借鉴,发挥各自优势,在和而不同中发展,相互促进,在未来,中西医养生文化的基本走向是二者的共生与并存.

中医药文化是我国优秀文化的代表,中医药文化国际传播有利于树立良好国家形象,增强我国的综合国力.为了顺应时代发展,本文在系统分析中医药文化国际传播现状基础上,提出中医药文化国际传播的建议:因地制宜融入中医药文化;突破语言障碍,打造中医药文化交流新表述;规范道地药材管理,从源头把握中医药疗效;培养中医药文化传播的复合型人才;借助新媒体作为传播平台,增加英语交流模式.目前中医药文化国际交流任重道远,新媒体作为科技时代的趋势.中医药文化交流需迎合发展,寻找新媒体国际传播的突破口,传播养生、治未病等特色中医药文化,让中医药文化在国际交流中大放异彩.

对中医院校核心课程《方剂学》的“课程思政”教学改革提出了以下方案:一是结合课程特点,挖掘思政元素;二是修订融入思政教育的教学大纲,匹配教学设计;三是强化自我教育,纳入分数考核;四是督导与评教结合,强化教学过程管理;五是将课内教育与课外自主学习相结合,拓展思政教育的实效性.通过改革,使学生在《方剂学》教学中全面接受医德教育,同时增强学生对于中医药的文化自信.

To study the effects of combination of Aconiti Lateralis Radix Praeparata( Fuzi) with Trichosanthis Fructus( Gualou) on cardiac function,electrocardiogram,inflammatory response and myocardial fibrosis in pressure overload( PO) rats,and further explore the mechanism based on β2-AR/PKA signaling. PO rat model was established by constricting the abdominal aorta. Twelve weeks after the operation,these rats were randomly divided into model goup( PO),low dose Fuzi group( FL,5. 4 g·kg-1·d-1),Gualou group( GL,5. 4 g·kg-1·d-1),Fuzi and Gualou combination group( FG,5. 4 g·kg-1·d-1+5. 4 g·kg-1·d-1) and high dose Fuzi group( FH,10. 8 g·kg-1·d-1). At the same time,sham operation group was set. After intervention for 6 weeks,carotid blood pressure,cardiac function,electrocardiogram and heart mass index were measured. HE staining was used to observe the inflammatory response in the rat heart and kidney. Masson staining was used to determine the myocardial fibrosis. Western blot was used to detect the protein expression of β2-AR and PKA. As compared with sham operation group,the blood pressure and heart mass index were obviously increased in PO model group,but there was no significant difference in various treatment groups in the above indexes. As compared with PO model group,FH treatment significantly increased the ejection fraction( EF) and GL treatment effectively enhanced the cardiac output( CO),but other treatment groups had no significant effect on these parameters. Moreover,FG treatment can synergistically attenuate QT and QTc internal prolongation,but it also aggravated inflammatory response in the heart and kidney tissues and promoted myocardial fibrosis as compared to FZ or GL alone treatment,with toxic effects equivalent to FH treatment group. Following FG and FH treatment,simultaneously,β2-AR and PKA protein levels were significantly elevated,indicating that the increasing toxicity of FG could be associated with activation of β2-AR/PKA signaling. These results suggested that combination of FZ and GL could synergistically enhance toxicity of FZ in special pathological states such as pressure overload,and caution should be taken in clinical application.

肠黏膜屏障是指肠黏膜阻止肠腔内有害物质如致病微生物、多种生物大分子和抗原进入血液循环而形成的屏障,以维护人体健康.正常菌群在人体某一特定部位黏附、定植和繁殖,形成一层“菌膜屏障”,能够抵抗外源微生物定植,对机体组织免受外来病原菌的侵袭具有重要作用.肠黏膜在休克、缺血、胰腺炎等情况下,其通透性增高引起细菌和内毒素移位、促炎因子释放,加重原发疾病的发生,激发炎症反应,引发胰岛素抵抗、中枢神经系统损伤,甚至诱发多脏器功能衰竭等.中药在治疗肠黏膜屏障功能紊乱疾病方面具有明确的优势,但中药药效成分大多生物利用度低,中药经口服后可先与肠道菌群接触并发生相互作用,进而调节人体相关机能.从肠黏膜机械屏障、免疫屏障、微生物屏障及化学屏障4个角度,系统总结了中药通过调控肠道菌群改善肠黏膜屏障的作用,以期对中药调控肠道菌群治疗肠黏膜屏障功能紊乱相关疾病的研究提供一定线索.

Diabetes mellitus is a metabolic disease often accompanied by a series of complications, such as diabetic nephropathy, retinopathy, and diabetic foot. The survival time of diabetics has been significantly prolonged due to advancements in medicine. However, the prolonged survival time for diabetics can increase the prevalence of diabetic central nervous system disease. Diabetic encephalopathy (DE) has become one of the main complications of the disease, and the main clinical manifestation of DE is cognitive dysfunction. However, the typical morphological and pathological characteristics of the brain in DE are rarely systematically reported. Thus, this phenomenon severely restricts the diagnosis and treatment of DE. This article presents a description of the pathology characteristics of DE, including atrophy of the brain (gray matter, white matter, and hippocampus), changes in cerebrovascular morphology and function, impairment of synaptic plasticity, and dysfunction of neuroglia. In addition, abnormalities in the glymphatic clearance system of the brain are closely related to the progression of DE. A review of typical brain morphological and pathological characteristics would aid in the diagnosis and treatment of DE.

目的:从代谢组学角度探究金芪降糖片改善2型糖尿病大鼠脂代谢紊乱的作用机制.方法:雄性Wistar大鼠45只,采用高脂饲料喂养联合3次小剂量腹腔注射链脲霉素(STZ,35 mg·kg-1)复制2型糖尿病模型,造模成功后随机分为正常组、模型组、金芪降糖片组.金芪降糖片组连续给药4周,给药结束后腹主动脉取血,利用半自动生化分析仪检测血脂水平,苏木精-伊红(HE)染色观察肝脏病理变化;采用UPLC-Q-TOF-MS对不同组别的血液样本进行检测,运用主成分分析(PCA)和偏最小二乘法-判别分析(PLS-DA)筛选正常组、模型组和金芪降糖片组之间的差异代谢物,结合质谱信息和公共数据库检索对差异代谢物进行鉴定并进行京都基因与基因组百科全书(KEGG)代谢通路分析.结果:与正常组比较,模型组大鼠血脂水平明显升高,金芪降糖片组血脂较模型组明显下降,模型组肝脏出现明显的脂肪粒细胞,金芪降糖片组肝细胞脂肪粒明显减少.模型组和正常组大鼠有12种内源性物质发生了显著性变化,经金芪降糖片干预后花生四烯酸,左旋肉碱,溶血磷脂酰胆碱(LysoPC)(17∶0),LysoPC(P-18∶0),LysoPC[22∶4(7Z,10Z,13Z,16Z)],硬脂酰肉碱这6种代谢物水平出现了不同程度的回调,得到1条关键代谢通路——花生四烯酸代谢通路.结论:金芪降糖片对2型糖尿病脂代谢紊乱大鼠体内的差异代谢物有一定的回调作用,其作用机制主要与花生四烯酸代谢通路有关.

Objective To establish a new method for evaluating the anaphylactoid reaction of traditional Chinese medicine injection in vitro.Rapid evaluation of anaphylactoid reaction ofYiqi Fumai Lyophilized Injection (YQFM) from different batches was conducted.Method The basophilic leukemia cell line RBL-2H3 cells were cultivated in vitro,and Compound 48/80 was selected as the positive drug.The effect of Compound 48/80 on cell index (CI) was monitored by using real-time cell analyzer (RTCA).Then the cell morphology and cytoskeleton changes were observed by using toluidine blue and phalloidin staining,histamine and beta hexose glucosidase release were used to verify the degranulation of RBL-2H3 cells.Finally,20 batches of YQFM (100 μg/mL) were selected for the anaphylaxis evaluation.Results Compound 48/80 could significantly increase the CI value of RBL-2H3 cells,further morphological study found that Compound 48/80 could make the cell morphology and cytoskeleton change obviously and show obvious degranulation at the same dose.Histamine and beta hexose glucosidase release experiments also confirmed that Compound 48/80 could lead to the release of inflammatory mediators and induce obvious degranulation at this dose.These results suggest that the RTCA system can be used to evaluate the degranulation of RBL-2H3 cells quickly and sensitively.RTCA monitoring results showed that different batches of YQFM had no significant effect on the CI value of RBL-2H3 cells,suggesting that the selected batches of YQFM were eligible batches without anaphylactoid reaction.Conclusion An in vitro rapid evaluation method for anaphylactoid reaction has been established based on RTCA system,which can be used for rapid evaluating the anaphylactoid reaction of YQFM and other traditional Chinese medicine injections in vitro.

针对心血管疾病的治疗通常采用药物进行治疗,其中附子在治疗心血管疾病中是常用到的药物,但由于附子本身存在其毒性,对心血管疾病患者产生效果的同时会产生毒性刺激,影响患者的恢复,并且会诱发其他不良反应,不利于患者的健康.故要想提高附子在心血管疾病治疗中的价值,就要加强对附子的药理学分析并要探究其治疗心血管疾病的有效成分,从而更好的为治疗心血管系统疾病提供帮助.

介绍留学生《方剂学》教学的方法.从克服语言障碍、培养中医思维、调整教学大纲、选择恰当教法4个方面,介绍留学生方剂学教学体会,以期进一步提高留学生方剂学教学水平.

Objective] The objective of this study was to investigate the application of prescriptions in textbook of formulas in clinical disciplines' textbooks that would provide scientific data for future textbook revision. [Methods] Take the textbook of formula published by China Press of Traditional Chinese Medicine and eight clinical disciplines' textbooks as research objects, to analyse the application of prescriptions list in formula textbook. [Results] The average proportion of prescriptions' application (including main and additional prescriptions) in clinical disciplines' textbooks was 48.4%. Thirty-six main prescriptions listed in formulas' textbook were not mentioned in clinical disciplines' textbooks. [Conclusions] The interacted selection of prescription between the textbook of formulas and clinical discipline should be strengthened that would be helpful for the mastery of knowledge in formulas and even better understanding and application.

目的:运用频数分析法,拟对《中医方剂大辞典》里的治疗肺系疾患的含半夏与附子古方的配伍方剂进行分析,探讨半夏与附子同方配伍的特点.方法:搜集整理《中医方剂大辞典》中包含半夏与附子配伍治疗肺系疾患的方剂,运用统计和频数分析方法将这些方剂进行归纳,总结其方剂的药物组成、半夏与附子剂量关系,治疗疾病特点.结果:①半夏与附子配伍方剂中,所涉及的补益药和解表药使用频次较高,如甘草、人参、白术;细辛、麻黄、生姜等.②半夏与附子配伍剂量基本相等,二者使用以各一两居多.③半夏与附子配伍在治疗肺系疾病的方剂中,以治疗感冒、咳嗽、痰饮、哮喘为主.结论:半夏与附子配伍在历代方剂中应用较多,不宜作为绝对配伍禁忌.

AIM:To investigate the association between endogenous hydrogen sulfide (H₂S) and portal hypertension as well as its effect on vascular smooth muscle cells.METHODS:Portal hypertension patients were categorized by Child-Pugh score based on bilirubin and albumin levels, prothrombin time, ascites and hepatic encephalopathy. Plasma H₂S concentrations and portal vein diameters (PVDs) were compared between portal hypertension patients and control participants, as well as between portal hypertension patients with varying degrees of severity. In addition, we established a rabbit hepatic schistosomiasis portal hypertension (SPH) model and analyzed liver morphology, fibrosis grade, plasma and liver tissue H₂S concentrations, as well as cystathionine γ-lyase (CSE) activity and phosphorylated extracellular signal-regulated kinase (pERK)1/2, B cell lymphoma (Bcl)-2 and Bcl-XL expression in portal vein smooth muscle cells, in addition to their H₂S-induced apoptosis rates.RESULTS:In portal hypertension patients, endogenous H₂S levels were significantly lower than those in healthy controls. The more severe the disease was, the lower were the H₂S plasma levels, which were inversely correlated with PVD and Child-Pugh score. Liver tissue H₂S concentrations and CSE expression were significantly lower in the SPH rabbit livers compared with the control animals, starting at 3 wk, whereas pERK 1/2 expressions gradually increased 12-20 wk after SPH model establishment. In portal vein smooth muscle cells, increasing H₂S levels led to increased apoptosis, while Bcl-2 and Bcl-XL expression decreased.CONCLUSION:H₂S prevents vascular restructuring caused by excessive proliferation of smooth muscle cells via apoptosis induction, which helps to maintain normal vascular structures.