湿温、湿热辨析及其临证意义

历代医家对湿温、湿热的概念出处和认知等存在较大争议,这使得时人及后人对二者的差异混淆不清,从而影响临证。该研究通过辨析湿温和湿热的概念出处及其内涵演变,探讨二者的区别和联系。结果显示,金元时期的医家们认为“湿热”多为内伤杂病,“湿温”则多为外感热病;从病因来看,二者皆是湿热为患。明清之后的医家将二者的区别逐渐淡化,湿温被统一在湿热中,统称为“外感湿热证”。历代医家对湿温与湿热的认知过程,经历了从病因或病机到病证名的变迁。湿温与湿热内涵的演变拓展了中医对疾病病因、病机、病证的认识。通过辨析“湿温”与“湿热”,可明确疾病的病因与病证发展,从而正确指导用药及判断预后。

针刺通过增加前额叶皮层突触蛋白的表达对两种抑郁症动物模型的快速抗抑郁作用

Objective:To investigate the effect of acupuncture onset time and synaptic structure in two different models of depression.Methods:A total of 150 healthy male adult SPF C57BL/6J mice were divided into five time-point groups:1 h,3 h,6 h,12 h and 24 h.Each time-point group was further divided into three groups:the model,scopolamine and acupuncture groups with 10 rats each.Rats were given forced swimming stimulation(15 min,once)before the intervention.A total of 200 healthy male adult specific pathogen-free(SPF)Sprague-Dawley(SD)rats were divided into 30 normal rats,and 170 modelling ones.A total of 90 rats were successfully modeled,and were randomly divided into three time-point groups:1 h,6 h and 24 h.And each time-point group was further divided into the normal,model,scopolamine,and acupuncture group.Chronic unpredictable mild stress(CUMS)combined with individual feeding was used to establish the depressed rat model.The sucrose preference test(SPT)and open field test(OFT)were used to evaluate the success of the model.There were 10 rats in each group.The acupuncture intervention was performed once for 20 min on"Baihui(GV20)","Yintang(GV29)","Hegu(LI4)",and"Taichong(LR3)"without any other operations for the corresponding animals.Other groups were given corresponding medications.According to different time points,the forced swimming test(FST)was conducted in mice,and the FST and novelty-suppressed feeding test(NSFT)were measured in rats.Monoamine neurotransmitters(NE,DA,DOPAC,5-HT,5-HIAA,HVA)in the prefrontal cortex and hippocampus were detected with high performance liquid chromatography(HPLC).The expression of synapsin I,PSD95,p-mTOR,mTOR,and BDNF in the prefrontal cortex and hippocampus was determined by western blot.Results:At the 1 h time point,compared with the model group,the immobility time was significantly decreased in the acupuncture group(P<0.05).At 3 h,6 h,12 h,and 24 h,compared with the model group,the immobility time was significantly reduced in both scopolamine and acupuncture groups(P<0.05).At the 1 h time point,compared with the normal group,the immobility time of FST and the latency to feed were significantly increased in the model group(P<0.05).Compared with the model group,the immobility time of FST showed a significant reduction in the acupuncture group(P<0.05).At the 6h and 24 h time points,compared with the normal group,the immobility time of FST and the latency to feed were significantly increased in the model group(P<0.05).Compared with the model group,the immobility time of FST was significantly decreased in the scopolamine and acupuncture groups(P<0.05).At the 1 h and 24 h time points,compared with the normal group,the expression levels of 5-HT,5-HIAA,NE,DA,DOPAC,and HVA of the prefrontal cortical and hippocampal tissues were significantly reduced in the model group(P<0.05).At the 1 h and 24 h time points,compared with the model group,the expression levels of synapsin I,PSD95,p-mTOR,and BDNF of the prefrontal cortex were significantly increased in the acupuncture group(P<0.05).At the 1 h and 24 h time points,compared with the normal group,the expression levels of synapsin I,PSD95,p-mTOR,and BDNF of the prefrontal cortex were significantly reduced in the model group(P<0.05).Compared with the model group,the expression levels of synapsin I,PSD95,p-mTOR,and BDNF of the prefrontal cortex were significantly increased in the acupuncture group(P<0.05).At the 1 h and 24 h time points,compared with the normal group,the expression levels of synapsin I,PSD95,p-mTOR,and BDNF of the hippocampal tissues were significantly reduced in the model group(P<0.05).Compared with the model group,the expression levels of synapsin I,PSD95,p-mTOR,and BDNF of the hippocampus were not significantly different in the acupuncture group(P>0.05).Conclusion:Acupuncture may play a rapid antidepressant effect by increasing the expression of synaptic plasticity proteins in the prefrontal cortex.

基于循证医学原则探讨针刺双盲试验装置与举例

循证医学中强调随机对照临床试验是目前评估医学干预措施临床效果最严谨、最可靠的科学方法,但目前针刺试验面临着棘手的问题——如何设计规范的安慰针对照组。针对此问题,本团队研发了一款针刺临床双盲试验装置,该装置有如下特点:安慰组与治疗组所用装置外观一致,操作简易,对操作者及受试者都有良好的蒙蔽作用;装置由针管与球体的螺纹连接,其可实现360°试验角度,满足斜刺等多角度针刺试验;装置可调节针刺深度,也满足留针要求,可应用于针刺手法临床试验;可配合已有针具,一根针一个器具使用,降低针刺感染等风险,适用范围广。本装置可在临床试验研究中推广应用,为针刺双盲试验中安慰针组设计提供思路。

针刺双盲临床试验辅助装置的优化设计与应用

随机对照临床试验是评估医学干预措施临床效果最严谨的科学方法,而针刺治疗的临床试验中,设计结构合理的安慰针作为对照是目前迫切需要解决的问题之一。现有安慰针刺装置存在易破盲、操作复杂、不能实施针刺手法、成本高等问题。针对存在问题,研究者研制了一款评估针刺疗效的匿针式双盲试验装置。该装置由底座及竖向设在其中心的针管构成,针管分内、外套管,两者间隙中分别设导磁金属片、永磁环;装置主要靠永磁环与导磁金属片之间的引力,使内套管能在外套管的任意位置停留,可以将不同长度的试验用针隐匿在针管内。该装置的特点主要包括:不限制进针手法和速度;治疗组与安慰组可共用同一套针具;不受需治疗的腧穴部位、深度等更改针具;对施术者及受试者都有较强的蒙蔽作用,满足双盲要求。该装置具有双盲效果佳、低成本、可广泛应用等优点,可一定程度提升临床试验研究的质量,推动学科发展,亦为后续安慰针装置的研发提供思路。