运用《辅行诀》所载“汤液经法图”理论开展中药治疗痹证的药学监护及干预1例

《辅行诀》所载“汤液经法图”展示了一套以五脏虚实辨证结合五味补泻治疗为基础的辨证论治体系,体现了中医组方配伍的根本原理,可用于中药饮片处方审核和临床药师药学会诊。本文记载1例中药临床药师运用“汤液经法图”开展药学监护并进行药学干预的案例。患者老年女性,主因反复腰痛5余年,加重伴右下肢麻木2个月入住院。医师请药师采用“汤液经法图”进行联合会诊分析。药师运用“汤液经法图”理论体系,判定该患者为肝虚合并肾虚,虚实夹杂,处方应以补肝补肾为主,补泻兼施,药味以辛、苦为主,酸、甘为辅,并与医师联合拟定中药饮片处方一首,患者用药后治疗效果满意,出院后药学随访效果满意。此案例提示,临床药师运用“汤液经法图”开展中药饮片处方的药学评价和药学监护是可行的和有效的。

脾肾同治唾液腺分泌增多症验案举隅

唾液腺分泌增多症的根本病因在于脾肾亏虚,水液运化失司,摄纳失调,临床分为多涎症与多唾症两种不同表现。辨证应从脾肾两脏着手,以温阳化饮、健脾益肾为治法。本文列举唾液腺分泌增多症验案2则,以理中汤、苓桂术甘汤温阳化饮为基础方,加用益肾摄涎之品,疗效显著。

合病、并病研究述要

《伤寒论》中明确指出合病、并病的条文仅12条,且都集中在三阳经病变当中,对三阴经、阴经与阳经之间是否存在合病、并病并未涉及,医家更是众说纷纭,莫衷一是。本文在分析原文及参考众多文献的基础上对合病、并病进行了探讨,认为合病、并病理论贯穿于《伤寒论》始终,是张仲景对六经辨证的补充;原文中除了明确指出的12条条文外,还有其他许多关于合病、并病的论述,三阴经、阴阳两经之间亦存在合病、并病。在此基础上,对合病、并病的治疗原则有了初步的把握,认为合病治疗应分清主次,并病治疗应遵循先表后里、先外后内、先急后缓、合方的原则。

浅谈消谷善饥、饥不能食与饥不欲食

对《伤寒论》中关于消谷善饥、饥不能食与饥不欲食的论述进行梳理。在此基础上,对三者的病机进行分类;消谷善饥的病机为胃火炽盛、瘀血内停、瘀热互结;饥不能食的病机为胃虚气逆、胃热腑实、胸中郁热、痰饮阻胃;饥不欲食的病机为上热下寒。

‘红美人’杂柑在丽水的引种表现及栽培技术要点

以柑橘‘红美人’品种为试材,对其在丽水的植物学特性、成熟期、丰产性、果实外观性状及TSS的观测分析。结果表明,品种表现适应性、抗病性、丰产性较好,且果实美观品质优良风味好。适宜在丽水中低海拔山区发展种植。总结‘红美人’在丽水的引种表现及栽培注意事项,以供参考。

益智清心方对自然衰老大鼠学习记忆能力和肠道菌群的影响

目的观察益智清心方对自然衰老大鼠学习记忆能力和肠道菌群的影响。方法采用Morris水迷宫筛选出认知功能障碍的自然衰老大鼠。按照分层随机的方法分为模型组、盐酸多奈哌齐组(0.45 mg/kg)、益智清心方低剂量组(0.3 mg/kg)、益智清心方高剂量组(0.6 mg/kg),每组10只,并选用10只认知功能正常的自然衰老大鼠作为空白对照组,分别给予相应的药物或相同体积的蒸馏水灌胃8周。通过Morris水迷宫测评大鼠的空间学习记忆能力;采用16S rDNA生物信息技术分析肠道菌群结构。结果与空白组比较,模型组大鼠逃避潜伏期延长,在原平台象限活动路程比降低(P<0.05,P<0.01)。与模型组比较,盐酸多奈哌齐组、益智清心方组的逃避潜伏期均缩短(P<0.01),益智清心方组在原平台象限活动路程比均增加(P<0.01);益智清心方组OTU指数、Chaol指数和进化距离指数均降低,覆盖度指数升高(P<0.05,P<0.01)。与模型组比较,盐酸多奈哌齐组未检测到蓝藻菌;益智清心方组肠道菌群群落丰度、多样性及结构都发生了显著改变,特别是降低蓝藻细菌的丰度、下调厚壁菌门/拟杆菌门相对丰度的比例,促进变形菌门和放线菌门富集。结论益智清心方能够提高自然衰老大鼠的空间学习记忆能力,其机制可能与调节肠道菌群结构,保持肠道微生态平衡相关。

从中医学“清浊相干”理论探讨肠道微生物群与认知障碍

认知障碍的发病率和负担不断增加,是亟需研究的热点问题。最新研究发现肠道微生物群与认知障碍关系密切。本文提出“清浊相干”即脾胃升降失常,内生浊邪,导致清气不升、脑失所养,浊邪不降、上犯清窍,为肠道微生物群紊乱引发认知障碍的关键病机;病久由浊转毒,而败坏脑髓、损害脑神,是导致认知障碍不断加重的重要因素和病理转归。从“清浊相干”与肠道微生物群紊乱角度防治认知障碍,可能是中医药研究的新方向。“调整脾胃肠,升清降浊毒”为中医药防治认知障碍的重要方法,肠道微生物群及其代谢产物是中医药防治认知障碍的新靶点。

Clinical Experience in Treatment of Alzheimer’s Disease with Jiannao Yizhi Formula (健脑益智方) and Routine Western Medicine

Objective:To investigate the long-term therapeutic effects of the Chinese medicine Jiannao Yizhi Formula(健脑益智方,JYF)in the treatment of Alzheimer’s disease(AD).Methods:Sixty mild-to-moderate AD participants were recruited and randomly allocated to the treatment(30 with JYF)and the control groups(30 with donepezil)for 6 months with the random numbers.The primary outcomes were scores of Alzheimer’s Disease Rating Scale-Cognitive(ADAS-Cog)and Chinese Medicine Symptom Scale(CM-SS).The secondary outcomes were scores of Mini Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),and Activities of Daily Living(ADL).Safety assessments were conducted at baseline and the 6 th month of treatment.Serum levels of acetylcholine(Ach),amyloid-β protein 42(Aβ42),and the microtubule-associated protein tau(Tau)were also determined by enzyme-liked immunosorbent assay.Results:Fifty-one participants were included in the final analyses(JYF n=27;donepezil n=24).Compared with baseline,both JYF and donepezil increased the MoCA and MMSE scores and decreased the ADAS-Cog and CM-SS scores(P<0.05 or P<0.01).Both drugs increased the serum levels of Ach and decreased the serum levels of Aβ42 and Tau(all P<0.05).There was no significant difference in these variables between the two groups,which showed that JYF was not inferior to donepezil.No obviously significant changes were observed in the ADL.No severe adverse events were observed in both groups.Conclusion:The effect and safety of JYF for the treatment of AD were not inferior to those of donepezil.

Efficacy and Safety of Guilingji Capsules(龟龄集胶囊)for Treating Mild-to-Moderate Cognitive Impairment:Study Protocol for A Randomized,Double-Blind,Positive-Controlled,Multicenter and Noninferiority Trial

Background:The incidence of cognitive impairment(CI)is gradually increasing,which has attracted more attention from medical researchers worldwide.Definitive mechanisms of pathogenesis remain elusive,and there are few medications that have been proven effective for CI.The utilization of Chinese herbal medicine has shown positive therapeutic effects for a broad spectrum of diseases,including CI.Objective:The purpose of this study is to evaluate the safety and efficacy of Guilingji Capsules(GLJC,龟龄集胶囊)in treating mild-to-moderate CI with Shen(Kidney)and marrow deficiency syndrome.Methods:This is a randomized,double-blind,positive-controlled,multicenter clinical trial with a noninferiority design that included 348 participants randomly divided into an experimental arm and an active comparator arm.Individuals in the experimental arm(174 cases)took 0.6 g of GLJC once a day and 19.2 mg of Gingko biloba extract mimetic 3 times a day.Individuals in the active comparator arm(174 cases)took 0.6 g of GLJC mimetic once a day and 19.2 mg of Gingko biloba extract in tablet form 3 times a day.The intervention period included two sessions over 24 weeks.The primary outcome be the effectiveness of GLJC on cognitive improvement after 24 weeks of treatment,which was defined as an increase in the Mini Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)Scale.The secondary outcomes were improvement in independence,daily living ability,and Chinese medicine(CM)syndrome,which were measured with the Alzheimer’s disease Rating Scale-Cognitive Project(ADAS-Cog),Clinical Dementia Rating(CDR)Total Score,Activities of Daily Living(ADL)Total Score and the Chinese Medicine Symptom Scale(CM-SS),respectively.Serum acetylcholine,acetylcholinesterase,bax and bcl-2 were monitored to explore the mechanism of GLJC on CI.In addition,safety measures,including vital signs,electrocardiography,laboratory indicators(full blood count,kidney and liver function tests,routine urine test and routine stool test)and adverse events,were also recorded.Discussion:The purpose of this trial is to evaluate the efficacy and safety of GLJC in patients with mild-to-moderate CI with kidney and marrow deficiency syndrome.If successful,the results would provide a viable treatment for patients with mild-to-moderate CI.