Therapeutic Effects of Herbs Activating Blood Circulation and Dispersing Stasis on Acute Lung Injury after Abdominal Operations

Objective: To observe the effect of acute lung injury after abdominal surgical operations treated with herbs activating blood circulation and dispersing stasis. Methods: Forty-four patients complication with acute lung injury after abdominal operation were analyze with multiple clinical and laboratory parameters and were treated early with herbs activating blood circulation and dispersing stasis. Results: After 2 days of medication,arterial oxygen saturation (SaO2 ) and partial pressure of oxygen in artery (PaO2 ) markedly improved, with significant difference as compared with those before medication (P < 0. 01 ). After continous medication for 4 days, SaO2, PaO2 and chest X-ray as well as synthetic physiologic parameters obviously improved, prostaglandin F1a,thromboxane B2 (TXB2 ), C-reactive protein (CRP), erythrocyte C3b were very significantly different from those medication (P < 0. 01 ), the synthetic physiological parameters returned generally to normal. After 5 days of herbal medication, all parameters resumed normal with satisfactory physiologic criteria. Conclusions: Early application of herbs activating blood circulation and dispersing stasis could obviously improve hypoxemia and the lung lesions, and consequently the general condition of the patient.

王灿晖教授辨治肺癌的学术思想探赜

王灿晖教授是全国著名温病学家,江苏省名中医,在治疗内科疑难杂症方面经验丰富,对于肺癌的临床治疗更是独具匠心。王灿晖教授认为肺癌与肺、脾、肾密切相关,主张补气当贯穿整个疾病始终。本文总结王灿晖教授对于肺癌的常见分型、治疗大法及临床经验,以期中医药在本病治疗中发挥独特优势。

Activating Blood Circulation to Remove Stasis Treatment of Hypertensive Intracerebral Hemorrhage:A Multi-Center Prospective Randomized Open-Label Blinded-Endpoint Trial

Objective： To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation （TRABC） in treatment of hypertensive intracerebral hemorrhage （HICH）. Methods： This was a multi-center prospective randomized open-label blinded-endpoint （PROBE） trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale （mRS）. Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale （NIHSS） scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded. Results： After 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups （P〈0.01）. Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group （P=0.038）. Average Barthel scores in the treatment group after treatment was 89.11 ＋ 19.93, and in the control group 82.18 ＋ 24.02 （P=0.003）. NIHSS scores of the two groups after treatment decreased significantly compared with before treatment （P=0.001）. Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment （P〈0.05）. There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group. Conclusion： The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.

Platelet proteomics and its advanced application for research of blood stasis syndrome and activated blood circulation herbs of Chinese medicine

The development of novel and efficient antiplatelet agents that have few adverse effects and methods that improve antiplatelet resistance has long been the focus of international research on the prevention and treatment of cardiovascular and cerebrovascular diseases.Recent advances in platelet proteomics have provided a technology platform for high-quality research of platelet pathophysiology and the development of new antiplatelet drugs.The study of blood stasis syndrome(BSS)and activated blood circulation of traditional Chinese medicine(TCM)is one of the most active fields where the integration of TCM and western medicine in China has been successful.Activated blood circulation herbs(ABC herbs)of Chinese medicine are often used in the treatment of BSS.Most ABC herbs have antiplatelet and anti-atherosclerosis activity,but knowledge about their targets is lacking.Coronary heart disease(CHD),BSS,and platelet activation are closely related.By screening and identifying activated platelet proteins that are differentially expressed in BSS of CHD,platelet proteomics has helped researchers interpret the antiplatelet mechanism of action of ABC herbs and provided many potential biomarkers for BSS that could be used to evaluate the clinical curative effect of new antiplatelet drugs.In this article the progress of platelet proteomics and its advanced application for research of BSS and ABC herbs of Chinese medicine are reviewed.

扶阳活血方治疗气滞血瘀型不能进行血运重建的冠状动脉粥样硬化性心脏病临床研究

目的:观察扶阳活血方治疗气滞血瘀型不能进行血运重建的冠状动脉粥样硬化性心脏病(Coronary atherosclerotic heart disease, CHD)的临床疗效。方法:将98例气滞血瘀型不能进行血运重建的CHD患者按照随机数表法分为研究组和对照组,每组各49例。对照组给予常规西医治疗,研究组在对照组治疗的基础上给予扶阳活血方治疗。比较两组患者的临床疗效及治疗前后中医证候积分、血液流变学指标以及血清生化指标[超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)、同型半胱氨酸(Homocysteine, Hcy)、血管扩张刺激磷蛋白(Vasodilatory stimulating phosphoprotein, VASP)]及生活质量评分变化情况。结果:对照组有效率为77.55%,研究组有效率为93.88%,两组患者有效率比较,差异具有统计学意义(P<0.05)。两组患者治疗后中医证候积分低于本组治疗前,且治疗后研究组低于对照组,差异具有统计学意义(P<0.05)。两组患者血液流变学指标水平低于本组治疗前,且治疗后研究组低于对照组,差异具有统计学意义(P<0.05)。两组患者治疗后hs-CRP、Hcy水平低于本组治疗前,VASP水平高于本组治疗前,且治疗后组间比较,差异具有统计学意义(P<0.05)。两组患者治疗后生活质量评分低于本组治疗前,且治疗后研究组低于对照组,差异具有统计学意义(P<0.05)。结论:扶阳活血方治疗气滞血瘀型不能进行血运重建的CHD,可改善患者临床症状和血液流变学指标,减轻炎症状态,提高生活质量。

平性活血化瘀中药及其化学成分抗血小板聚集作用机制的研究进展

文章在调研2014年版《江西省中药材标准》、2020年版《中华人民共和国药典》和相关文献的基础上,从抑制花生四烯酸代谢途径、抑制血小板内含物释放、血小板膜蛋白受体拮抗和影响核苷酸系统四个方面综述了苏木、桃仁、红景天等8味平性活血化瘀中药抗血小板聚集的作用机制,为抗血小板聚集中药的临床应用提供了一定的理论参考。

活血化瘀方药联合地诺孕素治疗子宫内膜异位症有效性与安全性Meta分析

目的 系统评价活血化瘀方药联合地诺孕素治疗子宫内膜异位症的有效性与安全性。方法 计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识服务平台、中文科技期刊数据库(VIP)、中国临床试验注册中心、PubMed、Web of science、Embase、Cochrane Library等关于活血化瘀方药联合地诺孕素治疗子宫内膜异位症的随机对照试验,检索时限为建库起至2022年11月。采用Cochrane协作网偏倚风险评估工具进行方法学质量评价,运用RevMan 5.4和Stata 16.0软件进行Meta分析。结果 共纳入9项研究,1078例患者,其中试验组539例,对照组539例。Meta分析结果显示,活血化瘀方药联合地诺孕素治疗在提高总有效率[RR=1.24,95%CI(1.17,1.30),P<0.000 01]、减小子宫内膜异位囊肿直径[MD=-1.01,95%CI(-1.63,-0.39),P=0.001]、降低疼痛视觉模拟评分(VAS)[MD=-1.68,95%CI(-2.67,-0.70),P<0.000 01]、降低糖类抗原125[MD=-17.05,95%CI(-23.44,-10.66),P<0.000 01]、降低雌二醇水平[MD=-22.91,95%CI(-25.34,-20.48),P<0.000 01]、降低孕酮水平[MD=-0.22,95%CI(-0.25,-0.19),P<0.000 01]、降低血清内皮生长因子[MD=-23.97,95%CI(-30.96,-16.99),P<0.000 01]、降低基质金属蛋白酶-2[MD=-42.29,95%CI(-45.68,-38.89),P<0.000 01]、降低基质金属蛋白酶-9[MD=-118.99,95%CI(-172.97,-65.02),P<0.000 01]、降低半乳糖凝集素-3[MD=-1.35,95%CI(-1.83,-0.87),P<0.000 01]、降低复发率[RR=0.28,95%CI(0.13,0.59),P=0.000 8]方面均优于单用地诺孕素治疗。总有效率漏斗图及Egger’s检验结果提示,不存在明显的发表偏倚。结论 活血化瘀方药联合地诺孕素治疗子宫内膜异位症疗效和安全性良好,但仍需要更多设计严谨的高质量随机对照试验提供证据。

冠心病血瘀证辨治

冠状动脉粥样硬化性心脏病(简称冠心病)证候要素前3位是血瘀、气虚、痰浊,血瘀贯穿冠心病始终。血瘀不化,则聚而生毒,毒邪又作为致病因素影响机体,伤及心之血脉,使正气愈虚,应治以益气活血解毒,在活血药物的基础上加连翘、黄连、黄芩、党参等益气解毒之品,防止瘀毒化热。肾为先天之本,元气之根,肾脏亏虚,心肾失交,脉气不充,血脉滞涩,形成血瘀,治宜补肾活血,并辅以健脾。阳虚为气虚之渐,心阳虚衰,寒客脉中,血凝而不行,采用乌头赤石脂丸通阳,并加入石斛、麦冬等顾护阴液。冠心病活动期症状符合“风”之特点,此期应在活血药物中加入羌胡、防风、威灵仙等祛风药,使风散血流。心气虚衰,母病及子,脾气亦衰,致津液难化,聚湿成痰,痰水互结,进一步加重血瘀,用二陈汤加利水渗湿药物,使瘀祛痰消。

Chinese patent medicine for chronic obstructive pulmonary disease based on principles of tonifying Qi, promoting blood circulation by removing blood stasis, and resolving phlegm: a systematic review of randomized controlled trials

OBJECTIVE: To assess the efficacy and safety of Chinese patent medicine(CPM) with the principle of tonifying Qi, promoting blood circulation by removing blood stasis, and resolving phlegm(TQ-PBC-RP)in the management of stable chronic obstructive pulmonary disease(COPD).METHODS: A systematic review of randomized controlled trials(RCTs) identified from electronic databases and print was conducted. RCTs testing CPMs with TQ-PBC-RP against any type of controlled intervention in patients with stable COPD and assessing clinically relevant outcomes were included. Methodological quality was evaluated with the risk of bias tool according to systematic review handbook 5.0.2. Quality of evidence was estimatedby the rating approach developed by the Grading of Recommendations, Assessment, Development,and Evaluation Working Group.RESULTS: Thirteen eligible RCTs with 12 oral CPMs were tested. Significant differences between groups in favor of CPMs were not reported in all trials. Most trials included were deemed to be of low methodological quality with poor evidence quality.Because of large data heterogeneity, statistical pooling was not performed for all outcomes.CONCLUSION: The effectiveness of CPM in the treatment of stable COPD is not supported by evidence. Currently, evidence from RCTs is scarce and methodologically weak. Considering the popularity of CPMs among patients undergoing COPD, rigorously designed trials are warranted.

中药中活血化瘀药对皮肤创伤愈合的影响

目的 探讨活血化瘀药中血竭、乳香和没药对角质形成细胞的影响及其治疗皮肤创伤的作用机理。方法 采用皮肤器官培养法 (浮游法 )培养SD小鼠皮片 ,比较观察不同浓度的中药对角质形成细胞的影响。结果 血竭在浓度为 2× 1 0 -1mg/ml、2× 1 0 -2 mg/ml和 2× 1 0 -3mg/ml时 ,皆有显著促游走作用 ,没药在浓度为 1× 1 0 -2 mg/ml和 1× 1 0 -3mg/ml时有促游走作用。乳香在各种实验浓度均无促游走作用。 结论 没药和血竭在一定浓度内有促进角质形成细胞的游走作用 。

活血消癥中药治疗糖尿病肾病的随机对照临床试验系统综述及Meta分析

目的:探讨活血消癥中药辨证治疗糖尿病肾病(Diabetic Nephropathy,DN)的有效性及安全性。方法:检索5个主要的电子数据库(中文数据库:中国知网(CNKI)、万方、维普(VIP),英文数据库:Medline、CENTRAL),检索日期从建库至2016年7月。筛选纳入并Meta分析活血消癥中药治疗DN的随机对照试验(Randomized Controlled Trials,RCT)。结果:活血消癥中药对于改善患者24 h尿蛋白定量(quantitative test of 24 h urinary protein,24 h UTP)(MD=-0.08 g,95%CI=[-0.13,-0.03],I^2=0%)和中医证候积分(MD=-3.82,95%CI=[-4.84,-2.79],I^2=0%)疗效优于ACEI/ARB类药物。对于SCr和BUN的影响,组间差异无统计学意义。结论:活血消癥中药降低DN患者24 h UTP和改善临床症状疗效优于ACEI/ARB类药物。

活血化淤代表方剂对肿瘤转移影响的实验研究

目的初步阐明活血化淤方药对恶性肿瘤转移是抑制还是促进及与红细胞免疫的关系。方法选用桂枝茯苓丸、抵当汤、丹参饮活血化淤3个代表方,观察其对实验动物大肠癌肝转移的影响。结果各组动物接种瘤细胞后均发生了不同程度的肿瘤转移情况,其中以发生红细胞免疫缺陷后接种肿瘤细胞组转移最为严重,与正常情况下接种肿瘤细胞组比较均P<0.05或P<0.01。正常情况下接种肿瘤细胞后服用抵当汤、桂枝茯苓丸、丹参饮均有明显抑制肿瘤转移作用,与模型组比较P<0.01;但是,红细胞免疫缺陷后接种肿瘤细胞再服用活血化淤三方与模型组比较P>0.05,并且各用药组红细胞免疫缺陷后接种肿瘤细胞与正常情况下接种肿瘤细胞组间有显著性差异,P均<0.01。结论在红细胞免疫功能障碍状态下,肿瘤的转移会加重。活血化淤药物对肿瘤转移确实有抑制作用,其抑制作用与红细胞免疫功能的正常与否密切相关。

消瘀接骨散促进骨折愈合的实验研究

目的 验证消瘀接骨散促进骨折愈合的疗效和探讨其治疗机理。方法 选用 40只健康雄性家兔 ,做双侧桡骨中、下 1/ 3人工骨折模型 ,随机分为实验组外敷消瘀接骨散和对照组不敷药 ,术后7天、14天、2 2天和 32天分别处死动物 ,取桡骨标本X线片检查、作生物力学测试和称取骨痂干重。结果 实验组的X线平片显示骨折修复优于对照组 ,而且生物力学性能和骨痂干重均显著高于对照组 (P<0 0 5或P <0 0 1)。

急性心肌梗死直接经皮冠状动脉介入术后应用益气养阴活血法治疗的效果:随机对照试验

背景:急性心肌梗死(acute myocardial infarction,AMI)再灌注治疗后,仍有许多患者存在心肌组织的无复流现象。如何改善AMI血运重建后心肌微循环的血流灌注,目前尚无明确有效的中、西医治疗方案。目的:探讨益气养阴活血法对AMI直接经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后的临床疗效,并探讨其对梗死部位心肌组织微循环血流的作用。设计、场所、受试者和干预措施:按照随机、对照、双盲的原则,选择北京大学人民医院2005年1月至2006年3月首次诊断为ST段抬高性AMI并接受急诊直接PCI治疗成功(KillipⅠ～Ⅱ),同时符合中医气阴两虚和心血瘀阻证的患者35例,分为两组。治疗组在西药常规治疗基础上加用益气养阴、活血化瘀的西洋参和丹参制剂,对照组在西药常规治疗基础上加用安慰剂。疗程为3个月。主要结局指标:观察两组患者治疗前后中医证候积分,静息状态及20μg/(kg·min)多巴酚丁胺负荷状态下的左心室射血分数、室壁运动计分指数、正常心肌百分比,观察反映微循环血流灌注速度的心肌声学造影参数k值。结果:治疗3个月后,治疗组中医证候积分显效率、有效率及总有效率均高于对照组,差异有统计学意义(χ2=4.118,P=0.042);多巴酚丁胺负荷状态下,治疗组左心室射血分数较治疗前显著增加(t=2.345,P=0.032),较对照组亦显著增加(t=2.130,P=0.041)。治疗3个月后,不同状态下治疗组k值增加的室壁节段数均较对照组多,但差异无统计学意义。结论:中医益气养阴活血法能改善AMI患者直接PCI术后的临床症状,对心肌微循环血流灌注与心肌收缩能力的改善有一定作用。

活血化瘀药对内毒素休克大鼠细胞因子释放的影响

目的 :探讨活血化瘀药对内毒素休克大鼠细胞因子释放的影响。方法 :Wistar大鼠 40只 ,随机平分为对照组 (NS)、内毒素休克组 (L PS)、地塞米松治疗组 (Dex)和活血化瘀药治疗组 (AMRS) 4组 ,分别检测各组血中内皮素 1(ET 1)、一氧化氮 (NO)、肿瘤坏死因子α(TNFα)和超氧化物歧化酶 (SOD)的浓度变化。结果 :在 L PS刺激下 ,血中 ET 1、NO和 TNFα的浓度与 NS组比较显著增加 (P均 <0 .0 1) ,而 SOD较 NS组浓度降低 (P<0 .0 5 )。 Dex组与 L PS组比有不同程度的恢复 ,但只有 ET 1降低明显 (P<0 .0 5 )。 AMRS组的各项指标均与 L PS组比有显著差异 (P均 <0 .0 5 )。结论 :AMRS影响 L PS刺激所诱导的血中 ET 1、NO、TNFα和 SOD浓度的改变 ,其在内毒素休克过程中对内皮细胞等靶细胞释放细胞因子具有重要的调节作用。

活血化瘀中药治疗慢性前列腺炎的系统评价

目的:评价活血化瘀中药复方治疗慢性前列腺炎的疗效和安全性。方法:全面检索截至2006年12月活血化瘀中药复方治疗慢性前列腺炎的随机对照试验,运用Jadad量表和试验分配隐藏评价纳入文献的方法学质量并提取有效数据进行Meta-分析,用RevMan 5.0软件完成统计和系统评价。结果:共9篇文献包含1815例患者符合纳入标准。前列安通片(对比舍尼通)与自拟复方(对比前列康)具有改善慢性前列腺炎患者前列腺炎症状评分的效应(P<0.02、0.00001);对比前列康,前列腺胶囊、前列腺汤、自拟复方均具有改善患者疼痛与排尿不适的作用(P值均<0.00001),与前列速康宝片、丹蒲胶囊(对比前列泰片)也均能使患者异常的按摩前列腺液白细胞计数(EPS-WBC)恢复正常(P值均<0.00001与<0.006、<0.03)。结论:活血化瘀类中药复方在改善慢性前列腺炎患者的症状、前列腺液指标可能优于前列康、舍尼通及前列泰片。

川芎—赤芍药对研究进展

川芎—赤芍是著名的活血化瘀药对,川芎活血行气、祛风止痛,赤芍清热凉血、散瘀止痛,二者均为活血要药,配伍后达到同类相须、相辅相成、相互促进等功用,能够发挥抗动脉粥样硬化,改善血液流变性,改善心肌缺血,保护内皮功能,保护脑组织及神经等作用。芎芍胶囊是川芎和赤芍有效组分配伍的典型应用,主要用于治疗心血管疾病。本文从功效及物质基础、药理研究、临床应用方面对川芎—赤芍药对的研究进行了系统的阐述,以期为川芎—赤芍药对的进一步研究与开发提供依据。

活血化瘀药佐治儿童痰热闭肺型支原体肺炎的疗效观察

目的:探讨活血化瘀药治疗儿童痰热闭肺型支原体肺炎的临床疗效。方法:选取60例符合痰热闭肺型支原体肺炎诊断标准患儿,随机分成两组,治疗组、对照组各30例。所有患儿均使用阿奇霉素针10 mg/(kg.d)静滴治疗5天,同时服用中药1周。治疗组在使用对照组的中药前提下加用活血化瘀药物,如丹参、桃仁、川芎、赤芍。观察患儿临床症状体征改善时间、病程、肺部炎症吸收时间等各项指标。结果:两组患儿热退时间、肺部罗音消失时间、住院时间,治疗组均优于对照组,经统计学分析,差异具有统计学意义(P<0.05);咳嗽明显缓解时间治疗组较对照组有所缩短,但差异无统计学意义(P>0.05);临床总体疗效治疗组显效率为93.3%,对照组为83.3%,经统计学分析差异具有统计学意义(P<0.05)。结论:加用活血化瘀药对改善儿童痰热闭肺型支原体肺炎的临床症状、体征、病程等方面具有一定的优势,临床疗效显著。

网络药理学方法探讨活血化瘀中药治疗冠心病作用机理

目的:采用网络药理学方法研究活血化瘀中药,探索其治疗冠心病有别于西药的独特作用机理。方法:选择活血化瘀中药丹参、红花、川芎、灯盏花、桃仁、三七、赤芍为研究对象,依据TCMD2009数据库得到其对应的322个化学成分,进而在STITCH数据库中搜集得到与化学成分对应的218个靶标;选取治疗冠心病的临床常用西药的作用靶标;通过文献查找与冠心病密切相关的靶标;利用Reac-tome数据库找到靶标所在的通路;采用Cytoscape软件分别构建出活血化瘀中药作用网络、西药作用网络及冠心病疾病网络模型。结果:网络拓扑结果分析表明,所建立3个网络模型是服从幂律分布的无标度网络,无标度特性值按冠心病、西药和中药分别为γ1=1.741,γ2=1.719,γ3=1.808,网络模型具有稳定性和鲁棒性。3个网络对比计算筛选得到中药与西药治疗冠心病相同的作用节点138个,中药独特作用节点397个。结论:中药治疗冠心病确存在有别于西药治疗的独特作用途径,有待深入分析和挖掘。

活血化瘀药物及其有效成分对生物转化酶的影响

生物转化酶在众多中西药物代谢中起着非常重要的作用。文章综述了近年来国内外学者就活血化瘀药物对生物转化酶影响的研究思路、方法和进展。通过深入研究活血化瘀药物对生物转化酶的影响,有利于中药基础理论的深入和发展;临床上应该重视活血化瘀药物与其他药物合用时所发生的代谢性相互作用,优化给药方案,从而提高临床用药的有效性和安全性。