Comparing the mechanism of four classic Gualou-Xiebai prescriptions for cardiovascular diseases with phlegm and blood stasis syndrome based on molecular network modeling

Background:Four classical Traditional Chinese Medicine prescriptions,namely Gualou Xiebai Baijiu decoction,Gualou Xiebai Banxia decoction(GLXBBX),Zhishi Xiebai Guizhi decoction(ZSXBGZ)and Danlou prescription(DL),have been frequently used for treatment of phlegm and blood stasis syndrome(PBSS)-related cardiovascular diseases.However,its therapeutic mechanism has not been clearly elucidated.This study aimed to explore PBSS and its molecular mechanism,clarify and compare the mechanisms of four prescriptions in treating PBSS-related diseases.Method:In this study,we collected four prescriptions’compounds,predicted therapeutic targets,and enriched pathways which were based on network pharmacology.Then,we analysed the commen and different mechanisms by combing the network of components,targets and pathways.Finally,molecular docking was engaged to assess the binding potential of key compounds and hub targets.Results:We showed that four prescriptions’intersection genes(VEGFA,SRC,EGFR,etc.)were commonly enriched in PI3K-AKT signaling pathway,HIF-1 signaling pathway,etc.In addition,platelet activation and cAMP signaling pathway were singly enriched from the GLXBBX through unique compounds 12,13-epoxy-9-hydroxynonadeca-7,10-dienoic acid and Cyclo(L-tyrosyl-L-phenylalanyl).These bioactive compounds may exert GLXBBX’s unique pharmacological pathways via involving in mediating PPARA,PTGER3,etc.Sphingolipid signaling pathway was singly enriched from the ZSXBGZ through unique compounds tetramethoxyluteolin,ergosterol peroxide,etc.These bioactive compounds could mediate ADORA1,ADORA3 and TNFRSF1A to regulate ZSXBGZ’s unique pharmacological pathways.AMPK signaling pathway was singly enriched from the DL through unique compounds kaempferol,evofolinb,ethyl acid and aureusidin.These bioactive compounds were involved in mediating the main targets of AMPK signaling pathway,such as TNF,TNFRSF1A,etc.Conclusions:Our research demonstrated that GLXB-prescriptions involved in almost all pathological stages of PBSS-related cardiovascular diseases by modulating high-frequency shared pathways and targets mainly through key compounds(quercetin,mandenol,sitosteryl acetate and luteolin,etc.),for example,participate in the process of atherosclerosis,lipid metabolism,inflammation,immune response,thrombosis,inhibit inflammatory factors and platelet aggregation,regulate immune function,vascular function,oxidative stress.In addition to common pharmacological efficacies,there could also be specificities among GLXB prescriptions due to different compounds.For example,GLXBBX tends to regulate the function of vascular and endothelial barrier,prevent thrombosis.ZSXBGZ tends to regulate lipid metabolism and protect the heart from lipid accumulation.DL tends to maintain energy homeostasis and improve inflammation.

Comparative evaluation in treating qi-yin deficiency and phlegm stasis syndrome of type 2 diabetes mellitus in a rat model

Objective:To compare the efficacy of traditional Chinese medicine (TCM),western medicine and integrative medicine in treating type 2 diabetes mellitus (T2DM) in a rat model.Methods:The T2DM rat model was established with a high-fat diet (HFD) for 35 days and a single injection of streptozotocin (STZ,30 mg/kg).The T2DM-induced rats were divided into three groups,and treated with Yiqi Yangyin Huatan (YQYYHT) granules (3.84 g/kg per day),pioglitazone (1.35 mg/kg per day) or YQYYHT granules + pioglitazone (3.84 g/kg per day+1.35 mg/kg per day) respectively for 14 days.Clinical features and behavioral changes,as well as T2DM indicators,were recorded to evaluate therapeutics effects in each treatment group.Results:The T2DM rat model expressed insulin resistance (IR),with features similar to qi-yin deficiency and phlegm stasis syndrome,including decreased cyclic adenosine monophosphate/cyclic guanosine monophosphate (cAMP/cGMP) ratio,decreased levels of Na+-K+-ATPase,superoxide dismutase (SOD) and high density lipoprotein-cholesterol (HDL-C),and increased levels of serum triglyceride (TG),total cholesterol (TC) and low density lipoprotein (LDL-C).All three treatment groups showed significant decreases in fasting blood glucose (FBG) and fasting insulin (Fins),and improvement of TCM syndrome to different degrees.Importantly,YQYYHT improved the most of the indicators of T2DM,followed by integrative medicine and pioglitazone alone.Conclusion:Compared with western medicine or integrative medicine,prescription of TCM based on syndrome differentiation may offer more advantages in the prevention and treatment of T2DM.

Effect of Gualou Xiebai Banxia decoction combined with Danshen Decoction on clinical efficacy of unstable angina with phlegm and blood stasis syndrome

Objective:To observe the clinical efficacy and safety of Gualou Xiebai Banxia decoction combined with Danshen decoction on unstable angina(UA)with phlegm and blood stasis syndrome.Method:Eighty patients with UA were randomly divided into treatment group(40 cases)and control group(40 cases)by random number table.The control group was given conventional western medicine treatment,and the experimental group was given Gualou Xiebai Banxia decoction and Danshen decoction on the basis of the control group.Both groups were treated for 4 weeks.Before and after treatment,the angina attacks,dosage of nitroglycerin,traditional Chinese medicine syndrome score,quality of life score,blood lipid,coagulation index and clinical total efficacy were observed and recorded.Results:After 4 weeks of treatment,the attack times and duration of angina in the two groups were both decreased compared with those before treatment.And the treatment group was more significantly reduced than the control group,the difference was statistically significant(p<0.05);the consumption of nitroglycerin of the treatment group was 90.0%,which was better than 67.5%of the control group,the difference was statistically significant(p<0.05);the total effective rate of the treatment group was 90%,which was better than 65%of the control group,the difference was statistically significant(p<0.05);the traditional Chinese medicine(TCM)syndrome score of the experimental group was lower than that of the control group,the differences was significant(p<0.05).The improvement of low density lipoprotein(LDL-C),total cholesterol(TC)and prothrombin time(PT)in the experimental group was better than that in the control group(p<0.05).During the study,there were no obvious adverse reactions in both groups.Conclusion:Gualou Xiebai Banxia decoction combined with Danshen decoction can effectively relieve the attack of angina and the consumption of nitroglycerin,improve clinical symptoms,regulate blood lipid and blood flow state,and improve the quality of life of patients with UA,with good clinical efficacy and safety.

Efficacy of Danlou Tablet in the Treatment of Coronary Heart Disease with Phlegm and Blood Stasis Syndrome and Its Effects on Serum Inflammatory Factors

[Objectives] To explore the efficacy of Danlou Tablet( DLT) in the treatment of coronary heart disease( CHD) with phlegm and blood stasis syndrome and its effects on serum inflammatory factors. [Methods]One hundred and ninety-seven patients with CHD and phlegm and blood stasis syndrome in our hospital from January 2016 to January 2018 were selected and randomly divided into two groups: control group( n =98) treated with aspirin plus atorvastatin,and research group( n =99) treated with DLT and aspirin plus atorvastatin for one month. The clinical efficacy and incidence of adverse reactions were observed. Serum secretory phospholipase A2( s PLA2),lipoprotein-associated phospholipase A2( LP-PLA2),oxidized low-density lipoprotein( ox-LDL),monocyte chemoattractant protein-1( MCP-1) and World Health Organization Quality of Life( WHOQOL-100) scores were compared before and after one month of treatment. [Results] The total effective rate was93. 94% in the research group,which was higher than that in the control group( 79. 59%,P < 0. 05);the levels of serum s PLA2,LP-PLA2,ox-LDL and MCP-1 in the research group were lower than those in the control group after one month of treatment( P < 0. 05). There was no statistical significance of the difference in the total incidence of adverse reactions between the research group and the control group( P > 0. 05).After one month of treatment,WHOQOL-100 scores were higher in two groups,which were higher in the research group than that in the control group( P < 0. 05). [Conclusions]DLT can significantly reduce the level of serum inflammatory factors,improve the quality of life in patients with CHD and phlegm and blood stasis syndrome.

温胆汤加减治疗气虚血瘀痰阻型缺血性脑卒中急性期的疗效及对NT-proBNP、ICAM-1和MCP-1的影响研究

目的:探讨温胆汤加减治疗气虚血瘀痰阻型缺血性脑卒中急性期患者的疗效,以及对N末端脑钠肽前体(NT-proBNP)、细胞间黏附分子-1(ICAM-1)和单核细胞趋化蛋白-1(MCP-1)水平的影响。方法:以2021年5月至2022年5月该院收治的气虚血瘀痰阻型缺血性脑卒中急性期患者100例为研究对象,根据随机数字表法分为对照组和观察组,每组50例。对照组患者给予常规治疗,观察组患者在对照组的基础上给予温胆汤加减治疗。比较两组患者的临床疗效,NT-proBNP、ICAM-1和MCP-1水平,美国国立卫生院卒中神经功能缺损评分量表(NIHSS)评分、改良Rankin量表(mRS)评分及中医证候积分。结果:治疗1个月后,观察组患者的总有效率为94.00%(47/50),显著高于对照组的80.00%(40/50),差异有统计学意义(P<0.05)。治疗1个月后,观察组患者NT-proBNP、ICAM-1和MCP-1水平显著低于对照组,血液流变学各指标(血浆黏度、血低切黏度、血高切黏度、纤维蛋白原和红细胞压积)水平显著低于对照组,差异均有统计学意义(P<0.05)。治疗7 d、1个月后,观察组患者的NIHSS评分低于对照组;治疗1个月后,观察组患者的mRS评分、中医证候积分低于对照组,差异均有统计学意义(P<0.05)。结论:温胆汤加减治疗气虚血瘀痰阻型缺血性脑卒中急性期患者的效果较好,可显著降低NT-proBNP、ICAM-1和MCP-1水平,促进血液流通和疾病的恢复,提高患者的生活质量。

基于转录组学分析降尿酸方对痰浊瘀阻型尿酸性肾病患者NLRP3/IL-1β信号通路的影响

目的:探讨降尿酸方对痰浊瘀阻型尿酸性肾病患者PBMCs中NLRP3/IL-1β的影响。方法:从一项单中心随机对照试验中随机选取6例受试者,其中试验组(降尿酸方联合非布司他治疗)和对照组(降尿酸方安慰剂联合非布司他治疗)各3例受试者。对试验组和对照组治疗前后与3例正常人群共15例样本的外周血白细胞进行mRNA-seq分析;提取试验组和对照组患者治疗前后的外周血单个核细胞,Western blot检测PBMCs中NLRP3、IL-1β蛋白水平差异,RT-qPCR检测PBMCs中NLRP3、Caspase-1、IL-18基因表达水平。结果:KEGG分析降尿酸方治疗后涉及到的通路有NOD样受体信号通路、NF-κB信号通路、Toll样受体信号通路等。试验组干预12周后PBMCs中NLRP3、IL-1β蛋白水平降低,NLRP3、Caspase-1、IL-18基因水平明显低于对照组(P<0.05)。结论:降尿酸方可以抑制痰浊瘀阻型尿酸性肾病患者NLRP3/IL-1β信号通路,减轻对肾脏的炎性损伤。

基于TRAF2/AP-1信号通路探讨柴苓合剂对痰瘀互结MS-IR大鼠炎症因子影响

目的基于TRAF2/AP-1信号通路探讨柴苓合剂对痰瘀互结代谢综合征胰岛素抵抗(MS-IR)大鼠糖代谢、脂代谢、炎症因子的部分作用机制。方法48只SPF级SD雄性大鼠随机分为空白组和造模组。造模组大鼠采用高脂高糖饲料喂养,注射小剂量链脲佐菌素(STZ)(35 mg/kg),同时用物理刺激方法,建立痰瘀互结型MSIR大鼠模型。造模成功后将大鼠随机分为模型组,柴苓合剂低、中、高剂量组,西药组进行干预。给药各组分别进行柴苓合剂、吡格列酮干预治疗3周,空白组、模型组给予等体积的蒸馏水灌服。生化检测大鼠空腹血糖(FBG)、空腹胰岛素(FINS)水平,计算胰岛素抵抗指数(HOMA-IR);ELISA法检测血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平;Western Blot检测肝组织TRAF2、JNK、AP-1蛋白表达;HE染色切片,光学显微镜观察用药前后肝细胞损伤、肝细胞坏死、脂质堆积、炎症细胞浸润等情况。结果(1)糖代谢指标水平。与空白组相比,模型组大鼠FBG、FINS、HOMA-IR水平均升高(P<0.01);与模型组相比,柴苓合剂低、中、高剂量组及西药组FBG、FINS、HOMA-IR水平均降低(P<0.01);与西药组比较,柴苓合剂高剂量组FBG、FINS、HOMA-IR水平差异无统计学意义(P>0.05);与柴苓合剂低剂量组比较,柴苓合剂高、中剂量组及西药组FBG、FINS、HOMA-IR水平均降低(P<0.01);与柴苓合剂中剂量组比较,柴苓合剂高剂量组及西药组FBG、FINS、HOMA-IR水平降低(P<0.01)。(2)脂代谢指标水平。与空白组相比,模型组大鼠甘油三酯(TG)、胆固醇(CHO)水平均升高(P<0.01);与模型组相比,柴苓合剂低、中、高剂量组及西药组TG、CHO水平均降低(P<0.01);与西药组相比,柴苓合剂中、高剂量组TG、CHO水平均降低(P<0.05,P<0.01),柴苓合剂低剂量组TG、CHO水平差异无统计学意义(P>0.05);与柴苓合剂低剂量组相比,柴苓合剂中、高剂量组TG、CHO水平均降低(P<0.01);与柴苓合剂中剂量组相比,柴苓合剂高剂量组TG、CHO水平均降低(P<0.01)。(3)TNF-α、IL-6水平。与空白组相比,模型组大鼠TNF-α、IL-6水平均升高(P<0.01);与模型组相比,柴苓合剂低、中、高剂量组及西药组TNF-α、IL-6水平均降低(P<0.01);与西药组相比,柴苓合剂低、中、高剂量组TNF-α、IL-6水平均降低(P<0.01);与柴苓合剂低剂量组相比,柴苓合剂中、高剂量组TNF-α、IL-6水平均降低(P<0.05,P<0.01);与柴苓合剂中剂量组相比,柴苓合剂高剂量组TNF-α、IL-6水平均降低(P<0.01)。(4)肝组织TRAF2/JNK/AP-1信号通路蛋白表达。与空白组相比,模型组大鼠肝组织TRAF2、JNK、AP-1蛋白表达均上调(P<0.01);与模型组比较,柴苓合剂低、中、高剂量组及西药组肝组织TRAF2、JNK、AP-1蛋白表达水平均降低(P<0.05,P<0.01);与西药组比较,柴苓合剂高剂量组肝组织TRAF2、JNK、AP-1蛋白表达水平均降低(P<0.01),柴苓合剂低、中剂量组肝组织TRAF2、JNK、AP-1蛋白表达水平差异无统计学意义(P>0.05);与柴苓合剂低剂量组比较,柴苓合剂高剂量组肝组织TRAF2、JNK、AP-1蛋白表达水平均降低(P<0.01),柴苓合剂中剂量组肝组织AP-1蛋白表达差异无统计学意义(P>0.05),TRAF2、JNK蛋白表达水平均降低(P<0.01);与柴苓合剂中剂量组比较,柴苓合剂高剂量组TRAF2、JNK、AP-1蛋白表达水平均降低(P<0.05,P<0.01)。结论柴苓合剂高剂量能显著改善痰瘀互结MS-IR大鼠糖代谢、脂代谢和炎症因子,其作用机制可能是柴苓合剂通过调控TRAF2蛋白作用于JNK蛋白,引起它的下游反应,又通过JNK的磷酸化作用于AP-1,释放炎症因子,从而TRAF2作用于JNK,然后磷酸化于AP-1使炎症因子降低有关。

哮病-喘证-肺胀病因病机辑要

目的现代医学哮喘-慢性阻塞性肺疾病(COPD)重叠(ACO)临床表现与中医文献哮病、喘证、肺胀等描述较为接近,特征为人群多发、发作更频繁、肺功能下降更快、病理机制不明等,全球哮喘防治创议(GINA)等相关国际医学学术组织长期关注ACO研究,目前诊断标准不统一,治疗手段仍较为局限。中医对于哮喘和慢阻肺的认识源远流长,古代文献中有详细的对哮喘病名、病因病机的记载,据慢阻肺特有的临床症状,发现自秦汉以来对于此病有诸多记载,探求古代文献发现慢阻肺与哮喘虽属不同疾病,但其病因相累,病机相联,均属本虚标实之证,故可相合并病。文章通过古代中医文献梳理哮喘和慢阻肺病因病机,结合现代医家研究成果,整理出ACO病因包括外邪侵袭、七情过用、饮食失宜、体质因素4个方面,病机从肝肾亏虚、痰瘀互结、痰热郁肺方面阐述ACO以期提供诊疗新思路。

“象思维”与“逻辑思维”相结合探讨“痰浊-痰结-痰瘀”现代生物学本质

痰瘀互结证是中医临床的高发证候,其重要病机形式为痰挟瘀血,表现为先生郁痰,痰血相杂,而致瘀结。“痰浊-痰结-痰瘀”是痰挟瘀血中医病机演变特点的具体体现。象思维注重创新性、整体性,是中医思维方式的核心。逻辑思维更具科学性、逻辑性,是现代临床思维的主要方式。该文以象思维为主导,结合逻辑思维加以整合,假借大自然现象中的泥石流形成过程为工具之象,类推“痰浊-痰结-痰瘀”各个时期“痰”与“瘀”的交互状态,并借助逻辑概念思维进行思考及推理,归纳其病机演变过程中的相关病理机制,阐释现代生物学视角下“痰浊-痰结-痰瘀”的理论内涵。既跳出了痰、瘀固有的概念和范畴,又体现了中医学整体思维和辨证思维的特色与优势,丰富了中医理论的科学内涵,为中医药防治“痰瘀”相关疾病的研究提供理论依据与思路。

Pathophysiological Characteristics of Phlegm-stasis Cementation Syndrome in Coronary Heart Disease:a Review and Update

The pathophysiological characteristics of Phlegm-stasis Cementation Syndrome in Coronary Heart Disease(CHD) has been summarized in this article. According to epidemiological investigations, phlegm-stasis cementation syndrome has become a dominant syndrome in CHD along with the improvement in living and dietary condition. The interaction between blood stasis and phlegm turbidity that is called Phlegmstasis Cementation Syndrome exists in CHD and other diseases. The bridge linked blood stasis and phlegm turbidity lies in the adversely effects of lipid metabolism disorder on platelet activation, vascular function and hemorheology indexes. Lipid metabolism disorder also can induce persistent inflammation including monocyte/macrophage activation and oxidative stress. Inflammation also is an important stimulating factor for atherosclerosis and the biology that underlies the complications of CHD,which belonged to the concept of "toxin" in Traditional Chinese medicines(TCM). On the other hand, the important function of inflammatory process on abnormal hemorheology,platelet activation and vascular dysfunction can be used to elucidate the basic pathogenetic condition of the toxin inducing blood stasis in TCM. Therefore, it is this pathological process that can be used to address the basic pathogenetic theory of phlegm turbidity inducing the symptom of toxin and blood stasis, and subsequently phlegm-stasis cementation in TCM. We deduced that lipid metabolic disturbance,inflammation activation, vascular dyfunction and hemorheological disorders could be as pathophysiological characteristics of Phlegm-stasis cementation syndrome.

益气活血祛痰方治疗支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证的研究

目的评价益气活血祛痰方联合西医治疗慢性持续期支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者的临床疗效。方法选择2016年1月—2021年6月于泰州市第四人民医院就诊的80例慢性持续期支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者,根据随机数字表分成对照组及观察组各40例,对照组给予常规治疗及持续气道正压通气,观察组在对照组治疗基础上给予益气活血祛痰方水煎液口服,2组均持续干预3个月。观察2组患者治疗前后中医证候积分(包括气喘、咳嗽、咳痰、打鼾、憋醒、日间嗜睡、倦怠乏力)、哮喘控制测试问卷(ACT)评分、圣乔治呼吸问卷(SGRQ)评分、Epworth嗜睡量表(ESS)评分、匹兹堡睡眠指数(PSQI)评分、肺功能指标[呼气峰值流速(PEF)、第一秒用力呼气容积占预计值百分比(FEV_(1)%预计值)、第一秒用力呼气容积与用力肺活量比值(FEV_(1)/FVC)]、多导睡眠图参数[呼吸暂停低通气指数(AHI)、快速眼动睡眠期(REM)、氧减指数(ODI)、动脉血氧饱和度(SaO_(2))、最低SaO_(2)、觉醒指数]、炎症相关指标[血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)水平和呼出气一氧化氮(FeNO)水平]变化,统计2组总体治疗效果及不良反应发生情况。结果2组治疗后中医证候积分、SGRQ评分、ESS评分、PSQI评分、AHI、ODI、觉醒指数及血清CRP、IL-6、TNF-α、VEGF水平和FeNO水平均较治疗前明显降低(P均<0.05),且观察组上述各项指标均明显低于对照组(P均<0.05);2组治疗后ACT评分、PEF、FEV_(1)%预计值、FEV_(1)/FVC、REM、SaO_(2)、最低SaO_(2)均较治疗前明显升高(P均<0.05),且观察组上述各项指标均明显高于对照组(P均<0.05)。观察组治疗3个月后的总有效率明显高于对照组[92.5%(37/40)比82.5%(33/40),P<0.05],治疗期间不良反应发生率明显低于对照组[10.0%(4/40)比27.5%(11/40),P<0.05]。结论益气活血祛痰方联合西医治疗支气管哮喘合并阻塞性睡眠呼吸暂停低通气综合征气虚痰瘀证患者的效果优于单纯西医治疗,在减轻患者临床症状,控制哮喘发作,改善肺功能和睡眠质量方面具有明显优势,其作用机制可能与抑制炎症反应相关。

益气复脉方治疗气虚血瘀、痰瘀互阻型室性期前收缩的临床疗效

目的:观察益气复脉方治疗气虚血瘀、痰瘀互阻型室性期前收缩的临床疗效。方法:选取2021年8月—2022年8月在北京中医药大学东方医院住院治疗的室性期前收缩病人60例,按照随机数字表法分为对照组和治疗组。在常规治疗基础上,治疗组采用益气复脉方(颗粒剂)治疗,对照组采用颗粒安慰剂治疗。评估并比较两组治疗前后室性期前收缩数量变化,中医证候积分及中医单项症状心悸、气短、神疲乏力、胸闷、胸痛、痰浊、自汗、食少纳呆积分变化。结果:治疗后,治疗组室性期前收缩数量较治疗前减少,且治疗组少于对照组,差异有统计学意义(P<0.05)。治疗后,两组中医证候总积分较治疗前降低,且治疗组低于对照组,差异均有统计学意义(P<0.001)。治疗后,两组心悸、气短、神疲乏力、胸闷、胸痛、痰浊、自汗、食少纳呆的症状积分均较治疗前降低,且治疗组低于对照组,差异均有统计学意义(P<0.05)。治疗后,治疗组总有效率高于对照组,差异有统计学意义(77.8%与24.0%,P<0.05)。结论:益气复脉方可减少气虚血瘀、痰瘀互阻型室性期前收缩病人室性期前收缩次数,改善中医证候。

淋巴瘤证型及其“痰瘀”证素与趋化因子及凝血指标的相关性研究

目的分析淋巴瘤证型和主要病性证素“痰瘀”与常见趋化因子及其受体、凝血指标的相关性,初步探讨淋巴瘤“痰瘀”证素的现代科学本质。方法选择198例淋巴瘤患者,统计并分析不同证型患者趋化因子及受体(CXCL2、CXCR2、CXCL8、CXCL12、CXCR4)和凝血指标(PT、APTT、FIB、FDP、D-D)水平差异;并采用二元Logistic回归分析探讨“痰”、“瘀”与上述各指标的相关性。结果CXCL2、CXCR2、CXCR4、CXCL8、PT、APTT、FIB、FDP、D-D在不同证型中均有差异(P<0.05),在痰瘀互结证型的表达水平高于其他证型(P<0.05);CXCL12在不同证型之间的水平差异无统计学意义(P>0.05)。痰、瘀是淋巴瘤最主要的病性证素,其中CXCR2、CXCR4、D-D、FIB对“痰”有影响,D-D与“瘀”有密切相关性。结论淋巴瘤证型、“痰瘀”证素与常见趋化因子及其受体、凝血指标具有明确相关性,趋化因子和凝血功能异常可能是淋巴瘤“痰瘀”证素相关的生物标志物。

身痛逐瘀汤加味联合盐酸普拉克索片治疗痰瘀痹阻型不宁腿综合征的临床观察

目的观察身痛逐瘀汤加味联合盐酸普拉克索片治疗痰瘀痹阻型不宁腿综合征(RLS)患者的临床疗效。方法将50名痰瘀痹阻型RLS患者按照随机数字表法分为2组,对照组25例予盐酸普拉克索片治疗,治疗组25例在对照组基础上联合身痛逐瘀汤加味治疗。2组均治疗1周为1个疗程,治疗2个疗程后统计疗效,比较2组治疗前后国际RLS严重程度评分量表(IRLS)评分、匹兹堡睡眠质量指数量表(PSQI)评分及中医症状评分变化情况。结果治疗组总有效率92.00%(23/25),对照组总有效率60.00%(15/25),治疗组总有效率高于对照组(P<0.05)。与本组治疗前比较,2组治疗后IRLS评分、PSQI评分及中医症状评分均降低(P<0.05),且治疗组治疗后IRLS评分、PSQI评分及中医症状评分均低于对照组(P<0.05)。结论身痛逐瘀汤加味联合盐酸普拉克索片治疗痰瘀痹阻型RLS疗效确切,可有效改善患者临床症状及中医症状,改善患者睡眠质量,操作简便,临床疗效显著,安全性良好。

补肾化痰通脉法治疗颈动脉粥样硬化不稳定斑块临床观察

目的 观察补肾化痰通脉法干预颈动脉粥样硬化不稳定斑块的临床疗效。方法 选择2020年12月—2021年12月太仓市中医医院收治的78例明确诊断颈动脉不稳定斑块患者为研究对象,采用随机数字表法将其分成对照组和试验组,各39例。其中对照组予西药干预;试验组在对照组的基础上加入补肾化痰通脉颗粒。观察每组颈动脉粥样硬化不稳性斑块的变化,同时检测血脂指标水平以及评定中医证候积分并进行对比分析。结果 两组颈动脉内中膜厚度和最大斑块大小明显改善,但两组间的最大斑块面积差异无统计学意义(P>0.05);两组血脂水平均改善,且试验组优于对照组(P<0.05);两组中医证候积分均降低,且试验组明显优于对照组(P<0.05)。结论 补肾化痰通脉法可能通过改善患者颈动脉内中膜厚度、血脂水平,控制颈动脉粥样硬化病变的进展。

桂枝加葛根汤联合当归芍药散治疗良性位置性眩晕的效果

目的 探讨桂枝加葛根汤联合当归芍药散治疗良性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的效果。方法 选取2021年2月-2023年8月收治的80例老年后半规管BPPV痰瘀互阻证患者,按照掷硬币法分为2组,对照组(n=40)采取常规西药治疗,观察组(n=40)另用桂枝加葛根汤联合当归芍药散治疗,比较2组疗效。结果 治疗7 d、14 d后,观察组中医证候积分较对照组低(P<0.05)。14 d治疗后,观察组眩晕评分、血液流变学指标、血清同型半胱氨酸(homocysteine,Hcy)水平均优于对照组(P<0.05)。治疗后,观察组脑血流动力学较对照组优(P<0.05)。2组在治疗期间均未出现头痛、乏力不良反应。结论 对老年后半规管BPPV痰瘀互阻证患者采取桂枝加葛根汤联合当归芍药散治疗,可明显减轻患者眩晕症状和中医证候积分,改善其血液流变学和脑血流动力学,值得推广。

Study on Correspondence between Prescription and Syndrome and the Essence of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease Based on Metabonomics

Studying the essence of a syndrome has been a key challenge in the field of Chinese medicine.Until now,due to limitations of the methods available,the progress towards understanding such complicated systems has been slow.Metabonomics encompasses the dynamics,composition and analysis of metabolites,enabling the observation of changes in the metabolic network of the human body associated with disease.Being from the point of view of the whole organism,metabonomics provides an opportunity to study the essence of a syndrome to an unprecedented level.Phlegm and blood stasis syndrome is the main syndrome associated with coronary heart disease（CHD）,which bring difficulties in clinical treatment due to difficulties associated with differentiation of symptoms and signs.The fundamental differences of material between the two also need to be interpreted.The authors consider that we can use the method of combining a disease（in this case CHD）with associated syndromes（phlegm and blood stasis syndrome）to select patients with phlegm and blood stasis syndrome of CHD,and utilize metabonomics to explore the essence of the syndrome by difference analysis of metabolite spectra.Meanwhile,we can study the syndrome in CM,observe the change regularity of metabolism spectra after the treatment of corresponding and non-corresponding prescription and syndrome,in order to validate the material fundament in the progress of syndrome formation and their differences.This will not only have great significance in enhancing the ability to identify syndrome of phlegm and blood stasis in CHD and to establish the clinical curative criteria,but will also offer a new approach of studying the essence for a syndrome using metabonomics.

Diagnostic Accuracy of Chinese Medicine Diagnosis Scale of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: A Study Protocol

Background Phlegm and blood stasis syndrome(PBSS) is one of the main syndromes in coronary heart disease(CHD). Syndromes of Chinese medicine(CM) are lack of quantitative and easyimplementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. Objective: To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. Methods: Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic(ROC) curve. Discussion: This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study.(No. ChiCTR-OOC-15006599).

加味瓜蒌瞿麦汤联合米非司酮治疗子宫肌瘤患者的疗效及对其性激素水平的影响

目的探讨加味瓜蒌瞿麦汤联合米非司酮治疗子宫肌瘤患者的疗效及对其性激素水平的影响。方法选取2020年2月—2022年3月期间于河南省南阳市第二人民医院就诊的痰湿瘀结证子宫肌瘤患者120例,按随机数字表法分为对照组和研究组,每组各60例。对照组单纯给予米非司酮治疗,研究组在对照组治疗的基础上联合加味瓜蒌瞿麦汤治疗,两组患者均于月经干净开始服药,经期停药,均治疗3个月。观察比较两组患者临床疗效及不良反应发生率,治疗前后月经质量、子宫肌瘤体积及子宫体积,并检测两组患者血清性激素[雌二醇(Estradial,E_(2))、促卵泡生长激素(Folliclestimulating hormone,FSH)、孕酮(Progesterone,P)、促黄体生成素(Luteinizing hormone,LH)]水平。结果治疗后研究组临床总有效率95.00%(57/60)明显高于对照组80.00%(48/60),差异有统计学意义(P<0.05)。治疗后两组患者视觉模拟量表(Visual analog scale,VAS)评分及月经失血图(Pictorial blood loss assessment chart,PBAC)评分均较治疗前降低,差异有统计学意义(P<0.05);且研究组VAS、PBAC评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者子宫肌瘤、子宫体积均较治疗前降低,差异有统计学意义(P<0.05);且研究组子宫肌瘤、子宫体积均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清性激素LH、P、E_(2)及FSH水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组血清性激素LH、P、E_(2)及FSH水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,研究组不良反应发生率10.00%(6/60)与对照组6.67%(4/60)比较,差异无统计学意义(P>0.05)。结论加味瓜蒌瞿麦汤与米非司酮联用能进一步提高子宫肌瘤的疗效,改善月经质量,缩小肌瘤体积,调节性激素水平,具有良好的安全性。

高氏流派从痰湿瘀阻论治少弱精子症

少弱精子症是临床常见病,也是男性不育的重要原因。目前中医治疗多从补肾入手,取得一定疗效。榆林高氏中医妇科流派认为,少弱精子症的发病与饮食、情志、劳逸失调密切相关。饮食不节,痰湿内盛,情志不畅,气滞血瘀,劳逸失调,损伤肾精。病位主要在脾,涉及肝、肾。病性“实多虚少”,以痰、湿、瘀实邪多见,肾虚精亏者较少。痰湿瘀阻为该病的主要病机,治法为“祛湿化痰,活血通络”,以自拟“生精汤”为主方,药物组成为陈皮、清半夏、茯苓等。此方特色鲜明,疗效突出,为中医临床提供更多思路和方法。