Mechanism of'Invigorating Qi and Promoting Blood Circulation'Drug Pair Ginseng-Danshen on Treatment of Ischemic Heart Disease Based on Network Pharmacology

Objective:Using network pharmacology to explore the mechanism of the'invigorating qi and promoting blood circulation'drug pair Ginseng-Danshen(Salvia miltiorrhiza)on treatment of ischemic heart disease(IHD).Methods:The chemical constituents of ginseng and Danshen drug pair were identified by searching the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),and the potential targets of the pair were identified.The pharmacodynamics of the pair was analyzed using network pharmacology.The targets of IHD were identified by database screening.Using protein-protein interaction network,the interaction targets of Ginseng-Danshen on IHD were constructed.A"constituent-target-disease"interaction network was constructed using Cytoscape software,Gene Ontology(GO)term enrichment analysis and biological pathway enrichment analysis were carried out,and the mechanism of improving myocardial ischemia by the Ginseng-Danshen drug pair was investigated.Results:Seventeen active constituents and 53 targets were identified from ginseng,53 active constituents and 61 targets were identified from Danshen,and 32 protein targets were shared by ginseng and Danshen.Twenty GO terms were analyzed,including cytokine receptor binding,cytokine activity,heme binding,and antioxidant activity.Sixty Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathways were analyzed,including phosphatidylinositol 3-kinase-serine-threonine kinase(PI3 K-AKT)signaling pathway,p53 signaling pathway,interleukin 17 signaling pathway,tumor necrosis factor signaling pathway,and the advanced glycation end product(AGE)-the receptor for AGE(RAGE)signaling pathway in diabetic complications.Conclusion:The specific mechanism of Ginseng-Danshen drug pair in treating IHD may be associated with improving the changes of metabolites inbody,inhibiting the production of peroxides,removing the endogenous oxygen free radicals,regulating the expression of inflammatory factors,reducing myocardial cell apoptosis and promoting vascular regeneration.

Invigorating Qi and Promoting Blood Circulation in Treatment of Chronic Idiopathic Thrombocytopenic Purpur

Twenty patients of chronic idiopathic thrombocytopenic purpura (ITP) were treated with suchkind of Chinese herbal medicine as invigorating Qi and promoting blood circulation for 4-8 weeks. The ther-apeutic effect was observed and compared with that of the two control groups treated with prednisone and co-enzyme A respectively. In the TCM group, the number of patients with marked effect, good effect and im-provement were 2, 4 and 7, the total effective rate being 65% . This efficacy was higher than that of the co-enzyme group and lower than that of the prednisone group. The changes of antiplatelet IgG antibody and hap-toglobin were also observed in the meantime, and results showed that after TOM treatment, both of themwere decreased as disease improved.

林谦教授从肝肾论治老年高血压的临床经验

现代中医学者大多从“眩晕”“头痛”“痰饮”的角度进行辨证论治来探讨高血压病。头为“诸阳之会”“清阳之府”,五脏六腑之精气皆上注于头,若气虚亏虚、阴阳失调、痰浊内阻、瘀血阻滞,致清窍失养,均可发为眩晕。林谦教授认为,本病的病因病机大约有4种:情志过极,忧思恼怒,致肝气郁结气滞化火;饮食不节,损伤脾胃,致湿浊中阻;先天不足或年老体衰致肝肾阴虚,阴不潜阳肝阳上亢;年老体虚或久病失养,损伤脾肾之阳,水湿不运,痰湿泛溢。林谦教授通过大量的临床实践经验,得出肝肾功能失调是老年高血压病的最常见基本病因病机,兼顾心、脾、肾、全身血管,以及情、气、血、瘀、痰等病理因素。治疗上以调肝补肾为主,兼顾“益气”“活血”“通络”“化痰”为辅,林谦教授自拟调肝补肾汤,临证兼顾个体辨证论治,临床治疗效果显著,病案举例2例。

4种治疗糖尿病周围神经病变补气活血类中成药的卫生技术评估

目的为临床选择糖尿病周围神经病变(DPN)治疗用补气活血类中成药提供参考。方法参考《医疗机构中成药遴选专家共识(第一版)》,结合临床实际,制订药物卫生技术评估细则,参考药品说明书、临床指南和文献,对4种中成药的安全性、有效性、经济性、适宜性、创新性、可及性、传承性进行评分,并计算总分。结果通心络胶囊、木丹颗粒、糖脉康颗粒、芪蛭降糖胶囊的评分分别为74.5分、72分、64.5分、57分。结论临床在选择治疗DPN的补气活血类中成药时,相对于糖脉康颗粒、芪蛭降糖胶囊,建议优先使用木丹颗粒、通心络胶囊。

Summary of 32 Patients with Cardiac Syndrome X Treated by TCM Therapy of Regulating Qi Relieving Chest Stuffiness and Promoting Blood Circulation

Objective： To evaluate the clinical effect of Liqi Kuanxiong Huoxue method （宽胸活血,LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circulation） in treating patients with cardiac syndrome X （CSX）. Methods： The prospective, non-randomized controlled study was conducted on 51 selected patients with CSX, who were non-randomly assigned to 2 groups, the treated group treated with LKH in addition to the conventional treatment （32 patients）, and the control group treated with conventional treatment （19 patients） like nitrate, diltiazem hydrochloride, etc. The treatment course was 14 days. The changes of such symptoms as angina pectoris, TCM syndrome and indexes of treadmill exercise test before and after treatment were observed. Results： After treatment, such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group （P〈0.05）; the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group （P〈0.05）. The treadmill exercise test showed that the maximal metabolic equivalent （Max MET）, the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups, but the improvement in the treated group was better than that in the control group respectively （P〈0.05）. Conclusion： The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX.

张勉之教授基于补肾活血法论治尿酸性肾病

尿酸升高是肾功能异常的独立危险因素,肾脏损伤也会导致患者尿酸排泄异常。尿酸性肾病的病因病机以禀赋素薄,脾肾亏虚为病理基础,饮食不节,湿瘀侵袭为发病机制。张勉之教授在以国医大师张大宁教授创立的补肾活血法为根本治疗大法的前提下,依据潜伏期、发作期、缓解期体现出的不同证型辨证施治,疗效满意。

Traditional Chinese Medicines alleviated myocardial ischemia by regulating Qi and promoting blood circulation

OBJECTIVE:To investigate the efficacy of Chinese medicines on Qi stagnation and blood stasis in rats with myocardial ischemia.METHODS:Fifty male Wistar rats were randomly divided into five groups(n=10)as follows:(a)sham operation(Sham),(b)myocardial ischemia(Model),(c)treatment that regulates Qi(Qi),(d)treatment that promotes blood circulation(Blood),(e)treatment that both regulates Qi and promotes blood circulation(QB).The rat model was established via activities restriction for 6 h followed by tail clamp stimulation for 5 mins every day for 7 d and occlusion left coronary anterior descending artery.Afterwards rats were treated with medicines that regulate Qi and/or promote blood circulation via gavage for 14 d.Behavioral parameters were evaluated using open field and elevated plus-maze tests.The tongue color and sublingual vein were visually examined.Blood flow perfusion of tongue and auricle were detected using PIMⅡ.The mesenteric microcirculation was examined via capillaroscopy,and hemodynamics was assessed using a polygraph system.Serum homocysteine(Hcy),creatine kinase isoenzyme(CKMB)levels and endothelin-1(ET-1)were measured.Hematoxylin and eosin staining and transmission electron microscopy were employed to detect the myocardial morphology and ultrastructure,respectively.RESULTS:Compared with findings in Sham group,rats in model group had coarse hair,dark mucosa of the lips and claw,low activity,and increased anxiety.Compared with findings in Model group,rats in the three treatment groups exhibited a lighter tongue color without an extended and varicose sublingual vein.There were significant increases of auricle blood flow perfusion in the Qi group and tongue bottom blood flow perfusion in the QB group.Compared with findings in Model rats,rats in Blood group exhibited improved mesenteric microcirculation associated with increased mesenteric blood flow and a larger arteriole diameter.Moreover,compared with findings in Model rats,Qi and QB rats exhibited increased left ventricular±dp/dtmax,decreased serum CKMB,Hcy,ET-1 levels,and reduced myocardial ultrastructural damage.CONCLUSION:Myocardial ischemia damage was suppressed by Traditional Chinese Medicines that regulate Qi and promote blood circulation.

活血化瘀方治疗子宫肌瘤临床观察

目的分析活血化瘀方辨证对子宫肌瘤的治疗效果及安全性。方法选取2020年1月—2022年1月江西省乐安县人民医院收治的60例子宫肌瘤患者临床资料,分为对照组与治疗组,各30例。对比两组治疗3周后的临床效果、性激素水平[卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、孕激素(P)]、中医证候积分、不良反应。结果治疗组总有效率为93.33%(28/30),对照组为80.00%(24/30),两组比较差异无统计学意义(P>0.05)。治疗前两组性激素水平比较差异无统计学意义(P>0.05);治疗后两组FSH、LH、E2、P均降低,且治疗组均低于对照组(P<0.05)。治疗前两组中医证候积分比较差异无统计学意义(P>0.05),治疗后治疗组经期异常、下腹胀痛、乳房胀痛、肛门下坠评分均低于对照组(P<0.05)。治疗组不良反应发生率为6.67%(2/30),对照组为16.67%(5/30),两组比较差异无统计学意义(P>0.05)。结论活血化瘀方辨证对子宫肌瘤的治疗效果好,可改善患者临床症状及性激素水平,用药安全性高。

Effects of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation and their compatibility on differentially expressed genes of ischemic myocardium

This study was conducted to investigate the effects of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation and their compatibility on differentially expressed genes of ischemic myocardium which were selected from differential expression profile we had established before, and to explore the underlying mechanism. The acute myocardial infarction (AMI) model was established by ligating the left anterior descending (LAD) coronary artery, then the model rats were randomly divided into the model group, the Metoprolol group, the replenishing qi nourishing yin (RN) group, the activating blood circulation (AB) group, and the replenishing qi, nourishing yin and activating blood circulation (RA) group. In addition, the normal group and the sham group were set up. The rats of medication groups were administered by intragastric gavage with corresponding drugs on the second day after operations, and the rats of the normal group and the sham group were given normal saline as the same time.Then the ischemic hearts were harvested on the 8th day after operation. The myocardial pathomorphological changes were observed under a light microscope. The mRNA changes of target genes such as COX5a and ATP5e were detected using Realtime fluorescence quantitative PCR (QPCR), and the activities of related enzymes were detected by colorimetric assay. The main results were as follows: the histological changes were observed by HE staining, and cardiocyte swelling, inflammatory cell infiltration and cytolysis were showed in regional ischemic myocardium of the model group, while the pathomorphological changes in all medication groups did not show obvious changes. Two genes related to energy metabolism, COX5a and ATP5e, were selected as the target genes which were downregulated at the mRNA level in the medication groups. The activities of correlative functional enzymes also decreased in the RA group compared to that in the model group accordingly (P<0.05). The results indicated that the abnormal expression of genes involved in energy metabolism pathways could be one of the molecular mechanisms of AMI. The compatibility of Chinese herbs capable of replenishing qi, nourishing yin and activating blood circulation affects the expression of energyrelative gene COX5a, ATP5e, which is probably the mechanism of myocardial preservation, and is more effective than single herb of replenishing qi and nourishing yin or activating blood circulation.

单味中药有效成分治疗溃疡性结肠炎研究进展

研究表明,中药治疗溃疡性结肠炎不良反应少且复发率低,临床常用益气健脾、清热祛湿、活血化瘀、补血养阴类中药组方治疗,其主要药物的有效成分具有减轻炎症反应、修复黏膜损伤、调节肠道微生态、调节免疫反应等作用。本文对常用单味中药有效成分治疗溃疡性结肠炎的作用机制进行综述,为其临床治疗与中药新药研发提供参考。

脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效及转录组学研究

目的观察脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效,并通过转录组学方法初步阐明其可能的作用机制。方法将符合纳入标准的140例气虚血瘀型冠心病心绞痛患者依据随机数字法分为治疗组、对照组各70例,治疗期间对照组脱落3例。对照组予冠心病二级预防西医基础治疗,治疗组在对照组治疗基础上加服脉通君安汤,2组疗程均为8周。治疗前后评估2组患者中医证候积分、加拿大心血管学会(Canadian cardiovascular society,CCS)心绞痛分级、西雅图量表(Seattle angina questionnaire,SAQ)评分、焦虑自评量表(Self-rating anxiety scale,SAS)评分、抑郁自评量表(Self-rating depression scale,SDS)评分及不良反应,并基于性别、年龄、病程相匹配原则选取9例患者治疗前后外周血进行转录组学测序。结果治疗后,2组患者中医证候积分均明显下降(P<0.01),治疗组在改善胸痛、胸闷、气短、神倦乏力及总分方面优于对照组(P<0.05,P<0.01);治疗组CCS心绞痛分级总改善率优于对照组(P<0.05);2组治疗前后SAQ、SAS及SDS评分均显著改善(P<0.01),治疗组SAQ评分改善优于对照组(P<0.05,P<0.01)。转录组学结果显示,治疗前后具有显著差异表达的mRNA有862个,包括509个上调,353个下调;GO分析结果显示差异表达的mRNA生物学过程有666条,主要包括病毒基因表达、翻译启动、RNA分解代谢过程等,细胞组分112条,主要包括黏着斑、核糖体亚基、核斑点等;分子功能有94条,主要包括双链RNA结合、钙黏蛋白结合、转录共调节因子活性等;KEGG分析结果显示差异mRNA富集信号通路包括20条,主要包括甘油磷脂代谢通路、单磷酸腺苷激活的蛋白激酶(AMP-activated protein kinase,AMPK)信号通路、核糖体通路等。结论脉通君安汤能够改善气虚血瘀型冠心病心绞痛患者临床症状,其作用机制为多靶点多通路,可能与甘油磷脂代谢通路、AMPK信号通路、核糖体通路的调节相关。

基于“二阳结谓之消”探讨糖尿病性便秘病机及防治策略

“二阳结谓之消”语出《素问·阴阳别论篇》,是认识糖尿病性便秘的早期记载,但目前学界多据此仅从二阳(足阳明胃经、手阳明大肠经)结滞化热来解释消渴期发生便秘的病机,存在一定局限性。通过考究发现“二阳”并不单指手足阳明经脉或胃肠二腑,而是包括胃、大肠二腑及手足阳明经脉;“结”也并不完全指结热这一病邪,而是指病邪胶结难解、疾病难以治愈的程度,并且“二阳”之热易伤血脉,造成络脉瘀滞。基于对“二阳结谓之消”的重新理解,笔者认为糖尿病性便秘在糖尿病期以“热伤气阴”为主要病机,糖尿病并发症期以热伤血络、血脉瘀滞为主要病机。治疗方面,糖尿病期以清热益气养阴为本,糖尿病并发症期以活血化瘀为核心,此外还需重视体质从化,全面把握糖尿病性便秘的诊治。

2型糖尿病性周围神经病合并胰岛素抵抗病案--仝小林院士教学查房实录

以广安门医院内分泌科中2型糖尿病性周围神经病合并胰岛素抵抗患者为例,邀请仝小林院士进行教学查房,对2型糖尿病性周围神经病合并胰岛素抵抗的中医辨治思路、疾病发展、诊疗要点进行阐述。仝院士在查房过程中强调辨别瘦型糖尿病和肥胖型糖尿病异同,把握疾病发展的不同趋势。糖尿病通常合并胰岛素抵抗,但瘦型糖尿病患者胰岛功能衰竭速度快,甚至初期便能表现出胰岛功能损伤,以脾虚为核心病机,在治疗中应注重补脾益气,从脾论治,运用态靶辨治体系,提高临床疗效。

基于中医血脉理论谈从脾论治糖尿病血管病变

糖尿病血管病变是糖尿病严重的慢性并发症之一,目前已成为糖尿病患者死亡和致残的主要原因,其巨额的医疗费用给家庭、社会带来沉重的经济负担。文章从血管与血脉的相关性出发,基于中医血脉理论,结合传统医学与现代医学观点,认为脾气虚,运化无力,气机不畅,脂浊不化,致痰浊、瘀血、热毒等病理产物壅滞血脉是糖尿病血管病变发生的重要原因,可累及多个靶器官。结合五脏一体观,从脾为四脏之长、脾与其他四脏的病变关系论述从脾论治糖尿病血管病变的理论依据以及古今医家从脾论治糖尿病血管病的临床思路,并将中西医思想融会贯通,突出从脾论治糖尿病血管病变的重要性。治疗上注重益气养阴、活血解毒、健脾化湿之法,为临床防治糖尿病血管病变提供新思路。

岭南医家刘渊《医学纂要》中风辨治探析

清代岭南医家刘渊所撰的《医学纂要》是一本既言其验、又探其要的综合性医著。《医学纂要》对于中风的辨治既传承了张仲景与张景岳的理论与观点,又在遣方用药中体现了创新。刘渊在辨治中风时,从痰论治,调补脾肾;在仲景六经辨证的基础上,结合自身临证经验,创立了针对中风的六经证治;秉承标本分治的原则,治疗中风区分急缓,辨别急危重症。治疗中风用药时,继承张景岳“补虚不离桂附”之思路,或佐以肉桂与附子以追散失的元阳、生无根之气,或佐以桂枝与附子以通畅血脉,使寒邪自除;遣方用药多采用人参、黄芪、当归、川芎、白芍以补气养血,调补人体气血阴阳。

益气活血法治疗急性心肌梗死及并发症研究进展

气虚血瘀证为急性心肌梗死的常见证型,益气活血法作为急性心肌梗死的主要治法之一,常用于治疗急性心肌梗死后不同并发症如心绞痛、经皮冠脉介入治疗术后再狭窄、心室重构及心力衰竭等,临床效果显著。本文对益气活血法通过抑制炎症水平、改善心肌细胞凋亡与自噬、影响心肌纤维化及促进血管新生等方面治疗急性心肌梗死气虚血瘀证的作用机制进行综述,以期为益气活血法治疗急性心肌梗死气虚血瘀证的科学性与有效性提供理论参考。

刘如秀从心肾论治病态窦房结综合征经验

病态窦房结综合征(sick sinus syndrome,SSS)是由窦房结起搏功能受损和或冲动传导功能障碍引发的一种难治性心律失常性疾病,主要表现为心动过缓、窦性停搏、慢快综合征、头晕、晕厥、乏力等症状。目前植入人工起搏器是SSS最有效治疗方式,但存在诸多不良反应及禁忌证,且不降低病死率。因此,寻求安全有效的治疗方式成为亟待解决的问题。刘如秀教授传承创新国医大师刘志明学术思想,提出从心肾论治SSS,采用温肾、通阳、活血等疗法,临床疗效显著。

尹连荣教授论治高度近视早期视网膜退行性病变经验探析

[目的]总结尹连荣教授治疗高度近视早期视网膜退行性病变的临床经验及学术观点。[方法]通过跟师临证,医案整理,从高度近视早期视网膜退行性病变的发病机制、理论依据入手,总结尹教授治疗本病的临证思想及化裁经验,并附验案加以佐证。[结结果]高度近视视网膜退行性病变呈缓慢进展状态,近视性黄斑病变严重损害视力且不可逆转,目前尚无有效治疗手段。因此,尹教授临证时将“治未病”思想与“目受血而能视”理论相结合,提出将治疗节点前移,即在发生不可逆的黄斑病变前加以干预,尹教授认为本病早期病机关键为气血亏虚,脉络瘀阻,治疗时应紧扣益气养血、活血通络之法,灵活运用经方补阳还五汤加减以改善脉络膜、视网膜血流,从而延缓眼底病变进展,临床疗效肯定。所举医案中,尹教授综合脉症及眼底检查结果,辨其为气血亏虚、脉络瘀阻之证,以益气活血之补阳还五汤加减治疗,疗效卓著。[结论]尹连荣教授将“治未病”思想与“目受血而能视”理论相结合,在高度近视视网膜退行性病变早期阶段给予干预,通过益气活血法使气旺血行、瘀去络通,从而改善脉络膜、视网膜血流,延缓疾病进展,其经验值得临床学习借鉴。

孙郁芝运用益气活血行水法治疗肾性水肿经验

孙郁芝教授认为,脾肾两虚、气滞湿阻、瘀水互结是肾性水肿的主要病机,治以补肾健脾为主,佐以益气行水、活血化瘀,标本兼治,总结出“益气活血行水”特色疗法,治疗中运用经验方药,加以化裁,临床疗效满意。附验案一则分析。

益气活血类方治疗冠状动脉粥样硬化性心脏病气虚血瘀证的研究新进展

冠状动脉粥样硬化性心脏病(简称冠心病)是全球导致人类死亡的主要病因,具有较高的致残率与病死率,其病理机制包括冠状动脉脂质紊乱、血栓形成、炎症、血管平滑细胞活化/重塑、血小板活化、内皮功能障碍、氧化应激、基质代谢改变和遗传因素等,目前冠心病的病理机制虽然相对明确,二级预防用药也有效延缓了疾病进展、减少病死率,但冠心病患病人数仍不断攀升,现有药物治疗靶点单一,缺乏作用于多靶点、多途径的药物。近年来中医药在治疗冠心病的认知与作用机制上取得丰硕成果。冠心病属中医学“胸痹”“心痛”范畴,临床以气虚血瘀证最为常见,益气活血为主要治则。文章通过查阅大量的相关信息,整理了近五年益气活血类方治疗冠心病气虚血瘀证临床疗效的相关文献,发现其作用机制丰富,主要包括改善血液流变学、保护血管内皮、抑制炎症反应、抗氧化应激反应、改善心室结构及心功能、调脂、稳定斑块、改善冠状动脉血流量/慢血流、改善心肌损伤等,大量的研究结果表明在二级预防用药基础上加用益气活血类方治疗冠心病气虚血瘀证可以拓展该病的治疗靶点与途径,相较于现代医学具有独特优势,对后期临床实践与研究具有一定的理论参考价值。