补肾祛痹汤配合手法治疗老年性膝骨性关节炎106例

目的:观察补肾壮骨,活血祛痹类中药内服外用配合手法治疗老年性膝骨性关节炎的疗效。方法:自拟补肾祛痹汤(人参、黄芪、熟地、枣皮、麻黄、防风、附子、细辛、薏仁、防己、地龙等)内服,外用桃红逐瘀汤(桃仁、红花、当归、地龙、乳香、没药、香附、牛膝、鸡血藤等)熏蒸外洗,配合手法松解粘连,松筋止痛治疗本病106例。结果:治愈率37.7%,总有效率92.6%。提示:本方法治疗本病有强筋骨,祛外邪,通经络,散痹痛的功效。

Comparison of mechanisms and efficacies of five formulas for improving blood circulation and removing blood stasis

Objective This study aimed to compare the mechanisms and efficacies of five formulas that improve blood circulation and remove blood stasis.Methods(1)A network pharmacology method was used to determine the targets of five formulas that promote circulation and remove blood stasis.Compounds of the five formulas,namely Danshen Yin(丹参饮,DSY),Huoluo Xiaoling Dan(活络效灵丹,HLXLD),Shixiao San(失笑散,SXS),Taohong Siwu Tang(桃红四物汤,THSWT),and Xuefu Zhuyu Tang(血府逐瘀汤,XFZYT),were retrieved from the Traditonal Chinese Medicine System Pharmacology Database(TCMSP),the Shanghai Institute of Organic Chemistry of CAS,and the TCM Integrated Database.Drug target network was constructed by searching the Swiss Target Prediction database and the STITCH database.The target network of stasis was extracted from the PharmGKB database,the Online Mendelian Inheritance in Man(OMIM)database,the Genetic Association Database(GAD),and the Therapeutic Target Database(TTD).Candidate targets were determined using protein-protein interaction(PPI)network extension and topology selection.Thereafter,Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis was used to determine the differentiation of the mechanism of the five formulas.(2)Animal experiments were conducted to explore the efficacies of the five formulas in treating blood stasis.Seventy New Zealand rabbits were exposed to high-fat feeding+epinephrine injection to construct a blood stasis syndrome model.The rabbits were evenly divided into control,model,DSY,HLXLD,SXS,THSWT,and XFZYT groups.The latter five groups were orally administered the corresponding formulas[DSY:3.92 g/(kg·d),XFZYT:7.10 g/(kg·d),SXS:1.12 g/(kg·d),HLXLD:5.60 g/(kg·d),THSWT:4.48 g/(kg·d)].Serum lipid and blood rheology were analyzed,and pathology slices were observed.Results(1)A total of 269,358,288,370,and 376 candidate targets of DSY,HLXLD,SXS,THSWT,and XFZYT were obtained among which were 232 shared candidate targets.Fluid shear stress and atherosclerosis were the biological processes common to the five formulas.HLXLD,SXS,DSY,and THSWT regulated lipolysis in adipocytes,and XFZYT,HLXLD,SXS,and THSWT regulated the AGE-RAGE signaling pathway and complement and coagulation cascades.HLXLD,SXS,and XFZYT regulated the HIF-1 signaling pathway,DSY regulated the cGMP-PKG signaling pathway,HLXLD reduced platelet activation,SXS regulated the calcium signaling pathway,and XFZYT regulated the PPAR signaling pathway.(2)In the animal experiments,the values of total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL),high density lipoprotein cholesterol(HDL),TC/HDL,and TG/HDL in each group decreased,among which the ones seen in XFZYT,HLXLD,and SXS groups were statistically significant(P<0.05).XFZYT presented the best effect,followed by HLXLD and SXS.XFZYT and HLXLD decreased apolipoprotein B100(apoB100)and increased apolipoprotein A1/apoB100(P<0.05).XFZYT decreased all the values of hematocrit(HCT),plasma viscosity,whole blood viscosity(WBV);HLXLD and SXS affected HCT;and DSY and THSWT regulated WBV(P<0.05).All the five formulas decreased the values of optical density and area of plaque,among which XFZYT and HLXLD showed statistical significance(P<0.05).Conclusion Adjusting fluid shear stress and alleviating the injury of endothelial cells might be the common mechanisms by which the five formulas promote blood circulation and remove blood stasis.Different formulas also have unique targets,which may provide guidance for clinical drug selection.By regulating different indices,the five formulas can regulate blood lipid and hemorheology,improve the state of blood stasis,and decrease the degree of aortic plaque in the blood stasis model rabbits.XFZYT and HLXLD had higher efficacies than DSY,THSWT,and SXS.

万启南辨治内伤发热

万启南教授认为内伤发热不外乎气、血、阴、阳、肝、湿、瘀等,与气血阴阳失衡、脏腑功能失调有关。临证首辨阴阳,再分虚实,辨明气血,归属脏腑;分为阴虚发热、阳虚发热、气虚发热、血虚发热、气郁发热、血瘀发热、痰湿郁热。理气疏肝泻热-加味逍遥散,郁久化火-龙胆泻肝汤,益气养阴助阳-地黄饮子、青蒿鳖甲汤、清骨散、生脉散,清热化湿退热-甘露消毒丹,湿热并重-苍术白虎汤,祛瘀养血退热-血府逐瘀汤、桃红四物汤,清营解毒退热-白虎汤、清营汤、犀角地黄汤、清瘟败毒饮、安宫牛黄丸、紫雪丹。万启南强调辨证施治,攻补兼施,顾护脾胃,辨病与辨证结合。附内伤发热(气血两燔兼气阴两虚)验案1则。

ENDOMETRIOSIS TREATED BY THE METHOD OF RESOLVING BLOOD STASIS TO ELIMINATE OBSTRUCTION IN THE LOWER-JIAO

48 cases of endometriosis were treated with the Neiyi (ectopic endometrium) No. 2 Pills [symbol: see text] 2 [symbol: see text]) composed of fresh Dahuang (Radix et Rhizoma Rhei), Biejia (Carapax Trionycis) and Taoren Shuang (powdered Semen Persicae). After 3 months of treatment, high effective rates were obtained in menorrhalgia, dyspareunia, proctalgia, hysteromyoma, ovary cyst, and tubercles in the pelvic cavity, with a pregnant rate of as high as 26.7% in sterility. Meanwhile, the levels of plasma PGF2 alpha and PGE2 markedly dropped, while that of 6-keto-PGF1 alpha, beta-EP, and HYP significantly elevated.

不同活血化瘀方剂对重型颅脑损伤急性期大鼠的应用风险

目的探讨不同活血化瘀方剂对重型颅脑损伤(s TBI)急性期大鼠的影响。方法 306只SD雄性大鼠随机分为正常组、模型组、脑蛋白水解物组、桃红四物汤、血府逐瘀汤组、通窍活血汤组、补阳还五汤组7组。除正常组外其余各组采用改良的Feeney’自由落体方法制备s TBI大鼠模型。造模成功后脑蛋白水解物组、桃红四物汤组、血府逐瘀汤组、通窍活血汤组、补阳还五汤组分别给予相应药物1. 11 mg/200 g、2. 04 g/200 g、3. 12 g/200 g、1. 92 g/200 g、5. 74 g/200 g灌胃,正常组和模型组给予生理盐水3 ml/200 g灌胃,各组每日均灌胃1次,连续7天。灌胃后随时统计大鼠死亡率,在第1、3、7天分别观察大鼠脑组织病理评分,检测血清微管相关蛋白Tau、胶质纤维酸性蛋白(GFAP)含量。结果实验期间正常组与脑蛋白水解物组大鼠无死亡,其余各组大鼠死亡主要集中在前4天,前4天与正常组比较,模型组、桃红四物汤组、血府逐瘀汤组大鼠死亡率都显著升高(P <0. 01);与模型组比较,桃红四物汤组、血府逐瘀汤组大鼠死亡率也明显升高(P <0. 01),而通窍活血汤组、补阳还五汤组差异无统计学意义(P> 0. 05)。与正常组同时间相比较,各给药组大鼠脑组织病理评分及血清Tau、GFAP水平在3个时间段均明显升高(P <0. 05)。与模型组同时间比较,第1天血府逐瘀汤组、通窍活血汤组和补阳还五汤组大鼠病理评分升高,桃红四物汤组、血府逐瘀汤组、补阳还五汤血清GFAP蛋白水平升高(P <0. 05);而在第3天除桃红四物汤组外,其余各给药组病理评分较模型组降低;脑蛋白水解物组、通窍活血汤组、补阳还五汤血清Tau、GFAP水平降低(P <0. 05);第7天各给药组病理评分及血清Tau、GFAP水平均降低(P <0. 05)。结论 s TBI急性期使用桃红四物汤及血府逐瘀汤会加重病情,增加死亡风险。用活血化瘀药来治疗s TBI急性期的最佳时间段可能在发生损伤第4天后,并且以通窍活血汤和补阳还五汤效果最好。