甘草对药物代谢I相反应酶系相关基因表达的调控作用

目的:探讨甘草影响药物代谢作用的分子机制。方法:以200μg/ml的甘草水提物诱导人正常肝细胞L-02,48小时后收获肝细胞,Real-timePCR基因芯片检测甘草组和空白组基因的差异表达。结果:甘草组与空白组比较,全部84个基因中有10条差异表达明显的基因,其中上调和下调的基因各有5条;所有差异表达基因均只涉及药物I相代谢反应中的氧化反应。结论:应用Real-timePCR芯片技术筛选了甘草水提物诱导L-02细胞中参与I相代谢反应的差异表达基因,反映出甘草主要参与调节其中的氧化反应,且对于肝微粒体混合功能氧化酶系催化的氧化反应呈负相调控状态,占60%;而对非肝微粒体混合功能氧化酶系催化的氧化反应呈正相调控状态,占60%。

与药物作用相反的不良反应

药物治疗过程中,药物的治疗作用没有显示出预期效果;相反,却发生与药物作用相反的不良反应。这种现象已不是罕见的了。临床医药学人员应了解与药物作用相反的不良反应方可做到安全有效用药。 一、抗过敏药物发生过敏性反应 1.糖皮质激素 糖皮质激素的重要药理作用之一为抗过敏作用,然而也可引起过敏反应。天然的肾上腺皮质激素可引起湿疹型。

中风病相反配伍临床应用规律

中风病是以口眼歪斜,言语謇涩,半身不遂,甚至突然昏仆,不省人事为主症的一类疾病,具有高发病率、高致残率、高病死率的特点,被列为中医四大难症之首,因此挖掘治疗中风病的有效方药具有重要意义。反药被认为是合用可产生毒性反应或不良反应的药物,关于反药是否能在临床中应用,古今均存在较大争议,有反对者,亦有赞同者,对于其在中风病中的运用尤其如此。事实上,反药在中风病中应用历史悠久且较为普遍,据统计《中医方剂大辞典》中古今中风病方中,含有"十八反"相反药物者共173首,其中古代方剂111首,近现代方剂62首,其应用主要集中于3组药物,即乌头(包括川乌、草乌、附子、天雄)组,与半夏、瓜蒌、天花粉组合;藜芦组,与人参、细辛组合;甘草组,与海藻组合,作用主要表现在温经化痰、润通经脉、涌吐风痰等方面。临床应用经验表明,相反药物若辨证准确,运用得当,确能对中风病产生良好的防治作用,因此认为反药在中风病中的运用并非绝对禁忌。由于药物基源、品种、炮制方法、配伍等众多影响反药作用的因素存在,对于古文献中记载的相反药物应当客观地看待,需进一步行理论和实践的挖掘,不能墨守成规的认为反药均不可应用,以使确切有效的药物配伍湮没,影响患者的诊疗。

谈相反中药的临床应用

十八反药物属中药临床应用配伍禁忌,是临床用药必须遵守的重要准则。但是,某些相反药物的配伍应用,有时会收到意想不到的治疗效果。历代医家将相反药物配伍应用于临床者不乏其例。现代有关中药十八反的配伍应用及相互作用的研究也在不断深入。本文仅对相反药物的临床配伍应用探讨如下。甘草与相反药物的临床应用在相反药物的临床应用中,以甘草配伍海藻的应用最常见,其次是甘草配甘遂。甘草与相反药物的配伍应用中,以多味复方应用多。

中药药对在肿瘤临床的应用

中药药对的使用是中医药发展史上的一次飞跃,为方剂学的形成奠定了基础,受到历代医药学家的重视。《神农本草经·序例》云,药“有单行者,有相须者,有相使者,有相畏者,有相恶者,有相反者,有相杀者,凡此七情,合和视之,当用相须、相使者良,勿用相恶相反者;若有毒宜制,可用相反相杀者,不尔,勿合用也。”可见,当时对药对配伍使用已有深刻的研究。东汉,张仲景创甘遂半夏汤,将十八反药对甘遂、甘草同用,增强了祛痰逐饮功效。明·李言闻称此种相反药对有“怒性”。李时珍称其为“霸道”,会产生强烈作用,若发挥得当,可因“彼此相忌”而立奇功。

附子半夏临床同用刍议

相反药物同用在当今社会备受争议，尤其是附子与半夏，最初的十八反并不包括附子反半夏，直至清《本草逢源》才载附子反半夏，现今《药典》亦言附子反半夏。然卉今文献又有众多附子半夏同用的记载，且吕师将之应用于临床，疗效显著。二者同用，必有其道理，本文拟从以下4个方面论之。

“食物相反”名实考

"食物相反"是中医用以描述某些食物不宜同食,否则会对健康有害,如致病、中毒甚至死亡的概念。此说广泛见于元代以后多种古籍,但系统学术研究较少。旨在考证食物相反概念的起源与含义及"食物相反"内容的原始出处,为进一步深入研究奠定文献学基础。

Effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery

Objective:To observe the effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery.Methods:A total of 120 patients undergoing nasal endoscopic surgery were included,and all patients were under trachea intubation and general anesthesia.The patients were randomized into an observation group and a control group,with 60 patients in each group.Patients in the control group received conventional anesthesia resuscitation,while patients in the observation group received acupoint massage plus acupoint sticking therapy on the basis of conventional anesthesia resuscitation.Changes in the heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed at three time points including the end of the surgery (TO),the removal of the tracheal tube (T1) and 10 min after the removal of the tracheal tube (T2).The awakening and tube removal time,choking cough and restlessness,and adverse reactions (dizziness,nausea and vomiting) in 24 h post-surgery period were compared.Results:At T1 and T2,the comparisons of HR,SBP and DBP between the two groups showed statistical significance (all P＜0.05).Intra-group comparisons showed that the HR,SBP and DBP of the control group at T1 and T2 were significant different from those at TO (all P＜0.05).There were significant differences in the awakening time and tube removal time between the two groups (both P＜0.05).The incidences of choking cough and restlessness were 8.3％ and 3.3％ respectively in the observation group,versus 53.3％ and 30.0％ in the control group,and the between-group comparisons showed statistical significance (both P＜0.05).The incidences of dizziness,nausea and vomiting in 24 h post-surgery period were 3.3％,5.0％ and 0.0％ respectively in the observation group,versus 43.3％,33.3％ and 25.0％ in the control group,and the between-group comparisons showed statistical significance (all P＜0.05).Conclusion:Acupoint massage plus acupoint sticking therapy can effectively regulate the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery,and maintain a stable internal environment.

Identification of human cytochrome P450 and UGT enzymes involved in the metabolism of ferulic acid, a major bioactive component in traditional Chinese medicines

Ferulic acid(FA) is an active component of herbal medicines. One of the best documented activities of FA is its antioxidant property. Moreover, FA exerts antiallergic, anti-inflammatory, and hepatoprotective effects. However, the metabolic pathways of FA in humans remain unclear. To identify whether human CYP or UGT enzymes are involved in the metabolism of FA, reaction phenotyping of FA was conducted using major CYP-selective chemical inhibitors together with individual CYP and UGT Supersomes. The CYPand/or UGT-mediated metabolism kinetics were examined simultaneously or individually. Relative activity factor and total normalized rate approaches were used to assess the relative contributions of each major human CYPs towards the FA metabolism. Incubations of FA with human liver microsomes(HLM) displayed NADPH-and UDPGA-dependent metabolism with multiple CYP and UGT isoforms involved. CYPs and UGTs contributed equally to the metabolism of FA in HLM. Although CYP1 A2 and CYP3 A4 appeared to be the major contributors in the CYP-mediated clearance, their contributions to the overall clearance are still minor(< 25%). As a constitute of many food and herbs, FA poses low drug-drug interaction risk when co-administrated with other herbs or conventional medicines because multiple phase I and phase II enzymes are involved in its metabolism.

Therapeutic observation of grain-sized moxibustion for chemotherapy-induced myelosuppression for non-small cell lung cancer

Objective: To observe the clinical efficacy of grain-sized moxibustion in treating chemotherapy-induced myelosuppression for non-small cell lung cancer (NSCLC) and its effect on quality of life (QOL). Methods: Eighty NSCLC patients admitted to the Inpatient Department of Zhejiang Cancer Hospital between September 2016 and March 2018 were recruited and divided into an observation group and a control group by random number method, with 40 cases in each group. The two groups both received chemotherapy with paclitaxel plus cisplatin (TP regimen). The control group received oral administration of leucogen tablets starting from the first day of chemotherapy, 20 mg each time, three times a day, for consecutive 14 d;the observation group was additionally given grain-sized moxibustion, once a day, five days per week at a two-day interval, until the fourteenth day. The myelosuppression severity was observed and compared between the two groups prior to chemotherapy, at the 3rd, 7th and 14th days of chemotherapy;the QOL in the two groups was evaluated before chemotherapy, at the 14th and 21st days of chemotherapy. Results: Regarding myelosuppression, the peripheral blood indicators increased significantly at the 3rd day of chemotherapy in both groups (P<0.05 or P<0.01);at the 7th and 14th days of chemotherapy, the peripheral blood indicators presented a decreasing tendency in the two groups, but the level in the observation group was still significantly higher than that before chemotherapy (P<0.01);at the 3rd, 7th and 14th days of chemotherapy, the peripheral blood indicators in the observation group were higher than those in the control group (P<0.05 or P<0.01);the occurrence rate of myelosuppression in the observation group was significantly lower than that in the control group (P<0.01). The QOL score in the observation group was markedly higher than that in the control group at the 14th and 21st days of chemotherapy (both P<0.05). Conclusion: Grain-sized moxibustion can effectively improve myelosuppression after chemotherapy for NSCLC, reducing its occurrence and enhancing the patient's QOL.

Effect of mild moxibustion on cancer-related fatigue,serum ghrelin and adiponectin in patients undergoing chemotherapy after colorectal cancer surgery

Objective To observe the effect of mild moxibustion on cancer-related fatigue,serum ghrelin and adiponectin in patients undergoing chemotherapy after colorectal cancer surgery.Methods Seventy patients were divided into a control group and an observation group according to the random number table method,with 35 cases in each group.Patients in both groups were treated with conventional FOLFOX4 chemotherapy regimen.Patients in the control group also received routine treatments such as symptomatic treatment of complications,health education,nutritional support,and exercise intervention.Patients in the observation group received mild moxibustion on the basis of interventions used in the control group.The Piper fatigue scale-revision(PFS-R),Karnofsky performance status(KPS)and spleen and kidney yang deficiency syndrome were scored,and serum ghrelin and adiponectin levels were measured before and after treatment.Results After treatment,total score of PFS-R in the control group did not change significantly(P>0.05),while in the observation group it was significantly reduced(P<0.05)and lower than that in the control group(P<0.05);KPS scores in both groups were increased(both P<0.05),and it was significantly higher in the observation group than in the control group(P<0.05);total score of spleen and kidney yang deficiency syndrome in the control group did not change significantly(P>0.05),while it was significantly reduced in the observation group(P<0.05)and lower than that in the control group(P<0.05);serum ghrelin and adiponectin levels in the control group had no significant changes(both P>0.05),but the levels were significantly increased in the observation group(both P<0.05)and higher than those in the control group(both P<0.05).Conclusion Based on the routine treatments,mild moxibustion can relieve fatigue,improve quality of life,and improve the symptoms of spleen and kidney yang deficiency in patients undergoing chemotherapy after colorectal cancer surgery,which may be related to the regulation of serum ghrelin and adiponectin levels.

Scalp acupuncture combined with body acupuncture for 32 cancer cases with intractable hiccups after radiochemotherapy

Objective： To observe the therapeutic effect of scalp acupuncture combined with body acupuncture in treating cancer patients with intractable hiccups after radiochemotherapy. Methods; Thirty-two cancer patients with intractable hiccups after radiochemotherapy who met the inclusion criteria were selected. The Line 2 Lateral to Forehead （MS 3） of scalp stimulation areas as well as body acupoints including Danzhong （CV 17）, Zhongwan （CV 12）, bilateral Cuanzhu （BL 2）, Neiguan （PC 6）, Zusanli （ST 36） and Taichong （LR 3） were punctured. The treatment was given once a day, 5 treatments constituted a course, and the efficacy was evaluated after 2 treatment courses. Results： After 10 treatments, 26 cases were cured, 4 cases were improved, and 2 cases were invalid, and the total effective rate was 93.8%. Conclusion： Scalp acupuncture combined with body acupuncture in treating intractable hiccups in cancer patients after radiochemotherapy has reliable therapeutic effect, and it is easy-to-operate and can effectively alleviate the suffering of patients with less adverse reaction.

中药配伍禁忌浅谈

中药方剂,大都由多味药配伍组成。不同的中药配伍在一起,必然会产生相互的影响。如配伍不当,就会影响疗效,甚至产生毒性而造成严重事故。因此,注意配伍禁忌的研究,是非常必要的。现对相反,相畏药物浅谈讨论如下:

Observation of therapeutic effects of point application at Shenque(CV 8)plus moxa-salt hot compress for prevention of gastrointestinal adverse reactions after chemotherapy for non-Hodgkin Iymphoma

Objective:To observe the clinical efficacy of point application with De Huang(Rhizome Rhei Crude)powder at Shenque(CV 8)plus moxa-salt hot compress on the umbilicus for preventing gastrointestinal adverse reactions after chemotherapy for non-Hodgkin lymphoma(NHL).Methods:A total of 60 cases with NHL under chemotherapy were divided into two groups by hospitalization order,with 30 cases in each group.The control group was treated with routine nursing and the observation group was additionally given point application with Da Hueng(Rhizome Rhei Crude)powder plus moxa-salt hot compress on the umbilicus,to compare the effect in preventing gastrointestinal adverse reactions after chemotherapy between the two groups.Results:The occurrence rates of constipation,nausea,vomiting and poor appetite on the second day and fifth day after chemotherapy were obviously lower in the observation group than those in the control group,with statistically significant differences between the two groups(all P〈0.05).Conclusion;The point application with De Hueng(Rhizome Rhei Crude)powder at Shenque(CV 8)plus maxa-salt hot compress on the umbilicus can produce more significant efficacy in preventing the gastrointestinal adverse reactions after chemotherapy for NHL than routine nursing.Moreover,it is simple and easy to be used and popularized.

Effect of acupoint sticking at Shenque （CV 8） for preventing spleen-stomach disharmony caused by venous analgesia pump

Objective： To observe the clinical effect of acupoint sticking of Chinese medicine at Shenque （CV 8） for preventing spleenstomach disharmony caused by venous analgesia pump. Methods： A total of 120 post-surgery patients using venous analgesia pump and also conforming to the inclusion criteria were randomized into 2 groups by the random number table. There were 58 patients in the control group who received conventional post-surgery nursing care, and there were 62 patients in the treatment group who received acupoint sticking at Shenque （CV 8） on the basis of conventional nursing care. After treatment, the incidences of postoperative nausea and vomiting, and abdominal bloating were measured. Results： The total incidence of nausea, vomiting and abdominal bloating in the treatment group was 11.3%, versus 39.7% in the control group, and the difference of the incidence between the two groups showed a statistical significance （P〈0.05）. In comparison of the severity of spleen-stomach dishormony which happened during 72 h after surgery, cases in the treatment group showed lower severity than those in the control group （P〈0.05）. Conclusion： Acupoint sticking at Shenque （CV 8） can effectively prevent spleen-stomach disharmony caused by venous analgesia pump, which will alleviate sufferings of the patients.